This page is part of the National Directory of Healthcare Providers and Services (NDH) Implementation Guide (v1.0.0-ballot: STU1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

Exchange Use Cases

Support discovery of Electronic Service Information to enable the electronic exchange of information.

Electronic Service Information can be discovered by using any combination of data elements in a NDH entry using a fully qualified query to discover zero or more resulting records. These data elements in a query can include demographic data, geographic data, individual provider data, specialty data, National Provider Identity (NPI), organization, Tax Identification Number (TIN), etc. The results may include no records, one record, or multiple records

Users and Actors

Primary list of Users and Actors:

• Provider - Any individual or entity that provides healthcare related services or goods directly, or in support of, healthcare delivery
• Consumer - Any consumer, or potential consumer, of healthcare services or goods
• Benefits coordinator - An individual who provides help to employees navigating the benefits process, including healthcare benefits
• Care coordinator
• Referral coordinator
• Discharge planner
• Credentialing personnel (Hospital and Plan)
• Health Information Exchange (HIE)
• Health Information Network (HIN)
• Accountable Care Organization (ACO)
• Value based plan
• Managed care plan organization
• Licensing board
• Plan network management (enrollment and contracting)
• Plan claims management
• Plan directory maintenance management
• Health Information Service Provider (HISP) (if EHNAC-DTAAP accredited or participating in NATE Trust Bundle)
• Compliance/auditing staff
• Data analysts
• State registries, e.g. Immunization Information System(s) (IIS)
• Systems or Services (e.g. other infrastructure such as a Patient-Provide Attribution Service)

Information Flow

This diagram shows the information flow for this Use Case including the major senders and receivers (Actors) involved and the type(s) of information shared.

An Actor seeking Electronic Service Information sends a fully qualified query to the NDH. The query may include any combination of data elements, and may also include relative constructs such as “within 20 miles.” Queries may include partial values and may include inexact matches. The NDH processes the query and returns zero or more results to the Actor that sent the query. The results returned can include all or part of the record. The NDH should support queries including in the table below, but not necessarily limited to:

Subscribe to receive real-time notifications when data is created, updated, or deleted on the NDH server

Subscribe to changes in practitioner qualification for providers in the state of Maryland

A change in a practitioner’s qualifications doesn’t only impact the practitioner, but also any associated organizations and services. By subscribing to the “practitioner-qualification-change” topic, subscribers will receive notifications about these changes.

In this scenario, a subscriber wishes to be alerted whenever a practitioner in Maryland undergoes a qualification change. They also want notifications to include the resource identifier for all affected resources.

Here is the example of the subscription: Topicbased-Subscription-Practitioner-Qualification-Change

Bulk export to access large volumes information on demand

Bulk extract of all information for organizations, individuals, and services in the state of Maryland from the NDH

GET [base]/$export?_type=Organization,OrganizationAffiliation,Practitioner,PractitionerRole,HealthcareService,Location,InsurancePlan
&_since=[transactionTime]
&_typeFilter=Organization?address-state=MD,
Organization?type=ntwk&address-state=MD,
OrganizationAffiliation?location.address-state=MD,
OrganizationAffiliation?service.location.address-state=MD
Practitioner?address-state=MD,
PractitionerRole?location.address-state=MD,
PractitionerRole?service.location.address-state=MD
PractitionerRole?practitionerrole-network.type=ntwk&practitionerrole-network.address-state=MD
HealthcareService?location.address-state=MD,
Location?address-state=MD
InsurancePlan?plan.coverageArea.address-state=MD,
&_outputFormat=application/fhir+ndjson

Note: Bulk Data Export _typeFilter does not support _include and _revinclude search parameters.

Scheduled export

If a distributed workflow directory needs to retrieve information from the NDH on a scheduled basis, there are two approaches available.
The first approach is a client-side solution, where a job scheduler script is written on the client side to execute the Bulk export operation. This allows the client to control the export process and retrieve the data as needed.
Alternatively, the second approach is to utilize the “repeat $ndhexport” operation, which is a service-side solution available to all registered clients. Once the client has registered with the NDH, they only need to apply the $ndhexport operation once. From then on, the system automatically exports the data to the specified file storage location based on the defined schedule, making it convenient for the client to retrieve the data.

Ndhexport-operation-flow-diagram

Schedule extracts of specific resources for all organization and individuals in MD weekly

OperationDefinition-Ndhexport

GET [base]/$ndhexport
?_type=Organization,OrganizationAffiliation,Practitioner,PractitionerRole,HealthcareService,Location,InsurancePlan
&_typeFilter=rganization?address-state=MD,_include=*,revinclude=*
&_outputFormat=application/fhir_ndjson
&_startdate=2023-06-01
&_frequency=weekly
&_account=example-1
&_action=create

The NDH Consumer Application Help Patient Seeking Healthcare providers

Use Case: A patient seeks Orthopedic Services by using the NDH Consumer Application Online

This use case involves a patient who wants to schedule an appointment with Hartford Orthopedics, a group providing orthopedic services for the Acme of CT network at Hartford General Hospital. Hartford Orthopedics has two different locations and specific requirements for accepting new patients. The patient needs to find the suitable location, considering their needs and availability.

Preconditions:

• Hartford Orthopedic group provides services for Acme of CT network
• Acme of CT Network includes Hartford Orthopedics
• Hartford General Hospital where Hartford Orthopedics operates
• Patient is covered by the Acme of CT network’s standard network

The patient could the following information from the online application which take the data from the NDH

• Hartford Orthopedics’ contact information
• Insurance accepted by Hartford Orthopedics
• Locations of Hartford Orthopedics and which location are accepting new patients
• Facility information such as date and time of operation, accessibility, address, phone number

FHIR resources relationship diagram for the use case above

Discovery a HIE Endpoint via the NDH

Use Case: Discovery of SutterHealth TEFCA Endpoint

Actors:

• Health Information System (HIS)
• NDH (National Directory of Healthcare Providers & Services)

Preconditions:

• SutterHealth is a known participating organization in the Epic Organization.
• SutterHealth is participating in both the TEFCA and CareQuality Health Information Exchange (HIE) networks.

Main Flow:

1. The user (in this case a software agent of system) queries NDH to find the SutterHealth Organization
2. The user queries NDH for the OrganizationAffiliation resource instance with the code for ‘HIEResponder’ and ‘TEFCA-Organization’ to find an affiliation related to SutterHealth.
3. NDH returns the OrganizationAffiliation resource instance
4. The endpoint contained in the OrganizationAffiliation resource instance is the SutterHealth TEFCA Endpoint

FHIR resources relationship diagram for the use case above

Associate an organization with an Insurance Plan that operates without any network.

A State InsurancePlan Entity may contract directly with a provider organization which provides the HealthcareService. A logical Network could be used to link an InsurancePlan and an Organization which provides the HealthcareService for the InsurancePlan via an OrganizationAffiliation.

Relationship Use Cases

Relationship between Networks and Participants

An entity, whether it be an organization or a practitioner, might be part of multiple networks. There may be occasions when a specific network becomes unavailable or when a member decides to withdraw from an active network. To manage these potential changes - one originating from the network itself and the other from the participant’s side - the recommendation is to ensure that each PractitionerRole or OrganizationAffiliation resource instance only includes a single network.

The PractitionerRole is designated for practitioners, whereas the OrganizationAffiliation is geared towards organizations. Both these resources, PractitionerRole and OrganizationAffiliation, contain a period element. This element signifies the valid timeframe of a network’s relationship with its participants. In the event of a change in this relationship, a new instance would be created, encompassing the updated period.

This method allows for the efficient management of transitions, avoiding the creation of a more intricate system that would involve tracking expiration dates across multiple resources and relationships.

See Example