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
|