Provider
Provider
Introduction
The Provider data model is a fundamental component within healthcare information systems. It captures essential information about the individuals or entities responsible for delivering medical services to patients. Providers are a cornerstone of healthcare delivery, and the information stored in this model plays a critical role in managing and documenting patient care throughout the patient journey.
Use Case
Developers can use the Provider data model for a wide array of technical use cases that optimize healthcare services, facilitate documentation, and enhance overall care delivery:
- Provider Information Management: Develop applications and systems to efficiently manage provider information, including names, credentials, designations, and more. This ensures that accurate, up-to-date provider information is readily available.
- Provider Credential Validation: Implement features for validating provider credentials, ensuring that providers meet the necessary qualifications and certifications to offer specific medical services.
- Provider Demographics: Create applications for managing provider demographics, such as sex, family name, given name, and external names, which can be used for internal and external communication and identification.
- Provider Role and Type: Utilize provider type and employment designation information to categorize providers based on their roles within the healthcare system, such as physicians, nurses, specialists, and administrative staff.
- Provider Status Tracking: Develop tools to track the active status of providers, allowing healthcare organizations to manage staffing and resource allocation effectively.
- Healthcare Claim Processing: Develop functionalities for handling EDI claims by tracking provider data to facilitate accurate billing and reimbursement processes.
- Staff Resource Allocation: Optimize the allocation of staff resources based on provider information, ensuring that the right providers are assigned to patients and cases according to their credentials and specialties.
- Provider-Related Reporting: Create reports and analytics tools to monitor provider performance, workload, and compliance with regulations or standards.
- Provider Identification: Develop features for identifying providers within the healthcare system, such as EHR IDs, which simplify the process of associating providers with specific electronic records.
- Batch Processing: Use batch IDs to manage and process provider data in groups, streamlining tasks like updates, reporting, and auditing.
- Data Integration: Ensure that provider data is integrated seamlessly with other healthcare information systems, such as scheduling, billing, and telemedicine platforms.
- Provider Search and Lookup: Create tools that allow users to search for and look up provider information, supporting tasks like appointment scheduling and referrals.
- Provider Relationships: Establish and manage relationships among providers, such as referring physicians or primary care providers, which are essential for coordinated patient care.
Data Fields
| Attribute Name | Description | HL7 Mapping | Data Type | Label | Use Case |
|---|---|---|---|---|---|
| provider_second_name | Provider Second Name Or Initia | DG1-16-4, PR1-8-4, PR1-8-4, PR1-11-4, PR1-12-4, ORC-10-4, ORC-11-4, ORC-12-4, NTE-5-4, RXA-10-4, PPN-10-4 | string | Provider Second Name Or Initial | This field contains the second part of the name of the healthcare provider or clinician involved in diagnosing or treating the patient. It complements other provider information, such as the first name or identifier. It helps in identifying the specific healthcare provider associated with a particular diagnosis. |
| ehr_prov | This is EHR_PROV attribute | NA to HL7 | string | EHR provider | Electronic Health Records (EHR) provider refers to a healthcare organisation, company, or service that offers electronic health record software and related solutions to healthcare facilities and professionals. |
| prov_abbr | This is prov_abbr attribute | NA to HL7 | string | Provider Abbreviation | "Provider Abbreviation" typically refers to a shortened or abbreviated representation of a healthcare provider's name, facility, or organisation. These abbreviations are often used for brevity and convenience in medical records, billing, and clinical communication. |
| bundle_id | ID of bundle | MSH-10 | string | Bundle ID | “bundle ID" typically refers to a unique identifier assigned to a group or bundle of related messages or data elements. This identifier is used to associate multiple messages or pieces of information that are related to a specific patient, event, or transaction. |
| prov_cred | This is prov_cred attribute | NA to HL7 | string | Provider Credential | "Provider Credential" refers to the qualifications, certifications, licenses, and other credentials that healthcare professionals obtain to practice medicine, offer healthcare services, or perform specific roles within the healthcare system. |
| active | This is active attribute | NA to HL7 | string | Active Status | This field Indicates whether a healthcare provider (e.g., physician, nurse, therapist) is currently practicing and available to offer healthcare services. This status can change if a provider retires, takes a leave of absence, or moves to a new practice. |
| sex | This is sex attribute | NA to HL7 | string | Sex | "Sex" refers to the biological and physiological characteristics that differentiate individuals as male or female. |
| edi_claim_active | This is EDI_CLAIM_ACTIVE attribute | NA to HL7 | string | EDI Claim Active? | "EDI Claim Active" typically refers to the status of an electronic data interchange (EDI) claim submitted by a healthcare provider to a payer, such as an insurance company or government health program. |
| res_name | This is res_name attribute | NA to HL7 | string | Staff Resource Name | "Staff Resource Name" typically refers to the name of an individual staff member or resource in an organisation, often used for identification and communication purposes. In a healthcare context, this term would apply to healthcare professionals, administrators, or any staff members involved in the delivery of healthcare services. |
| prov_family_name | This is prov_family_name attribute | DG1-16-3, PR1-8-3, PR1-8-3, PR1-11-3, PR1-2-1, ORC-2-1, ORC-2-1, ORC-2-1, NTE-2-1, RXA-2-1, PPN--2-1 | string | Provider Familiy Name | This field contains the family name (last name) of the healthcare provider who is involved in diagnosing or treating the patient. It represents the provider's family name. It helps in identifying the specific healthcare provider associated with a particular diagnosis. |
| report_grouper_six | This is REPORT_GROUPER_SIX attribute | NA to HL7 | string | Employment Designation | "Employment Designation" refers to the specific job or role that an individual holds within an organization. It is a way to categorize or define the responsibilities, duties, and functions that an employee or staff member is expected to perform within their workplace. |
| prov_name | This is prov_name attribute | NA to HL7 | string | Provider Name | "Provider Name" refers to the name of a healthcare provider, such as a medical doctor, nurse, hospital, clinic, or any entity that delivers healthcare services. The provider's name is a critical piece of information for identifying and credentialed healthcare professionals and organizations. |
| lineage | This is lineage attribute | Fixed - HL7 | string | Lineage | "lineage" refers to the information about the origin or source of a message. It helps trace the path of the message, indicating where it originated, how it was transmitted, and any intermediate systems or components it passed through before reaching its destination. |
| prov_id | This will be Epic ID | NA to HL7 | string | EHR ID | "EHR ID" refers to an Electronic Health Record Identifier. It is a unique code or number associated with an individual's electronic health record (EHR) within a healthcare system or EHR software. |
| ext_name | This is ext_name attribute | NA to HL7 | string | External Name | "External Name" generally refers to a label or identifier used to represent a person, medical provider, or other entities in external systems or communications. |
| prov_given_name | This is prov_given_name attribute | DG1-16-3, PR1-8-3, PR1-8-3, PR1-11-3, PR1-12-3, ORC-10-3, ORC-11-3, ORC-12-3, NTE-5-3, RXA-10-3, PPN-10-3 | string | Provider Given Name | This field contains the given name (first name) of the healthcare provider who is involved in diagnosing or treating the patient. It represents the provider's first name. It helps in identifying the specific healthcare provider associated with a particular diagnosis. |
| prov_type | This is prov_type attribute | NA to HL7 | string | Provider Type | "Provider Type" refers to the classification or categorisation of healthcare professionals and organisations based on the services they offer and their roles within the healthcare system. Provider types help in identifying and differentiating the various entities and individuals involved in delivering medical services. |
| report_grouper_twelve | This is REPORT_GROUPER_TWELVE attribute | NA to HL7 | string | Special Status Indicator | |
| batch_id | batch id | System Generated | string | Batch ID | "batch ID" is a unique identifier assigned to a group of messages that are logically grouped together for processing or transmission. Batching messages is a common practice in healthcare systems to efficiently manage and transmit multiple messages as a single unit |
| prov_cred_id | This is prov_cred_id attribute | NA to HL7 | string | Clinician Title (ID) | This field typically refers to the specific title or role of a healthcare clinician, often associated with a unique identification number (ID) that distinguishes them in healthcare records. |