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S&I Framework Prescription Drug Monitoring Program Initiative PDMP-to-EHR Data Format Standard Driving To Consensus – Assessment of Four Candidate Data Formats

First Topic - Review Page 3 Reach consensus on data format standard for exchanging patient information between PDMP and provider EHR systems 11 February: – Consensus on Data Elements to support the Use Case – Consensus on the four candidate data format standards – Initiated discussion of attributes to be used for assessment

Data Format Standard – Community Discussion Page 4 Google Groups Discussions: – Continued discussion of assessment attributes Ten attributes proposed, grouped by qualitative level of importance to the Use Case Three rankings suggested for each For Today (25 February): – Brief overview of the assessment process – Share assessment of the four standards – Develop consensus recommendation for the data format standard

PDMP Data Format Evaluation 5 The Use Case – A provider logs into an EHR system for a patient encounter – Patient presents with pain treatable with a controlled substance – EHR automatically queries the PDMP using patient identification – PDMP presents Provider with existing patient prescription information – Provider can make informed decisions about treatment options Overview of the strategy for evaluating the proposed standards – List the standards under consideration – Establish the criteria for the evaluation, and the appropriate weighting for the Use Case Assess each standard and make a recommendation

Standards for Consideration 6 Based on PDMP S&I Framework Community WebEx meetings and discussions managed over Google Groups threads, the following standards have been identified by the community for evaluation: ASAP Web Service NCPDP Script (Medication History Request and Response messages) PMIX PDMP Schemas (based on NIEM) Consolidated CDA

Attributes for Standard Assessment 7 AttributeRelative Scale Weighted Value Availability of an XML formatVery important3 Ease of adoption and integration by EHRs/HIEs– includes technical complexity Very important3 Speed of adoption into the EHR/HIE Ecosystem– how widely used is it, plus others Very important3 Wide use of the XML version of the formatImportant2 Suitability for the PDMP-to-EHR Patient Encounter Use Case– coverage of necessary data elements Important2 Separation of transport and contentImportant2 Ease of adoption and integration by PDMPsLess important1 Speed of adoption into the PDMP EcosystemLess important1 Available at no costLess important1 Accredited standards bodyLess important1

Assessment Raw Score 8 Each of the attributes proposed as an assessment criterion can be found in shortened version in the left column labels in the following table. Each standard was applied a raw score according to the following: Raw Score DescriptionRaw Score Standard meets 3 Standard partially meets 2 Standard does not meet 1

Assessment Table 9 CriterionWeightASAPNCPDPPMIX/NIEMCCDA Raw Score Score x Weight Raw Score Score x Weight Raw Score Score x Weight Raw Score Score x Weight XML Spec EHR Ease EHR Speed XML Use Suitability Separation PDMP Ease PDMP Speed Cost Accredited TOTALS

Consensus on Data Standard 10 NCPDP and CCDA rank highest, with NDPDP edging out CCDA Do we have consensus around NCPDP as the data standard that best addresses our Use Case?

PDMP S&I at HIMSS 11 PDMP: Technical Framework for Interoperability WHEN: Wednesday, March 6 th TIME: 11:00 AM – 12:00 PM CT LOCATION: HIMSS13 Conference, New Orleans, LA MITRE Government VIP Room #213 MITRE will convene representatives from the S&I Initiative, the EHR vendor community, and other interested parties to explore the recommendations from the Standards & Interoperability Framework Initiative. There will be a demonstration featuring an open source reference implementation for integrating PDMPs with electronic health record systems. The goal of this forum is to allow participants to connect and summarize the outcomes of the effort to enable interoperability between HIE/EHR and PDMP vendors.

Also at HIMSS… 12 PDMP: An Introduction to Using Health IT to Combat Prescription Drug Abuse WHEN: Monday, March 4 th TIME: 2:00 – 3:00 PM CT LOCATION: HIMSS13 Conference, New Orleans, LA MITRE Government VIP Room #213 This session will share an overview of the effort to enhance access to prescription drug monitoring programs (PDMP). The goal is to educate, raise awareness and build connections between key stakeholders who have not been involved in the project work to date. Sharing information to date will provide stakeholders with the initial framework to pursue PDMP initiatives. PDMP: Pilot Impact, In Their Own Words WHEN: Tuesday, March 5 th TIME: 4:00 – 5:00 PM CT LOCATION: HIMSS13 Conference, New Orleans, LA MITRE Government VIP Room #213 The PDMP project is conducting multiple pilots to rapidly test the feasibility of using health IT to enhance PDMP access and affect clinical decision making. This session will present a deeper dive into the design and outcomes of four FY13 pilots showcasing the workflow, ease of use, and added technical value of presenting PDMP data in EHR and pharmacy systems. The goal of this session is to have multiple pilot participants share specific information about their pilot designs and outcomes.

13 Backup

Jan 28 Meeting: Scoping – the Use Case The primary use case centers on getting initial PDMP information to EHRs 14 Not all data elements can be regarded the same Some elements may not be recorded in the PDMP (variations across states, for example) Some elements may be more important for this use case than others

PDMP S&I Community Focus/Scope Page 15 Pharmacy PMPi / RxCheck PMPi / RxCheck PDMP Other State PDMPs NCPDP Script PDMP Portal Switches NCPDP Telecom ASAP Pharmacy Benefits Mgmt Provider EHR System NIEM-PMP Provider EHR System Provider EHR System Data Out Needs for standards (data format and content; transport and security protocols)

WG Recommended Set of Data – the “Complete” List ■The Work Groups defined a standard set of data that should be available to support clinical decision making Page 16 PatientPrescriberDispenserPrescription First name Last name Street address City State ZIP code Date of birth Identification (ID) qualifier and/or patient identifier (situational) Gender code (situational) Species code (situational) Phone number (situational) First name Last name Street address City State ZIP code Phone number (situational) Drug Enforcement Agency (DEA) number (situational) Pharmacy or dispensing prescriber name Street address City State ZIP code Phone number (situational) DEA number (situational) National Council for Prescription Drug Programs (NCPDP)/National Association of Boards of Pharmacy (NABP) Provider ID (situational) National Provider Identifier (NPI) (situational) Name of drug Strength Form Quantity dispensed Days’ supply dispensed Date prescription filled Date written Refills authorized Refill number Refill status to indicate a full or partial refill Prescription number Full list recommendation: section page 16-17