The National Committee for Quality Assurance (NCQA) convened an expert consensus panel to consider and recommend the elements that constitute quality in electronic physician directories for consumers.
There are several reasons why such recommendations are needed:
- A large proportion of the population now relies on Web sites for health information, and most health plans have put their directories online.
- The electronic medium is preferable to paper-based directories in many ways, including its greater efficiency and cheaper maintenance costs.
- In spite of this potential, there are problems. There is much variation among online physician directories, and often a lack of accuracy and timeliness. Online directories can thus be confusing and misleading for consumers.
- There is no agreement on the “best” way to present a directory online, and no way for consumers to know if the information is accurate or the directory itself is trustworthy.
To begin to articulate standards for this important area, the NCQA consensus panel examined the subject from multiple vantage points. The panel included directory providers, consumer groups, traditional health plans, Internet-based health plans, physicians and physician organizations, state regulators, and large public and private purchasers.
The panel made recommendations about the kinds of information that would best help consumers choose doctors and health plans. Specifically, NCQA asked the panel to recommend 1) the essential elements in directories, and 2) how the information should be presented to be most useful to consumers. The panel worked from informational elements that already exist in many online directories and did not assume that every physician directory would include the same information. A previous Fund report identified many of the elements to consider.
The recommended elements are grouped into five general categories. For each element, the panel recommended whether and how often the directory provider should verify and update the information.Physician Descriptors and Characteristics
Physician Expertise and Knowledge
- Name, gender, contact information, years in practice, languages spoken
- Specialty(ies), education, and training (verified)
- Health plan and hospital affiliations, acceptance of Medicare and Medicaid
- Licensure and board certification (verified)
- Disciplinary actions and malpractice history, where available (with verification and caveats that help consumers interpret and use the information
Relationship with Patients
- Acceptance of new patients in all health plans, including Medicare and Medicaid
- Special aspects of access such as e-mail, availability of same-day appointments, handicap access, access to public transportation, and availability of off-street parking
A special section on clinical interests that would be supplied by the doctor and subject to editing, covering subjects such as the particular area of the specialty in which the physician sees the most cases.Performance Measures
Any publicly available, evidence-based measures of quality, including NCQA or other quality measures, mortality rates, and patient survey data.
The panel concluded that other elements should be optional and that some could be problematic. For example, links to physician Web sites may be difficult to verify and may imply an endorsement by the directory's administrators.
How information is presented is as important as what elements are included. Directories should clarify their sponsorship, sources, and the logic behind the order in which physicians appear. Each field of information should be defined and sourced, and it should be clear how often the fields are updated and/or verified. For elements that are difficult to keep up to date, such as whether a physician is taking new patients from a particular health plan, the directory should caution consumers to verify that information for themselves. Any information about quality and quality problems should be accompanied by explanations that place the information in context and explain its meaning. For example, to help consumers interpret malpractice information, it is important to inform the consumer that malpractice histories tend to vary by specialty and by case mix.
The panel also considered the navigability of online directories. Most members strongly advise that as many elements as possible be searchable, so that consumers have the maximum flexibility in finding the providers they want. However, the panel agreed not to specify which particular items should be searchable (i.e., whether a consumer should always have the ability to search by specialty, gender, board certification, etc.), since different directories have different use patterns and purposes, and the same set of search elements may not fit all sites. Further, the group believed that the market for online directories will to some extent determine these requirements: the most searchable sites will likely become the most popular.