Tuesday, April 26, 2016

#Health Articles saved on Delicious by @ekivemark

It’s Tuesday, April 26, 2016 at 09:00AM
and time to bring you some Delicious #Health posts

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Tuesday, April 19, 2016

#Health Articles saved on Delicious by @ekivemark

It’s Tuesday, April 19, 2016 at 09:01AM
and time to bring you some Delicious #Health posts

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Tuesday, April 12, 2016

#Health Articles saved on Delicious by @ekivemark

It’s Tuesday, April 12, 2016 at 09:01AM
and time to bring you some Delicious #Health posts

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Tuesday, April 05, 2016

#ONCPDW #PDWorkshop Provider Directory Demo – Alan Viars (@viars)

Provider Directories – Keep it Simple!

Alan Viars at ONC has presented a demo of modern technologies in Provider Directories

Use Case:

A state wants to receive updates.
System will have APIS both public and private for displaying content

Three technologies

  • Document oriented architecture
  • REST
  • OAuth2.0

Why do the three things go together.

  • Documented Architecture


JSON has risen in popularity in recent years. Rise of javascript, more compact on the wire.

  • REST

Simpler to implement.
Vendor agnostic

  • OAuth2.0
    As used by major services such as Facebook, LinkedIn, Twitter.

Presenter: Alan Viars, Videntity / ONC

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#ONCPDW #PDWorkshop – FHIR Today: Brian Postlethwaite

An example use case

  • Patient visits a hospital for a colonsoscopy
  • Visit GP
  • Referred to Gastroenterologist
  • Visit Gastroenterologist
  • Prescribed Medications
  • Take Medications
  • Have Tests Done
  • Visit Gastroenterologist
  • Book Colonoscopy
  • Admission to Hospital
  • Colonoscopy performed
  • Discharged from Hospital
  • Review Results with Gastroenterologist

All steps involve Search / Lookup


Fill out forms


Directories support all other health processes. They are everywhere.

We will never get to a single directory. Too many different uses.

Directory Use Cases

  • Practitioner Looking up a known Practitioner
  • System looks up an endpoint

  • Practitioner search for a practitioner that provides a specifc service

  • Practitioner searching for a service

  • Consumer searching for Practitioner availability

Fundamentals for Success:

  • Accurate
  • Current
  • Breadth of Content
  • Relevant Terminology
  • Accessible
  • Minimal technical barriers
  • Securely access information

Different Directory Types

  • Provider Directory
  • Service Directory

  • Practitioner Roles

Australian National Services Directory

  • Single Source
  • Curated content
  • Consumer friendly
  • Practitioner Vocabulary
  • API enabled
  • Geo-locaiton
  • Electronic endpoints included


  • HCSPDir (HL7)
  • ServD (OMG/HL7)
  • FHIR (HL7)

Shortest History of FHIR

  • Based on modern web technologies (ease of implementation and easy to find personnel to implement) – Core Resource Model
  • Defined Wire Format (XML/JSON)
  • CRUD Support
  • Search (single or multiple resources)
  • Extensible
  • Profile-able/Conformance
  • Natively supports Distributed Data
  • Supports REST, Messaging and Services

  • Moving extensions form lessons learned in to Core.

  • Already in Production
  • Inclusive of Service Directory Data

Presenter: Brian Postlethwaite, FHIR Core Team member

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#ONCPDW #PDWorkshop Provider Directories Lessons Learned – Eric Heflin

Lessons Learned

Business and Clinical Use Cases

  • Enable search by people or organization and attributes (eg. Languages)
  • Search based on relationships
  • Keep directory data current – be proactive
  • Get objects eg. Electronic services such as PubSub
  • Taget Patient Consent Expresson

eHealth Exchange Directory Usage

  • 120 Participants with 100M + patients connected in production today
  • in use for 9 years
  • Directory based on UDDI v3, organized by business entities, metadata such as contacts, then by services and endpoints.
  • Primary use case is electronic end point service discovery – Query by Geography, version of service supported, name of organization or by list of all organizations.
  • Version control is implemented in the directory. An essential requirement.

Positive Lessons

  • Directories can provide significant value
  • Many use cases require PDs
  • National Scale PD is viable

Negative Lessons

  • Manual Quality Assurance is important and costly
  • Automations is essential for efficiency
  • Interoperability of each data element is important including all components of address, type of contacts, version of services supported.
  • Adding support for other key elements designed to allow for more process automation
  • suport single source of truth file to allow generation of multiple directories to enable multiple versions. eg. when switching standards.
  • adding specification enhancements to enable 100% automated on-boarding. Sync wth Argonaut and other standard setting bodies.

HPD Context

  • Federation or similar data aggregation/management si required for some use cases and is interoperability issue.

  • LDAP may not be liked but it gives benefits, such as bulk data export file standard and tools.

Current HPD Work

  • Create a national USA extension
    -HL7 Argonauts: One of top 4 priorities. Work started last week (Mar31, 2016)

  • Full CRUD operations wil need support.

  • All data elements in PD should be tightly constrained for interoperability


  • Have ONC as a voice at the table to provide resource and direction.
  • Keep track of Argonaut and IHE work. Let’s find a single standard.

  • Get Involved.
    — Get your requirements known to the standards development organization

Presenter: Eric Heflin

[category News, Health]

[tag health, cloud, ONC, opendata, Provider]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://2.healthca.mp/1b61Q7M
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries.

The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less Hassle, Better Care.

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#ONCPDW #PDWorkshop EHR HIE Interoperability Workgroup

Provider Directory Specification

Provider Directories was an integral components of a wider standard.

States, EHR Vendors and HIE/HISP Vendors all participated.

– Statewide Consumable Continuity of Care Document (CCD-based C32/C83 -> C-CDA) – Push: Send and Receive Patient Record Exchange
– Pull: Statewide Patient Data Inquiry Service

Provider Directory Considerations

  • Send /Receive Specification for Statewide use

  • Prefer HPD+ over base specification

  • 2013 explores models to Query EHR to HISP and HISP to HISP exchange

  • Facilitate open discussion for federated PD Solution

  • HPD Appendix updated to reference Final IHE HPD Profile (ie. Support for Federated Solutions)

  • 2015 Broad Health Industry Partnership via HIMSS (ConCert)

  • 3 Cert Programs: Concert Approved EHR / Concert Approved HIE / Concert Approved HISP

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#ONCPDW #PDWorkshop S&I Framework Initiatives – Bob Dieterich

Provider Directory Initiatives

Two Initiatives:
1. Discovery of Digital Certificates

  • A Hybrid DNS/LDAP solution
  1. Definition of Electronic Service Information
  • Minimum data set, data model and schema for Provider Directories – Specific Query and response
  • Map dataset, model and schema to stndards for LDAP/x.500, HPD, ASC X12 (274) and identify gaps – Work with standards bodies to incorporate identified gaps. eg. HPD+

Query and Response: Individual / Organization /Relationship

Allow query and response on almost all data elements.

  • What method using
  • What information is being exchanged
  • Security relating to exchange
  • Endpoint
  • Preference for multiple endpoints.

Next Steps:

  • Establish Standard, fRee code sets for use by all members of community. – Provide detailed implementation descriptions

FHA Healthcare Directory Workgroup

  • Guiding Parties: CMS, HHS, ONC, Indian Health Service, CDC, SSA, VA – identify alternative approaches
  • identify short/mid and longterm solution proposals

Assessment and Evaluation Criteria for agencies:

Provider directory is part of a workflow process.

– Centralized
– Federated model
– Hybrid model

Central common directory.
Local implementations

Federated model was ranked highest because it gave control to local agencies

– Short = Federation
– Mid = Hybrid
– Long = Hybrid Alternative Approach

Detail Work:

  • Completed: Recommendations to establish Trust Relationships / Direct + eHealth Exchange ESI
  • Additional Topics:

  • Support Complex Queries
  • Support multiple query technologies inc. FHIR
  • Federation (Directory Discovery, Security, Content Replication) – Maintenance and Access
  • Audit Trails
  • Certification and Accreditation
  • Granular Security

Presenter: Bob Dieterich

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#ONCPDW #PDWorkshop: Te Past of Provider Directories – Micky Tripathi

The History of Provider Directories (ONC/FACA PDActivities)

2010: information Exchange workgroup asked to make policy recommendations on Federal Approach to Provider Directories.

Nov 2010 – Mar 2011: HITPC recommendations on Entity-Level Provider Directories and Individual-level Provider Directories. (Two different recommendations for policy purposes)

Mar 2011: ONC Provider Directory Bootcamp

May 2011: S&I Framework use case development to support Direct Project

Fall 2011: HITSC decides sufficient standards do not exist to act on HITPC recommendations

Mar 2012: ONC PD CoP guide on field practices to populate Provider Directories

May 2012: ONC PD Opportunities Analysis

Apr 2013: HITPC approves IE WG Recommendations to CMS to apply open data principles to MPPES, MU, NPI databases to allow private sector development of Provider Directories.

Oct 2015: ONC Interoperability Roadmap: By 2018 CMS should require Direct Addresses and Electronic Service Information are entered into and maintained in NPPES.

Has the world changed since 201?

in some ways the world has changed. More market activity.

Presenter: Micky Tripathi, MA eHealth Collaborative

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#ONCPDW #PDWorkshop Modernizing NPPES – Peter Gilbert

Modernizing NPPES

  • Where we were
  • Where NPPES is going


10 digit number

Type 1 = Individuals
Type 2 = Organizations

Organizations can have multiple NPIs

26K new per month
63K Updates

The Past

NPPES was a number generator

2016 industry sees NPPES as a directory.

  • NPPES not designed as a directory


  • Adopt best-practices from consumer web sites.
  • Use Federal design standards
  • Increase the relevance
  • Align and integrate with other programs
  • increase integrity (consistency, freshness, valid, recertification) – Role in Fraud Prevention

The Path

  • Alan Viars – EIR
  • New Public Search
  • Open Source
  • Modern Technologies

In 2015 launched real-tim NPPES Search.

In 2016 deliver a new provider experience:
– Modern look
– Easier screens
– Clearer Expectations
– Surrogacy (for organization administrators)
– more optional identifiers – including Direct Addresses
– Data and reporting

In 2017 – more improvements:
– Automation
– Integrity (anti-fraud measures, cross-referencing)
– Enforcement and NPI Deactivation
– Notify discrepancies via email

Look at Data input to NPPES via API


  • Looking to how to disclose group affiliations without disclosing Tax ID.

Will be adding in multiple practice locations and enabling a default

NPI Final rule dictates what information is maintained.
Provider has to confirm the information.

Presenter: Richard Gilbert, CMS – CPI

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