Modeling your Provider Directory
Provider Directories are critical databases housing essential details about healthcare providers, from individual practitioners to entire organizations. Accurate and standardized modeling of these directories, ensures a better patient experience via improved coordination coordination of care and operational efficiency.
This section provide a series of guides on how to properly model your organization's provider directory. It focuses on a few key challenges:
- How to model the organizational structure of your provider group: How to represent the clinical divisions and care teams in your clinical organization, including how to represent providers who participate in multiple teams.
- How to model provider participation insurance networks: How to model insurance plans and the in-network/out-of-network status of providers.
- How to model provider qualifications, certifications, and licenses: How to represent state licensure and specialty certifications for each provider to ensure proper staffing across geography and clinical.
These guides are based on, and compatible with, the Da Vinci PDEX Payer Network guide. The Da Vinci Project is a private sector initiative comprised of industry leaders, including Blue Cross Blue Shield, Cigna, and Optum, etc. working together to accelerate the adoption of FHIR as the standard to support and integrate value-based care (VBC) data exchange.
Key Resources
| Resource | Description |
|---|---|
CareTeam | A definition of a group of providers assembled for a specific Patient. |
Practitioner | A resource that defines the profile of each provider (i.e., physician, nurse, administrator, etc.). |
Key Code Systems
| Code System | Description |
|---|---|
| SNOMED | Used to annotate the roles of Practitioner resources. Below is a selection of common SNOMED role codes. |
| Role | SNOMED Code |
|---|---|
| Primary Care Physician | 446050000 |
| Registered Nurse | 224535009 |
| Social Worker | 106328005 |
| Physical Therapist | 36682004 |
| Occupational Therapist | 80546007 |
| Recreational Therapist | 308191009 |
| Dietitian | 159033005 |
| Center Manager | 159441000 |
| Home Care Coordinator | 768730001 |
| Personal Care Attendant | 768836001 |
| Driver | 236320001 |