Issues with Provider Matching in HL7

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Permalink Reply by Madhur 'Mike' Jadala on December 30, 2009 at 1:50pm

Hi Patty,
we are going through an exercise of stardardizing our "Reporting Organizations" here in Illinois for our upcoming release. These organizations include Laboratories, Hospitals, Local Health departments. Some of them report via HL-7 and some through non HL-7 means. Everything references an internal master table that we have created. We undertook this project to starndardize the names of these organizations in our system for running reports against them.

For Labs, we use the unique CLIA ID and lookup its reference in our master table, and use that text string to populate the Reporting Organization. For non lab orgniaztions, we use a unique Site ID to identify the organizations. But, only the labs report via Hl-7 now. The rest report through a user interface extension(Provider Reporting) of our Sureveillance system(I-NEDSS).

We do not depend on the exact match of the provider name to select which ones to import. We rely on the CLIA IDs and if the CLIA ID is in our list of approved partners, the labs gets imported.

Hope that helps.

Mike Jadala PMP
Project Manager
IL DPH

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Permalink Reply by Charles Fisher on December 31, 2009 at 1:11pm

Hi, Patty,

My what a can of worms you have opened!

New York State, in our Electronic Clinical Laboratory Reporting System (ECLRS)
doesn't even try to do what you are doing. We just store whatever they enter
for either Provider or Facility. Our standard Search screen does not
offer either Provider or Facility as a search parameter. If someone
ever asks us to do so,
it will have to be as a substring search, due to lack of standardization.

Right off the bat there is a semantic discussion
to be had about who/what is a provider and what is a facility (Ordering Facility,
ORC-21). We don't usually get provider name in the ordering facility,
but we get facility in the provider field. We would generally prefer the
Ordering Provider (ORC-12) to be the person -- physician, PA, etc... -- who placed
the order for the lab and for the hospital or practice to be in the Ordering Facility.
So we would consider your Boone Hospital Center not to be a provider at all,
rather to be the ordering facility.

Since all providers are licensed, you would think we would have a standardized
database to which we could match providers. However, that licensing function
is part of the Department of Education. Their database of providers is
accessible via a browser, but there is no web service that would allow our
system to query it.

We use CLIA codes for labs. However, a lab is rarely either
the provider or the facility.

New York State has used a Master Facility Index for years to identify
healthcare facilities licensed in the state. Each facility got a "PFI"
or "Permanent Facility Identifier". As healthcare expanded and got more
complex, that proved to be insufficient, so a new, much more complex
"Health Facility Information System" (HFIS) was created, with a whole new
identification system, about 5 years ago. The transition from MFI to HFIS
is still ongoing, probably for many years to come.

I hope some of this ramble is of interest and possible use to you.

Charles Fisher

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Permalink Reply by Patty Osman on December 31, 2009 at 4:39pm

Thanks Charles something to think about while I watch the football games. Have a Happy New Year.

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Permalink Reply by Rita Altamore on January 4, 2010 at 8:22pm

Right on the money, IMO, Charles, as usual :-)

WA state does much the same as New York: we use CLIA numbers to uniquely identify labs, and we don't worry about what text string is associated with that identifier in the messages.

For both providers (interpreted as persons) and facilities, we encourage use of the NPI
a href="http://www.cms.hhs.gov/nationalprovidentstand/" target="_blank">http://www.cms.hhs.gov/nationalprovidentstand/ > but some use their WA state license number. Fortunately, provider and facilities licensing (including labs) is part of DOH here in WA, so we have good access to those systems.

HL7 (and CDC) are pretty firmly committed to the use of OIDs, but there are many issues about the management of OIDs that have yet to be settled.

In general, we try to work with what submitters can send us, in order to encourage participation in electronic reporting. Makes it easier for them, harder for us...

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