Healthcare Provider Directory HPD Data Model Discussion IHE

Healthcare Provider Directory (HPD) Data Model Discussion IHE TCON January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT

Topics § HPD Overview § HPD Data Model Review § Next Steps January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 2

HPD Overview § This proposal recommends development of a unified approach for electronic lookup query where, upon initiated with a unique identifier or key demographic elements, an authorized user may obtain content of a unique provider entry with high reliability. § Beyond the query lookup functionality, there is a minimum set of transactions required to create and maintain the directory service, first of which is the ability to make additions and updates to provider entries. § The scope of this proposal focuses initially on the minimum “foundational” set required for defining a provider directory, resulting in a usable work product as well as recommendations for future phase expansions. January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 3

HPD Actors and Transactions Provider Directory Source Add/Update Provider Notify of Change Provider Directory Consumer Lookup Provider Secure IT Infrastructure Healthcare Provider Directory Subscribe Transaction Actor January 7, 2010 Authentication SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT Auditing 4

HPD Content Model § The HPD Content Model supports the query for provider based on properties, relationships, and classifications Properties Relationships Provider Classifications January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 5

Metadata based Directory January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 6

Individual Provider View Provider Has Alias Individual Provider Organization (s) Has Has Education (s) Credential (s) has business Relationship (s) Is composed of (many) Department (s) Is housed in (many) Facility (s) Specialty Is located at has business Relationship (s) Is composed of (many) Is housed in (many) Has January 7, 2010 Is located at Addresses (s) SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 7

Organization View Provider Has Alias Organization Is composed of (many) Has Specialty (s) Credential (s) (many) business relationship (s) Department (s) Is housed in (many) Individual Provider Facility (s) Which are located at Which are at (Many) Business Relationship (s) Is Composed of (many) Is housed in (many) Has January 7, 2010 Addresses (s) SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 8

Use Case View Has Provider Alias Organization Belongs to HIE/HIO May support Business Use Case (s) Owns May Support Belongs to January 7, 2010 Use Case Owner SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 9

Attributes Provider Entity Individual Provider § HPD Provider ID – HPD Generated Identifier § Provider Middle Name § Provider Status – active/inactive in HPD § Provider Validation Flag: determines if provider information has been validated for the HPD § Provider First Name § Provider Last Name § Provider Suffix § Languages Spoken List § Provider Type – Individual or Organization § Provider Gender § Effective Start Date - the date a record in HPD record is effective from § Provider Race § Effective End Date - the date a record in HPD is effective up to § Provider Birth Date § Provider Birth State Code § Provider Birth Country Code January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 10

Attributes Organization Provider Alias § Clinical Organization Role - role of an organization that further classifies the clinical responsibility for the healthcare delivered during an encounter. E. g. cardiology service, pediatric service, nursing services § Alias Last Or Organization Name - various names the provider is known by including maiden name or previous legal name § Organization Description § Organization Name – name of a group or party other than an individual that render health care services § Trusted Source - Identifies if this information should be trusted or nontrusted January 7, 2010 § Alias First Name § Alias Middle Name § Alias Type Code - code identifying the type of alias name, e. g. professional name, doing business as (d/b/a) name, maiden name § Effective Start Date - the date a record in HPD record is effective from § Effective End Date - the date a record in HPD is effective up to SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 11

Attributes Address § HPD Location ID: HPD Generated Address ID § Location Description § Location Type - type of address associated with the provider i. e. mailing, residence, remote, etc § First Line Address § Second Line Address § County § City § Country Code § Zip Code § State Code § Fax Number § Telephone Number § URL § Effective Start Date - the date a record in HPD record is effective from SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT § Effective End Date - the date a record in HPD is effective up to January 7, 2010 12

Attributes Credential § Certification Type Name: Type of certification earned by a provider. § Certification Type Description § Certificate Verification Date § Certification License Number § Certificate Issuing Organization § Certificate State Code § Certificate Country Code: Country where certificate is valid § Certification Award Date - date on which the certification was awarded § Certification Renewal Date Specialty § Specialty Type: A major grouping of service(s) or occupation(s) of provider. E. g. Dermatology, Dental, Internal Medicine, Orthopedic etc. § Specialty Name: Provider’s specialization, , a specific medical service, a specialization in treating a specific disease. E. g. Bariatric Medicine, Geriatric Medicine, Pediatric Dermatology etc. § Effective Start Date - the date a record in HPD record is effective from § Effective End Date - the date a record in HPD is effective up to § Certification Status: Active/Inactive/Pending etc. § Effective Start Date - the date a record in HPD record is effective from § Effective End Date - the date a record in HPD is SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT January 7, 2010 13

Attributes Provider Identifier § Identification Number – Unique Identifiers that may exist for a provider in a particular domain, state or country § Identifier Type: Type of identifier such as tax identification number, state issued number, National Provider Identifier, drug identifying number, social services number, etc. § Identifier Issuing Agency: Name of the agency that issues this identifier § Identifier Issue Date: Date when this identifier is issued § Identifier Expiration Date § Identifier Status - status of the identifier: active, inactive, revoked, dropped or suspended § Identifier Description § Deactivation Reason Text § State Code: State where this identifier is valid § Country Code: Country where this identifier is valid January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 14

Attributes Business Relationship This entity establishes relationship either between Individual & Organization, Organization & organization § HPD Business Relationship ID – HPD Generated Identifier for business relationship § Relationship From ID: HPD Provider Id from which business relationship originates § Relationship To ID: HPD Provider Id to which business relationship is being established § Relationship Type - type which describes the business relationship between an Individual or Organization as defined in the HPD. (i. e. Individual provider "is member" of a health system) § Relationship Status – active/inactive/pending § Relationship Validation Flag - determines if relationship information has been validated § Effective Start Date - the date a record in HPD record is effective from § Effective End Date - the date a record in HPD is effective up to § Relationship Number (local identifier) - unique number that an individual provider may be known by in a particular organization or department based on this business relationship. For example, an employee ID number in a hospital January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 15

Attributes HIE/HIO § HIE Name: Name of a Health Information Exchange/Network Organization. § HIE Contact Information - demographic information that allows contact with the designated individual who disseminates and receives information pertaining to an HIE/HIO (i. e. name or phone number). § HIE Identifier (OID): Unique Identifier assigned to this HIE. § HIE Certification Status: Active/Inactive/Pending status of HIE Certification by a Certifying body § HIE Certification Agency: Certification body certifying a HIE § Data Sharing Agreement Level - level of the Data Sharing Agreements for the HIE/HIO such test/production § HIE Network Info: Service end points of the HIE network. § Effective Start Date - the date a record in HPD record is effective from § Effective End Date - the date a record in HPD is effective up to January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 16

Attributes Business Use Case Owner § Use Case Name – name of the Business Services (Use Cases) in which a HIE participates § Use Case Owner Address § Use Case Service Description § Use Case Service Status § Effective End Date § Effective Start Date January 7, 2010 § Use Case Owner Phone Number § Use Case Owner Contact Name § Use Case Owner Name - the entity (Agency, individual) who develops and owns use cases that describe business service SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 17

Next Steps § Decide on a Data Modeling tool ► Current use: IBM Rational Software Architect and Computer Associates ERWIN ► Propose Open source data modeling tool § Standards (TCON – January 19, 2010) January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 18

Backup Information January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT

Use Case View January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 20

Feedback and considerations on data model Entity 1 Department 2 3 4 5 Attribute/Relationship Change Comments Delete Facility Add a credentialing relationship with Individual Provider Facility Add a relationship to “Alias” Facility Add a relationship to Business Relations Education Add relationship May need a business relationship between Facility and Individual Provider Add relationship Business relationship could exist between facility and provider (not department). Delete Organization Add a relationship to Organization from Organization. Add relationship Needs a recursive relationship to document “an organization can be a supertype to zero, one or many subtype organizations. Organization/ Individual Provider Add a privileges attribute Add attribute 7 A privilege distinguishes the type of “credentials” i. e. in good standing a individual provider has at a organization. 8 Individual /Education Add a credential attribute Add attribute A “credentialing attribute will document educational degrees. Organization Add “governance” Add attribute Governance should determine “privileges/credentialing of providers. 6 9 January 7, 2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 21