A couple of weeks ago, I attended ONC’s Direct Bootcamp in Crystal City, VA. A hot topic at the two-day conference was the notion of a “Provider Directory” that incorporates Direct email addresses.

I also read that HHS/CMS intends to revamp the National Plan and Provider Enumeration System (NPPES). This is the system that manages National Provider Identifiers or (NPIs). Every individual provider and provider organization has one of these numbers, sort of like a tax ID for providers. A common complaint I hear is that it contains information that is often out of date and/or incorrect.

So what, you might ask, does the NPPES have to do with the Direct Project? Having worked with the NPPES data and having some background with Direct, the idea of “killing two birds with one stone” has captured my imagination. (Nerdy and wonky I know.) This is an opportunity for government efficiency by consolidating systems. Efficiency can only be achieved if the new system is simple, however. Too often in health information technology, consultants and vendors introduce complexity for complexity’s sake. After all, complexity is good for the bottom line for many companies because it means more billable hours and more services sold. Sadly, I see this sort of thing all the time. As an American and a taxpayer it ticks me off.(See footnote)

To illustrate what I mean by “simple”, I’ve built a prototype web service application that illustrates my vision of a combined NPPES and Direct email Provider Directory. Before I outline that technical proposal, however, I’d like to point out how adding some other data fields to NPPES could result in a an empowering service for patients, providers, and payers.

Adding Other Data Points to NPPES

While a full NPPES would involve adding more fields and require pagination, which I have not included here, items that I think contain more fields and would require pagination that is not illustrated here, items that I think would be most useful to add include:

1. Diagnosis and Procedure Codes such as ICD9, ICD10, and CPT codes that are typically provided by the provider.

2. Payer and health plan identifiers to make it easy easy to search and determine if a provider takes a particular insurance plan, for example.

3. State Medical Board License information to determine in which state(2) the provider is licensed.(An even better idea is for our nation to adopt a national medical board and do away with state medial boards altogether.)

An NPPES Web Service Proposal

This is my proposal for a simple NPPES web service in a RESTFul style. I have provided examples and defined some basic HTTP request and response expectations.

Here is an example of a simple search query looking for all doctors named “Fred Smith” that have a practice within the zip code 20004. We simply use the any web client to query the database. In this example we return the data in JSON, but we could also just as easily return it in XML, CSV, or HTML.

 GET http://localhost/nppes/example.json?first_name=Fred&last_name=Smith&zip=21223

If any results are found, we get back an HTTP 200 response and a JSON file containing a non-empty list of results.

{

    "message": "OK",
    "num_results": 1,
    "results": [
        {
            "first_name": "Fred",
            "last_name": "Smith",
            "npi": "23456789",
            "address_1": "901 Pennsylvania Ave",
            "address_2": "",
            "city": "Washington",
            "state": "DC",
            "zip": "20004",
            "telephone": "202-555-5555",
            "fax": "202-777-7777",
            "provider_type": "",
            "regular_email": "fred@yahoo.com",
            "direct_emails": [
                {
                    "organization": "Hope Hospital",
                    "npi": "3453456985",
                    "email": "fred@direct.hope-hospital.org"
                },
                {
                    "organization": "Fred Smih MD",
                    "npi": "23456789",
                    "email": "fred@direct.fredsmithpractice.com"
                }
            ]
        }
    ]

}

Note that within the results is a field called “direct_emails”. We assume each provider could have many Direct addresses, for example, if he or she works at multiple organizations. This field maps all other NPIs and Direct addresses together.

We can also query by a Direct address…..

GET http://localhost/nppes/example.json?direct_emails.email=fred@direct.fredsmithpractice.com

…and we can also query by an NPI…..

GET http://localhost/nppes/example.json?npi=23456789

The above two example returns the same result as before. So we can query by name, address, provider type, etc. and we can also query just by a Direct email address or an NPI.

For cohesiveness, I’d like to outline what things look like when no results are returned (i.e. an unhappy path). If no results are found or some sort of error occurs, then the NPPES web service responds with something other than an HTTP 200 status. Here are two unhappy examples; A valid query returning no results, and an invalid query.

No Results

Request:

GET http://localhost/nppes/search/?first_name=Fred&last_name=Appleseed

Response:

{
    "message": "No search result matched your query.",
    "results": [ ]
}

The HTTP response code is 404.

Invalid Query

Request:

GET http://localhost/nppes/search/?foo=bar

Response:

{

    "message": "You supplied an invalid search parameter: foo",
    "results": [ ]

}

The HTTP response code is 400.

Next Steps

This blog post is an open letter to HHS/CMS on how to construct a new NPPES without the complexity that often accompanies health IT. Comments and feedback are welcome.

Resources and Background NPPES

Currently the NPPES data is made available as a comma separated value (CSV) file. The field headers/names are in a separate CSV file. This URL is not on a .gov domain and is somewhat hard to find. I’ve published a link to it here. Thanks Fred Trotter. The sign up and update is not an electronic process. Here is a link to the PDF sign-up/update form. Almost certainly any NPPES modernization effort would involve making this an online process.

Footnote: John Stewart made this point well in his segment “The Red Tape Diaries – Veterans Benefits” (VIDEO). At Videntity, we subscribe to the mantra that building things as simply and as efficiently as possible is always the best design choice, even if it means a smaller contract.