PDMP & HITI Solution Planning Workgroup Session June 19, 2014

Agenda 1.Solution Planning Approach / Status 2.Prioritization of relevant workflows via transaction-level analysis

Solution Planning Work Group Approach 1. Overlay standards currently in general use per transaction - focus on transactions for integrated solutions 3. For each alternate workflow, propose solutions for harmonizing standards in order to pull PDMP information into EHR or Pharm. IT Systems synchronously 2. 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

- 4 - Controlled Substance History Report, Integration Architecture Drivers TO: Easy, timely, consistent access to reliable PDMP data FROM: Pervasive challenges to access data within clinical workflows As-Is Architecture  Segmented conceptual framework for data exchange  Varying solution practices  Varying state requirements and source ownership (e.g., authorization, authentication protocols)  Flexible interstate data sharing and intermediaries facilitating open data exchange for authorized users  Constraints on cost for Δ in source data architecture  Constraints on ease of implementation of foreign standards in established functional models/frameworks To-Be Design Principles  Congruent data / message formats across integration sites  Compatible with established PMIX-NIEM architecture  Ability to support various front-end capabilities  Ability to integrate within existing technical systems and evolve to support regulatory/technology changes Health Information Exchanges Data harmonization and structuring of a data integration layer Interstate Data sharing Hubs Continuous improvement of real time reporting Vision Architecture Drivers Controlled Substance History Information Needs

- 5 - Integrated PDMP Data Exchange Architecture Solution Plan - Multi -Level Standards State PDMPs EHREMR User Interface (Presentation) Health IT / Clinical Databases Data Harmonization Source Systems Recommendation/Notes Pharmacy IT Out of scope - however… User access modes important to consider in standards selection. Modules within ambulatory and enterprise in- patient EHRs vary. Where would the interface be most effective? Define a comprehensive query-response strategy aligned to both EHRs and Pharmacy IT systems compatible with state PDMP architecture/regulations and intermediary capabilities/infrastructure. Defined standards architecture based on source data framework: PMIX-NIEM. Metadata transformations, routing PDMP Med History Architecture Pharm. Int / HIEs Establish standard data models and an approach for data harmonization; achieve standard and consistent data in this layer for query-response while addressing the source system layer in parallel. Translations are essential for compatible standards to interoperate. Hubs Translation / Transformation ePrescribing CDS PMS Functions Med History/ Reconciliation Internal Med Orders HIE/PDMPs (Nebraska) Other Medication History Sources (eg. PBMs) Data Extraction / Transformation HL7 SCRIPT SCRIPT ASAP PMIX PMIX

Relevant Workflows Current Landscape Proposed Solution Set EHR  In-State PDMP Pharmacy  In-State PDMP EHR  Intermediary  In-State PDMP Pharmacy  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 PDMP Pharmacy  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 *Intermediary - An entity (service, or set of services) that routes the transaction to a receiving entity. May perform value added services such as translating data from one format to another Legend Proposed Potential Remove

Begin detailing solution and technical details (standards) Prioritize EHR/Pharm  Hub Solution Prioritize EHR/Pharm  Hub Solution Develop holistic solutions for Hub, Intermediary, and Direct workflows Leverage Hub Solution for EHR/Pharm  Intermediary workflow guidance Defer direct connection workflow model due to limited scalability and restriction of interstate data sharing Develop IG content based on PDMP Hub solution Develop IG content based on PDMP Intermediary solution Develop IG content based on PDMP Direct solution Deferment does not equate to elimination of workflows from inclusion in future solution plans and iterations/updates to the Implementation Guide

EHR Prioritization #Workflow ModelPrioritizationJustification 3a EHR to PDMP Hub to PDMPs High Capable of facilitating interstate data exchange with reduced complexity PDMP Hubs are compliant with state regulations regarding access and routing of PDMP-data Future hub capabilities support efficient workflow model Interstate data exchange drives organized data sourcing and in turn, is critical element to most interoperable state of data flow 2a EHR to Intermediary to PDMP (PDMP Hub to PDMP) Medium Scalable Provides flexibility in accommodating multiple standards Ability to leverage existing connections for clinical data Increased complexity due to additional connections and implication of policy/regulations on third party use 1aEHR to In-State PDMPLow Supports unique implementations and PDMP infrastructure Restrictive in expanding efficient interstate data sharing Reduced complexity, though not as highly scalable Perhaps necessary where policy hinders use of third parties for translation/transformation Pharmacy IT Prioritization #Workflow ModelPrioritizationJustification 3b Pharmacy IT to PDMP Hub to PDMPs High Same as transaction 3a Existing pilots established using workflow 2b Pharmacy IT to Intermediary to PDMP (PDMP Hub to PDMP) Medium Same as transaction 2a Concern regarding cost to participate May allow for future-state PDMP-data access through third parties 1b Pharmacy IT to In- State PDMP Low Same as transaction 1a Pharmacies typically leverage third party for medication history Limited perceived interest from user community

Evaluate Proposed Solutions Solution Plan:

Next Steps Review: Transaction and solution evaluations Next All Hands meeting is Tuesday, 6/24 from 12:00 pm to 1:00 pm ET o Data Elements Analysis Next Solution Plan Workgroup Session is Thursday, 6/26 from 12:00 pm to 1:00 pm ET o Evaluate prioritization of proposed workflows o Overlay technical standards for prioritized workflows to develop concrete solution 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 – mepage mepage