Over the last few years, federal and state health IT policymakers have paid little attention to the problem of managing provider identities.
The exception is the National Provider Identifier (NPI), a unique 10-digit identification number the Centers for Medicare and Medicaid Services (CMS) began issuing to providers in 2006 to help manage transactions protected by the Health Insurance Portability and Accountability Act.
But while the NPI supports Medicare and Medicaid payments, it does not address broader provider identity management challenges that will become more critical as health information exchange (HIE) evolves and the nationwide health information network (NHIN) begins to spreads its roots.
Electronic information exchange cannot realistically function across thousands of point-to-point nodes without some way of managing provider identification at the state and local level or even regionally.
Some of these issues were recently aired in discussions before the Office of the National Coordinator's Health IT Policy Committee and its workgroups. HIE-dependent firms such as Surescripts, Availity and Emdeon testified about how they have responded to the lack of a national ID management framework by creating provider directories of their own.
One of the federal government's own NHIN use cases " the exchange of disability information between healthcare providers and the Social Security Administration " clearly illustrates the demand for such tools. In that instance, the need to know who state and local providers are, where they practice and where SSA information requests should be sent, is the linchpin of the value exchange.
In these cases, electronic directories at a state or even regional level are needed to manage the myriad clinical and administrative hand-offs to be facilitated by the NHIN. Such systems will even have value as providers struggle with managing identities and associated data moving across a single organization.
The SSA pilot, as well as other forms of HIE, underlines the need for provider registries that help can sort through critical identity management challenges confronting new and emerging HIE players. The Office of the National Coordinator as well as CMS would do well to champion this cause so that their considerable efforts fostering a national health information sharing system will bear the most fruit.
Fernandes is vice president and healthcare industry ambassador for Initiate Systems, Inc.
