Learn About the Provider Data Model

Learning Objectives

After completing this unit, you’ll be able to:

• Explain the purpose of the Provider data model.
• Describe the objects for healthcare providers and healthcare facilities.
• Describe the objects for payer and facility networks.
• Describe the objects for healthcare provider specialties.
• Describe the objects for healthcare provider certification, education, and licenses.

The Provider Data Model

The Provider data model represents healthcare providers, including individual practitioners and facilities, the network they participate in, and their specialties and credentials.

Sara Johnson is a physical therapist who’s affiliated with the PT Health Specialists organization, which has multiple facilities. Sara works at the PT Health Specialists - Downtown branch from 9 AM until 5 PM on Mondays, Wednesdays, and Fridays. This branch is in the Bloomington Health Plans PPO network, which is the network for the PPO plan that Charles Green enrolled in. 

Sara has a National Provider Identifier (NPI) number, a business license, and awards and credentials, including her American Board of Physical Therapy Specialties certification. She specializes in orthopedic physical therapy, which makes her a great choice for Charles’s lower back pain condition. 

Healthcare Providers

When you model healthcare providers in Health Cloud, represent them as a person or an organization, and represent what they do. 

The Account object with a Business record type represents providers that are organizations. 

For people, use either person accounts or contacts, but we strongly recommend person accounts. Person accounts are a better fit for healthcare providers who are their own independent entity with practicing rights at a number of locations. These individuals have their own unique identification number, such as a National Provider Identifier (NPI), which follows them regardless of where they work. If you map individual providers as contacts, there are limited capabilities for these records.

The Healthcare Provider object represents what the providers do. This object stores business-level details about the healthcare organization or the individual, such as the provider type. 

A healthcare provider record and person account combine to represent the FHIR Practitioner resource in Salesforce. The healthcare provider record is the base, and it references the person account record using the AccountId field.

If you model providers only as person accounts, you may not be able to use Health Cloud capabilities such as provider search. However, when you model providers using both the Healthcare Provider object and person accounts, then this ensures they’re aligned to the FHIR Practitioner resource and they can use provider search. To learn more, see Practitioner.

People

Sara Johnson is a physical therapist.  Use the Account object with a Person record type for people. 

Sara’s person account record (1) represents Sara as a person and her healthcare provider record (2) represents her as a physical therapist. 

In the UI, Sara’s healthcare provider record has an Account field that references her person account. Note that Sara’s person account record may have more than one related healthcare provider records, as Sara is one person but she may have multiple healthcare provider roles.

Organizations

PT Health Specialists is a healthcare organization that Sara is affiliated with. Use the Account object with a Business record type for organizations. 

A business account record (1) represents PT Health Specialists as an organization and a healthcare provider record (2) represents what this organization does. In the UI, the healthcare provider record references the business account in the Account field.

The PT Health Specialists organization has multiple facilities. Let’s see the objects that represent them.

Healthcare Facilities and Facility Practitioners

Think of a healthcare facility as a building and a healthcare facility practitioner as a person who works in that building. The building has many people who work there, and a practitioner may work in more than one building. The next two objects cover these scenarios: Healthcare Facility and Healthcare Practitioner Facility.

Healthcare Facilities

The Healthcare Facility object represents a healthcare facility and its physical, functional, geographic, or business details. A healthcare organization’s local branches or facilities need healthcare facility records that reference a business account and a healthcare provider record for that specific branch or facility.  

PT Health Specialists has a Downtown branch.

A business account record represents the PT Health Specialists Downtown branch (1). The business account record references:

• A healthcare provider record for PT Health Specialists Downtown (2)
• A healthcare facility record for PT Health Specialists Downtown (3)
• The business account record for the parent business account (4)

Next, let’s represent Sara’s affiliation with the PT Health Specialists Downtown branch.

Healthcare Practitioner Facilities

The Healthcare Practitioner Facility object represents the set of services that a practitioner provides at a specific location. 

Sara works at the PT Health Specialists Downtown branch from 9 AM to 5 PM on Mondays, Wednesdays, and Fridays. 

Here’s a summary of the objects and records.

If Charles Green searches for a physical therapist at this point, he knows that Sara is available in a facility close to him on specific days. But how does he know if Sara is in the Bloomington Health Plans PPO network?

Healthcare Payer and Facility Networks

To represent the payer network that a healthcare provider is affiliated with, two objects come into play: Healthcare Facility Network and Healthcare Payer Network.

Here’s a summary of the objects and records.

Now when Charles Green searches for a provider, he sees that Sara Johnson is a physical therapist who is available in a nearby location and in his network. However, how can Charles be sure she specializes in the type of physical therapy he needs for his ailment? Let’s see how to represent Sara’s healthcare specialties next.

Healthcare Provider Specialties

A healthcare provider can have multiple specialties and subspecialties. To represent them, Health Cloud has several care specialty objects. 

Sara specializes in orthopedic physical therapy.

Here’s a summary of the objects and records.

Next, let’s see how to represent that Sara is formally qualified with these healthcare specialties.

Healthcare Provider Certification, Education, and Licenses

Health Cloud has objects that represent a practitioner’s certifications, education, and licenses. These objects relate to either or both of the Person Account and Healthcare Provider objects.

Sara has a National Provider Identifier (NPI) number, a business license, awards and credentials, including her American Board of Physical Therapy Specialties certification. 

Here’s a summary of the objects and records. Unless otherwise stated, records reference both the person account and the healthcare provider records. 

For more details about the objects we introduced in this unit, see the Salesforce Health Cloud Developer Guide.

The next unit wraps up our tour of Healthcare data models with a look at the objects in the Utilization Management data model. 

Resources

• Salesforce Help: Provider Network Management
• Trailhead: Provider Network Management with Health Cloud