Provider Directory’s ‘Rosetta Stone’

The title of this blog post might suggest something exotic or foreign or mysterious to some readers. Well, it may be just that… but we will do almost anything to get a bit of attention for Provider Data as a Service (PDAAS), a topic we feel is extremely important for our clients and all healthcare leaders to better understand… especially with the need for accurate Provider ‘demographic’ information that will be required to meet interoperability standards.

The ‘Rosetta Stone’ …like the famous stone translating Egyptian hieroglyphs into the Greek alphabet for comprehension…. also translates Provider demographics into an accurate and useful and comprehensive Provider Directory.

What is this ‘Rosetta Stone’ link?

Perhaps you have or haven’t guessed, but just in case, here is the answer:… Facility Demographics… Really?  and more specifically unique facility information that represents the practice location and name of each and every organization delivering healthcare.  And we don’t mean just billing, mailing, or contact locations… but actual specific practice information where healthcare is actually delivered.

In fact we go so far as saying that you cannot have an accurate, useable Provider Directory without having an accurate, useable Facility Demographic database.

Let’s start with Healthcare facilities.  We all know them:  Group Practices, Physician Hospital Organizations, Hospitals, Mental Health Institutions, SurgiCenters, Walk In Healthcare, Ambulatory Care facilities, Solo Practices, etc. But do you include Hospital addresses with unique detached facility locations or departments?  Do you include solo practices that are part of a group network?  Do you include the ‘required’ departmental descriptors at large academic hospitals? Those are separate Facility locations where patients are seen and healthcare delivered.  So we are not talking just about affiliation information, although that is important too, but the actual physical delivery of healthcare.

Actually creating a list of individual healthcare Providers is not particularly difficult. In fact if you have a low tolerance for accuracy (let’s say 50% initially) then you can learn how to format and download a number of electronically available files. But you typically will want to segregate that from your own internal files you have been maintaining over time because of the unknown quality of the external files (more about that later). Taking a snapshot of healthcare Providers descriptively without unique Facility Demographics has been done by many of our clients… before they became our clients.

The tough part of an accurate, useable Provider Directory is finding and maintaining the relationships of Providers across Healthcare Facilities, and to do that you need the most accurate, useable Directory of Healthcare facilities.

Why do we say that?

For several reasons: First, there is a lot of change in Provider Directories but personal information about Providers does not change all that dramatically.  An individual Provider rarely changes his or her personal information unless there is a name change (marriage, etc.), an additional medical specialty, additional certification, or new Medical License numbers.  On the other hand the changes that occur continuously are changes in Practice address, and affiliations, and phone numbers and fax numbers, etc.  So if you want to be accurate and useable you have to keep up with Facility information.

Second, Provider information is typically generated based on patient contact.  Guess how patients identify Providers?  By name, yes…(names can be duplicative or incomplete, etc), but then it is WHERE the patient was delivered healthcare.  And that could be a Group name, a Clinic name or some other organizational name OR the practice address—street/suite/building OR a phone number, etc.  And to make it even more complicated, we know Providers practice in multiple physical locations. In short the Facility name and address and phone number are important means of accurate Provider identification.

Third, Providers provide ‘personal’ information in initially being licensed in a state or in applying for an NPI.  They self report personal information such as name, medical school, specialty, NPI and/or UPIN. And also they initially self report an address.  After this initial application, the ‘personal information’ stays the same and therefore no further ‘self reporting’ is needed but unfortunately this seems to apply to Facility addresses where a great deal of change does occur.  In other words Providers are understandably busy and are not really motivated to self-report practice information and practice information changes when all other ‘personal’ information remains the same.

Fourth, the relationship of Providers to a particular practice location and facility is crucial in maintaining the relationship of ALL Providers to that location.  Because Facility change information can be revealed in dribs and drabs of input, it is important to assess that information in the context of all Providers linked to that facility.  For example, if the address or phone number of one Provider in a 6 man Group practice changes, it is an important step to determine whether all members of the group now are at the new location, whether the Provider is setting up a satellite office for the same group, whether the Provider has left the Group for another Group or solo practice down the road, whether the Provider has moved out of the state, whether the Provider has retired, etc.  In short, unique Healthcare Facility information and the linkage to Providers in that facility is a critical step in maintaining Provider accuracy.

So to summarize:

The ‘Rosetta Stone’ of Provider Directories is…accurate Provider Demographics, yes, but equally if not more important is accurate Facility Demographics…Practice Location is the key driver of change in a Provider Directory, it is a fundamental source of Provider identification for patients, it is not self reported by Providers, and it is a key determinant in analyzing and leveraging discrete information that may apply to larger groups of Providers.

Unique Healthcare Facility location information is a key foundation for FolioMed’s ‘Provider Data as a Service’ and a key reason for our outstanding accuracy.

Tags: , , , , ,

4 Responses to Provider Directory’s ‘Rosetta Stone’

  1. DrStatuere says:

    The Rosetta Stone is a cipher to make sense of civilizations; FolioMed’s Provider Directory does the same in mapping the shambolic streams of information in the 21st Century. Finally someone who understands the importance of healthcare location information.

  2. sonbarbara says:

    It is good that someone has really understood the importance of healthcare location information and doing something to maintain the records. I can understand that it is a mammoth task but I think you can do it. The way you have defined the problem shows that you are equipped to find solutions too.

  3. Patric says:

    It is the nature of service provided by healthcare facilities that make the task difficult. There is a difference between where patients are actually delivered the service and the facility locations. The relationship between providers and healthcare facilities is complex. It is not a one-to-one relationship at all. This makes it difficult to maintain correct information.

  4. Nancy says:

    Very true. The personal information of providers’ seldom changes but the other details are continuously updated. This makes it a problem to maintain up-to-date data. To get accurate data all such changes have to be tracked.


September 2020
« Sep