social security administration-hit support 1 february 3, 2010 list of hpd use cases: yellow...

SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 1February 3, 2010

List of HPD Use Cases: Yellow Pages/Contact Data Query Look up providers and their associations for Social

Services Disability Determination Emergency Responders Identification during an

emergency event Certificate Retrieval Add Provider Update Provider Keeping Provider information current


Use Cases: Yellow Pages Query/Contact Data Query: A patient is to be referred to an endocrinology specialist for an urgent lab test. The referring physician needs to

get the contact data of close-by endocrinologists departments in order to ask whether one of them can perform this test in their own lab.

While prescribing a medication with high risks for side effects, a physician consults the patient’s medication record. He recognizes that another physician prescribed the same medication two years ago but the patient cannot remember the details. He wants to get in contact with this physician. All the information he can get from the medication record is the physician’s name and specialty.

Provider Search Request (to request a list of providers that meet certain criteria):• Requestor Information (for authorization purpose)

• Provider Name

• Specialty Type

• Other Criteria

- Certification Type

- Location: can be one or more of the following, depending on the desired result: Street Address, Zip Code, City, State;

• Expected Response Information Set (Identifies the categories of information expected to be returned). In this case, it includes Demographics, Address, Certification and Specialty, Provider status

Provider Search Response:• List of Providers who meet the criteria, including demographics, address, facilities, status, certification

and specialty information

• Response Status: requestor not authorized/No Result found etc


Use Cases: Look up providers for Social Services Disability Determination:

A citizen, as a claimant, applies for disability benefits from the Social Services Department because of a medical condition. The claim has a list of the providers and other medical services that this claimant has obtained related to his disability. In order to determine claim, medical evidence must be collected from all the reported providers and then reviewed. For that purpose the Social Services department needs to obtain Provider’s location (geographic, electronic end points (if any)) and provider’s relationship with other organizations such as HIE.

Lookup Provider Request: ►Requestor Information (authorization purpose)►Provider Information:

• Provider Category type (Type of Organization, individual, etc) • Provider Name (or an alias) and demographics (Gender, etc.) • Provider Address• Provider Identifier(s) (local or global identifiers)• Provider Specialty

►Expected Response Information Set (Identifies the categories of information expected to be returned in addition to request parameters):

• Business Relationship with Organization and HIE/HIO, Facilities• Associated Organization and HIE/HIO electronic end points

HPD returns Lookup Provider Response with the following options:• Provider Demographics, Identifiers, Address(es), Specialty, Provider Type (Organization, Individual), Status • Expected Response Information Set


Use Cases: Emergency Responders Identification during an emergency event:

At an emergency site, the HPD can be queried based on geography (e.g. 10 miles radius ) to quickly identify, seek out, and grant permission to credentialed providers to enter the scene. Emergency workers can determine the zip codes to be searched, and then query the HPD to identify appropriate providers in the desired zip codes.

Message Flow:► Provider Search Request (to request a list of providers that meet certain criteria):

• Requestor Information (for authorization purpose)

• Provider Type (Individual Provider)

• Location Criteria can be one or more of the following: Zip Code, City, State;

• Other Criteria

- Certification Type;

- Specialty Type

• Expected Response Information Set (Identifies the categories of information expected to be returned). In this case, it includes Demographics, Address, Certification and Specialty

► Provider Search Response:

• List of Providers who meet the criteria, including demographics, address, facilities, status, certification and specialty information

• Response Status: requestor not authorized/No Result found etc


Use Cases: Certificate Retrieval:

National regulations in many European countries require that an electronically transmitted doctor’s letter is encrypted in a way that only the identified receiver is able to decrypt it. In order to encrypt the letter, the sender has to discover the encryption certificate of the receiver.

Lookup Provider Request: • Requestor Information (for authorization)

• Provider Category type (Type of Organization, individual, etc);

• Provider Name

• Provider address

• Provider identifiers

• Expected Response Information Set (Identifies the categories of information expected to be returned). In this case, it includes encryption certificate request.

Provider Search Response:• Provider Demographics, Identifiers, Address(es), Specialty, Provider Type (Organization,

Individual), Status • Expected Response Information Set (Encrypted Certificate)• Response Status: requestor not authorized/No Result found etc


Use Cases: Add Provider: The following are a list of possible events that would require the addition of a

Healthcare Provider to the HPD. ► A provider adds himself/herself to the HPD► An agent for the provider adds the provider to the HPD► An HIE not yet on the HPD adds itself, its Organizations (hospitals, etc), the organizations

associated departments, and its providers to the HPD► An entity already on the HPD, like an HIE or Organization, adds Providers (Individual or

Organization) ► A credentialing organization has credentialed new members and would like to add them to

the HPD (Providers may not exist, this should be an add request) Add Provider Request:

• Requestor Information (for authorization)

• Provider Information: Provider Category type (Type of Organization, individual, etc); Provider Name, and demographics (Gender, etc.); Provider Address (single or multiple); Communication information; Other Identifier(s), Specialty; Credential; Provider relationships

Add Provider Response:• Provider HPD Identifier, demographics • Response Status: Requestor not authorized/Provider Added/Already Exist


Use Cases: Update Provider: The following are a list of possible events that would require the updating of a Healthcare Provider to the HPD.

►A provider or an agent updates information for provider: adds/deletes/changes his/her location, or adds/deletes a relationship, changes his/her name, adds/deletes/updates a credential, adds/deletes/updates identifiers adds himself/herself to the HPD

►A provider retires and wishes to inactivate himself/herself from the HPD ►An HIE not yet on the HPD adds Organizations (hospitals, etc), the organizations associated departments, and

its providers to the HPD (Organizations, providers might already exist having relationships with other entities, and information may need to be created. Some information to be created may be additional addresses added, relationships built, alias names created)

►An entity already on the HPD, like an HIE or Organization, adds Providers (Individual or Organization) (Organizations, providers might already exist having relationships with other entities, and information may need to be created. Some information to be created may be additional addresses added, relationships built, alias names created)

►A credentialing organization has issued/renewed/discontinued credentials of an existing HPD provider and would like to add credential to the HPD

►An entity already on the HPD, like an HIE or Organization, has modified Provider information (Individual or Organization). Either the location has changed, providers have disassociated themselves with the organization, a new location has been added, a provider has moved departments, a provider has retired.

Update Provider Request:

• Requestor Information (for authorization)

• Provider Lookup Information: Provider Category type (Type of Organization, individual, etc); Provider Name, and demographics (Gender, etc.); Provider Address (single or multiple); Communication information (including phone numbers and electronic); Provider Identifier(s), Specialty; Certification; Provider relationships (enough information to identify the provider)

• Provider Status• Provider Change Information: Targeted entity new data

Update Provider Response:

• Response Status: Requestor not authorized/Provider Updated/Not Found/Unsuccessful

• Relationship organizations not available


Use Cases: Keeping agency Provider information current:

A German government agency dealing with healthcare services for its constituents wishes to keep its agencies healthcare provider information current. The agency determines that it will use the HPD to access the most current provider information. The German agency only requires a subset of the HPD available information. On a regular basis, the HPD provides to the agency with the information needed.

Message Flow:► Provider Search Request (to request a list of providers that meet certain criteria):

• Expected Response Information Set (Identifies the categories of information expected to be returned). For this agency expected response will include Demographics, Identifiers, Addresses, relationships, names

• Provider Type (Individual Provider)

• Criteria can be none or many of the following, depending on the desired result: Zip Code, City, State; Country,

• Requestor Identifier (requestor must be authorized to make this request)

• “ Requested After” Date (Only return records that were updated after this date,)

► HPD returns Lookup Provider Response with the following options:• List of Providers who meet the criteria

• Requestor not authorized

• No records found

social security administration-hit support 1 february 3, 2010 list of hpd use cases: yellow...

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