There have been many attempts over the years to have some kind of standardized directory for healthcare providers. In fact, almost every Health Insurance Payer has some sort of searchable directory of providers that participate in their network available to their members via a web portal. While these “provider finders” are very helpful for patients in need of an in-network doctor or specialist, they aren’t what we would call “interoperable” - meaning that beyond the scope of the health insurance payer providing the web portal for their members, they serve little purpose.
With the recent uptick in FHIR adoption within the healthcare industry in the US and recent regulations giving patients more ownership of their healthcare data and their personal care, the need for a scalable healthcare directory has become more pronounced. As people move between health insurance payers, or move within the 50 US states, there is a greater need for an accurate, easily-accessible repository of not only providers of healthcare, but of payers, of services of varying types, etc. With data exchange becoming such an essential part of the US healthcare landscape, how do we ensure that all of the data is interoperable and easily accessible as patients give consent to providers and payers alike to share and access their data? If I were to switch my family doctor tomorrow, how would they know how and where to get my clinical data from my previous doctor?
Enter the National Directory of Healthcare Providers and Services - an initiative being undertaken by the FHIR At Scale Taskforce (FAST). Built upon the provider network principles founded in Da Vinci’s PDex Plan Net FHIR implementation guide, the NDH implementation Guide serves as a foundation for the creation and maintenance of a centralized “source of truth” for provider and service data within the US. With a repository of validated, attested data from Providers, Payers, and Services, we can now make this data available and consumable by an array of local directory services, third-party applications, and other entities seeking to exchange healthcare data with each other. Patients will be able to leverage this for an accurate database of providers, their locations, the services they provide, and their FHIR API endpoints for any number of use cases.
With all of this in mind, it is important that we understand that this effort will need to be undertaken by the Centers for Medicare and Medicaid Services (CMS), to ensure the integrity and availability of the data. Privatizing this effort could constrain access and call into question the veracity and quality of the data - but having CMS build and maintain this FHIR data repository of Organizations, Practitioners, and all of their associated FHIR Endpoint data ensures that the goal of a completely interoperable and discoverable directory for healthcare is realized. Once the data is collected, attested to, verified, and validated, access to the data in the repository will be given two main flavors - a standard FHIR API where people can access the required data via the use of third party applications, or through system-to-system communication with standard REST calls to FHIR endpoints. The second flavor will come in the form of a Bulk-on-FHIR API for organizations wishing to obtain a subset of the entire directory for use in a local or distributed access directory - a state-level Health information Exchange, for example. To ensure that data stays up-to-date in these downstream local directories, the NDH implementation guide promotes the use of FHIR subscriptions using the R4 backported subscription implementation guide. This cutting-edge use of the R4 FHIR standard (required in the US for certification, and required by numerous regulations) would allow consumers of the National Directory data to be automatically notified when any changes occur.
Given that CMS have been heavily invested in the development of this FHIR-based solution, they have embarked on a pilot program with the Oklahoma Office of the Insurance Commissioner to create a localized directory of providers and services for the Qualified Health Plans offered by payers within the state. This directory would contain the provider networks for each of these Qualified Benefit Plans, and serve as a proof of concept for the future development of a National Healthcare Directory. While currently in the planning stage, there is excitement around the development of this Oklahoma QHP directory.
So there we have it, the promise of FHIR embodied in a centralized hub for information about healthcare providers and services, with the ultimate goal of easing the on-ramp to interoperating between patients and providers, between providers and payers, between payers and other payers or healthcare services. The use cases are myriad and the promise is near-limitless. Bellese continues to closely monitor developments with the NDH and will provide input and support in the creation and refinement of the FHIR implementation guide.