Finalized Solution Plan July 1 st, 2014

Solution Planning Work Group Approach 1. Overlay standards currently in general use per transaction - focus on transactions for integrated solutions 3. For prioritized 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

Solution Planning Approach 1. How to take HL7 V2, NCPDP SCRIPT, ASAP and transform to PMIX Architecture-NIEM Standards? 2. What gaps have been identified to perform necessary query out of HIT specific to PDMP? 3. Define technical architecture of total solution. Variant 1: Intermediary provides translation functionality Variant 2: Translation is handled at EHR, providing mapping to PMIX from native EHR standards Variant 3: Interface engine at EHR-level provides functionality to send PMIX message derived from native EHR standards. EHR / Pharmacy EHR / Pharmacy Ph. Interm. HIE PDMP Hub PDMP Most preferred workflow Translation / Routing EHR Origin Standard: HL7 V2 (acute) NCPDP SCRIPT (ambulatory + optional acute settings) ASAP Web Services PDMP Standard PMIX Pharmacy Origin Standard: HL7 V2 (in hospital) NCPDP SCRIPT (large retail pharmacies) ASAP Web Services

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

Solution Plan Finalization Implementation Approach Focus: Process: 1.Document PMIX payload + container data elements 2.Map HL7 V2, NCPDP SCRIPT Medication History, and ASAP Web Services message queries to PMIX Standard a.Detail required fields based on PMIX specification b.Identify gaps and optionality of request standards 3.Identify and document appropriate transport protocol that accommodates message content 4.Detail messaging schemas HL7 V2.7 Messaging NCPDP SCRIPT ASAP Web Services V1.R1 PMIX NIEM XML GRA Hub-to-Hub

Appendix

Use of an Intermediary: An entity or service that accepts an electronic transaction from another organization and electronically routes the transaction to a receiving entity. A switch/intermediary may perform value added services including detailed editing/messaging of input/output of data for validity and accuracy and translating data from one format to another. Intermediary Model EHR  HIE / Pharm. Intermediary / Switch / Clinical Exchange Network  In-State PDMP EHR  HIE / Pham. Intermediary / Switch/ Clinical Exchange Network  PDMP Hub  PDMPs Pharmacy  Pharm Int. / Switch / Clinical Exchange Network  In-State PDMP Pharmacy  Pharm Int. / Switch / Clinical Exchange Network  PDMP Hub  PDMPs Intermediaries EHR  Intermediary EHR  Intermediary  In-state PDMP EHR  Intermediary  Hub  PDMPs EHR  Intermediary Pharmacy  Intermediary  In-state PDMP Pharmacy  Intermediary  Hub  PDMPs