Differences in Managing Patient and Provider Data: Unanswered Questions
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Patient and provider records require very different approaches
I've been heads down working with customers and focus groups to identify the most important requirements to manage provider information across the health system.
On top of the scores of lists of attributes that are necessary to credential, provision, bill and reimburse a provider, I have been really trying to understand how patient data is similar to or different from provider data management.
I began by posing several questions. Through research and focus groups, I pulled together some good answers and definitions:
How is provider data different than patient data?
- There is much less of it
- It changes less often
- A provider can be a person or a place
- You don't need as much information on a referring provider as one that is on-staff - you just need to be able to stay in contact with them
How is provider data similar to patient data?
- The same data quality challenges exist regarding mis-keyed or misspelled names
- Providers change their last names due to marriage, move to new offices, and change employers and insurance contracts, just like patients
- Changes in status or roles (from resident to attending to visiting to fellow or any combination) can significantly alter when a provider should have visibility to patient information and for how long
What is needed to get this data to the systems and people who need to use it?
- Efficient lookup by a number of parameters (including name, IDs, specialization, practice affiliations, geographic location) must help ensure that a new provider record is not created where one may already exist
- Identification of provider histories and historical relationships to patients, even if only for a short period of time. For example, a visiting physician who should only be privy to patient status updates for a specific time period
- Creation of provider lists - by patient or organization, or a combination of both - to support physician relations, marketing and central business functions
However, I still have some unanswered questions.
From my research, automated provider data sharing is limited today. I'd love to hear about your experiences with the interfaces needed to share this data:
How can new and updated provider data be made available from a credentialing or scheduling system?
Do these systems offer out-of-the-box interfaces to share this information with other systems or organizations?
Should those interface methods be similar to or different from those standards used for patient data? HL7 for maintenance? LDAP for access? Both?
What approaches are you taking today and what challenges will you face?
Thanks for your feedback!
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How do the privacy and security considerations differ for storing provider information versus patient information?
Emily -
Thee is a lot of discussion around provider directories recently - specifically within the HIT Policy committee and I would imagine that recommendations/guidelines around provider information will be published shortly as part of the deliverables.
What I have found while talking about this with my customers and other leading healthcare organizations are:
- Individial Provider information is not "protected" to the extent that patient information is, in that there are no rules/regulations protecting what information can be shared with other parties.
- Transactional security must be in place to ensure that only parties authorized/delegated to maintain information on behalf of a provider is authorized to do so. This is especially important for HIE implementations
- Though certain provider information is considered "public domain" regarding practice locations, and is often available in public directories - other information regarding credentials should not be shared with the general public as they may be used for fradulent activity. Attribute specific protection is necessary based on where the information is exposed to
- Consider what information to store ABOUT a provider that can be used for authentication - such as provider digital certificates and electronic signatures
- Some individual providers may wish to select which information to share about themselves. For instance, medical school and affiliations may be considered valuable information to share when a physician is thinking of referring a patient to another phyisician, but if that information is out of date, or the physician is trying to focus his or her practice in a new area, they may not want to share their entire credentialling history but target it based on who interacts with it.
I hope this sheds some light on the questions and requirements I am receiving - I'd love to hear from others areas we may not be considering that are also important.
Deanna Nole