1. PDMP & Health IT Integration Use Case & Functional Requirements
February 21, 2014 1

2. PDMP & HIT Integration Initiative Proposed Use Case & Functional Requirements Development Timeline
Week
Target Date (2014)
All Hands WG Meeting Tasks
Review & Comments from Community via Wiki page
due following 12 noon 1
1/7
Use Case Kick-Off & UC Process Overview
Introduce: In/Out of Scope, Context Diagram and Scenario
Concert Series Presentation: ASAP
Review: In/Out of Scope, Assumptions, and Context Diagram 2
1/14
Review: In/Out of Scope, Context Diagram, Assumptions , Scenario
Introduce: User Stories
Review: User Stories, In/Out of Scope, Assumptions, and Context Diagram 3
1/21 4
1/28
Review: Context Diagram and User Stories
Introduce: Pre/Post Conditions, Actor and Roles
Concert Series Presentation: OneHealthPort & WADOH
Review: Pre/Post Conditions, Actors and Roles, and User Stories 5
2/4
Review: Context Diagram and User Stories
Review: Pre/Post Conditions, Actors and Roles, and User Stories 6
2/11
Review Pre/Post Conditions, Actors and Roles, and User Stories 7
2/21
Review: User Stories, Post Conditions, Actors and Roles, Activity Diagram and Base Flow
Review: Activity Diagram and Base Flow 8
2/25
Review Functional Requirements and Sequence Diagram
Introduce: Data Requirements and Issues and Risks
Review: Data Requirements and Issues and Risks 9
3/4
Review: Data Requirements and Risks & Issues
Begin End-to-End Review
End-to-End Review by community 10
3/11
End-to-End Comments Review & disposition
End-to-End Review ends 11
3/18
Finalize End-to-End Review Comments & Begin Consensus
Begin casting consensus vote 12
3/25
Consensus Vote*
Conclude consensus voting

3. Click the icon to open the
Section Review
Note- Below sections will be reviewed within the separate Use Case word document:
Discuss and review the following sections:
User Stories
Post-Conditions
Actors and Roles
Activity Diagrams and Base Flows
Click the icon to open the
Word Document

4. PDMP Workflow
It is understood that there are various workflows that could take place when a Healthcare Professional queries a PDMP and the specific processes may vary depending on the type of user.
A Healthcare Professional may need to obtain patient history of controlled substances dispensed from a PDMP for a Person of Interest. To do so, the Healthcare Professional may need to authenticate to his/her specific Health IT system. It is also understood that an adjudication process may take place between the Healthcare Professional’s Health IT system and the PDMP to filter which prescriptions belong to the intended patient. At the end of the adjudication process, the Healthcare Professional’s receiving system is hosting a set of prescription records and renders the records. After receiving the query response, the Healthcare Professional could make an informed decision of whether or not to prescribe/dispense the medication or modify the treatment based on the information received.
A Health IT system (EHR or Pharmacy IT system) can be used to seek out information stored in a PDMP regarding medications dispensed to patients. This Use Case considers 3 possible workflows:
HIT to In-State PDMP directly
HIT to Hub to PDMP
HIT to HIE/Pharmacy Intermediary to PDMP
For the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, Hub, or HIE/Pharmacy Intermediary

5. HIE/ Pharmacy Intermediary
Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
Scenario #1 – HIT to In-State PDMP
Scenario #2 – HIT to Hub
Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy System
EHR or Pharmacy System
Hub
EHR or Pharmacy System
HIE/ Pharmacy Intermediary 5

6. HIE/ Pharmacy Intermediary
Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
Scenario #1 – HIT to In-State PDMP
Scenario #2 – HIT to Hub
Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy System
EHR or Pharmacy System
Hub
EHR or Pharmacy System
HIE/ Pharmacy Intermediary 6

7. Scenario #1 – HIT to In-State PDMP User Story 1
Scenario #1 – HIT to In-State PDMP User Story 1.1 – Legally authorized provider queries PDMP before writing a prescription for a PDMP reported controlled substance for a patient
Draft User Story: A patient arrives at the physician’s office or hospital for treatment that may require a controlled substance prescription. If necessary, the physician authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to the State PDMP to obtain patient history of controlled substances dispensed. After receiving the query response from the PDMP, the physician makes an informed decision of whether or not to prescribe the medication or modify the treatment based on the information received.
1. Query is sent to State PDMP to obtain patient history of controlled substances dispensed
2. PDMP sends query response 7

8. Scenario #1 – HIT to In-State PDMP User Story 1
Scenario #1 – HIT to In-State PDMP User Story 1.2 – Pharmacist queries PDMP prior to dispensing a PDMP reported controlled substance to a patient
Draft User Story: A patient arrives at the pharmacy to have a prescription filled. The pharmacist authenticates to the Pharmacy Dispensing system. After, the pharmacist sends a query to the State PDMP through the Pharmacy Dispensing system to obtain patient history of controlled substances dispensed. After receiving the query response from the PDMP, the pharmacist makes an informed decision of whether or not to dispense the medication based on the information received.
1. Query is sent to State PDMP to obtain patient history of controlled substances dispensed
2. PDMP sends query response 8

9. HIE/ Pharmacy Intermediary
Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
Scenario #1 – HIT to In-State PDMP
Scenario #2 – HIT to Hub
Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy System
EHR or Pharmacy System
Hub
EHR or Pharmacy System
HIE/ Pharmacy Intermediary 9

10. Scenario #2 – HIT to Hub User Story 2
Scenario #2 – HIT to Hub User Story 2.1 – Legally authorized provider queries PDMP through a hub before writing a prescription for a PDMP reported controlled substance for a patient
Draft User Story: A patient arrives at the physician’s office or hospital for treatment that may require a controlled substance prescription. If necessary, the physician authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to a Hub through the Health IT system to obtain patient history of controlled substances dispensed. The Hub receives the query. The Hub sends the query response back to the Health IT system where the query originated. After receiving the query response(s), the physician makes an informed decision of whether or not to prescribe the medication or modify the treatment based on the information received.
1. Query is sent to a Hub to obtain patient history of controlled substances dispensed
Hub
2. Hub sends query response 10

11. Scenario #2 – HIT to Hub User Story 2
Scenario #2 – HIT to Hub User Story 2.2 – Pharmacist queries PDMP through a Hub prior to dispensing a PDMP reported controlled substance to a patient
Draft User Story: A patient arrives at the pharmacy to have a prescription filled. The pharmacist authenticates to the Pharmacy Dispensing system. After, the pharmacist sends a query to the Hub through the Pharmacy Dispensing system to obtain patient history of controlled substances dispensed. The hub receives the query. The hub sends the query response back to the Health IT system where the query originated. After receiving the query response, the pharmacist makes an informed decision of whether or not to dispense the medication based on the information received.
1. Query is sent to a Hub to obtain patient history of controlled substances dispensed
Hub
2. Hub sends query response 11

12. HIE/ Pharmacy Intermediary
Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
Scenario #1 – HIT to In-State PDMP
Scenario #2 – HIT to Hub
Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy System
EHR or Pharmacy System
Hub
EHR or Pharmacy System
HIE/ Pharmacy Intermediary 12

13. Scenario #3 – HIT to HIE/Pharmacy Intermediary User Story 3
Scenario #3 – HIT to HIE/Pharmacy Intermediary User Story 3.1 – Legally authorized provider queries PDMP through an HIE before writing a prescription for a PDMP reported controlled substance for a patient
Draft User Story: A patient arrives at the physician’s office or hospital for treatment that may require a controlled substance prescription. If necessary, the physician authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to an HIE through the Health IT system to obtain patient history of controlled substances dispensed. The HIE receives the query. The HIE sends the query response back to the Health IT system where the query originated. After receiving the query response(s), the physician makes an informed decision of whether or not to prescribe the medication or modify the treatment based on the information received.
1. Query is sent to an HIE to obtain patient history of controlled substances dispensed
HIE
2. HIE sends query response 13

14. Pharmacy Intermediary
Scenario #3 – HIT to HIE/Pharmacy Intermediary User Story 3.2 – Pharmacist queries PDMP through a Pharmacy Intermediary prior to dispensing a PDMP reported controlled substance to a patient
Draft User Story: A patient arrives at the pharmacy to have a prescription filled. The pharmacist authenticates to the Pharmacy Dispensing system. After, the pharmacist sends a query to the Pharmacy Intermediary through the Pharmacy Dispensing system to obtain patient history of controlled substances dispensed. The Pharmacy Intermediary receives the query. The Pharmacy Intermediary sends the query response back to the Health IT system where the query originated. After receiving the query response, the pharmacist makes an informed decision of whether or not to dispense the medication based on the information received.
1. Query is sent to a Pharmacy Intermediary to obtain patient history of controlled substances dispensed
Pharmacy Intermediary
2. Pharmacy Intermediary sends query response 14

15. PDMP & HIT Integration – Pre/Post Conditions
To be reviewed in Word Document
Pre-Conditions
The necessary access controls and authorization protocols based on State and/or Federal regulations (which could include patient consent or privacy permissions) for any of the systems or users described, are in place
The Health IT system application can provide necessary/required authorization, authentication or privacy information to the PDMP
The Health IT system can apply PDMP authorization requirements to restrict access to PDMP data to authorized users
If an intermediary, such as a Hub, is used it provides necessary technology infrastructure to allow PDMP data exchange from the PDMP to the Health IT system
Query parameters required to create the query in a standardized format by the Health IT system/Hub are recognized and accepted by the PDMP system
The PDMP system can provide a query response in a standardized format which is recognized and accepted by the Hub/Health IT system
Health IT System and PDMP have a common understanding of the shared vocabulary that are required to initiate the queries and provide the query results
In the event a request is parsed out to other states and the other states respond back, the Health IT system, Hub (if applicable) and PDMP systems will have knowledge about the order of succession to provide the response
Health IT System or Hub is able to determine which state PDMP(s) should receive the query
Post-Conditions
Health IT System has sent a query
PDMP system has received the query
PDMP system has sent a response to the Health IT system
Health IT system has successfully received the query results from the PDMP system
Health IT system can display/present query response

16. PDMP & HIT Integration – Actors and Roles
To be reviewed in Word Document
Actor
System
Role
Health Care Professional
Health IT System
Send query
Receive query response
PDMP
PDMP System
Receive query
Send query response
Hub ?

17. PDMP & HIT Integration – Activity Diagrams & Base Flows
An Activity Diagram is a special form of a state transition diagram in which all or most of the states are activity states or action states. An action state represents the fulfillment of associated responsibilities in response to the communication received from the previous step. Most transitions are triggered by completion of activities in the source states.
The Base Flow presents the step by step process of the information exchange depicted in the activity diagram (above). It indicates the actor who performs the action, the description of the event/action, and the associated inputs (records/data required to undertake the action) and outputs (records/data produced by actions taken).
The following slides consist of an Activity Diagram and Base Flow for each scenario:
HIT to In-State PDMP directly
HIT to Hub to PDMP
HIT to HIE/Pharmacy Intermediary to PDMP

18. Step #
Actor
Role
Event/Description
Inputs
Outputs 1
Healthcare Professional
Request Sender
HC Professional’s HIT System sends query to obtain patient history of controlled substances
HC Professional identifies patient of interest from his/her HIT System.
Patient history of controlled substances request initiated and sent in standard format and content specification 2
PDMP
Request Receiver
PDMP receives the query for patient history of controlled substances through HC Professional’s HIT System
Patient history of controlled substances request
Patient history of controlled substances in standard format 3
Results Sender
PDMP sends query response to HC Professional through his/her HIT system
Patient history of controlled substances 4
Results Receiver
HC Professional receives query response through his/her HIT System
END

19. Step #
Actor
Role
Event/Description
Inputs
Outputs 1
Healthcare Professional
Request Sender
HC Professional’s HIT System sends query to obtain patient history of controlled substances
HC Professional identifies patient of interest from his/her HIT System.
Patient history of controlled substances request initiated and sent in standard format and content specification 2
Hub
Request Receiver
Hub PDMP receives the query for patient history of controlled substances through HC Professional’s HIT System
Patient history of controlled substances request
Patient history of controlled substances in standard format 3
Results Sender
Hub sends query response to HC Professional through his/her HIT system
Patient history of controlled substances 4
Results Receiver
HC Professional receives query response through his/her HIT System
END

20. Step #
Actor
Role
Event/Description
Inputs
Outputs 1
Healthcare Professional
Request Sender
HC Professional’s HIT System sends query to obtain patient history of controlled substances
HC Professional identifies patient of interest from his/her HIT System.
Patient history of controlled substances request initiated and sent in standard format and content specification 2
HIE/Ph. Intermediary
Request Receiver
HIE/Ph. Intermediary receives the query for patient history of controlled substances through HC Professional’s HIT System
Patient history of controlled substances request
Patient history of controlled substances in standard format 3
Results Sender
HIE/Ph. Intermediary sends query response to HC Professional through his/her HIT system
Patient history of controlled substances 4
Results Receiver
HC Professional receives query response through his/her HIT System
END

21. Next Steps Review: Activity Diagrams and Base Flows
Next Meeting is Tuesday, February 25 from 12:00pm - 1:30pm EST
Reminder: All PDMP & HIT Integration Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and general information will be posted on the PDMP Wiki page

22. Contact Information
For questions, please feel free to contact your support leads:
Initiative Coordinators:
Johnathan Coleman
Sherry Green
ONC Leads:
Mera Choi
Jennifer Frazier
Helen Caton-Peters
SAMHSA Leads
Jinhee Lee
Kate Tipping
Support Team:
Project Management:
Jamie Parker
Ali Khan (Support)
Use Case Development:
Ahsin Azim
Presha Patel
Vocabulary and Terminology Subject Matter Expert:
Mark Roche