NHIN needs a better provider directory, workgroup says

The next major component needed for the federal government-sponsored Nationwide Health Information Network (NHIN) is a directory of up-to-date e-mail addresses, phone numbers and fax numbers for providers of medical data into the system, members of an advisory workgroup said today.

Creating and maintaining such a directory is a “core need” for the NHIN, Farzad Mostashari, senior adviser to HHS’ Office of the National Coordinator for Health Information Technology, said at a meeting of the NHIN Workgroup meeting. The workgroup advises the Health and Human Services Department.

At the same time, establishing a directory that is up-to-date, accurate and complete at all times is likely to be a difficult task, and there is no defined strategy on organizing and governing such a directory, workgroup members said.

Currently, physicians submit their directory information to an average of 17 privately operated directories a year. The private lists all use different terms and formats and do not consistently share information with each other when changes are made, such as when a doctor changes his or her e-mail address.

“What is the incentive for a provider to submit to a central directory?” asked Kathleen Mahan, vice president of product management for SureScripts, an e-prescribing vendor that maintains its own national directory of 155,000 providers.

Another model is a universal provider directory that has 800,000 providers listed, which was created in 2002 by the nonprofit Council for Affordable Quality Healthcare. Council members today said their solution “significant advances its objective of reducing redundancy, inefficiency and costs associated with the provider data collection process.”

However, current solutions may not be adequate because they have outdated information, said James Borland, special adviser for health IT to the Social Security Administration.

SSA is exchanging medical data on the NHIN with MedVirginia to help it determine whether applicants for disability assistance meet the requirements. The use of the NHIN and electronic exchange has greatly sped up the availability of the medical data, in comparison to paperwork exchanged in the past.

To obtain e-mail addresses and phone numbers of providers, SSA has been using a “home-grown” national provider directory named the Source Reference File, which is a conglomeration of vendor files from all 50 states and four territories.

However, that database has duplicates, aliases, misspellings, incomplete and out-of-date information, Borland said. A single hospital system may have more than 1,000 entries that need to be constantly monitored and updated, which is not easy to do, he said.

SSA currently is developing requirements for creating its own national provider directory with standard identification information, records location, fax number, e-mail address, electronic health record end point and preferred response method for each provider.

“Our needs are far from unique,” Borland said. “SSA and other NHIN participants have a common need for an authoritative directory of medical providers to facilitate interoperability and support electronic communication and data exchange.”

In addition, NHIN also needs to establish a system to authenticate the identities of users on the network, Mostashari said. A public hearing on that topic is scheduled for Jan. 7.

NHIN, which was established by HHS, is a set of protocols, standards and services that can be used to carry out secure exchange of medical data over the Internet. The tools used by participants include a common vocabulary, messaging standards, delivery protocols, security, directories and authentication standards.

The NHIN currently is used on a demonstration basis by the SSA, Veterans Affairs Department and several other federal agencies and private entities. It will likely take on a much broader role in national health data exchange as part of the distribution of $20 billion in incentives under the economic stimulus law. It is anticipated that under the regulations being written by HHS, doctors and hospitals eligible for the incentive payments will be required to participate in health data exchange.