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How do you build trust as you build your statewide HIE

States are now deep into the requirements gathering and planning phase of architecting plans to deliver a statewide HIE. Perhaps they have decided on one of the models previously discussed, or are developing a hybrid approach to address their specific requirements.

A key focus is determining which services to offer that will yield the most improvements in timely exchange of health information, cost and efficiencies of the health care delivery system.

A Master Patient Index is a nearly universally-recognized service that must be delivered as part of a successful HIE architecture, but, what about a Master Provider Index? The concept of delivering a statewide provider registry service is being widely discussed for a very good reason: Meaningful Use.

In January of 2010, the HIT Policy Committee identified the following key elements that will facilitate and encourage the broadest range of providers (individuals and organizations) to achieve meaningful use in 2011. Taken directly from the Committee, the requirements include:

• Secure Internet transport
• Addressing and associated directories to allow parties to definitively route information to the intended participant
• Means to authenticate/validate identity of parties involved in information exchange
• Trust fabric that provides parties with sufficient confidence that the exchange can be accomplished successfully

While the government identified the key elements that should be implemented, they have not advocated a particular approach to achieving these goals, and are not likely to do so. After all, as Dr. Blumenthal is fond of saying, there is “no one size fits all” solution that will satisfy all of the requirements of each state. Potential solutions include:

National Provider Registry

Many have wondered if this shouldn’t be the domain of the federal government, perhaps as part of the National Plan and Provider Enumeration System (NPPES) which aggregates provider data via a provider’s National Provider Identifier (NPI).

While the NPPES has done an admirable job of standardizing HIPAA transactions, in some cases it provides too much information (a provider may have multiple NPI numbers) or, in other cases, too little. (The NPPES is not intended to convey the current license or credential status of the physician).

Also, a great amount of work (and quite likely a literal act of Congress) would be necessary to ready the system for the types of transactions required of such a system and the manner in which the information would be updated and reviewed for accuracy.

Centralized Provider Database

A repository of provider information, including routing tables, could satisfy the key elements identified by the HIT Policy Committee, but many questions need to be answered such as:

• Who will maintain the database?
• How will it be governed and updated?
• Who will “own” the data held in it?
• Will it consist primarily, or even exclusively, of licensing data or information that payers maintain about providers?
• Will it rely on providers voluntarily updating the database with current information?

Statewide Provider Registry Service

A light-weight statewide provider registry service can help solve these challenges and help providers meet meaningful use objectives by creating (and making available) a unified view of a clinician across the many disparate data sources that are encompassed in HIE, such as the: state licensing databases, many payers in the state and participating providers.

Which Solution Makes Sense?

After speaking with many organizations, the solution that makes the most sense is for the state to provide a provider registry service. By offering such a service, the state HIE would enable participants to:

• Confidently authenticate the identity of a provider with whom clinical or laboratory results need to be shared
• Verify that the provider is allowed to receive health information, if licensing databases and consent management systems are included as source systems
• Send and receive results in a more accurate and timely manner by identifying the correct location for a physician to send results

States should take great care when planning to meet these meaningful use requirements in 2011. Relying on a static directory of routing information populated by NPPES information may not provide the element of trust that a statewide provider registry must give to a participant.

Participants must trust that the clinical results being exchanged will arrive at the correct address, in the most efficient manner, and will only be opened by a licensed, credentialed provider with the privileges to access and read the message.That’s meaningful.

To hear more, join Lorraine Fernandes, our VP and Industry Ambassador, and Pat Pope, Provider Relations Coordinator, Carespark, on July 28 as they present a webinar, The Value of a Provider Registry in HIE.