San Diego 2015: Proceedings - Healthcare

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Healthcare Forum

Objective of Meeting

The objectives of the meeting were to:

  • Welcome new members and broaden Forum perspective to private sector aggregators and Canadian providers and registry work
  • Hold a final F2F meeting to discuss the FHIM White Paper before formal Forum review on Plato
  • Conduct a Provider Directory Data Workshop
  • Hold two Healthcare Track Presentations
  • Discuss Forum direction of work and potential new membership

Summary (Closed Meetings)

FHIM Program of Work

  • Introduced new members to FHIM evaluation.
  • Discussed WP #1 from provider and aggregator perspectives.
  • Deeper dive into architecture of the FHIM.
  • Discussed relevance of model in (a) private sector and (b) Canada.
  • Discussed relevance of FHIM to ONC Standards Advisory of 2015.
  • Discussed possible next FHIM project(s).

Other (Various)

  • Discussed usefulness for PDD program of work.
  • Discussed potential work in mHealth and wearables.
  • Discussed potential work in pharmaceutical innovation and work processes.

Summary (Open Meetings)

Provider Directory Data Workshop

  • Introductions and Problem Definition:

    • Draft working definition of the problem: Lack of standardization of provider directory data and processes inhibit the delivery of healthcare.
    • Draft scope: contracting, credentialing and demographic data.  Limited to administrative, not clinical.
    • Draft processes: contracting, credentialing, demographic. and provider search (for patients).
  • Stakeholder Mapping:
    • Identify stakeholders and their concerns, beginning with people in the room, and continuing with known players in industry, government, etc.
    • Deliverable: Map of stakeholders and their concerns.
  • Inventory of Related Efforts:
    • Delve deeper into stakeholders who are actually working on the problem.
    • Deliverable: Map of organizations, their initiatives, and their goals.
  • Next Steps for HC Forum PDD Program:
    • Opportunity: Where does the Forum fit in?
    • Hypothesis: Laying out an overall architecture for provider directory data management as a way of weaving together efforts and guiding investments.
    • Deliverable: Statement of audience perspectives on what the Forum can do.
    • Planning: Outlining deliverables; e.g., White Papers; identifying others to involve; individual roles and commitments.
    • Deliverable: Action plan, including plan for future meetings.


Summary of the Provider Directory Data White Paper Discussion

Problem: Lack of standardized provider data and therefore processes.

Long-term vision: Well-understood and efficiently processed provider information flows readily and appropriately between providers, aggregators, payers, and healthcare consumers.

Domains of interest: Provider contracting, credentialing, demographic data, collectively known as Provider Directory Data (PDD).

Project goal: Publish a series of White Papers that recommends a set of data standards that enables the long-term vision.

Initial White Paper: PDD Landscape Assessment.

  • Develop a high-level model that shows PDD subject areas and their most important relationships.
  • Identify major PDD stakeholders.
  • Identify and summarize PDD usage scenarios.
  • Inventory and categorize PDD standards bodies, standards, and specification efforts.
  • Produce a grid showing category coverage, including overlaps and gaps.

Scope: Survey and position existing data standards and standards efforts for domains of interest. Identify usage scenarios and gaps. Focus on data standardization to lay a foundation for process improvement, rather than process improvement itself.

Define impact of problem:

  • Payer: Avoidable costs and delays in building provider networks due to the complex and manual nature of data acquisition and maintenance.
  • Provider: Delays in adding practitioners (credentialing, enrolment); lack of ready access to contracting data; difficulty in making accurate referrals that are in the patient’s best financial interest.
  • Consumer: Reduced or delayed care options; difficulty in comparing networks when choosing health plans (this will become more important as more employers send their employees to exchanges).

Next Steps

  1. Put FHIM White Paper in for formal review.
  2. Continue planning for second phase of FHIM evaluation work.
  3. Review provider and payer reference models.
  4. Consider reference models as basis for PDD add-on.
  5. Continue discussion of new lines of work and new members.