Final Current Standards Landscape Analysis June 3 rd, 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 2a+7a+6: EHR to out-of-state PMP via HIE + Hub 2b+7a/7b+6: Ph to out-of-state PMP via HIE/Ph. Int + Hub 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/Ph. Interm. In-State PDMP Out of State PDMP Hub EHR or Pharmacy System Hub 88

Summary of Transactions Data Flow Transactions Reviewed on 5/15 & 5/22 & 5/29 SPWG TransactionSystem - OutboundSystem Intermediary 1System Intermediary 2System Inbound 1aEHR-- PDMP 1bPharmacy IT-- PDMP 2aEHRHIE--PDMP 2bPharmacy ITPharm. Int. / Switch--PDMP 3aEHR--PDMP HubPDMPs 2a+7a+6EHRHIEPDMP HubPDMPs 3bPharmacy ITPDMP HubPDMPs 2b + 7a / 7b + 6Pharmacy 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 NARxCheck to PMIX Illinois and Ohio use a direct connection Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – Complete 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 Kansas leverages HIEs and PMPi data hub for all of their connections 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

TransactionSummary from SPWG 5/15Items Required for Further Clarification 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 SureScripts to enable this transaction (Intermediary to PDMP) in the future Lynne Gilbertson to verify if standards are currently being used (Nebraska) – Complete TransactionSummary from SPWG 5/22Items Required for Further Clarification 3a: EHR System to PDMP via Hub Ohio, Kansas use PMIX to connect to PMPi data hub PMP Gateway will be used in the future to centralize translations, where endpoints can communicate with gateway EHR provides translation from HL7 (V2/ADT?) to PMIX in Kansas pilots Hub functions as aggregator, depending on arrangements Clay Rogers and Jeff McGonigal to verify translation/EHR generating PMIX request– Complete

TransactionSummary from SPWG 5/22Items Required for Further Clarification 2a + 7a + 6: EHR System to HIE to Hub to PDMP Indiana and North Dakota provides translation to PMIX from the HIE to the Hub HIE translates using NCPDP SCRIPT with PMIX wrapper for Hub SureScripts and Emdeon used by EHR Systems to obtain medication history data – not yet used for controlled substance history Emdeon does not support HL7 SureScripts predominantly supports SCRIPT Ohio EHR Systems leverages NARxCheck as an interface to in-state PDMP Does not go through HIE or Hub (PMPi) HL7 ADT used as a trigger to send query NARxCheck handles transformation of HL7 to PMIX architecture Message received by PMP: PMIX-NIEM NARxCheck does not act as a hub but may get information from PMPi Does not go through interconnect directly Jinhee Lee to verify how Indiana performs translation from HIE to Hub – Complete Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP – Complete

TransactionSummary from SPWG 5/29Items Required for Further Clarification 3b: Pharmacy IT System to PDMP via Hub Hub to PDMP available for use but is not currently in production Pharmacy IT System to hub not currently in use Technology may be used in the future Ohio to possibly pilot for a pharmacy chain to go through hub (one of 16 states that is a part of SAHMSA grant) Support Team to determine what standards these transactions are based on – In progress 2b + 7a/7b + 6: Pharmacy IT System Interstate Workflow Not currently in use but Pharmacy IT System May be able to go through intermediary in the future Pharmacy workflow using controlled substance medication history through a Pharmacy Intermediary could be a future use case PDMP checking on a claim vs. query of history for controlled substances N/A

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

Summary Analysis Strategy Details  Implementation Guide focus will shift to those organizations providing transformations/translation/ ETL services  ASAP can provide point-to-point PDMP data exchange for Pharmacies and EHRs a like – can be transformed into PMIX Architecture via Appriss, Inc. (PMPi)  Intermediaries provide translation service or metadata transformations as “wrappers”  Data elements will need to be modified or added, specified within the PDMP & HITI Implementation Guide Example Container/Payload Configuration ASAP Web Services HL7 V2 Messaging NCPDP SCRIPT Medication History PMIX-NIEM Architecture PDMP Hub Intermediary Health IT System Standard PDMP Standard Translation (Patient Data)

Transaction Workflows

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

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 NARxCheck

Current In-State Pharmacy Workflow (Pharmacy Int. / Switch) Pharmacy System Pharmacy Intermediary / Switch In-State PDMP Request Response Legend ? ? ? ? Transaction 2b SCRIPT used for medication history but does not currently pull Controlled Substance history from Intermediaries using SCRIPT standard.

Current In-State EHR Workflow (Hub) EHR System In-State PDMP Request Response Legend PMIX Transaction 3a – Not Effective Workflow? Currently Active? PDMP Hub Interface PMIX HL7

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

Current Interstate EHR Workflow EHR System HIE In-State PDMP Request Response Legend NCPDP SCRIPT (Medication History) Third Party Software PMIX-NIEM 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

System Transaction-Relationship Flow Known To Confirm Legend