Visual Examples of Healthcare Service Providers in Hospital Networks

These visual examples provide a graphical representation of different healthcare service providers in hospital networks, showcasing their affiliations, specialties, and network relationships. The drawings complement the implementation guide examples by illustrating the relationships between instances without annotating the full data payload. Each example highlights a specific clinic or group providing services within a hospital network, along with relevant affiliations and specialties.

• Healthcare
• Hospital Networks
• Service Providers
• Visual Examples
• Affiliations

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1. Plan-Net Patterns August 19, 2020

2. Introduction These drawings complement the examples provided in the implementation guide. They refer to the example instance names. The drawings do not annotate the full data payload of the examples. Their purpose is to graphically illustrate the relationships between the instances. Instance IDs are in purple. See the examples data for full data content

3. Example: Group Providing Service at Hospital Network Acme of CT Standard Organization Organization Hospital HartfordOrthopedics AcmeofCTStdNet providedBy participatingOrganization network managingOrganization Healthcare Service category: Group Specialty: Orthopedics (207X00000X) Location type: Hospital OrganizationAffiliation Code: Provider HospLoc1 HartfordOrthopedicServices location HartfordOrthopedicAffil organization Represents: Hartford Orthopedics (is a group) providing Orthopods for Network Acme of CT at Hartford General Hospital and is in-network for Acme of CT s standard network.

4. Example: Clinic That is Owned by a Hospital Network Organization Organization partOf HamiltonClinic Hospital AcmeofCTStdNet providedBy participatingOrganization network managingOrganization Healthcare Service category: Outpatient Specialty: Family Medicine (207Q00000X ) Location type: Hospital HospLoc1 OrganizationAffiliation Code: Outpatient HamiltonClinicServices location HamiltonClinicAffil Represents: Hamilton Clinic, owned by Hartford General Hospital, provides Family Medicine Services at Hospital Location 1

5. Example: Clinic Provides Services to a Hospital Network Organization Organization AcmeofCTStdNet BurrClinic Hospital providedBy participatingOrganization network managingOrganization Healthcare Service category: Outpatient Specialty: Family Medicine (207Q00000X ) Location type: Hospital HospLoc1 OrganizationAffiliation Code: Outpatient Burr ClinicServices location BurrnClinicAffil organization Represents: Burr Clinic is located at Hartford General Hospital s site #1 and provides outpatient family medicine services. It is in network for Acme of CT s standard network.

6. Example: Clinic Belongs to an HIE Organization Organization ConnHIE BurrClinic participatingOrganization organization OrganizationAffiliation Code: bt (Member Of) ConnHIEAffil Represents: - Burr Clinic belongs to the Connecticut HIE

7. Example: Pharmacy Chain Organization Type:bus BigBox Network Organization Type:Provider AcmeofCTStdNet PharmChain managingOrganization providedBy participatingOrganization network Healthcare Service category: Pharmacy Specialty: Retail Pharmacy Location Location Location Location OrganizationAffiliation Code: Pharmacy Specialty: Retail Pharmacy PharmLoc4 PharmLoc3 PharmLoc2 PharmLoc1 PharmChainRetailService PharmChainAffil1 Represents: - Chain of pharmacies provided by PharmChain - Only 2 of the pharmacy locations are in-network for Acme of CT Standard Network - 2 of the pharmacy locations are managed by BigBox

8. Example: Compounding Pharmacy Network Organization AcmeofCTStdNet PharmChain managingOrganization providedBy participatingOrganization network Healthcare Service category: Pharmacy Specialty: CompoundingPharmacy Location Location OrganizationAffiliation Code: Pharmacy Specialty: CompoundingPharmacy PharmChainAffil2 PharmLoc2 PharmLoc1 PharmChainCompService Represents: - Chain of Compounding pharmacies provided by PharmChain - 2 of the pharmacy locations are in-network for Acme of CT Standard Network

9. Example: MailOrder Chain Network Organization AcmeofCTStdNet PharmChain providedBy participatingOrganization network Healthcare Service category: Pharmacy Specialty: Mail Order OrganizationAffiliation Specialty: Mail Order PharmChainMailService PharmChainAffil3 Represents: - Mail order pharmacy provided by Pharmchain - In-Network for Acme of Connecticut PPO Network

10. HealthCareService Location Example: Practitioner location category: Outpatient specialty: Internal Medicine Dr Smith works at a the Burr Clinic during the week Moonlights at the Hartford Hospital on the weekend in the ER Has admitting privileges at Harford Hospital HospLoc2 BurrClinicServices providedBy healthcareservice Practitioner PractitionerRole code: Physician Organization practitioner JoeSmith JoeSmithRole2 BurrClinic organization network practitioner practitioner Network AcmeofCTStdNet PractitionerRole code: Admitting Privileges (AP) Organization Hospital JoeSmithRole3 organization network PractitionerRole code: Emergency Medicine healthcareservice providedBy HealthCareService organization JoeSmithRole1 category: Emergency Specialty: Emergency Medicine Location Organization location HospERService HospLoc1 Hospital

11. PractitionerRole Example #2 Location 123 Main St Ste 4 Chicago IL 60601 HealthCareService location PractitionerRole code: Physician Specialty: Internal Medicine Available: M-W-F Dr Smith works M-W-F in one group works tu-Th in another group has hospital admitting privileges category: Group specialty: Internal Medicine healthcareservice organization Practitioner providedBy Network Name: Acme Network of IL practitioner Name: Jane Smith Qualifications: - Medical Doctor (issuer IL) - Internal Medicine (issuer ABIM) - Cardiology (issuer ABIM) Organization Name: Internal Medicine LLC Type: Provider Group partOf practitioner Organization PractitionerRole code: Physician (PH) Specialty: - Internal Medicine - Cardiology - Available: Tu-Th Name: Physicians Group LTD Type: Provider Group partOf organization Organization Name: Multi-specialty Group Assoc Type: Provider Group practitioner PractitionerRole code: Admitting Privileges (AP) Specialty: - Internal Medicine - Cardiology providedBy healthcareservice HealthCareService Location category: Group Specialty: Cardiology, Internal Medicine, etc organization Location 123 Main St Ste 1 Chicago IL 60601 Organization location Name: Some Hospital Type: Provider Not Implemented

12. Example: Solo Practitioner Location location HansSoloClinic HealthCareService Solo Practitioner HansSoloService PractitionerRole healthcareservice HansSoloRole1 practitioner Practitioner HansSolo Network AcmeofCTStdNet

13. PractitionerRole Example #4 PractitiorRole without a specific Practitioner. Specifying a role. location Location HealthCareService CancerClinicLoc CancerClinicService PractitionerRole code: Physician Specialty: Internal Medicine healthcareservice providedBy AnonRole organization Network AcmeofCTStdNet Organization CancerClinic

14. Example: Insurance Plan and Network. Acme of CT Medicare Advantage Network Organization name: Acme of CT Acme of CT Standard Network Location name: State of CT location-boundary- geojson: shape of CT address: CT ownedBy coverageArea InsurancePlan Name: Acme Medicare Advantage Type: MedicareAdvantage Endpoint name:Acme Formulary Connection-type: hl7-fhir-rest payloadtype: NA address: url of formulary Usecase.type = TREAT Usecase.standard = Formulary IG URL Not Implemented

15. Example: Insurance Plan and Network. Acme QHP Plans Network Organization Network AcmeofCTStdNet Acme AcmeofCTPremNet Location network ownedBy StateOfCTLocation coverageArea InsurancePlan Type: QHP Plan.type: Bronze InsurancePlan Type: QHP Plan.type: Gold Endpoint Connection-type: non-fhir-rest payloadtype: NA Usecase.type = HOPERAT AcmeQHPBronze AcmeQHPGold AcmeOfCTPortalEndpoint