It highlights the decisions we had to make (Entity v. Individual, Central v. Federated, web API verses LDAP, etc)
Issue: Should we include organizations, individuals or both in the provider directory? Answer: The directory should have a schema that enables lookup of entities (e.g., Organizations, Departments, State Agencies, Payer Organizations, Patient Health Record services) AND an individual's affiliation with an entity trusted by the HIE. You can lookup John Halamka to discover that I'm affiliated with BIDMC, then lookup BIDMC to determine how to exchange data with my organization.
Issue: Should the Provider Directory be centralized or federated? Answer: The Provider Directory should be centralized at the State level, given lack of proven scalable approaches to federated provider directories standards and architecture. However, Public Key Infrastructure can be federated based on the Direct DNS specification for certificate exchange.
Issue: How should we expose Provider Directory services to the Internet? Answer: A SOAP-based web services API will support query/response, add/change, and delete operations over the Internet. An LDAP approach will support directory access for applications behind the MassHealth firewall.
Issue: How should we populate the provider directory? Answer: Commercial databases often lack timely updates. In Massachusetts, we have several existing data sources to leverage including those used by payers for quality reporting, those used by provider organizations, and those used by the regional extension center.
Issue: How will we integrate this service into EHRs? Answer: We will work with EHR vendors via a centralized program management office to procure software components that integrate provider directory and HIE transport services into the workflow of the EHR itself. We will not force clinicians with certified EHRs to use a disconnected portal outside of their the EHR.
I look forward to speaking with the Provider Directory Community of Practice (CoP) to hear about approaches in other states and share lessons learned.