Establishing a Provider Directory API: Pennsylvania Patient and Provider Network (P3N)

Case Story

AWS-partner-network

Program Overview

The Pennsylvania Patient and Provider Network (P3N) hub enables statewide health information exchange, which provides patients and providers with better care coordination, improved patient safety, and lower costs.

More about P3N: The Pennsylvania eHealth Partnership is responsible, under Act 76 of 2016, for the creation and maintenance of Pennsylvania’s secure health information exchange, known as the PA Patient & Provider Network, or P3N. The P3N improves and coordinates patient care by helping health care providers find their patients’ medical records and receive alerts—in real-time—from anywhere on the P3N network. The eHealth Partnership also works within the Department of Human Services and across selected state agencies to offer a provider directory and facilitate health care provider reporting to various state registries, including immunization, laboratory reporting, cancer, and Prescription Drug Monitoring Program.

Customer Challenge

Establish a Statewide Provider Directory API to Enhance Access to Care

The Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule establishes policies to enhance patient access to their health information, improve interoperability and drive innovation, while reducing burden on patients and providers. This rule required health payers to implement a Fast Healthcare Interoperability Resources (FHIR)-based Provider Directory API by July 1st, 2021. The resulting Provider Directory, which outlines the in-network providers, is a public-facing digital reference available on payers’ websites. This promotes public discovery, accessibility, and workflow efficiency.

Partner Solution

FHIR Data Transformation Using AWS HealthLake

The P3N solution uses AWS HealthLake to ingest provider data from the following data sources:

  • Provider files from the Pennsylvania Department of State (DOS)
  • Provider and facility files from the Pennsylvania Department of Drug and Alcohol Programs
  • National Plan and Provider Enumeration System
  • Facility files from the Pennsylvania Department of Health.

HealthLake helps standardize and normalize the data by converting it into a common format using FHIR. Each record is assigned a unique identification key in AWS HealthLake. Consumers use the web to access the P3N Provider Directory. 

Results and Benefits

AWS HealthLake fulfills the CMS Interoperability and Patient Access Final Rule requirement by offering a dynamic P3N Provider Directory. Users can search for providers with multiple search criteria including name, facility, specialty, location, etc.

The P3N Provider Directory returns detailed information about the provider including qualifications, licensure, contact information, associated facilities, and specialty information.

Benefits of the P3N Provider Directory include:

  • Improved Transparency: Beneficiaries can make informed choices when selecting a healthcare provider using accurate, up to date information.
  • Enhanced Access to Care: Medicaid Beneficiaries can easily find healthcare providers who are in-network and available to provide the care they need. This reduces the risk of unexpected out-of-network costs and helps ensure timely access to care.
  • Enhanced Network Adequacy: The P3N Provider Directory also addresses network adequacy requirements, ensuring that Medicaid beneficiaries have access to an adequate number of healthcare providers within a reasonable distance. This helps P3N ensure beneficiaries don’t experience lack of care due to network access limitations. 

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