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Modernizing National Health Care Provider Information with Document-Oriented Data Models

June 02, 2015

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Business Alan Viars, President at Videntity & Former HHS Entrepreneur in Residence at Centers for Medicare and Medicaid Services (CMS)

As a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HHS/CMS has enumerated all health care providers in United States. Most of the collected information about providers is publicly available. The enumeration system, called the “National Plan and Provider Enumeration System (NPPES)”, manages about 4.5 million health provider records of individuals and organizations. Riddled with problems, NPPES was identified by CMS and HHS as a system in need of modernization to improve usability, scalability and data quality. Part of the overall modernization strategy includes representing health providers as JSON documents and creating RESTFul APIs for record updates and public search. Storing provider information as JSON documents allows CMS to more easily adapt to changing requirements. The NPPES Modernization effort resulted in a collection of open source tools for quickly building a RESTful API atop MongoDB.

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