february 1,2010 social security administration-hit support healthcare provider directory (hpd) data...

SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 2February 1, 2010

Topics

HPD Overview

HPD Content Model Review

Next Steps


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.


Use Cases

Use Case Use of HITPR Stakeholders

Social Services Department Disability Determination

Identify claimant’s providers by demographics & affiliations

Locate providers’ electronic end points in the network to support directed electronic requests

Claimants, Providers, SSA, Health Information Exchanges, Social Services programs

Emergency Response Contact providers and identify “Medical Reservists”

Verify provider credentials

Citizens, Providers, Public health Officials, State & Local Epidemiologists, Response Workers

Consumer Access to Provider List Select provider of care list from registry to grant or deny access permissions

Alerts on provider demographic updates

Consumers, Families, PHR vendors, providers

E-Prescription Prescriber credentials (DEA) validation

Identify & communicate with prescribers on drug recall

Providers, Patients, Pharmaceuticals, Drug Safety Officials


HPD Content Model The HPD Content Model supports the query for provider

based on properties, relationships, and classifications

Relationships

Properties

Classifications

Provider


Metadata based Directory

Provider HITPR Metadata

Properties- Identifiers- Name, Alias- Location- Electronic end URLs- Specialty- Certificates- Status- User- defined

Relationships- Provider Credentials- Provider Affiliations- Geographic- Status - user-defined

Classifications- Provider Type- Location Type- Credential Type

Organization- Hospital- Lab- Practice- Radiology- Business Entity- Etc

Individual- Physician - Nurse- Lab Technician- Pharmacist- Physical Therapist - Etc


Individual Provider View

Individual Provider

Alias

Organization (s)

Education (s)

Department (s)

Addresses (s)

has

is composed of (many)

Is located at

Is located athas business Relationship (s)

Is composed of (many)Is housed in (many)

Credential (s)

Specialty

hashas

has

Has

Provider has

Business Relationship

HIE/HIO

belongs to

with

with


Organization View

Organization

Specialty (s)

Department (s)

Facility (s)Addresses (s)

is housed in (many)

Is composed of (many)

Which are at(Many) Business Relationship (s)

Is Composed of (many)Is housed in (many)

Credential (s)

hashas

Is located at

Has

AliasProvider has

HIE/HIO belongs to

Business Relationship

has

is housed in (many)


Use Case View

Organization

HIE/HIO

Use Case Owner

OwnsMay Support

BusinessUse Case (s)

May support

Belongs to

Belongs to

Owns

AliasProvider Has


AttributesProvider Entity HPD Provider ID – HPD Generated

Identifier

Provider Status – active/inactive in HPD

Provider Validation Flag: determines if provider information has been validated for the HPD

Validation Source - Identifies the source that validated the information

Validation Date – the date this record is validated

Provider Type – Individual or Organization

Creation Date - the date a record in HPD record is effective from

Last Update Date - the date a record is last updated in the HPD

Individual Provider Provider First Name

Provider Middle Name

Provider Last Name

Provider Suffix

Provider Prefix

Language Spoken List

Provider Gender

Provider Race

Provider Birth Date

Provider Death Date

Provider Birth State Code

Provider Birth Country Code



AttributesOrganization Organization Name – name of a group or

party other than an individual that render health care services

Organization Type

Organization Description


Provider Alias Alias Last Or Organization Name -

various names the provider is known by including maiden name or previous legal name

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

Status: Active/Inactive

Creation Date - the date a record in HPD record is created



AttributesAddress HPD Location ID: HPD Generated Address ID

Location Purpose Type - type of address associated with the provider i.e. mailing, residence, practice etc

First Line Address

Second Line Address

City

Country Code

Zip Code

State Code

Location Description

Fax Number- Area Code + Number

Telephone Number - - Area Code + Number + Extension

Electronic URL List

Status: Active/Inactive




AttributesSpecialty Specialty Type: A major grouping of

service(s) or occupation(s) of provider. E.g. Dermatology, Dental, Internal Medicine, Orthopedic, Pediatric 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.

Specialty Role Type: Role of provider that further classifies the provider clinical responsibility. E.g. Physician, Licensed Practical Nurse, Midwife, Chiropractor, Nursing service

Status: Active/Inactive Creation Date - the date a record in HPD

record is created Last Update Date - the date a record is

last updated in the HPD

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 Issue Date - date on which the certification was issued

Certification Renewal Date

Certification Status: Active/Inactive/Pending etc.




AttributesProvider 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 Description

Deactivation Reason Text

State Code: State where this identifier is valid

Country Code: Country where this identifier is valid

Identifier Status - status of the identifier: active, inactive, revoked, dropped or suspended




AttributesBusiness RelationshipThis 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 Target 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 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

Creation Date - the date a record in HPD record is created Last Update Date - the date a record is last updated in the HPD


AttributesHIE/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 URL List: Service end points of the HIE network.

HIE Status: Active/Inactive




AttributesBusiness Use Case Use Case Name – name of the the

Business Services (Use Cases) in which a HIE participates

Use Case Service Description

Use Case Service Status

Effective End Date

Effective Start Date

Use Case Owner Use Case Owner Address

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


Next Steps

Discussion on Data Modeling tool

Review Use Cases

Review Standards and Transaction

February 1,2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT

Backup Information


Use Case View


Feedback and considerations on data model

Entity Attribute/Relationship Change Comments

1 Department Delete

2Facility Add a credentialing relationship

with Individual ProviderAdd relationship May need a business relationship between Facility and

Individual Provider

3 Facility Add a relationship to “Alias”

4Facility Add a relationship to Business

RelationsAdd relationship Business relationship could exist between facility and

provider (not department).

5Education Delete

6Organization 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.

7Organization/ Individual Provider

Add a privileges attribute Add attribute A privilege distinguishes the type of “credentials” i.e. in good standing a individual provider has at a organization.

8Individual /Education

Add a credential attribute Add attribute A “credentialing attribute will document educational degrees.

9Organization Add “governance” Add attribute Governance should determine

“privileges/credentialing of providers.

february 1,2010 social security administration-hit support healthcare provider directory (hpd) data...

Documents

provider list

provider entries

directory slide

business relationship

provider credentials

provider of care list

unique provider entry

credential s specialty