National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 2.0.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions

Resource Relationships

Page standards status: Informative

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NDH Resources and Relationships

The NDH IG contains the following resources, which are based on FHIR R4 base 4.0.1 and US Core 6.1.0.

• Endpoint: The technical details of an endpoint that can be used for electronic services
• HealthcareService: The details of a healthcare service
• InsurancePlan: Details of a Health Insurance product/plan provided by an organization
• Location: Details and position information for a physical place
• Network (based on Organization): A healthcare provider insurance network
• Organization: An organization is a formal or informal grouping of people or organizations with a common purpose
• OrganizationAffiliation: Details of relationships between two or more organizations
• Practitioner: A practitioner is a person who is directly or indirectly involved in the provisioning of healthcare
• PractitionerRole: Describes the relationship between a practitioner and an organization. A practitioner provides services to the organization at a location. Practitioners also participate in healthcare provider insurance networks through their role at an organization
• Verification (based on VerificationResult): Provide information on which verification process was performed, what was verified, when the verification took place, who performed the verification, and how it was verified for a given instance of a resource

Overview of NDH - Resource Relationships

Note: the following diagrams provide a high-level view of the relationships between resources used in this IG. They do not necessarily reflect all of the relationships/references between resources.

All Resource Relationships 1

A high-level view of the relationships between resources. In the NDH resource profiles, there is no inherent relationships. Both Organizations and OrganizationAffiliations can declare a network relationship. Consider a scenario where an OrganizationAffiliation, which is part of a Network, is associated with a PractitionerRole through the Organization. This relationship is not automatically inherited by the PractitionerRole. The PractitionerRole must have its own direct link to the Network. Likewise, any network affiliation declared by a PractitionerRole is not automatically inherited by the organization.

All Resource Relationships 2

All resources reference the Endpoint resource.

Practitioner Role Relationships

PractitionerRole describes the relationship between a practitioner and an organization. A practitioner provides services to the organization at a location. Practitioners also participate in healthcare provider insurance networks through their role at an organization.

Every practitioner operates in the context of one or more roles with an organization that employs or contracts with them, and may also practice as part of one or more clinician groups. The PractitionerRole resource represents each of these roles and serves as the central hub that connects the Practitioner resource to the other directory resources associated with that role. Through a PractitionerRole, a practitioner is associated with the Organization or Group in which they practice, the Location(s) where they perform that role, the HealthcareService(s) they provide at those locations, and the Network(s) in which they participate while performing that role. A practitioner may have multiple PractitionerRole instances to represent different practice settings, organizations, specialties, or network affiliations.

For example: To find all Endpoints for a given Practitioner, the broadest search would search on PractitionerRole for that given Practitioner, augmented with _include=PractitionerRole:endpoint,PractitionerRole.location. This will return a Bundle of the PractitionerRole resource(s) for that Practitioner, all of the Location resources and all of the Endpoint resource(s) pointed to by all of the PractitionerRole.endpoint.

%%{init: {'themeCSS': '.edgeLabel rect { fill: #ffffff !important; }'}}%%
flowchart LR
    P["<i>&lt;&lt;Practitioner&gt;&gt;</i>\nPractitioner"]
    PR["<i>&lt;&lt;PractitionerRole&gt;&gt;</i>\nPractitionerRole"]

    subgraph C3[ ]
        direction TB
        O["<i>&lt;&lt;Organization&gt;&gt;</i>\nOrganization"]
        G["<i>&lt;&lt;Group&gt;&gt;</i>\nGroup"]
        L["<i>&lt;&lt;Location&gt;&gt;</i>\nLocation"]
        HS["<i>&lt;&lt;HealthcareService&gt;&gt;</i>\nHealthcareService"]
        N["<i>&lt;&lt;Network&gt;&gt;</i>\nOrganization"]
    end

    P -->|practitioner 0..1| PR
    PR -.->|specialty 0..*| P

    PR -->|organization 0..1| O
    G -->|member 0..*| PR
    PR -->|location 0..*| L
    PR -->|healthcareservice 0..*| HS
    PR -->|network 0..*| N
    PR --> G

    classDef practitioner fill:#E9D5FF,stroke:#7E22CE,color:#111111,stroke-width:2px
    classDef practitionerRole fill:#EEF4FF,stroke:#1E3A8A,color:#111111,stroke-width:2px
    classDef organization fill:#EEFBEF,stroke:#2E7D32,color:#111111,stroke-width:2px
    classDef group fill:#EAFBFD,stroke:#0E95A3,color:#111111,stroke-width:2px
    classDef location fill:#FFE2C2,stroke:#CC5200,color:#111111,stroke-width:2px
    classDef healthcareService fill:#FFF5E6,stroke:#D48806,color:#111111,stroke-width:2px
    classDef network fill:#BFDBFE,stroke:#1E40AF,color:#111111,stroke-width:2px

    class P practitioner
    class PR practitionerRole
    class O organization
    class G group
    class L location
    class HS healthcareService
    class N network

    style C3 fill:transparent,stroke:transparent,color:transparent
    linkStyle 7 stroke:transparent,color:transparent

Organization Affiliation Relationships

Similar to PractitionerRole, OrganizationAffiliation describes relationships between organizations. For example:

1. The relationship between an organization and an association it is a member of (e.g., hospitals in a hospital association)
2. An organization that provides services to another organization, such as an organization contracted to provide mental health care for another organization as part of a healthcare provider insurance network
3. Distinct organizations forming a partnership to provide services (e.g., a cancer center)

Network / Insurance Plan Relationships

A network is a group of practitioners and organizations that provide healthcare services for individuals enrolled in a health insurance product/plan (typically on behalf of a payer).