Organization: National Committee for Quality Assurance
Date of Implementation: July 2003
Target Population: Consumers and physicians
The issue: It should come as no surprise that more than one-third of the 143 million Americans using the Internet in 2001 were searching for health care information. Physician groups, hospitals, health plans, and other providers, due in part to increasing consumer demand for a role in their health care decisions, have developed Web sites that provide information on the services they offer. Some of these Web sites feature physicians associated with a particular institution. While online physician directories have several advantages over traditional paper directories, including greater efficiency and lower cost, these sites can be problematic. In a 2001 study of 40 online physician directories, the Massachusetts Health Data Consortium (MHDC) concluded that there were "significant problems with the quality, quantity, and accuracy of information." The MHDC study found discrepancies in the information reported by two different health plans for the same physician. There also are inconsistencies in the information provided, with only 10 percent of electronic directories listing the number of years a physician had been in practice and 63 percent providing information on the medical schools attended by physicians. In many cases, data were incomplete or missing and verification or updating protocols were not explained. Consumers have no way of discerning whether information is accurate or the directory itself trustworthy.
The intervention: To address concerns that online physician directories could mislead consumers, the National Committee for Quality Assurance (NCQA) convened a consensus panel to begin to articulate standards. This panel was designed to include the creators and users of physician directories as well as experts on Web-based health care information. As such, there were representatives from AARP, the U.S. Office of Personnel Management, Federation of State Medical Boards, Massachusetts Health Data Consortium, Definity Health, American Medical Association, Pacific Partners, Doctor Quality, AOL Time Warner Inc., Ford Motor Company, American Board of Internal Medicine, Pacific Business Group on Health, GeoAccess Inc., and the Massachusetts Board of Registration in Medicine.
The consensus panel focused on sites designed to help consumers choose physicians and health plans. They set out to make recommendations for content and validation protocols, while avoiding prescriptive requirements. The panel concluded that online directories should provide users with easy access to descriptive and quality-related information about physicians, context for the detailed data reported, and search capabilities for as many elements as possible. More specifically, they concluded that the following elements are useful for consumer choice and feasible for site sponsors to obtain and maintain. The elements are grouped into five categories:
- Physician Descriptors and Characteristics. This category includes basic information such as physician name, gender, languages spoken, specialties and subspecialties, medical school, post–medical school training, years in practice, professional appointments, health plan affiliation, hospital affiliation, and Medicaid and Medicare acceptance. The panel made recommendations about how frequently each of these items should be updated.
- Physician Expertise and Knowledge. These items, which require validation and regular updates, give the patient information on state licensure, board certification, disciplinary actions, malpractice history, and volume of selected procedures, if available.
- Patient Access. This tells consumers whether a physician is accepting new patients, the office location, practice hours, and other details, such as the availability of same-day appointments.
- Relationship with Patients. This category includes one measure, a self-reported statement of clinical interests.
- Performance Measures. These include both patient-reported and clinical measures, including clinical recognition, mortality rates, and patient survey data.
In addition to these elements, there were several items on which the NCQA panel was unable to reach consensus. They include race/ethnicity, date of birth, photograph, physician Web site link, open-ended patient comments, philosophy of care, and honors and awards. It also left several questions unanswered, such as the cost of maintaining directories that adhere to these standards and the feasibility of including information from multiple organizations, for instance, multiple health plans.
Last July, The Commonwealth Fund awarded a grant to the Midwest Business Group on Health (MBGH) to conduct a demonstration project focused on these issues. A group of Chicago-based health plans, hospitals, and physician organizations will test the feasibility of implementing the recommended standards on their Web sites and evaluate their cost and value. They include Advocate Health Care, Blue Cross Blue Shield of Illinois, Chicago Medical Society, and Evanston Northwestern Healthcare. As part of the MBGH project—which expects to release preliminary results in the fall of 2004—a broad-based Directory Advisory Council, with employer, medical, hospital, consumer and research members, has been formed to review the standards. The NCQA also plans to examine its own physician directories for improvement and consider adopting these standards for accreditation in the future. At right, you can download the model physician directories or read a related Fund report.