PDMP & HITI Solution Planning Workgroup Session May 22, 2014

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

Summary of Transactions Data Flow Transactions Reviewed on 5/15 SPWG TransactionSystem - OutboundSystem IntermediarySystem Inbound 1aEHRN/APDMP 1bPharmacy ITN/APDMP 2aEHRHIEPDMP 2bPharmacy ITPharm. Int. / SwitchPDMP Data Flow Transactions To Be Reviewed on 5/22 SPWG TransactionSystem - OutboundSystem Intermediary 1System Intermediary 2System Inbound 3aEHRPDMP HubPDMPs 3bPharmacy ITPDMP HubPDMPs 2a+7a+6EHRHIEPDMP HubPDMPs 2a + 2b + 7a + 7b + 6 Pharmacy 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 PMIX Kansas leverages HIEs and PMPi data hub for all of their connections Illinois and Ohio use a direct connection – need further clarification on standards used Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – In progress 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 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 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

Current In-State HIT Integrated System Workflows

Current In-State EHR Workflow (Hub) EHR System In-State PDMP Request Response Legend ? PMIX ? ? Transaction 3a – Not Effective Workflow? Currently Active? PDMP Hub Notes: Ohio, Kansas uses PMIX to connect to PMPi (data hub) PMIX data model *Future: PMP Gateway – centralize translations (endpoints can communicate with gateway) Kansas pilots – EHR provides translation from HL7 (V2/ADT?) to PMIX AI Clay/Jeff – Verify translation/EHR generating PMIX request Hub functions as aggregator, depending on arrangements

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

Current Interstate HIT System Workflow

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 Notes: Indiana, North Dakota (HIE-Hub) AI Jinhee: Verify Indiana translation HIE translates using NCPDP SCRIPT with PMIX wrapper for Hub Parking lot item: Ambulatory vs. Acute (different standards for different EHR systems?); In-hospital pharmacies vs. retail pharmacies AI Danna Droz/Chad Garner: Confirm third party software functionality – NARxCheck via NABP

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 Notes:

Questions to be answered: 1.Differences in pharmacy and clinician workflows / data systems and expectations in PDMP data transmitted? 2.How do we define intermediaries and their relationships to Health IT systems? 3.What components of PDMP report are extracted for decision support? 4.Can EHR and Pharmacy IT systems handle the proposed standards (in the context of PDMP systems)? 5.What standard(s) fit into message and workflow configuration per transaction type? 6.Are transactions collapsible in terms of capability of leveraging same standard? 7.Are all transactions necessary? 8.Differences between retail and in-hospital pharmacies workflow/architecture? 9.What is the cost associated with the proposed solutions? 10.How do we define an aggregator? (collection of response from different PDMPs back to recipient) 11.Parking lot item: Ambulatory vs. Acute (different standards for different EHR systems?); In-hospital pharmacies vs. retail pharmacies

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

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

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

Current In-State Pharmacy Workflow (Direct) Pharmacy IT System In-State PDMP Request Response Legend Transaction 1b

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 Notes: SureScripts: Not live today (intermediary to PDMP) but may be a future state Does not include PDMP but is part of a future enhancement to provide requestor