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Overview

This is he first official connectathon for the Validated Healthcare Directory Implementation Guide and is targeted to ensure that the guide is implementable, and that some common scenarios are checked.

This diagram describes the concepts behind the validated health care directory.


PractitionerRole describes the relationship between a practitioner and an organization. A practitioner provides services to the organization at a location. Practitioners also participate in healthcare provider insurance Networks through their role at an Organization.

Figure 1: PractitionerRole

Similar to PractitionerRole, OrganizationAffiliation describes relationships between organizations. For example: 1) the relationship between an organization and an association it is a member of (e.g. hospitals in a hospital association), 2) an organization that provides services to another organization, such as an organization contracted to provide mental health care for another organization as part of a healthcare provider insurance network, and 3) distinct organizations forming a partnership to provide services (e.g. a cancer center).


Figure 2: OrganizationAffiliation










Network is a group of practitioners and organizations that provide healthcare services for individuals enrolled in a health insurance product/plan (typically on behalf of a payer). InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

Figure 3: Network / InsurancePlan


Roles

  • Local Requester (Client)

An application that can search for information necessary to support scenarios which support obtaining provider data.

Available Clients

    • Validated Healthcare Directory (Server)

A server that makes Validated Healthcare Directory available to local implementations of directories.

Available Servers

Scenarios

Scenarios 1-6 are repeated from the Virtual Connectathon held December 11th, 2018. If you participated in that Connectathon you may consider starting with Scenario 7. 

Find details on an individual practitioner


These actions allow the Local Requester to find current, detailed information on a practitioner from a Validated Healthcare Directory to support local workflow. Expected uses include verifying the local data is current e.g. address, license status, accepting new patients, etc.


Scenario 1: Local Data Validation - A Local Workflow Environment needs to verify details on a prior known individual as part of a local use case.

This scenario tests the ability to send a fully qualified query to the Healthcare Directory to receive data that describes an individual provider. Local Requester will use predetermined NPI numbers to get the practitioner, the practitioners qualifications and any Validation profiles.  

        1. Using a Practitioner’s NPI number 9998367938 get the practitioner’s qualifications.

        2. Verify the Practitioner has a current, validated license in the state of CT (Connecticut). Note this can be done via a rev-include (or first getting the practitioner, then finding the verification result).

        3. Stretch goal - programmatically determine the status of the qualification

        4. Stretch goal - persist the data in the local system


Profiles Utilized: Practitioner, PractitionerRole, Validation

Precondition: Server is available, local system can access server

Success Criteria: Visual inspection of data received.


Scenario 2: Request data on a set of practitioners  - A Local Workflow Environment needs the data on a set of practitioners as defined by jurisdictional boundaries, in this case a state.  This might be an initial fetching of information, a bulk update/verification or similar local use case where obtaining information on a state is required.

This scenario tests the ability to send a qualified query to the Validated Healthcare Directory and receive data on a set of providers. (This example will be obtaining data with addresses in a particular state jurisdiction.)

        1. Request all practitioners with any practitioner.address that is in the state of CT (Connecticut).

        2. Or any practitioners who have a qualification (e.g. license) where the qualification is valid is in the state of CT (Connecticut).

        3. Stretch goal - persist the data received in the local system.

        4. Feel free to repeat for Massachusetts (MA) and Rhode Island (RI).

        5. Stretch goal II - programmatically identify any providers who are license outside of the state where they live.

Profiles Utilized: Practitioner, PractitionerRole, Location

Precondition: Server is available, local system can access server

Success Criteria: Visual inspection of data.

Find details on an individual organization


Scenario 3: Request data on an individual  organization - A Local Workflow Environment needs current data on an individual organization including all locations, and services.

This scenario tests the ability of a Local Requester to query the Healthcare Directory and receive organizational information including locations and services provided by the organization.  Local Requester will use a specific organization to receive the locations of the organization and specialty areas by location.

        1. Using the organization GREATER LAWRENCE FAMILY HEALTH CENTER, INC., query the locations and services for that organization.

        2. The requester will be querying on a specific organization to determine details which identify location and services of that organization.

Profiles Utilized: Organization, HealthcareService, Location

Precondition: Server is available, local system can access server

Success Criteria: Visual inspection of data.


Scenario 4: Request Data on Organizations - A Local Workflow Environment needs current data on an individual organization’s affiliations; including all locations and the services delivered at those locations.

This scenario tests the ability of a Local Requester to query the Healthcare Directory and receive organizational information including affiliations with other organizations.   Local Requester will use a specific organization to receive the locations of the organization and specialty areas by location.

        1. Using the organization BAY STATE COMMUNITY SERVICES, INC. query the Healthcare Directory to receive related organizations and HealthcareServices provided for each organization.

        2. This scenario will get the Direct email addresses of any entity returned.


Profiles Utilized: Organization, OrganizationAffiliation, HealthcareService

Precondition: Server is available, local system can access server

Success Criteria: Visual inspection of data.

Find details on a provider and their organizational relationships


Scenario 5: Request Organization data for a specific Provider - A Local Workflow environment needs updated information for a specific provider and all organizations the provider is affiliated with.

This scenario tests the ability for a Local Requester to query by a given provider to find all associated organizations, locations, networks and practice specialty, including a Direct address if available.

        1. Given the NPI 9994024518, query for the associated provider, the organizations he/she is affiliated with, all locations and services and the networks he subscribes to.

        2. Determine the existence of a Direct address


Profiles Utilized: PractitionerRole Organization, OrganizationAffiliation, Network, Location, HealthcareService

Precondition: Server is available, local system can access server

Success Criteria: Visual inspection of data.


Scenario 6: Identify data associated with a Network - A Local Workflow needs available data from a Healthcare Directory concerning a Network, including all services, locations, practitioners, and organizations.

        1. Using the Network MA Bronze Plan PPO, locate all services, locations, providers and organizations who belong to the network.

        2. Stretch goals: the following networks are on the server:

MA Bronze Plan PPO

MA Bronze HSA HMO

MA Silver 70 PPO

CT Bronze Plan PPO

CT Bronze HSA HMO

CT Silver 70 PPO

RI Bronze Plan PPO

RI Bronze HSA HMO

RI Silver 70 PPO

Feel free to build a simple network Directories based on the data on the server

Profiles Utilized: Network, OrganizationAffiliation, Practitioner, Location, HealthcareServices, Organization, PractitionerRole

Precondition: Server is available, local system can access server

Success Criteria: Visual inspection of data.


Sceanrios 7-n are under development. 

Scenario 7      Geo Coded Query I - A local workflow needs HcDir information for a given state.

      • Get all providers with home address is contained in the area (location) of MA (Massachusetts)  or have a license in MA. 
      • Eliminate all those providers with a [HOME ADDRESS] in the "Greater Boston Area" (note this is a location). 
      • There is are locations with the Geographic definitions for MA and Greater Boston area. License will use the jurisdiction of the 

Scenario 8      Services - local workflow needs information either limited by or including services  

      • Return all organizations providing Respiratory Services in Rhode Island

using the chained search...

`[base]/HealthcareService?type=respiratory-therapy%Location.address-state=RI`

*Note address-state parameter in FHIR but not VHDIR IG*


        1. KENT COUNTY MEMORIAL HOSPITAL
        2. COMPREHENSIVE COMMUNITY ACTION, INC.
        3. SOUNDVIEW ORTHOPAEDIC ASSOC. LLP
        4. RHODE ISLAND SUBSTANCE ABUSE TREATMENT INC
        5. CODAC INC
        6. RHODE ISLAND SUBSTANCE ABUSE TREATMENT, INC.
        7. BAYSIDE ENDOSCOPY, LLC
        8. DISCOVERY HOUSE UTAH
        9. ROGER WILLIAMS MEDICAL CENTER
        10. TOLLGATE SLEEP DISORDERS CENTER, INC.


      • Return all organizations and the services provider by that Organization in MA.

using the chained search...

`[base]/HealthcareService?Location.address-state=MA`

*Note address-state parameter in FHIR but not VHDIR IG*

1187 services provided by Organizations in MA*** 

      • Return all organizations and the services provider by that Organization in Barnstable County, MA. 

using the chained search...

`[base]/HealthcareService?Location.address-state=MA&Location.address=Barnstable`

*Note

      • address-state  parameter in FHIR but not VHDIR IG
      • address-county parameter not in FHIR or VHDIR IG
      • county not required in VHDIR
      • example data not populated with county


      • Return all organizations providing a Respiratory Services within 100 miles of the provider named "Ernesto Cornejo". 

step 1 get provider practice location (lat = 41.764349, lon = -72.726388)

step2 using that location chained search...

[base]/HealthcareService?Location.near=lat|lon|100|[mi_us]

Note

              • near parameter in FHIR but not VHDIR IG
              • test server not supporting near parameter
      • From that same point (Dr. Cornejo) find all the insurance plans and networks with coverage in that area.

step 1 get provider practice location (lat = 41.764349, lon = -72.726388)

step2 using that location chained search

[base]/InsurancePlan?coverageArea.near=lat|lon|100|[mi_us]

Note

              • near parameter in FHIR but not VHDIR IG
              • test server not supporting near parameter

 Scenario 9 - Find credentials and other items that are expiring


    • Find all licenses that are expired or will expire in the next 90 days. (period on active qualification on practitioner, note:  period and status may be out of sync).

{{url}}/Practitioner?qualification-period=eb2019-03-09

! no search parameter defined for Qualification period in VHDIR*

! period and status are two different axis. inactive and active are not the same as expired.

Scenario 10 - Certificates  and Validation that are expiring

        • All practitioners that had their license verified in the last 60 days - (last performed date 60 days & the status is validated)


`GET [base]/VerificationResult?status-date=sa[today-60days]&validation-status=validated`

*NOTE*: Searches parameters appear not supported in the VHDIR Demo Server

        • All practitioners that failed verification in the last 30 days.  (last performed date 30 days & the status is validation failed or re validation failed)


GET [base]/VerificationResult?status-date=lt[today-30days]&validation-status=val-fail,reval-fail

NOTE: Searches parameters appear not supported in the VHDIR Demo Server

        • Identity certificates expiring in the next 60 days – (doesn’t store it) many a bonus

GET [base]/Practitioner?certificate-date=gt[today+60days]

NOTE: No search parameter for certificate date

Scenario 11 - Membership

        • Find all the organizations and providers that are members of the "CT Silver 70" PPO Network.

Scenario 12 - Subscription (Eric Haas to review/flesh out)

      • Specific trigger for a status change on a practitioner qualification or verification status , push includes the data

Scenario 13 - Refresh data (pull) based on a "last update query".

Scenario 14 - Bulk data (TBD if build data is available on test servers)

Scenario 15 - Care Teams - (TBD)

    • Diabetic Care Team, form a team with a variety of roles
    • Red team/blue team concept - shell of a team

Other thoughts that were discussed - TBD if to include

  • Qualified Health Plans
  • Include a verifier role - Verify some content and send verification result
  • Shapes for a service area – geo-Json and utilization of contains, near
  • Reference implementation client –

 Attendees

Brian Postlethwaite (Telstra Health)

Dan Chaput (ONC)

Eric Haas (health edata)

Lindsay Hoggle (IRIS Health Solutions)

Ron Shapiro (Qvera)

Jay Wall (immutaMED)

Joel Francis (Canada Health Infoway)

...

Notes


Outcomes/Next Steps





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