1. PRESENTATION TO THE STANDARDS AND INTEROPERABILITY FRAMEWORK WORKGROUP MAY 21, 2014 3 PM Prescription Drug Monitoring Programs and the PMIX Architecture

2. What is a Prescription Drug Monitoring Program? A prescription drug monitoring program (PDMP) is a state program that collects controlled substance prescription records from dispensers and then provides prescription histories and other compiled and/or analyzed data to authorized end-users for use in clinical care, law enforcement, regulation of professional practice, research and evaluation.

3. PDMP Models States with internally developed solutions *  Data storage – 16  Report generation – 15  Data collection – 8  Web hosting - 8 States with third party solutions (Six different vendors)*  Data collection – 41  Web hosting – 38  Report generation – 34  Data storage – 33 Staffing - Average staff size 2.96**  13 PDMPs have 1 employee  16 PDMPs have 2 employees  7 PDMPs have 3 employees  5 PDMPs have 5 or more employees Mandated participation vs voluntary participation * - responses are from a March 2014 survey of PDMPs by the PDMP Training and Technical Assistance Center at Brandies University. 47 PDMPs responded to this portion of the survey. **41 PDMPs responded

4. Status of Prescription Drug Monitoring Programs (PDMPs) AK AL AR CA CO ID ILIN IA MN MO MT NE 1 NV ND OH OK OR TN UT WA AZ SD NM VA WY MI GA KS HI TX ME MS WI NY PA LA KY NC SC FL VT WV Operational PDMPs Enacted PDMP legislation, but program not yet operational Legislation Pending NH MA RI CT NJ DE MD DC 2 1 The operation of Nebraska’s PMP is currently being facilitated through the state’s Health Information Initiative. Participation by patients, physicians, and other health care providers is voluntary. 2 The Mayor of D.C. has approved the legislation but it is pending a 30-day review process by Congress. © 2014 The National Alliance for Model State Drug Laws (NAMSDL)..

5. Prescription Information Collected by PDMPs Patient identification:  Name & Address  DOB & Gender  Pt Identifier Prescriber Information Dispensing Pharmacy Information Drug Information, e.g.  NDC # = name, type, strength, manufacturer  Quantity & date dispensed  Source of payment (some states)

6. Data Collected from Pharmacies PDMPs Collect Dispensed Controlled Substances Rx:  30 collect Schedules II – V  18 collect Schedules II – IV  1 collects Schedule II & III  1 collects Schedules II only  Some Collect Non-Controlled Medications  8 collect tramadol (Ultram®)  1 each – Butorphanol, butalbitol w/acetamenophen Some states collect “Drugs of Concern” e.g. Tramadol Reporting Frequency varies – POS, 24 hours, 7-30 days

7. PDMP Data Data is Provided to:  Doctors and other prescribers  Pharmacists  Health Professional Licensing Boards  Law Enforcement  Medical Examiners  Medicaid State Agencies  Other:  Drug Courts  Worker’s Compensation  Third Party Payers  Certified Drug Counselors These vary depending on individual state regulations regarding data sharing.

8. Impact of Prescription Monitoring in Virginia

10. Impact of Prescription Monitoring in Kentucky PDMP Use is Mandatory in KY HB1 made use mandatory as of 7/20/2012 Mandated use of the PDMP (KASPER) by Prescribers for Schedule II or Schedule III with hydrocodone Data provided by Kentucky All Schedule Prescription Electronic Reporting system

11. Impact of Prescription Monitoring in Kentucky Prescribers must: Query KASPER before initially prescribing Query once every 3 mos. for ongoing treatment Query before issuing new prescriptions or refills Data provided by Kentucky All Schedule Prescription Electronic Reporting system

12. Prescription Monitoring Information Exchange (PMIX) As electronic monitoring of prescription drugs advanced, the need to share data between PDMPs grew. The states realized that a standard for the exchange was needed. The initiative that established PMIX grew out of the Bureau of Justice Assistance/IJIS Institute PMP Committee.

13. The Four Pillars of the PMIX Architecture End to End Security Standards Based Exchange (GRA) Common Exchange Data and Metadata (NIEM) Hub Connections (Hub to Hub)

14. PMIX Architecture A information exchange standard designed by PDMP Administrators and based on:  National Information Exchange Model (NIEM) data & metadata  Global Reference Architecture (GRA) Profile  Open Standards Contains:  Information Exchange Package Documentation (IEPD)  State to State Service Specification  Hub to Hub Service Specification  Execution Context Document

15. PMIX Architecture Specifically designed for:  Flexibility in its use  Hub to Hub  State to State  Direct Connections by various third parties  PMP to PMP security and privacy using Public Key Infrastructure (PKI)  Cost Effective Use (no fees for using PMIX)  Compliance with Grant Requirements Supported by NABP and BJA/IJIS

16. Choice and Flexibility Hub State Routing Service (SRS) SRS Potential In-state Partners PMP System PMP System PMP System PMP System Hub PMP System PMP System

17. Ohio Automated Rx Reporting System (OARRS) HIT to PDMP Data Sharing utilizing the PMIX Architecture Coming Soon!

18. HIT to OARRS Connectivity Utilized Web Service (PMIX Architecture) A web-based application intended for software consumption Typical credential is digital certificate The connecting software/customer organization authenticates – not the end user

19. PMIX Work Group Representatives from AL, CA, FL, KY, ME, NM, OH, OK, VA, WA, Bureau of Justice Assistance and the PDMP Training and Technical Assistance Center. Recommend, review and approve enhancements to PMIX

20. Summary of PDMP Data Sharing Resources limited in many PDMPs State Regulations guide sharing Data available to share varies from state to state PMIX standard built on the common elements between states

21. Expanded Data Sharing Have a strong desire to data sharing with HIE, HIT and other parties Broad consensus that ease of access for providers will increase timely access and utilization of data

23. For More Information Chad Garner, Director, Ohio Automated Rx Reporting System (OARRS) – cgarner@ohiopmp.gov Ralph Orr, Director, Virginia Prescription Monitoring Program – ralph.orr@dhp.virginia.gov Don Vogt, PMP Program Manager, Oklahoma Bureau of Narcotics Prescription Monitoring Program – dvogt@obn.state.ok.us Jean Hall, Integration Project Manager, Kentucky All Schedule Prescription Electronic Reporting – jean.hall@ky.gov