PDMP & Health IT Integration

Standards and Harmonization

June 3rd, 2014

PDMP Harmonization Timeline

March April May June July

3/25 Harmonization Kick-off

Stan

dard

s Ev

alua

tion

Candidate Standards List

UCR-Standards Mapping

Gap Mitigation Plan

HITSC Evaluation*

Solu

tion

Plan

ning

IG

Dev

elop

men

t

Solution Plan

Create IG Template

IG Development

End-to-end Review & Community Consensus

(Today)

7/29 Harmonization Close

Week Target Date (2014) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page

due following Monday @ 12 noon

1 3/25 Harmonization Kick-Off & Process OverviewIntroduce: Overview of UCR-Standards Mapping Review: N/A

2 4/1 Introduce: Candidate Standards List & UCR-Standards Mapping Review: Candidate Standards List

3 4/8 Finalize: Candidate Standards ListReview: UCR-Standards Mapping Review: UCR-Standards Mapping

4 4/15 Review: UCR-Standards Mapping Review: UCR-Standards Mapping

- 4/22 Cancelled for National Rx Summit

5 4/29 Finalize: Outcome of UCR-Standards MappingIntroduce: Gap Mitigation Plan Review: Gap Mitigation Plan

6 5/6 Review: Gap Mitigation Plan Review: Gap Mitigation Plan

7 5/13 Finalize: Gap Mitigation PlanIntroduce: Solution Planning Workgroup Review: N/A

8 5/20 Review: Outcomes of Solution Planning WorkgroupIntroduce: Implementation Guide (IG) Template Review: Implementation Guide Template

9 5/27 Review: Outcomes of Solution Planning WorkgroupIntroduce: Minimum Dataset Requirements

Review: Minimum Dataset Requirements & IG Template

10-11 6/3 – 6/10 Review: Outcomes of Solution Planning Workgroup & Minimum Dataset Requirements

Review: Minimum Dataset Requirements & IG Content

12 6/17 Finalize: Proposed Solution Review: Proposed Solution & IG Content

13-15 6/24 – 7/8 Review: Implementation Guide Content Review: Implementation Guide

16-17 7/15 – 7/22 End-to-End Community Review of Implementation Guide End-to-End Review of Implementation Guide

18 7/29 Consensus Vote

Harmonization Weekly Timeline

Review: Solution Planning Workgroup

Session 5/29

Current-State Transaction: Standards Landscape

Transactions Scope

From Via To

1a1b

EHRPharmacy

- In-State PDMP

2a 2b

EHRPharmacy

HIEPh. Int

In-State PDMP

3a3b

EHRPharmacy

Hub In-State PDMP

4 In-State PDMP - Out of State PDMP

5a5b

HIEPh. Intermediary

- Out-of-State PDMP

6 Hub - Out-of-State PDMP

7a7b

HIEPh. Intermediary

Hub In-State PDMP

8 In-State PDMP Hub Out-of-State PDMP

PMP/HITI User Stories with Alternate WorkflowsEHR or Ph. to In-State PMP: 1a: EHR to In-state PMP 1b: Ph. to In-state PMP 2a: EHR to In-state PMP via HIE 2b: Ph. to In-State PMP via HIE 3a: EHR to In-state PMP via Hub 3b: Ph. Intermediary to In-State PMP via HubEHR or Ph. to Out-of-State PMP: 1a+4: EHR to out-of-state PMP via In-state PMP 1b+4: Ph.to out-of-state PMP via In-state PMP 2a+4: EHR to out-of-state PMP via HIE & In-state PMP 2b+4: Ph. to out-of-state PMP via Ph. Int & In-state PMP 2a+5: EHR to out-of-state PMP via HIE 2b+5: Ph. to out-of-state PMP via HIE 3a+4: EHR to out-of-state PMP via Hub & In-State PMP 3b+4: Ph. to out-of-state PMP via Hub & In-State PMP 1a+8: EHR to out-of-state PMP via In-State PMP & Hub 1b+8: Ph. to out-of-state PMP via In-State PMP & Hub 3a+6: EHR to out-of-state PMP via Hub 3b+6: Ph. To out-of-state PMP via Hub

HIE/Pharmacy

Intermediary

In-State PDMP

Out of State PDMP

Hub

EHR or Pharmacy

System1

2

3

42

36

57

7

Hub8 8

Summary of Transactions

Data Flow Transactions Reviewed on 5/15 & 5/22 & 5/29 SPWG

Transaction System - Outbound System Intermediary 1 System Intermediary 2 System Inbound

1a EHR -- -- PDMP

1b Pharmacy IT -- -- PDMP

2a EHR HIE -- PDMP

2b Pharmacy IT Pharm. Int. / Switch -- PDMP

3a EHR -- PDMP Hub PDMPs

2a+7a+6 EHR HIE PDMP Hub PDMPs

3b Pharmacy IT PDMP Hub PDMPs

2a + 2b + 7a + 7b + 6

Pharmacy IT Pharm. Int. / Switch orHIE

PDMP Hub PDMPs

Transaction Summary from SPWG 5/15 Items Required for Further Clarification

1a: EHR System to

PDMP (Direct)

• EHRs don’t generally query PDMPs directly• Ohio connectivity model is a direct connection to OARRS via

PMIX• Kansas leverages HIEs and PMPi data hub for all of their

connections• Illinois and Ohio use a direct connection – need further

clarification on standards used

• Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – Complete

• Jean Hall to confirm Ohio connectivity model – Complete

2a: EHR System to

PDMP via HIE

• HL7 messaging relatively uncommon in EHRs for PDMP connections

• Kentucky using QRY^T12 as request and DOC^T12 as acknowledgment and response message – CCD structure

• Some states that cannot make interstate connections might have no other option but to use this model

• Washington, Maryland, Maine, Oklahoma use this model• Washington response – PMIX-NIEM is mapped to NCPDP

SCRIPT and responding with NCPDP SCRIPT message• ADT used as trigger in Ohio, Indiana, Illinois, Kansas

• Jean Hall to further clarify what the query/message pairing used to engage EHR system to HIE – Complete

1b: Pharmacy IT System to

PDMP (Direct)

• Transaction 1b is not currently in use• ASAP Web Services standard was developed specifically with

this transaction in mind• NCPDP Medication History might be suitable for this purpose

but is not used currently

• Jean Hall to further clarify standards currently in use – Complete

Transaction Summary from SPWG 5/15 Items Required for Further Clarification

2b: Pharmacy IT System to

PDMP via Pharmacy

Intermediary/ Switch

• NCPDP SCRIPT Medication History is being used today but not for the purposes of querying PDMP data

• Real-time query for claim to be dispensed through switch via Telecommunication standard

• Not yet in use but is possible via claim submission• SureScripts to enable this transaction (Intermediary to

PDMP) in the future

• Lynne Gilbertson to verify if standards are currently being used (Nebraska) – Complete

Transaction Summary from SPWG 5/22 Items Required for Further Clarification

3a: EHR System to

PDMP via Hub

• Ohio, Kansas use PMIX to connect to PMPi data hub• PMP Gateway will be used in the future to

centralize translations, where endpoints can communicate with gateway

• EHR provides translation from HL7 (V2/ADT?) to PMIX in Kansas pilots

• Hub functions as aggregator, depending on arrangements

• Clay Rogers and Jeff McGonigal to verify translation/EHR generating PMIX request– Complete

Transaction Summary from SPWG 5/22 Items Required for Further Clarification

2a + 7a + 6: EHR System to HIE to Hub to

PDMP

• Indiana and North Dakota provides translation to PMIX from the HIE to the Hub

• HIE translates using NCPDP SCRIPT with PMIX wrapper for Hub

• SureScripts and Emdeon used by EHR Systems to obtain medication history data – not yet used for controlled substance history

• Emdeon does not support HL7• SureScripts predominantly supports SCRIPT

• Ohio EHR Systems leverages NARxCheck as an interface to in-state PDMP

• Does not go through HIE or Hub (PMPi)• HL7 ADT used as a trigger to send query• NARxCheck handles transformation of HL7 to

PMIX architecture• Message received by PMP: PMIX-NIEM

• NARxCheck does not act as a hub but may get information from PMPi

• Does not go through interconnect directly

• Jinhee Lee to verify how Indiana performs translation from HIE to Hub – Complete

• Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP – Complete

Transaction Summary from SPWG 5/29 Items Required for Further Clarification

3b: Pharmacy IT System to

PDMP via Hub

• Hub to PDMP available for use but is not currently in production

• Pharmacy IT System to hub not currently in use• Technology may be used in the future

• Ohio to possibly pilot for a pharmacy chain to go through hub (one of 16 states that is a part of SAHMSA grant)

• Support Team to determine what standards these transactions are based on – In progress

2a + 2b + 7a + 7b + 6:

Pharmacy IT System

Interstate Workflow

• Not currently in use but Pharmacy IT System• May be able to go through intermediary in the future

• Pharmacy workflow using controlled substance medication history through a Pharmacy Intermediary could be a future use case

• PDMP checking on a claim vs. query of history for controlled substances

• N/A

Solution Planning Work Group Approach

1. Overlay standards currently in general use per transaction - focus on transactions for integrated solutions

2. For each alternate workflow, propose solutions for harmonizing standards in order to pull PDMP information into EHR or Pharm. IT Systems synchronously

3. Document pros and cons for each proposed solution and prioritize in terms of technical feasibility D

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Next Steps for SPWG 6/10, 6/17

1. Identify effective workflows2. Prioritize workflows according to current landscape

analysis, standards evaluation, and future state models

3. Collapse workflows to represent proposed solutions incorporated in the Implementation Guide

– Analyze pros/cons, technical feasibility, impact to stakeholders, adoptability, scalability, etc.

Summary Analysis + Relevant Workflows

Current Landscape Workflows

Proposed Solution Set Workflows

EHR In-State PDMPPharmacy In-State PDMP

EHR Intermediary In-State PDMPPharmacy Intermediary In-State PDMP

EHR Hub PDMP(s)Pharmacy Hub PDMP(s)

EHR Intermediary Hub PDMP(s)Pharmacy Intermediary Hub PDMP(s)

EHR In-State PDMP Hub PDMP(s)Pharmacy In-State PDMP Hub PDMP(s)

EHR In-State PDMPPharmacy In-State PDMP

EHR Intermediary*Pharmacy Intermediary

EHR Hub Pharmacy Hub

1. Aligns to in-scope Use Case scenarios

2. Approach may require translation mapping between ASAP, NCPDP SCRIPT Medication History, and H L7 V2 Messaging to PMIX Architecture

3. Implementation Guide will have to include data element modifications/additions to fully support PDMP & HITI Use Case requirements

1

2

3

*Intermediary - An entity that routes the transaction to a receiving entity. May perform value added services such as translating data from one format to another

Summary Analysis

Strategy Details

Implementation Guide focus will shift to those organizations providing transformations/translation/ ETL services

ASAP can provide point-to-point PDMP data exchange for Pharmacies and EHRs a like – can be transformed into PMIX Architecture via Appriss, Inc. (PMPi)

Intermediaries provide translation service or metadata transformations as “wrappers”

Data elements will need to be modified or added, specified within the PDMP & HITI Implementation Guide

SCRIPT Med History

PMIX Architecture

(Authentication)

Example Container/Payload Configuration

ASAP Web Services

HL7 V2 Messaging

NCPDP SCRIPT Medication History

PMIX-NIEM Architecture

PDMP Hub

Intermediary

Health IT System Standard PDMP StandardTranslation

(Patient Data)

Data Element Analysis

Implementation Guide – Data Elements and Attributes

Data Requirements Analysis - PDMP & HITI Use Case

Request Transaction Data ElementsGeneral Authorized User Patient

1. Request Date2. Request Timestamp3. State of Request4. Requestor Location5. Requested State(s) [if

applicable]6. Authenticator7. System authentication8. Initiating requestor’s

routing ID9. Responder ID10.Message ID11.Requestor’s Internal

Patient ID12.Start Date13.End Date

1. First Name2. Last Name3. Generational Suffix [if

applicable]4. Address Information5. Optional Address

Information 6. City Address7. State Address8. ZIP Code Address9. Email Address10.Phone Number11.Authentication Credentials

[DEA, NCPDP/NABP Provider ID, NPI, License #, Delegate ID

12.Type of User

1. First Name2. Last Name3. Address Information4. Optional Address Information5. City Address6. State Address7. ZIP Code Address8. Phone Number9. Patient Gender10.Country11.Date of Birth12.Identification Qualifier of

Patient Identifier13.Identification of Patient

Data Requirements Analysis - PDMP & HITI Use Case

Response Transaction Data Elements

General Patient Prescription Prescriber Dispenser

1. Response Date2. Response

Timestamp3. Response Time4. State of Response5. Response Identifier6. Message ID7. Summary8. Create Time9. Intended Recipient10. Status of Request

1. First Name2. Last Name3. Address

Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Country9. Date of Birth10. Identification

Qualifier of Patient Identification

11. Identification of Patient

12. PDMP Patient Reference Number

13. Gender Code14. Species Code15. Phone Number

1. Name of Drug2. Strength3. Form4. Quantity Dispensed5. Days Supply

Dispensed6. Date Written7. Refills Authorized8. Refill Number9. Partial Fill10. Prescription

Number11. Date Prescription

Filled12. Date Prescription

Sold/Dispensed13. Drug Identifier14. Payment Method

1. First Name2. Last Name3. Address Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Phone Number9. DEA #10. Authentication

Credentials11. PDMP Prescriber

Reference #

1. Pharmacy or Dispensing Prescriber’s Name

2. Address Information

3. Optional Address Information

4. City Address5. State Address6. ZIP Code Address7. Phone Number8. DEA #9. NCPDP/NABP

Provider ID10. NPI11. PDMP Dispenser

Reference #

Consolidated Standard Data Set– PDMP & HITI Use Case

PDMP & HITI Use Case Data ElementsGeneral Patient Prescription Authorized User*

1. Request Date2. Request Timestamp3. State of Request4. Requestor Location5. Requested State(s) [if

applicable]6. Authenticator7. System authentication8. Initiating requestor’s

routing ID9. Responder ID10.Message ID11.Requestor’s Internal

Patient ID12.Start Date13.End Date14. Response Date15. Response Timestamp16. Response Time17. State of Response18. Response Identifier19. Summary20. Create Time21. Intended Recipient22. Status of Request

1. First Name2. Last Name3. Address Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Country9. Date of Birth10. Identification Qualifier of

Patient Identification11. Identification of Patient12. PDMP Patient Reference

Number13. Gender Code14. Species Code15. Phone Number

1. Name of Drug2. Strength3. Form4. Quantity Dispensed5. Days Supply Dispensed6. Date Written7. Refills Authorized8. Refill Number9. Partial Fill10. Prescription Number11. Date Prescription Filled12. Date Prescription

Sold/Dispensed13. Drug Identifier14. Payment Method

1. First Name2. Last Name3. Address Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Phone Number9. DEA #10. Authentication Credentials11. PDMP Prescriber Reference

#12. Pharmacy or Dispensing

Prescriber’s Name13. NCPDP/NABP Provider ID14. NPI15. PDMP Dispenser Reference

#16. Type of user

*Includes Physician and DispenserData Element

Analysis

Standard Data Set– MITRE WG Recommendation

MITRE Standard Data ElementsPatient Prescriber Dispenser Prescription

1. First name2. Last name3. Street address4. City5. State6. ZIP code7. Date of birth8. Identification (ID)

qualifier and/or patient identifier (situational)

9. Gender code (situational)

10. Species code (situational)

11. Phone number (situational)

1. First name2. Last name3. Street address4. City5. State6. ZIP code 7. Phone number

(situational)8. Drug Enforcement

Agency (DEA) number (situational)

1. Pharmacy or dispensing prescriber name

2. Street address3. City4. State5. ZIP code6. Phone number

(situational)7. DEA number

(situational)8. National Council for

Prescription Drug Programs (NCPDP)/National Association of Boards of Pharmacy (NABP) Provider ID (situational)

9. National Provider Identifier (NPI) (situational)

1. Name of drug2. Strength3. Form4. Quantity dispensed5. Days’ supply dispensed6. Date prescription filled7. Date written8. Refills authorized9. Refill number10. Refill status to indicate

a full or partial refill11. Prescription number

Next Steps

• Review: Minimum Dataset Requirements

• Next Solution Planning WG meeting is Thursday, June 5 from 12:00pm – 1:00pm ET

• Next All Hands meeting is Tuesday, June 10 from 12:00pm - 1:00pm ET

• Reminder: All PDMP & HIT Integration Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Harmonization materials, Use Case, Project Charter and general information will be posted on the PDMP Wiki page– http://wiki.siframework.org/PDMP+%

26+Health+IT+Integration+Homepage

Contact Information

– Initiative Coordinators: • Johnathan Coleman jc@securityrs.com• Sherry Green sgreen@namsdl.org

– ONC Leads:• Mera Choi mera.choi@hhs.gov• Jennifer Frazier Jennifer.Frazier@hhs.gov• Helen Caton-Peters

Helen.Caton-Peters@hhs.gov

– SAMHSA Leads• Jinhee Lee Jinhee.Lee@samhsa.hhs.gov• Kate Tipping

Kate.Tipping@samhsa.hhs.gov

– Support Team:• Project Management:

• Jamie Parker jamie.parker@esacinc.com

• Ali Khan Ali.Khan@esacinc.com (Support)

• Use Case Development: • Ahsin Azim

Ahsin.Azim@accenturefederal.com • Presha Patel

presha.patel@accenture.com

• Standards Development Support:• Alex Lowitt

alexander.s.lowitt@accenturefederal.com

• Harmonization Support:• Divya Raghavachari

divya.raghavachari@accenturefederal.com

• Atanu Sen atanu.sen@accenture.com• Implementation Guide Development:

• Rita Torkzadeh rtorkzadeh@jbsinternational.com

• Vijay Shah vshah@jbsinternational.com• Vocabulary and Terminology Subject Matter

Expert: • Mark Roche mrochemd@gmail.com

• For questions, please feel free to contact your support leads:

Appendix

Current In-State EHR Workflow (Direct)

EHR SystemIn-State PDMP

NARxCheck

Request

Response

Legend

Transaction 1a

NARxCheck

Current In-State EHR Workflow (HIE)

EHR System HIE In-State PDMP

Request

Response

Legend

HL7 OBXXML Report

NCPDP SCRIPT (Med History)HL7 DOC^T12 - CCD

HL7 ADT feedsNCPDP SCRIPT (Med History)HL7 QRY^T12

HL7 A04NCPDP SCRIPT with PMIX

WrappersThird Party Software

HL7 QRY^T12

XML ResponseNCPDP SCRIPT with

PMIX WrapperHL7 DOC^T12

Transaction 2a

Current In-State Pharmacy Workflow (Direct)

Pharmacy IT System

In-State PDMP

Request

Response

Legend

Transaction 1b

NARxCheck

NARxCheck

Current In-State Pharmacy Workflow (Pharmacy Int. / Switch)

Pharmacy System

Pharmacy Intermediary

/ Switch

In-State PDMP

Request

Response

Legend

NCPDP SCRIPT (Medication History)

NCPDP SCRIPT (Medication History)

?

?

Transaction 2b

Current In-State EHR Workflow (Hub)

EHR SystemIn-State PDMP

Request

Response

Legend

?

PMIX ?

?

Transaction 3a – Not Effective Workflow? Currently Active?

PDMP Hub

Current In-State Pharmacy Workflow (Hub)

In-State PDMP

Request

Response

Legend

?

Translation? PMIX

PMIX

Transaction 3b – Not Effective Workflow? Currently Active?

PDMP HubPharmacy

System

Translation?

Current Interstate EHR Workflow

EHR System HIEIn-State PDMP

Request

Response

Legend

NCPDP SCRIPT (Medication

History)

Third Party SoftwarePMIX-NIEM

Out-of-State PDMP

PMIX-NIEM

PDMP Hub

PMIX-NIEM

XML

PMIX-NIEM

PMIX-NIEMXML

Transaction 2a + 7a + 6

Current Interstate Pharmacy Workflow

HIEIn-State PDMP

Request

Response

Legend

NCPDP SCRIPT

Third Party SoftwarePMIX Wrappers

PMIX-NIEM

PDMP Hub

PMIX-NIEM

XML

PMIX-NIEM

PMIX-NIEMXML

Pharmacy System

Pharmacy Int. /

SwitchOut-of-State PDMP

NCPDP SCRIPT

?

?

Transaction 2a + 2b + 7a + 7b + 6

Questions to be answered:

1. Differences in pharmacy and clinician workflows / data systems and expectations in PDMP data transmitted?

2. How do we define intermediaries and their relationships to Health IT systems?3. What components of PDMP report are extracted for decision support?4. Can EHR and Pharmacy IT systems handle the proposed standards (in the context

of PDMP systems)?5. What standard(s) fit into message and workflow configuration per transaction

type?6. Are transactions collapsible in terms of capability of leveraging same standard?7. Are all transactions necessary?8. What is the cost associated with the proposed solutions?9. How do we define an aggregator? (collection of response from different PDMPs

back to recipient)10. Parking lot item: Differences in care settings - Ambulatory vs. Acute; In-hospital

pharmacies vs. retail pharmacies. Are different standards needed for different EHR systems?

Initiative Progress & Current Status

Implementation GuideDevelopment

Solution Planning

•Narrowed down candidate standards via mapping to Use Case Requirements

• Identified and analysed gaps for all narrowed down standards in the Gap Mitigation Plan

•Develop Implementation Guide (IG) based on selected solution

Standards Evaluation

•Determining standards currently in general use per transaction workflow

•Select harmonized standard solution based on current and recommended standards landscapes