EMR Systems and Provider Databases

As EMR implementation continues, there is increasing awareness of the lack of accuracy and utility of the Provider Databases that underlie new systems.  This reflects the heightened emphasis on accuracy required by HIPAA regulations in communicating patient PHI, but also the lack of resources available to provide quality external Provider information.

Typically the new EMR system allows either self or batch enrollment of the client’s internal and/or credentialed provider file. Some vendors, however in order to increase the competitive features of their systems, have formed Health Information Service Providers (HISP’s) and offer Provider information external to the client’s own information. Typically this involves a national Provider file, the National Plan and Provider Enrollment file (NPPES). Utilization of this national file or even portions of it, creates its own set of current and future quality problems. Current difficulties stem from the limited dataset of the file. For example only a single practice street address is listed, typically without reference to any facility name. Hospital departmental information is inconsistent and hospital contact information may reside with the enrollment staff and not the provider. The more serious issue is the lack of updating. For example, in analyzing the current NPPES file of approximately one million MD/DO records only 1/3 of the database had been edited in the last 3 years and over 2/3 of the records were last edited or modified before 2012.

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September 2020
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