The DirectTrust Directory Improvement Initiative continues to advance forward daily in 2022. As we mentioned in our “Introducing the Directory Improvement Initiative” post, the Directory Improvement Initiative (DII) is composed of three “Eras” with specific goals to be achieved through focused “Continuous Improvement Cycles”.

  • Era 1: Improve Directory Confidence and Accuracy by:
    • Launching a community-wide communication and education campaign designed to reveal content accuracy problems and provide clear guidance on how to correct the problems.
  • Era 2: Increase Directory Accessibility and Use by:
    • Offering a new FHIR-based API which can be adopted by HISPs to improve searching of the Directory information.
  • Era 3: Enhance Directory Updatability and Sustainability by:
    • Offering a new Directory entry updating API designed to make it easier to correct Directory entries in real-time or batch-mode.

Progress in Era 1: Improve Directory Confidence and Accuracy

Introducing the Directory Improvement Initiative to EHRs

Era 1 is ongoing throughout the year, beginning even before 2022. In April, DirectTrust hosted an EHR Roundtable to introduce the DII and emphasize Directory quality. DirectTrust presented our hypotheses around what an EHR and their healthcare clients might be able to do to help improve the Directory. Participants gave remarkable feedback and together we adjusted the plan to be more scalable for all parties involved. We plan to have a second EHR Roundtable in the Fall of 2022 to reconvene on progress and adjust course if necessary.

In attendance at the April EHR Roundtable:

    • athenahealth
    • Cerner
    • CGM (eMDs)
    • CPSI
    • eClinicalWorks
    • Epic
    • Greenway
    • MatrixCare
    • MEDHOST
    • MEDITECH
    • NextGen

Providing New Data Quality Reporting and Validation

Towards the end of June, robust data quality reporting was made available to all contributors of the DirectTrust Directory. This is a huge milestone for the project and immense work from our contracted partners went into making these features a reality. Prior to this release, Directory records were subject to minimal data validation and any issues found as a result of that validation were merely counted without any real insight as to why or how a record was being flagged. 

The new system implements dozens of new rules, many of which call external data sources such as 

  • NPPES (provider NPIs, names, addresses, etc.), 
  • Google Places API (addresses), AWS Pinpoint (phones and faxes), and 
  • NUCC value sets (specialty codes). 

Each submitted Directory record gets run through this new validation engine while the accompanying detailed reports give thorough insight into the findings. 

Employing a Collaborative Approach

A key tenant of DirectTrust is collaboration, and this initiative is no different.  We’ve utilized both a Workgroup and a Tiger Team to help inform and guide our work.

Our Direct Directory Policy Workgroup meets every other week and is open to all DirectTrust Members. The Directory Data Quality Tiger Team continues to meet weekly in 2022. This smaller and more focused Tiger Team group dives into the weeds of improving Directory data quality. We have representatives from all levels of the Directory data chain in attendance, including HISPs, EHRs and Vendors, and healthcare organizations. With multiple  points of view covered, we are well equipped to analyze current states and provide future guidance for improvement.

Updated Directory Guidance

As an example, we identified a contradiction in our Directory Services User Guide (new version deploying soon) with the community’s expectations around workflow or organizational addresses in the Directory. Our old User Guide suggested these address types be formed in a way that interfered with our upcoming (and optional) move to FHIR. Additionally, the old guidance caused some HISPs to omit these vital address types from the Directory entirely. Obviously, users of the Directory would benefit from the publication of workflow/organizational addresses in the Aggregated Directory.  We look forward to seeing the impact of updated guidance on these addresses in the Directory.

This group has produced many new best practices and strategies that, when published, will provide key guidance for all players in the Directory data chain. Furthermore, the Tiger Team is responsible for executing our Continuous Improvement Cycles (CIC). The first CIC involves establishing the baseline of Directory content quality and formulating strategies and plans to improve in areas that require attention. These cycles follow the IHI’s Plan, Do, Study, Act methodology. 

Highlighting Directory Success

As one part of our work, DirectTrust plans to interview HISPs that perform well in specific Directory quality areas to understand how the community might match their success. The overall hypothesis of this first CIC is that Directory quality will improve and the percentage of accurate Directory entries will increase as a result of the new validation engine’s reporting, publishing of new best practice guidance, and continued outreach to the community.

Looking Towards Era 2: Increase Directory Accessibility and Use

In the coming weeks, we will enter into Era 2 which aims to increase Directory Accessibility and Use through a new FHIR-based API. 

Increasing DirectTrust Directory Agility

Historically, the Directory has only been an aggregation of flat CSV files from each contributing HISP. The result of which is a very large flat file that probably cannot be opened on your computer. By the end of August, this flat file model will still exist, but the Directory will also synchronize to its own FHIR server. 

The new API built on top will give contributing HISPs the option to adopt this functionality as they see fit. There will even be some bonus data available in this new model. We realized that our validation engine’s connection to the Google Places API returned the latitude and longitude of the locations it was validating. Rather than discarding this information (there is no place for geometric data in the CSV version of the Directory), we will include it in the FHIR mapping. This extra data point allows a FHIR based query of the Directory to show “all providers within 10 miles of X location with a provider specialty of Orthopedic Surgery Physician”, for one example,  without the HISP making these significant external API calls themselves. 

Demonstrating Updates and the FHIR API

DirectTrust is partnering with MaxMD and NextGen for pieces of the DII. At the Civitas Networks for Health 2022 Annual Conference, a Collaboration with the DirectTrust Summit, we will present DII updates. A component of the presentation includes demonstrating the FHIR API work.  Join us Monday August 22, 2022 at 2:15 CT for our updates and demo.

By the end of the year, HISPs will be able to update all or one of their records in real time with the same FHIR-based API (they can also continue to provide flat CSV files daily if they prefer) instead of relying solely on the daily aggregation of an entirely new submission file. 

Sign Up for Additional Updates

Our Directory Improvement Initiative has made significant progress, but there’s more to come! Interested in staying in the loop as we make additional updates? Subscribe for Directory updates on the progress of this and other functionality coming later this year.

This post was contributed by Alex Young.