PDMP & HITI Solution Planning Workgroup Session I May 15 th, 2014

Purpose: Interdisciplinary work group (WG) comprised of PMP, Pharmacy, and EHR to develop technical architecture across actors and system functions to accelerate solution planning. SWG will provide recommendations to at-large community based on development of technical architecture and system/business requirements. Address the following questions: 1.Differences in pharmacy and clinician workflows / data systems and expectations in PDMP data transmitted? 2.What components of PDMP report are extracted for decision support? 3.Can EHR and Pharmacy IT systems handle the proposed standards (in the context of PDMP systems)? 4.What standard(s) fit into message and workflow configuration per transaction type? 5.Are transactions collapsible in terms of capability of leveraging same standard? Solution Planning Workgroup

4 main players and associated systems: 1.EHR/EMR systems are predominantly based off HL7 standards and functional models for internal module connectivity and NCPDP SCRIPT for transmission of e-prescriptions 2.Pharmacy IT systems leverage NCPDP for Rx file transfer, structured sig, claims, and billing 3.PDMPs leverage PMIX Architecture for interstate data exchange of controlled substance medication history 4.Dispensers follow ASAP Reporting Standards for submission of controlled substance medication history reports to state PDMPs 5.Interstate data sharing is currently enabled by passing queries through HIEs and then routing to PDMP Hubs 6.Most EHR integration is currently enabled via HIEs Current State: What We Know… ActorSystem CliniciansEHR | EMR PharmacistsPharmacy IT PDMP AdministratorsState PDMP Databases IntermediariesPDMP Hubs | HIEs | Pharmacy Intermediaries, Switches

1. Full view of Pharmacy IT transaction workflows 2. Reality of certain system-to-system transactions a. Pharmacy IT to PDMP Hub b. Pharmacy IT to HIE c. Direct connection from EHR to PDMP Hub d. HIE direct connection to Out-of-State PDMP 3. Transaction – Standard pairings across all viable interchange functions, focusing on HIT integrated PDMP data access a. Generally accepted solutions for each transaction involved in the integration of PDMP data within HIT System Current State: What We Don’t Know

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.

Context Diagram HIE/ Pharmacy Intermediary In-State PDMP Out of State PDMP Hub EHR or Pharmacy System Hub = In Scope

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

Current In-State HIT Integrated System Workflows

Current In-State EHR Workflow (Direct) EHR System In-State PDMP PMIX? Request Response Legend Transaction 1a Further clarification needed from Chad Garner on use of PMIX – AI: Jean Hall Need information on transactions occurring in Illinois, Kansas, Indiana – AI: Jinhee Lee EMRs don’t generally query PDMPs directly

Current In-State EHR Workflow (HIE) EHR System HIE In-State PDMP Request Response Legend HL7 OBX XML Report NCPDP SCRIPT HL7 ADT feeds NCPDP SCRIPT HL7 A04 NCPDP SCRIPT with PMIX Wrappers Third Party Software XML Response NCPDP SCRIPT with PMIX Wrapper Transaction 2a Some states that cannot make interstate connections might have no other option but to use this model Washington, Maryland, Maine, Oklahoma use this model Relatively uncommon in EHRs AI: What is the query/message pairing used to engage EHR system to HIE? Jean Hall to clarify further Washington response – PMIX-NIEM is mapped to NCPDP SCRIPT and responding with NCPDP SCRIPT message ADT used as trigger in Ohio, Indiana, Illinois, Kansas

Current In-State EHR Workflow (Hub) EHR System In-State PDMP Request Response Legend ? ? ? ? Transaction 3a – Not Effective Workflow? Currently Active? PDMP Hub

Current In-State Pharmacy Workflow (Direct) Pharmacy IT System In-State PDMP Request Response Legend Transaction 1b 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 Transaction 1b is not currently in use AI: Jean Hall to further clarify standards currently in use

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 SCRIPT Medication History and Telecommunication standards are 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 AI: Lynne Gilbertson to verify where standards are currently being used (Nebraska)

Current In-State Pharmacy Workflow (Hub) In-State PDMP Request Response Legend ? ? ? ? Transaction 3b – Not Effective Workflow? Currently Active? PDMP Hub Pharmacy System

Current Interstate HIT System Workflow

Current Interstate EHR Workflow EHR System HIE In-State PDMP Request Response Legend NCPDP SCRIPT Third Party Software Out-of- State PDMP PMIX-NIEM PDMP Hub PMIX-NIEM XML PMIX-NIEM XML Transaction 2a + 7a + 6

Current Interstate Pharmacy Workflow HIE In-State PDMP Request Response Legend NCPDP SCRIPT Third Party Software PMIX Wrappers PMIX-NIEM PDMP Hub PMIX-NIEM XML PMIX-NIEM XML Pharmacy System Pharmacy Int. / Switch Out-of- State PDMP NCPDP SCRIPT ? ? Transaction 2a + 2b + 7a + 7b + 6

Considerations: 1. Are all transactions necessary? 2. Differences between retail and in-hospital pharmacies workflow/architecture?

Next Steps: 1. Confirm relevant transactions-standards pairings for segmented data exchange workflows 2. Review and clarify System-Transaction Relationship workflow

Appendix

System Transaction-Relationship Flow Known To Confirm Legend