Thursday, September 30, 2010

Provider Directories

The Information Exchange Working Group of the Health IT Policy Committee had a public hearing today on the topic of Provider Directories. The FACA Blog has some background on the issues that we covered today. We have a lot of information to process regarding some very complex issues and unfortunately on a very compressed timeline. Some of the major themes that came out of today's hearing are:

  • We've got to get rid of the "yellow pages" and "white pages" analogies to Provider Directories. It's fraught with all of the general flaws of analogies, but more important, as my co-chair David Lansky said, "no one under 30 will know what we're talking about."
  • That said, it is useful to distinguish directories that support machine-to-machine routing from those that have more of a lookup role that might be focused more on use cases involving person-in-the-loop functions. Arien Malec noted that while the latter might initially be used more by humans, there would be interesting applications for machine-to-machine transactions as well, such as identifying providers involved in "post-exchange" continuity of care. Keith Boone suggested that we use the terms "service discovery directory" and "provider discovery directory" to more appropriately describe how technology works today. Abby Sears described the need for provider directory functions, however defined, to be embedded within EHRs to make them useful to end-users.
  • There are many well-developed directories out there already, so whatever we recommend needs to provide help to enable approaches that have barriers to moving forward while at the same time not stifling forward progress for approaches that are moving ahead. JP Little noted that a number of national directories already exist today, with some degree of interoperability. Charles Kennedy noted that there are is a lot of administrative infrastructure in the market already today, but very little clinical, so we should be thinking of ways to leverage the administrative infrastructure to lower the cost of developing and maintaining clinical infrastructure. Syd Thornton offered that though InterMountain Healthcare maintains its own directory of external providers, they would be interested consuming it from a higher-level aggregator that might offer better economies of scale. Robb Chapman described how the CDC leverages medical registration data from the Federation of State Medical Boards for its Physician Registry Project, but Martin Laventure noted that public health directories are not dynamically linked with any outside systems so updating them is difficult. Karen Trudel described that there are no "one-and-done" solutions in the market today, and even large, nationwide directories such as the NPI and PECOS have significant limitations with respect to the clinical exchange transactions being contemplated today.
  • Directories are the means for performing value-generating business functions, they are not the end. Tom Morrison said it most clearly when he stated that "data is a by-product of a business process." Sorin Davis recommended provider accountability for entering and maintaining their data. Anita Sarnoff noted that Axolotl recommended NOT having providers be responsible for maintaining their data and leveraging existing accreditation and credentialing information instead. Linda Syth described that it cost $3M to create the provider registry used by the Wisconsin Medical Society, and about $700K per year to maintain it. Carladenise Edwards recommended mandating the use of specified provider directories to better support their sustainability. Putting all of these together suggests that we need to create or leverage directories that enable services that providers have high interest in consuming so that they themselves will feel the need to assure that their information is timely and complete.
  • If we do nothing else, creating a framework and taxonomy for key concepts would be helpful in and of itself. Greg Debor noted that though we refer to "provider" directories, there are other health care participants (such as public health and health plans) that would be important to future value. Hunt Blair pointed to the need for a common ontology of terms such as "provider", "practice", "entity", etc.
  • As states move to implementation of their HIE Strategic and Operational Plans, there is an urgent need for some type of guidance or coordination to capture any possible synergies across these efforts and to ensure future interoperability. Goerge Oestreich noted that the pressing need for immediate solutions limited how much central orchestration could be expected and suggested that the focus should therefore be on developing standard interfaces and data formats to support a federated architecture which would allow states and private actors to continue with their own development but with some level of alignment. Steve Waldren cautioned against "over-designing" too early to remain flexible to the many changes that technology change and health reform might bring. Jeff Barnett recommended the need for standards to be able to uniquely identify individuals and organizations. While there seemed to be a general consensus that "a federated approach" was preferable to any other, we did not have enough time today to define the parameters of federation in this context and what requirements would be needed to make it feasible.
  • There seemed to be rough consensus that while both were important, the "routing directory" should be a priority. Dan Nigrin noted that they know who they need to send information to, but they often don't know how.
These are just some of the many thoughts that emerged from our hearing today. There are more comments posted on the FACA Blog, and additional comments will be collected through October 4.

Wednesday, September 29, 2010

What's in a name?

So what's in a name? The full quote of course is: "What's in a name. That which we call a rose by any other name would smell as sweet."

On September 28, the Office of the National Coordinator awarded the New Hampshire Regional Extension Center to the Massachusetts eHealth Collaborative. Is it odd that an organization with Massachusetts in our name is running the New Hampshire Regional Extension Center? I suppose so, on the face of it, but the reality is that we provide professional services in many states outside of Massachusetts. For example, we're already doing work with the regional extension centers in New York and Rhode Island, as well as Massachusetts. And we're currently working on a project with New Hampshire stakeholders on their Health Information Exchange Strategic and Operational Plan.

All companies have to be based somewhere, and we happen to based in Massachusetts. Granted, most companies don't have their home state in their name. That is a reflection of our non-profit, collaborative roots. We were founded in 2004 by 34 non-profit Massachusetts-based health care organizations. Our mission then and now is to improve the quality, safety, efficiency, and affordability of care through effective adoption of health information technology. Since our founding we've developed a national reputation for being operationally effective, mission-oriented, and consensus-driven.

We have the name collaborative because we work as partners -- we share what we've learned, and we look to learn more things that we can share. We try to develop deep ties with each new engagement, and we could not have gotten this federal award without the endorsement and backing of the State of New Hampshire -- we're grateful for the confidence they've shown in us.

My father is a family physician and surgeon who has practiced his entire career from his office in Pelham, New Hampshire. We're based in the Massachusetts Medical Society, which reflects our strong affiliation with clinicians -- we have deep ties to the physician community and we make it our business to understand the needs of physician practices.

We feel genuinely privileged to have the opportunity to help the clinicians of New Hampshire achieve their meaningful use objectives, and we look forward to deepening the ties that we already have with health care stakeholders across the Granite State. If you're a priority primary care provider in New Hampshire, we're going to be looking for you!