Provider Directory
Provider directories are essential databases that house critical information about healthcare providers, ranging from individual practitioners to entire organizations. Accurate and standardized modeling of these directories ensures a better patient experience through improved coordination of care and operational efficiency. This section provides a series of guides on how to properly model your organization's provider directory, focusing on key challenges:
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Organizational Structure: Learn how to represent the clinical divisions and care teams within your organization, including how to handle providers who participate in multiple teams.
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Insurance Networks: Understand how to model insurance plans and the in-network/out-of-network status of providers.
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Provider Qualifications: Discover how to represent state licensure and specialty certifications for each provider to ensure proper staffing across different geographies and clinical areas.
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, working together to accelerate the adoption of FHIR® as the standard to support and integrate value-based care (VBC) data exchange.
Key Resources
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CareTeam: Defines a group of providers assembled for a specific patient.
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Practitioner: Defines the profile of each provider (e.g., physician, nurse, administrator).
Key Code Systems
- SNOMED: Used to annotate the roles of Practitioner resources.
Modeling Your Provider Directory
Provider directories are essential databases that house critical information about healthcare providers, ranging from individual practitioners to entire organizations. Accurate and standardized modeling of these directories ensures a better patient experience through improved coordination of care and operational efficiency. This section provides a series of guides on how to properly model your organization's provider directory, focusing on key challenges:
-
Organizational Structure: Learn how to represent the clinical divisions and care teams within your organization, including how to handle providers who participate in multiple teams.
-
Insurance Networks: Understand how to model insurance plans and the in-network/out-of-network status of providers.
-
Provider Qualifications: Discover how to represent state licensure and specialty certifications for each provider to ensure proper staffing across different geographies and clinical areas.
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, working together to accelerate the adoption of FHIR® as the standard to support and integrate value-based care (VBC) data exchange.
Key Resources
-
CareTeam: Defines a group of providers assembled for a specific patient.
-
Practitioner: Defines the profile of each provider (e.g., physician, nurse, administrator).
Key Code Systems
- SNOMED: Used to annotate the roles of Practitioner resources.