Integrating Provider Directories

Business problem
Every computerized clinical system has a dictionary of providers. Unfortunately, most systems are designed to exist in isolation, lacking a process to integrate with any other dictionary. Larger healthcare organizations have multiple systems with provider dictionaries, and must find a way to connect these dictionaries to ensure patient safety and data quality.

The "master" provider directory
The primary clinical system until recently was Meditech client/server, and the Meditech provider dictionary is still considered the "master" list of clinicians. For some reason, although Meditech has a payroll module there is no way to connect someone in the provider dictionary with someone in payroll, so it is impossible to link an employee ID with a clinician.

Many clinicians aren't payroll employees anyway, so we added a field to the provider dictionary for our ITID (Who works here?). This connected the provider dictionary to all our other worker data.

Meditech also does not provide any connection between the provider dictionary and the user dictionary, so we manually add the provider ID to the relevant user dictionary record.

Oops... we really have two "master" directories
The medical staff office is the clinical gatekeeper for any hospital. Provider credentialing, one of the office's key functions, verifies the background of every clinician and ensures that they are fully qualified for every privilege they will be granted at the hospital.

The credentialing system is the master list of clinicians with privileges, but only if the data can be connected with provider directories in other systems. Unfortunately, there was no common provider ID in the Meditech and credentialing systems, so there was no way to reconcile these two master directories.

The Meditech provider dictionary is much more extensive than the credentialing system. While the credentialing system contains only credentialed providers, the Meditech dictionary contains many other providers who refer patients or are the primary care providers for patients. These clinicians are not part of the hospital network, but are recorded in the dictionary so they can receive test results and reports. This means that the providers in the credentialing system are really a subset of the Meditech provider dictionary, so the Meditech provider ID should serve as the common identifier.

Audit reports by the dozen
After updating the Meditech provider dictionary with the ITID, and the credentialing system with the Meditech provider ID, we needed a practical way to ensure that everything is continuously updated. A series of daily, automated audit reports do the trick:

• Invalid ITID in Meditech provider dictionary — Checking for inputting errors.
• Missing ITID in Meditech provider dictionary — A list of providers with encounters in the past 90 days (who seem to be actively seeing patients) but who do not have an ITID in the dictionary. This list is a trigger for further investigation and possibly adding a non-employee position for the clinician.
• Invalid provider ID in Meditech user dictionary — Checking for inputting errors.
• Meditech user dictionary account missing from IT user access database — Checking for omissions by user access.
• Meditech provider ID in credentialing, but no ITID in Meditech — The Meditech dictionary may need updating, but there may also be some other data problem.
• Meditech provider ID missing from user dictionary — Checking for omissions by user access.
• Invalid Meditech account in IT user access database — Checking for inputting errors.
• Invalid Meditech provider ID in credentialing — Checking for inputting errors.
• Missing Meditech provider ID in credentialing — Checking for omissions by medical staff office.
• NPI mismatch between credentialing and Meditech — Checking for inputting errors.
• Possible name matches from Meditech provider dictionary for credentialing missing Meditech provider ID — Useful tool to help medical staff office identify the correct Meditech provider ID.
• Duplicate Meditech provider ID in credentialing — Checking for inputting errors.
• Admitting privilege status mismatch between credentialing and Meditech provider dictionary — Ensuring that Meditech dictionary is always "in sync" with credentialing system for admitting privileges.
  

Lessons learned

• With a little ingenuity, disparate directories can be connected.
• Automated audit reports are a terrific tool for ensuring good data, both as a shortcut for staff and as a daily reminder of data quality issues.
• While connecting the directories and building audit tools, invariably we learn other useful things about these systems and processes.

Posted 21 March 2008