Micky Tripathi, president and CEO of Massachusetts eHealth Collaborative (MAeHC) [based in Waltham], has been chairman of the HIT Policy Committee Information Exchange Workgroup since the group’s inception a year and half ago. One of the workgroup’s missions is to pursue the use of directories across state HIEs to support provider and patient information exchange, as well as public health reporting. It is one of the first in the country to focus on this particular issue, and as Tripathi explains to HCI ’s Associate Editor Jennifer Prestigiacomo, the group is now weeding through the complexities behind this mammoth project.
Healthcare Informatics: Where did this idea of provider directories come from?
Micky Tripathi: The provider directories issue arose from two different places. One, is the ongoing effort to try to build approaches to get interoperability across the country that’s universally accessible and available to clinicians to help them get to their meaningful use requirements, in particular summary of care exchange, e-prescribing, and lab results delivery. So it was an ongoing effort to create an approach to allow physicians, regardless of where they are in the community, the ability to do those meaningful use transactions. That led to the inception of NHIN [The Nationwide Health and Information Network] Direct [a wiki to promote a set of standards to enable secure health information exchange over the Internet.]
If you have a directed exchange model where I say I’m going to use the Internet electronically to mimic those flows of information that happen in the real world today, I can build it on the current consent and legal framework, which may sound trivial, but it’s actually huge. Privacy is obviously a paramount concern of everyone when we think of health information exchange.
The issue of provider directories comes up because if I’m going to have just a way of sending a secure document or message, what are the core things that I need to have in that system? I need to be able to create the message in my own system, have it addressed, and then have it securely transported, and then have it received on the provider’s end so they can get it to the right person. I need something that will allow me to do that in the same way e-mail does today. If directed exchange doesn’t have that today, then the question is how would I create some kind of directory that at a minimum would enable the routing of information. So, if I’m a hospital and I want to send something to the PCP, like the discharge summary, I’m going to enter that it’s going to reach this particular practice who referred this patient to me. I need to have some sort of directory service to do that. That’s the minimum.
There is a more expansive definition of what a provider directory might be, which is more like a big universal list of all the doctors in the country, and which entities they practice at and perhaps other information like their medical license numbers in whichever states they deliver care in, credentialing information, MPI number from Medicare, their DEA number from a prescribing perspective. You may want to have that type of information to use for a variety of other purposes. One purpose could be a Yellow Pages; if you want to look up a physician and you need to get information to him or her. Another might be for organizations that spend a lot of time creating directories like health plans or credentialing organizations. The Department of Public Health or the state licensing board can use this single directory when they’re trying to identify physicians. So, you can imagine that you could create something that could have multiple uses. That’s the second conception of a provider directory, which is more expansive.
If we’re going to have directed exchange, and NHIN Direct has one particular way of doing that, we’re going to have some type of universal addressing directory service. That was one of the questions handed to our workgroup. The second reason that this was proposed for us to work on is there is now roughly $600 million being distributed to 56 designated entities for health information exchanges. If you look at the original FOA, the funding opportunity announcement, or the PIN, the program information notice, that went up in July, both of those point specifically to providing guidance to the states. A number of states were thinking of provider directories as something that they’ve been given some encouragement from ONC and that they also see value in. [Since there are] 56 states out there—some number whom are going to be spending money on what they’re calling provider directories—and from a government and a tax payer perspective, at a minimum we want to be able to rationalize the approaches so they are systematic and interoperable with other states.