Provider attributes
Clinical information systems use structured data elements to identify and categorize individuals and groups of health care providers. These provider attributes describe the person, credentials, services, and business practices of providers. They may also describe providers' relationships to patients, other providers and organizations. Health care reform and incentive programs such as the federal Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs (“Meaningful Use”) and the growth of accountable care organizations have increased the demand for data exchange and clinical decision support specific to the individuals and groups of providers involved with different episodes or phases of care delivery. Since the 2010 passage of the Affordable Care Act, there have been increasing efforts to standardize and integrate provider attributes into clinical information systems, particularly electronic health records and health information exchanges.
Contents
Standards-based Provider Attributes
- Credentials
NOTES: Business entity Role within system
Specialty: training, board certification Specialty: billing designation Specialty: custom uses (UHC, etc.)
Taxonomies: ANSI ASC X12 Health Care Provider Taxonomy; HL7 [get email sent to UPT] CMS-HIPAA taxonomies
Clinical service Clinical microsystem Hospital unit
Non-Standard Attributes
Examples
- Role
- Hospital privileges
- Clinical service
- Clinical microsystem
Use Cases
Electronic Health Records
- Security Settings (Chart access, Order authorization, Note attestation, message routing)
- Clinical Decision Support (Information filtering, preference lists...)
- Patient-Centric Information Sharing
Hospital Analytics and Quality Improvement
Health Information Exchange
Challenges
Semantic inconsistencies across interfaced clinical information systems and the lack of standards integration are significant barriers to provider attribute-determined functionality. Admission, Discharge, Transfer (ADT) systems typically house provider attribute data associated with practice management such as the cost center construct(s) assigned to a given provider. For EHR systems in which the ADT is separate from the rest of the EHR, differing data structures and interface limitations can lead to mismatched provider attribute mapping or the creation of records with values that are out of synch with actual patient-provider-encounter relationships. An example of the first challenge would be an EHR displaying a general cost center name or academic specialty rather than a clinical service. An example of the latter would be a change in the EHR record of a hospitalized patient that specifies a new attending provider (a role) that is not shared with with the ADT system.
"Specialty" is a particularly problematic provider attribute given the wide range of meaning ascribed to the word specialty as well as the myriad terminologies in existence.
Though "clinical service" was not adopted as an attribute by the Integrating the Healthcare Enterprise (IHE) Information Technology Infrastructure (ITI) Technical Committee (see: #Non-Standard Attributes) did specify that nested "organizational provider" entities could provide the same function.
Maintenance of provider attributes is a pervasive challenge. Rapid role turnover was cited by the IHE ITI Technical Committee as the basis for excluding "role" as a provider attribute for its trial implementation of its IHE IT Infrastructure Technical Framework Supplement – Healthcare Provider Directory (HPD).
Provider Directory and Related Standards
| Standard | Type | Standard Developer | Comment |
| IHE IT Infrastructure Technical Framework Supplement – Healthcare Provider Directory (HPD) | Structural | Integrating the Healthcare Enterprise | Comment |
| HL7 Version 3 Standard: Healthcare, Community Services and Provider Directory, Release 1 A Service Model Specification | Structural | HL7 International | Comment |
| Health Care Provider Taxonomy | Content | National Uniform Claim Committee (NUCC) | Comment |
| Crosswalk: Medicare Provider/Supplier to Healthcare Provider Taxonomy | CMS Center for Program Integrity, Division of Policy & Regulatory Development | Comment | |
| Specialty medical boards | Content | Multiple professional organizations | Comment |
| Provider Directory (ASC X12 004050X109) | Transactional | ASRX12 (The Accredited Standards Committee) | Comment |
| Provider Directory (4010X109), Inquiry and Response (4010X185) | Content/Transactional (Implementation Specifications) | ASRX12 (The Accredited Standards Committee) | Comment |
