Last Fall, CMS opened a proverbial Pandora’s Box by publishing a Request for Information (RFI) about a possible National Directory of Healthcare Providers & Services.
It was undoubtedly the right call to gather industry input—who better to identify the key challenges and opportunities in building a national provider directory than the hospitals, payers, health information exchanges, and other stakeholders who feel the pain?
The RFI itself also highlighted the complexity and massive cost of directory updates for healthcare delivery organizations. One estimate is that if all physicians used a single channel to submit and update directory information, each would save $4,746/year, or about $1.1B in annual savings nationwide. 1 And the costs to hospitals, health plans, and others only add to that total.
Although their RFI comments were few, hospitals have arguably the most resource-intensive processes to maintain and operationalize their provider directories due to the following:
- Data complexity: There is a wide range of information, including contact information, credentials, specialties, and affiliations.
- Multiple data sources: Hospitals gather information from many sources, such as their EHR vendor, NPPES, credentialing systems, insurance networks, etc. Integrating these sources into a unified and accurate directory is cumbersome.
- Data volume: There are hundreds of thousands of physicians and millions of clinicians and tertiary care providers nationwide. A typical acute care hospital maintains a directory of over 50,000 healthcare providers.
- Continuous updates and maintenance: Provider data is dynamic. Over one-quarter of providers change organizations or locations each year, and many others change their fax, phone, or Direct secure email addresses. Sustaining accurate and up-to-date data requires monitoring, maintenance, and frequent updates, which impacts virtually every department and drives up costs.
- System interoperability: The data must be accessed across many systems within an organization. Achieving seamless data exchange among these systems is costly and brings integration challenges, interface development, and data standardization efforts.
Ideally, a hospital would have mature provider data management practices to maintain a reliable directory for its organization. And indeed, some hospitals do. This helps them establish a baseline while implementing their EHR directory, ensures efficient ongoing maintenance, and eases the burden of communicating beyond the walls of the EHR. But too many facilities rely on burdensome, manual processes and are left with data of questionable quality.
In fact, many hospital departments and clinicians must regularly chase down new contact information to share patient records or treatment plans with outside providers. Is this how clinicians and administrative teams should be spending their time?
As CMS implied in the RFI, the industry would be far more efficient with a single unified source of healthcare provider data—one that is accurate and comprehensive and would eliminate many of the industry’s manual processes.
careMESH SEARCH is a private-sector example of how hospitals dramatically reduce administrative and EHR user burden. A typical hospital can save the time of two full-time IT analysts plus hundreds of hours of EHR user time each year by outsourcing directory requirements. The platform is implemented with Epic, Cerner, and other systems and is
available via HL7 ® FHIR ® APIs, data upload, web app, and more.
With many hospitals struggling with budgetary and staffing constraints, it's the right time to eliminate time-consuming internal provider directory maintenance.
1 CAQH. (2019). The Hidden Causes of Inaccurate Provider Directories. Retrieved from
https://www.caqh.org/sites/default/files/explorations/CAQH-hidden-causes-provider-directories-whitepaper.pdf