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The challenges of managing provider data – and how to solve them

Provider Data Management

The importance of provider data 

Provider data is crucial for driving key initiatives and sustaining core aspects of your business. But the potential negative impact of low-quality and underutilized provider information, often obscured by data silos, can result in significant costs for your organization. 

Health IT leadership faces a substantial challenge in comprehending and navigating the complicated nature of provider data. Their responsibility is to ensure the effective support and full operational integration of every business stakeholder within the organization. 

Provider data is critical to delivering care 

On average, organizations might have as many as 18 different EHR systems. With multiple users accessing those systems and updating provider data to facilitate care, provider information quickly becomes outdated. 

This can pose a risk as provider information is required to ensure a seamless patient referrals, routing of test results, and other clinical information exchanges used to facilitate the management and coordination of a patient’s care. Lab results must be sent to the correct provider to approve a prescription for a patient at their preferred pharmacy. 

For seamless care coordination, clinical information must be shared across multiple providers requiring accurate and complete contact information. Furthermore, a provider directory is typically used to power digital experiences such as online scheduling capabilities, a patient portal or app, and even the organization’s website. These workflows are all using provider data across multiple systems from different EHRs, patient facing and other administrative systems.  

Provider data is critical to revenue cycle management 

Revenue cycle management requires a completely different set of systems and applications than the clinical teams using EHR systems. Accurate provider data is required for billing, including provider name, NPI, and specialty. As a result, yet another set of users accesses and updates provider information in different places from the clinical teams. This can have costly implications for both providers and healthcare organizations if provider data is of poor quality.  

Provider data integrity is crucial to advancing innovation to drive more sophisticated experiences and workflows for both members and providers, which depend on having comprehensive and trusted provider data. Healthcare IT teams must have a strategy to manage the conflicting information across every different version of provider data across their organization, which is nearly impossible without a centralized distribution hub.  

Provider data is challenging to manage 

Provider data is complex because it can represent many different types of entities – a person, location, and sometimes both. Additionally, this data has an intricate hierarchy structure that is unstructured and varied with endless permutations of all critical attributes that have severe business implications from billing to care access. These combinations often lead to missing and inaccurate information, further contributing to the layers of complexity associated with rationalizing all forms of provider data.  

Provider data is constantly changing because of the mobility of providers to change when, where, and what services they offer. The rate at which this data changes adds to the operational complexity of continuously managing and ensuring this data is consistently accurate- regardless of what system within your organization that is using this data. Additionally, this can also create scenarios in which your organization must fill in the gaps as key information may be missing.  

Provider data is used by many different systems and applications across every part of your business and created and modified by many different users across every department within your organization. As a result, the scale of managing the conflicting information across every different version of provider data within your organization is nearly impossible without a centralized distribution hub. Then, healthcare IT teams must support the large-scale reconciliation and management of third-party data from NPPES and state licensing organizations, a task which typically healthcare IT teams are not resourced appropriately to do in the first place.  

Why identity management is critical in solving provider data 

Provider data is critical in running every part of a healthcare organization, from clinical workflows to billing and payment processes- all requiring accurate provider information. 

A typical healthcare organization has multiple different applications and business units that create and modify provider data. If the management of this data isn’t synchronized, your tools and applications can quickly become unaligned, impacting care delivery and financial operations.   

Despite vast investments in business applications to fulfill specific workflows, such as the clinical and revenue cycle management teams, the challenge remains in having a single source of truth of provider data that is continuously synchronized to every system and user across your entire enterprise. 

Tackling the provider data integrity challenge facing the healthcare industry requires an ability to identify, enrich, synchronize clinician and organization information to the necessary downstream systems across an enterprise, and manage that information over time ensuring the accuracy and completeness of all provider information. 

How Verato can help 

At Verato, we understand the unique challenges of managing diverse provider data across disparate data sources and how to solve them. That’s why Verato Provider Data Management™ enables you to gain a 360-degree view of every provider in your network. 

We assist you in curating and harmonizing provider data, consolidating it into a centralized hub that can be distributed throughout every facet of your organization with unparalleled accuracy. This ensures that your systems and workflows are working with precise data, optimizing business outcomes. The result is a comprehensive and reliable set of provider data for improved decision-making, collaboration, and the facilitation of more effective and efficient workflows. 

Book a strategy session to find out how Verato can support your provider data initiatives.