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The Opala Provider Directory API

Provider directories play a key role in enabling the identification of individual providers and provider organizations. The Provider Directory API enables you to use your application to access information about providers and provider organizations. The Provider Directory API is publicly accessible and it does not require any authorization to access the data.

Opala's Provider Directory supports the Da Vinci PDEX Plan-Net standard External Link for search and retrieval, based on FHIR R4. The Provider Directory uses a push service to send new records and updates to the FHIR Repository.

Plan-Net

The PDEX Payer Network (a.k.a., Plan-Net) Implementation Guide is, conceptually, based on the Validated Healthcare Directory Implementation Guide (VHDir IG), an international standard, which in turn is based on FHIR Version 4.0. The primary changes made by Plan-Net are:

Removal of the validation and restriction resources
Use of US Core for R4 as the base suite of profiles (where possible)
Elimination of extensions that are unnecessary for this use case
Introduction of additional constraints (e.g., search criteria, cardinality, value-set bindings, and MustSupport) where appropriate.

Note: Alignment with VhDir is maintained by adapting VhDir content where possible.

The Plan-Net IG was written for a US audience, and describes resources from US Core STU 3.1 External Link where available (Practitioner, Organization, Location), and from R4 (OrganizationAffiliation, PractitionerRole, HealthCareService, Endpoint) otherwise.

The Network profile is based on USCore Organization, since there is no contradiction between the USCore profile and the Plan-Net requirements; however, the NPI and CLIA identifier types, which are Must-Support, are intended for provider organizations only and are not expected to be populated for other organization types.

Note: The PractitionerRole profile from US Core was not used because it is overly constrained for use in a Provider Directory based on Payer information.

Use Cases

The Provider Directory enables you to find a practitioner or organization. This section describes the use cases and search expectations for the Provider Directory.

Search for a practitioner by demographics (e.g., name, specialty).
Search for a practitioner or specialty within a region (e.g., city, state, distance from location). Or search for every practitioner with a specific specialty within a region.
Search for an organization and facility.
Search for a practitioner by organizational relationship (e.g., a practitioner in a specific health organization, a practitioner in a specific clinic)

Note: When searching for a practitioner by region using a postal code, Opala recommends you do not use the zip+4 format. Including the +4 suffix limits the results to a very specific area and is much less useful for finding a practioner within a postal code area.

Searches

The _include and _revinclude Parameters

The _include and _revinclude parameters request that search results include additional resources related to the resources directly matching the query (i.e., the primary results). Use these parameters to retrieve additional resources with a single request rather than making a series of requests for the resources separately.

Forward inclusion using the _include parameter adds resources and resource versions referenced by the primary results.
Reverse inclusion with the _revinclude parameter adds resources that reference the primary results.

The Opala Provider Directory supports the _include and _revinclude parameters using the following syntax:

GET [baseUrl]/[resourceType]?[optional parameters]&[_include|_revinclude]=[parameters]

For example, https://provdir.pcinc.io:59101/pcinc/fhir/r4/Location?address-postalcode=98008&_revInclude=PractitionerRole:location

PractitionerRole

There are two methods for querying PractitionerRoles.