PatientScheduling - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Use Cases Provider Discovery
Provider Discovery
Overview
Provider discovery is a foundational capability in the patient scheduling
workflow. Patients and caregivers must be able to identify appropriate
healthcare providers based on a combination of clinical, logistical, and
personal constraints before scheduling an appointment.
This use case describes provider discovery as a composite capability
made up of multiple discovery dimensions. These dimensions may be implemented
independently and combined as needed by scheduling and directory systems.
Actors and context
Primary actors
Supporting systems
- Provider directory
- Scheduling system
- Payer or network directory
- Care coordination or referral system
Provider discovery typically occurs before appointment booking, but may also
be revisited during care coordination, referrals, or re-scheduling workflows.
Discovery dimensions
Provider discovery may involve one or more of the following dimensions:
- Clinical specialty or service
- Location and proximity
- Language and accessibility needs
- Insurance participation
- Appointment availability
- Ranking, sorting, and presentation of results
Each dimension below represents a distinct sub-use case with its own data,
interaction, and profiling considerations.
Specialty and service filtering
Patients often begin provider discovery by searching for providers based on
a desired clinical specialty or healthcare service.
User intent
- Find providers capable of delivering a specific clinical service
- Restrict results to relevant specialties or subspecialties
FHIR resources involved
- Practitioner
- PractitionerRole
- HealthcareService
- Organization
Key considerations
- Specialties may be represented at varying levels of granularity
- Providers may offer different services at different locations
- Specialty coding systems may vary across implementations
Profiling implications
- PractitionerRole.specialty must be consistently populated
- Clear terminology expectations are required for specialty and service codes
Location and proximity
Patients often need to discover providers based on geographic proximity
or care setting.
User intent
- Find providers near a specific address or region
- Restrict results to in-person or virtual care settings
FHIR resources involved
- Location
- PractitionerRole
- Organization
Key considerations
- Locations may represent physical sites or virtual endpoints
- Proximity calculations are typically performed outside FHIR
- Providers may practice at multiple locations
Profiling implications
- Location.address should be populated with sufficient granularity
- Clear linkage between PractitionerRole and Location is required
Language and accessibility
Patients and caregivers may require providers who meet specific communication
or accessibility needs.
User intent
- Find providers who speak a preferred language
- Identify providers offering accessibility accommodations
FHIR resources involved
- Practitioner
- PractitionerRole
- HealthcareService
Key considerations
- Language preferences may apply to individual providers or care teams
- Accessibility attributes may be inconsistently captured today
Profiling implications
- Practitioner.communication should be supported
- Guidance is needed for representing accessibility features
Insurance participation
Determining whether a provider accepts a patient’s insurance is a critical
step in provider discovery.
User intent
- Identify providers who participate in a specific plan or network
- Avoid discovering providers who are out-of-network
FHIR resources involved
- InsurancePlan
- Organization
- OrganizationAffiliation
- PractitionerRole
Key considerations
- Insurance participation data may be incomplete or out of date
- Acceptance may vary by location, service, or provider role
- Network relationships are often complex
Profiling implications
- Clear modeling guidance is needed for insurance acceptance
- Consistent identifiers for plans and networks are essential
Availability and scheduling
Patients may prioritize providers based on near-term appointment availability
rather than provider attributes alone.
User intent
- Find the earliest available appointment
- Restrict availability to specific date or time windows
FHIR resources involved
- Schedule
- Slot
- PractitionerRole
- Location
Key considerations
- Schedules may be published at different levels of detail
- Slot availability may be generated dynamically
- Availability may differ by service or location
Profiling implications
- Slot.start, Slot.end, and Slot.status must be supported
- Consistent relationships between schedules, roles, and locations are required
Ranking and presentation
Once providers are discovered, results are often ranked or filtered to support
decision-making.
User intent
- Sort providers by distance, availability, or other criteria
- View summarized provider information for comparison
FHIR resources involved
- Practitioner
- PractitionerRole
- Location
- HealthcareService
Key considerations
- Ranking logic is typically application-specific
- FHIR primarily supports data retrieval, not scoring
Profiling implications
- Profiles should support efficient querying and aggregation
- Display-oriented fields should be consistently populated
Summary
Provider discovery is a multi-dimensional capability that underpins effective
patient scheduling. This IG treats provider discovery as a composite use case
composed of interoperable sub-use cases, each with distinct modeling and
profiling requirements.
Subsequent sections of this IG will reference these discovery dimensions when
defining FHIR profiles, terminology expectations, and interaction patterns.