1. February 1,2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT Healthcare Provider Directory (HPD) Data Model Discussion IHE Face 2 Face February 1, 2010 Profile Leads: Shanks Kande (SSA) Nitin Jain (IBM) Toby Briks-Fader (IBM)

2. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 2 February 1, 2010 Topics  HPD Overview  HPD Content Model Review  Next Steps

3. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 3 February 1, 2010 HPD Overview  This proposal recommends development of a unified approach for electronic lookup query where, upon initiated with a unique identifier or key demographic elements, an authorized user may obtain content of a unique provider entry with high reliability.  Beyond the query lookup functionality, there is a minimum set of transactions required to create and maintain the directory service, first of which is the ability to make additions and updates to provider entries.  The scope of this proposal focuses initially on the minimum “foundational” set required for defining a provider directory, resulting in a usable work product as well as recommendations for future phase expansions.

4. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 4 February 1, 2010 Use Cases Use CaseUse of HITPR Stakeholders Social Services Department Disability Determination  Identify claimant’s providers by demographics & affiliations  Locate providers’ electronic end points in the network to support directed electronic requests Claimants, Providers, SSA, Health Information Exchanges, Social Services programs Emergency Response  Contact providers and identify “Medical Reservists”  Verify provider credentials Citizens, Providers, Public health Officials, State & Local Epidemiologists, Response Workers Consumer Access to Provider List  Select provider of care list from registry to grant or deny access permissions  Alerts on provider demographic updates Consumers, Families, PHR vendors, providers E-Prescription  Prescriber credentials (DEA) validation  Identify & communicate with prescribers on drug recall Providers, Patients, Pharmaceuticals, Drug Safety Officials

5. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 5 February 1, 2010 HPD Content Model  The HPD Content Model supports the query for provider based on properties, relationships, and classifications Relationships Properties Classifications Provider

6. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 6 February 1, 2010 Metadata based Directory

7. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 7 February 1, 2010 Individual Provider View Individual Provider Alias Organization (s) Education (s) Department (s) Addresses (s) has is composed of (many) Is located at has business Relationship (s) Is composed of (many) Is housed in (many) Credential (s) Specialty has Has Provider has Business Relationship HIE/HIO belongs to with

8. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 8 February 1, 2010 Organization View Organization Specialty (s) Department (s) Facility (s)Addresses (s) is housed in (many) Is composed of (many) Which are at (Many) Business Relationship (s) Is Composed of (many) Is housed in (many) Credential (s) has Is located at Has AliasProvider has HIE/HIO belongs to Business Relationship has is housed in (many)

9. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 9 February 1, 2010 Use Case View Organization HIE/HIO Use Case Owner Owns May Support Business Use Case (s) May support Belongs to Owns AliasProvider Has

10. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 10 February 1, 2010 Attributes Provider Entity  HPD Provider ID – HPD Generated Identifier  Provider Status – active/inactive in HPD  Provider Validation Flag: determines if provider information has been validated for the HPD  Validation Source - Identifies the source that validated the information  Validation Date – the date this record is validated  Provider Type – Individual or Organization  Creation Date - the date a record in HPD record is effective from  Last Update Date - the date a record is last updated in the HPD Individual Provider  Provider First Name  Provider Middle Name  Provider Last Name  Provider Suffix  Provider Prefix  Language Spoken List  Provider Gender  Provider Race  Provider Birth Date  Provider Death Date  Provider Birth State Code  Provider Birth Country Code  Last Update Date - the date a record is last updated in the HPD

11. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 11 February 1, 2010 Attributes Organization  Organization Name – name of a group or party other than an individual that render health care services  Organization Type  Organization Description  Last Update Date - the date a record is last updated in the HPD Provider Alias  Alias Last Or Organization Name - various names the provider is known by including maiden name or previous legal name  Alias First Name  Alias Middle Name  Alias Type Code - code identifying the type of alias name, e.g. professional name, doing business as (d/b/a) name, maiden name  Status: Active/Inactive  Creation Date - the date a record in HPD record is created  Last Update Date - the date a record is last updated in the HPD

12. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 12 February 1, 2010 Attributes Address  HPD Location ID: HPD Generated Address ID  Location Purpose Type - type of address associated with the provider i.e. mailing, residence, practice etc  First Line Address  Second Line Address  City  Country Code  Zip Code  State Code  Location Description  Fax Number- Area Code + Number  Telephone Number - - Area Code + Number + Extension  Electronic URL List  Status: Active/Inactive  Creation Date - the date a record in HPD record is created  Last Update Date - the date a record is last updated in the HPD

13. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 13 February 1, 2010 Attributes Specialty  Specialty Type: A major grouping of service(s) or occupation(s) of provider. E.g. Dermatology, Dental, Internal Medicine, Orthopedic, Pediatric etc.  Specialty Name: Provider’s specialization,, a specific medical service, a specialization in treating a specific disease. E.g. Bariatric Medicine, Geriatric Medicine, Pediatric Dermatology etc.  Specialty Role Type: Role of provider that further classifies the provider clinical responsibility. E.g. Physician, Licensed Practical Nurse, Midwife, Chiropractor, Nursing service  Status: Active/Inactive  Creation Date - the date a record in HPD record is created  Last Update Date - the date a record is last updated in the HPD Credential  Certification Type Name: Type of certification earned by a provider.  Certification Type Description  Certificate Verification Date  Certification License Number  Certificate Issuing Organization  Certificate State Code  Certificate Country Code: Country where certificate is valid  Certification Issue Date - date on which the certification was issued  Certification Renewal Date  Certification Status: Active/Inactive/Pending etc.  Creation Date - the date a record in HPD record is created  Last Update Date - the date a record is last updated in the HPD

14. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 14 February 1, 2010 Attributes Provider Identifier  Identification Number – Unique Identifiers that may exist for a provider in a particular domain, state or country  Identifier Type: Type of identifier such as tax identification number, state issued number, National Provider Identifier, drug identifying number, social services number, etc.  Identifier Issuing Agency: Name of the agency that issues this identifier  Identifier Description  Deactivation Reason Text  State Code: State where this identifier is valid  Country Code: Country where this identifier is valid  Identifier Status - status of the identifier: active, inactive, revoked, dropped or suspended  Creation Date - the date a record in HPD record is created  Last Update Date - the date a record is last updated in the HPD

15. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 15 February 1, 2010 Attributes Business Relationship This entity establishes relationship either between Individual & Organization, Organization & organization  HPD Business Relationship ID – HPD Generated Identifier for business relationship  Relationship From ID: HPD Provider Id from which business relationship originates  Relationship Target ID: HPD Provider Id to which business relationship is being established  Relationship Type - type which describes the business relationship between an Individual or Organization as defined in the HPD. (i.e. Individual provider "is member" of a health system)  Relationship Status – active/inactive/pending  Relationship Validation Flag - determines if relationship information has been validated  Relationship Number (local identifier) - unique number that an individual provider may be known by in a particular organization or department based on this business relationship. For example, an employee ID number in a hospital  Creation Date - the date a record in HPD record is created  Last Update Date - the date a record is last updated in the HPD

16. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 16 February 1, 2010 Attributes HIE/HIO  HIE Name: Name of a Health Information Exchange/Network Organization.  HIE Contact Information - demographic information that allows contact with the designated individual who disseminates and receives information pertaining to an HIE/HIO (i.e. name or phone number).  HIE Identifier (OID): Unique Identifier assigned to this HIE.  HIE Certification Status: Active/Inactive/Pending status of HIE Certification by a Certifying body  HIE Certification Agency: Certification body certifying a HIE  Data Sharing Agreement Level - level of the Data Sharing Agreements for the HIE/HIO such test/production  HIE Network URL List: Service end points of the HIE network.  HIE Status: Active/Inactive  Creation Date - the date a record in HPD record is created  Last Update Date - the date a record is last updated in the HPD

17. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 17 February 1, 2010 Attributes Business Use Case  Use Case Name – name of the the Business Services (Use Cases) in which a HIE participates  Use Case Service Description  Use Case Service Status  Effective End Date  Effective Start Date Use Case Owner  Use Case Owner Address  Use Case Owner Phone Number  Use Case Owner Contact Name  Use Case Owner Name - the entity (Agency, individual) who develops and owns use cases that describe business service

18. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 18 February 1, 2010 Next Steps  Discussion on Data Modeling tool  Review Use Cases  Review Standards and Transaction

19. February 1,2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT Backup Information

20. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 20 February 1, 2010 Use Case View

21. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 21 February 1, 2010 Feedback and considerations on data model EntityAttribute/RelationshipChange Comments 1 DepartmentDelete 2 FacilityAdd a credentialing relationship with Individual Provider Add relationshipMay need a business relationship between Facility and Individual Provider 3 FacilityAdd a relationship to “Alias” 4 FacilityAdd a relationship to Business Relations Add relationshipBusiness relationship could exist between facility and provider (not department). 5 Education Delete 6 OrganizationAdd a relationship to Organization from Organization. Add relationshipNeeds a recursive relationship to document “an organization can be a supertype to zero, one or many subtype organizations. 7 Organization/ Individual Provider Add a privileges attributeAdd attributeA privilege distinguishes the type of “credentials” i.e. in good standing a individual provider has at a organization. 8 Individual /Education Add a credential attributeAdd attributeA “credentialing attribute will document educational degrees. 9 OrganizationAdd “governance”Add attributeGovernance should determine “privileges/credentialing of providers.