Importance of National Provider Identifier in Healthcare

It’s been pretty much, pretty well accepted and documented that Health Information Exchanges need a master patient index.

The reason for that is that patient data scattered all throughout the healthcare spectrum. You go to hospital number 1, you go to 3 doctors’ offices and you go to a lab, at a radiology center. So, they will recognize, there is a challenge in pulling all of that data from multiple sites and they use a master patient index aggregated data from multiple sites. But then they have to use probable list reasoning to come to the right answer if there is different information about the same patient.

Conversely, a master provider index is also aggregating data about a provider from multiple sources. The real difference is that there is now a unique identifier called the NPI (National Provider Identifier). Whereas, if the patients have a unique identifier, it will a lot easier to get to the right answer and know that you are matching the right records for that provider. But you are not allowed to use the SSN as unique identifier for patient. It is very different on the provider side.

We now have this national provider identifier. It’s a unique identifier. So, when health market science goes out and pulls in data from 1700 primary sources and another several hundred secondary sources. Than we run our records rhythm to match the right records together. We index them all under that single unique identifier, the NPI and we’ve created a golden record. The reason that this is so important and should be considered just as critical as a master patient index, is that there are lot of stakeholders in that health information exchange and they don’t need to use data in different way. So if you have a health plan or a hospital or a physician office. They have different business processes. They utilize the provider data differently. A health plan may need the data to investigate claims or to do credentialing, for drug abusive investigation. A health plan may need the provider data to reach out to the community to try to get to some new doctors or staff and certainly health information exchange needs that data to ship the information during the transaction to the right provider. So it should be part of an infrastructure for health information exchange and it should well available to the different stakeholders.

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