Efficiency and Effectiveness FHIR API

The Efficiency and Effectiveness API provides data on one or more practitioner’s efficiency and effectiveness at providing care (“E2 data”) using a DSTU-2 compliant FHIR interface.

Individual Practitioners are identified using a composite search parameter that consists of their United States Tax Identifier for their affiliated practice, their National Provider Identifier, and the CMS taxonomy code for their specialty. As per the FHIR standard, each of these values is separated by a “$” and all dashes are removed. An example of a complete search parameter is: “12345678$1234567890$208D00000X”. This parameter identifies the Practitioner with NPI 1234567890, practicing at the organization whose tax identifier is 12-345678, with specialty 208D00000X.

Any individual practitioner may have a different rating for different specialties or affiliated organizations, so it’s important to specify each one. The API will accept, delimited with commas, up to 25 search parameters at once.

If a searched Practitioner is not found, the API will return an FHIR OperationOutcome with a severity of “warning” and a code of “not-found”. The text will explain which Practitioner was not found. In the event that multiple Practitioners are provided and more than one is not found, a separate Issue is provided in the OperationOutcome for each Practitioner not found. Only if no Practitioners provided are found is an HTTP 404 returned, along with the OperationOutcome in the response.

For each Practitioner that is found, the Practitioner.id field contains the NPI, the query string of the Practitioner.practitionerRole.managingOrganization URL contains the tax identifier, and the Practitioner.practitionerRole.specialty.coding.code contains the specialty. The specialty will contain two extension resources. Each resource is a CodeableConcept that contains the tiering information. You can distinguish the efficiency and effectiveness ratings by using the system property of the CodeableConcept; the efficiency ratings are in the system http://humana.com/fhir/analytics/provider/efficiency-tier, while the effectiveness ratings are in the system http://humana.com/fhir/analytics/provider/effectiveness-tier. It is possible for a Practitioner to have one rating but not the other.

Tiers

platinum gold silver bronze not-assigned – The Practitioner is not rated because insufficient data exists to rate them. (null) or (not-found in the OperationResult) – Humana declines to rate this provider for a reason other than insufficient data.

Relevant Links

FHIR Search

FHIR Practitioner

CMS Taxonomy Codes

For more information send us an email to apisupport@humana.com

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