Provider Directories—Past, Present and Future
By Justin Sims
July 19, 2019 — Tens of thousands of times each day, clinical staff use search engines like Google to find phone or fax information, call each other to check whether the other party accepts a certain insurance type, and fax each other lengthy patient records. It is inefficient, slow, prone to error, and exacerbated by a lack of reliable, centralized information about healthcare providers.
The roots of healthcare directories go all the way back to the Bill of Rights which gave states the right to regulate health and license physicians. State medical boards emerged soon after this and begun to issue licenses and publish lists of licensed physicians. But 200 years have passed and there has not yet been a single, national source to find a physician by specialty, view their affiliations, see which insurance they accept, or look up their contact information.
There are many sources of information about providers—you could call these directories. But all have significant flaws which perpetuate inefficient manual processes and hamper the exchange of patient health information between providers. Many are limited to a particular state, they may be updated infrequently, and in many cases, they only contain a subset of the most useful information, forcing users to search in multiple locations for a complete view of a provider.
The Office of the National Coordinator (ONC) has a team looking exclusively at provider directories and brought industry stakeholders together in Washington D.C. just a few weeks ago to discuss possible solutions. And the Centers for Medicare and Medicaid Services (CMS) is well aware of these challenges, too.
In its latest proposals on Interoperability and Patient Access, CMS has shared two new concepts:
Providers would need to publish electronic contact information in the NPI directory or risk being named as an “information blocker”.
Health Plans would each need to publish a directory of the providers that form part of their network through open APIs, specifically HL7® FHIR®.
These initiatives will certainly help, but the industry is crying out for an aggregator. An organization to invest in bringing all of the sources of data together. Structuring it, applying intelligence to it, and determining what is good vs. bad, old vs. new.
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