How Provider Data Is Changing but Challenges Remain

In today’s healthcare landscape, finding the right provider is crucial for patients and members seeking care. Reliable provider data plays a pivotal role in this process, ensuring that individuals can find the care they need efficiently and effectively in directories and in care coordination systems.

In today’s healthcare landscape, finding the right provider is crucial for patients and members seeking care. Reliable provider data plays a pivotal role in this process, ensuring that individuals can find the care they need efficiently and effectively in directories and in care coordination systems. However, provider demographic data is constantly changing, and there is no single source of truth. Provider shortages, burnout,  create an environment more churn in information as providers look for higher pay, better life balance, and more autonomyⁱ. Individual providers may find new organizations to work for, locations where they work vary by day of the week, and the ability to provide telehealth services through audio, video and asynchronous messaging makes for a complex landscape when a patient is looking for care close to their home or work. 

The new paradigm of provider information 

In addition to address, appointment phone and specialty information, consumers of healthcare are looking for new types of information about potential providers. Finding a provider “like me”, who is best suited to my personal needs, is uniquely defined by each person. That often translates to consumers seeking information about a provider’s spoken language capabilities, specific cultural competencies, race, ethnicity or other background characteristics that may inform how the provider interacts with patients. While these data points are often the focus of new legislation and regulation as a way to close health equity gaps, they are often difficult to collect, do not have standard values and definitions, and are often very personal to providers.   Collecting and publishing personal characteristics about a provider can be difficult due to the personal nature of that information, lack of data standards and a common reluctance to share it widely. Concerns from providers about discrimination or misuse of that information are reasonable. Barring federal legislation that mandates data collection and use standards for these personal characteristics, the challenge is not likely to go away any time soon. 

The availability of telehealth has further expanded how consumers can search for a provider. Telehealth delivery provides consumers with cost-effectiveness, scheduling flexibility and improved access to specialists that may otherwise be difficult to reach. Digital health visits can be delivered through audio, video or asynchronous messaging through an app or electronic health record. An individual provider may offer any or all of those modalities, across one or more organizations that they work for. Making that information available to consumers adds complexity to the quest for a reliable and complete provider data record. 

Establish a solid foundation first 

While additional insights about a provider’s training, personal characteristics and the types of visits they make available are valuable, organizations must consider the need to build a solid foundation before expanding scope into these more complex data types. A successful foundation begins with establishing your use cases, defining a data architecture that supports those use cases, identifying critical data elements, and building a management process to source and master the data. Core elements such as name, NPI, address, phone number, organizational relationships, specialties and office hours have their own difficulties to manage. Knowing who someone is, where they work, and how to schedule an appointment is key to building trust with consumers. Without those foundational elements being correct, the usability of more personal characteristics of providers is limited. For example, knowing a physician that speaks Spanish and has cultural training to support LGBTQIA+ persons is important but has limited utility if the consumer cannot reach the provider via phone to inquire about an in person or virtual appointment.  

Healthcare organizations that maintain provider demographic data and want to establish ways to collect and publish new types of information about providers, can take a step in the right direction to build trust and partnerships with providers today. Creating an efficient and effective process for gathering, curating and mastering data from multiple sources can help minimize the burden on providers who are constantly asked for updates. Having a solid, trustworthy process for today’s data challenges may help make future endeavors to curate more personal information easier and smoother.  

Benefits 

Mastering provider data is a challenge, but with the right planning, technology and partners, reliable data can be curated in a way that enables consumers to find the care they need and reduce cost, while minimizing the administrative burden for providers to update information in multiple places.