PDMP & Health IT Integration Standards and Harmonization May 20 th, 2014

Agenda TopicTime Allotted General Announcements5 minutes PDMP & HITI Standards and Harmonization Summary of outcomes from Solution Planning Workgroup 5/15 Overview of Initiative Progress Introduce IG Template 50 minutes Next Steps/Questions5 minutes

Review: Solution Planning Workgroup Session I Current-State Transaction: Standards Landscape May 20 th, 2014

Transactions Scope FromViaTo 1a 1b  EHR Pharmacy -In-State PDMP 2a 2b  EHR Pharmacy HIE Ph. Int In-State PDMP 3a 3b  EHR Pharmacy HubIn-State PDMP 4  -Out of State PDMP 5a 5b  HIE Ph. Intermediary -Out-of-State PDMP 6  Hub-Out-of-State PDMP 7a 7b  HIE Ph. Intermediary HubIn-State PDMP 8  HubOut-of-State PDMP PMP/HITI User Stories with Alternate Workflows EHR 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 Hub EHR 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 Intermediar y In-State PDMP Out of State PDMP Hub EHR or Pharmacy System Hub 88

Summary of Transactions Data Flow Transactions Reviewed on 5/15 SPWG TransactionSystem - OutboundSystem IntermediarySystem Inbound 1aEHRN/APDMP 1bPharmacy ITN/APDMP 2aEHRHIEPDMP 2bPharmacy ITPharm. Int. / SwitchPDMP Data Flow Transactions To Be Reviewed on 5/22 SPWG TransactionSystem - OutboundSystem Intermediary 1System Intermediary 2System Inbound 3aEHRPDMP HubPDMPs 3bPharmacy ITPDMP HubPDMPs 2a+7a+6EHRHIEPDMP HubPDMPs 2a + 2b + 7a + 7b + 6 Pharmacy ITPharm. Int. / Switch or HIE PDMP HubPDMPs

TransactionSummary from SPWG 5/15Items 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 Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – In progress 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 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 Lynne Gilbertson to verify if standards are currently being used (Nebraska) – Complete

Current In-State EHR Workflow (Direct) EHR System In-State PDMP PMIX? Request Response Legend Transaction 1a PMIX?

Current In-State EHR Workflow (HIE) EHR System HIE In-State PDMP Request Response Legend HL7 OBX XML Report NCPDP SCRIPT (Med History) HL7 DOC^T12 - CCD HL7 ADT feeds NCPDP SCRIPT (Med History) HL7 QRY^T12 HL7 A04 NCPDP SCRIPT with PMIX Wrappers Third Party Software HL7 QRY^T12 XML Response NCPDP SCRIPT with PMIX Wrapper HL7 DOC^T12 Transaction 2a

Current In-State Pharmacy Workflow (Direct) Pharmacy IT System In-State PDMP Request Response Legend Transaction 1b

Current In-State Pharmacy Workflow (Pharmacy Int. / Switch) Pharmacy System Pharmacy Intermediary / Switch In-State PDMP Request Response Legend NCPDP SCRIPT (Medication History) ? ? Transaction 2b

Reality of certain system-to-system transactions –Pharmacy IT to PDMP Hub –Pharmacy IT to HIE –Direct connection from EHR to PDMP Hub –HIE direct connection to Out-of-State PDMP Complete pairing of transactions to standards across all viable interchange functions, focusing on HIT integrated PDMP data access Identify (if applicable) generally accepted solutions for each transaction involved in the integration of PDMP data within HIT System To be Answered:

Harmonization Timeline Overview and Initiative Progress

PDMP Harmonization Timeline MarchAprilMayJuneJuly 3/25 Harmonization Kick-off Standards Evaluation Candidate Standards List UCR-Standards Mapping Gap Mitigation Plan HITSC Evaluation* Solution Planning IG Development 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 12 noon 13/25 Harmonization Kick-Off & Process Overview Introduce: Overview of UCR-Standards Mapping Review: N/A 24/1Introduce: Candidate Standards List & UCR-Standards MappingReview: Candidate Standards List 34/8 Finalize: Candidate Standards List Review: UCR-Standards Mapping 44/15Review: UCR-Standards Mapping -4/22 Cancelled for National Rx Summit 54/29 Finalize: Outcome of UCR-Standards Mapping Introduce: Gap Mitigation Plan Review: Gap Mitigation Plan 65/6Review: Gap Mitigation Plan 75/13 Finalize: Gap Mitigation Plan Introduce: Solution Planning Workgroup Review: N/A 85/20 Review: Outcomes of Solution Planning Workgroup Introduce: Implementation Guide (IG) Template Review: Implementation Guide Template 95/27 Review: Outcomes of Solution Planning Workgroup & Implementation Guide Template Review: Implementation Guide Template 106/3Finalize: Solution PlanReview: Implementation Guide Template /10 – 7/8Review: Implementation Guide ContentReview: Implementation Guide /15 – 7/22End-to-End Community Review of Implementation GuideEnd-to-End Review of Implementation Guide 187/29Consensus Vote Harmonization Weekly Timeline

Initiative Progress & Current Status Implementation Guide Development 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

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 Develop Technical Architecture  Can EHRs and Pharmacy ITs handle proposed Standards? Report findings to Community Goal is to prescribe a solution that would mitigate impact to the way PDMPs share data today.

IG Development Process Input from Community members Finalized Standards from Solution Plan Creation of Schemas Incorporate Community input Hold additional Working Sessions Actions Implementation Guide Support Team 17 UCR MappingStandards EvaluationSolution PlanIG Development

IG Development Template To develop the IG template we use:..and eventually iterative feedback from the initiative communities to understand what is best included in an IG document 18 HL7 Examples SME Input HITSP Outline Other IG examples Previous S&I IGs UCR MappingStandards EvaluationSolution PlanIG Development

Introduction of PDMP & Health IT IG Template The S&I Framework Implementation Guide (IG) template is intended to provide high-level direction for content development and organization IG Template consists of four main sections: 1.Introduction 2.Implementation Approach 3.Suggested Enhancements 4.Appendices

IG Outline: Introduction Provides initiative background Explains the scope of initiative and purpose of IG Offers guidance on navigating the IG and understanding conventions used to express conformance, cardinality, etc. Defines Actors and their role(s)

IG Outline: Implementation Approach Describes the technical details surrounding transactions, (standards), system/data requirements/components, and pre/post conditions Outlines recommended constraints on selected base standards Presents the Solution Plan to include pre- conditions/assumptions as well as post-conditions that need to be in place for implementation

IG Outline: Suggested Enhancements Identify gaps in base standards referenced in IG Outlines additional work that might be required Suggests options toward problem resolution and solutions Identifies possible owners for additional work and suggested follow-on action

IG Outline: Appendices Covers Acronyms and Key Terms used in IG Includes consolidated list of conformance statements, highlighting those that are constraints on base standards References Other IG-specific elements

Next Steps Review: Implementation Guide Template Next Solution Planning WG meeting is Thursday, May 22 from 12:00pm – 1:00pm ET Next All Hands meeting is Tuesday, May 27 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 – +Homepage +Homepage

Contact Information – Initiative Coordinators: Johnathan Coleman Sherry Green – ONC Leads: Mera Choi Jennifer Frazier Helen Caton-Peters Helen.Caton- – SAMHSA Leads Jinhee Lee Kate Tipping – Support Team: Project Management: Jamie Parker Ali Khan Use Case Development: Ahsin Azim Presha Patel Standards Development Support Alex Lowitt Harmonization Support Divya Raghavachari Atanu Sen Vocabulary and Terminology Subject Matter Expert: Mark Roche For questions, please feel free to contact your support leads: