1. PDMP & HITI Solution Planning Workgroup Session
May 29, 2014

2. HIE/ Pharmacy Intermediary
In-State PDMP
Out of State PDMP
Hub
EHR or Pharmacy System 1 2 3 4 6 5 7 8
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
Transactions
Scope
From
Via To
1a1b 
EHR
Pharmacy -
In-State PDMP
2a 2b
HIE
Ph. Int 3a 3b
Hub 4 
In-State PDMP
Out of State PDMP 5a 5b
Ph. Intermediary
Out-of-State PDMP 6 7a 7b 8

3. Summary of Transactions
Data Flow Transactions Reviewed on 5/15 & 5/22 SPWG
Transaction
System - Outbound
System Intermediary 1
System Intermediary 2
System Inbound 1a
EHR --
PDMP 1b
Pharmacy IT 2a
HIE 2b
Pharm. Int. / Switch 3a
PDMP Hub
PDMPs
2a+7a+6
Have not yet performed necessary analysis on EHRs capabilities to handle certain standards and implications to existing vendor solutions.
Data Flow Transactions To Be Reviewed on 5/29 SPWG
Transaction
System - Outbound
System Intermediary 1
System Intermediary 2
System Inbound 3b
Pharmacy IT
PDMP Hub
PDMPs
2a + 2b + 7a + 7b + 6
Pharm. Int. / Switch or
HIE

4. Items Required for Further Clarification
Transaction
Summary from SPWG 5/15
Items 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

5. Items Required for Further Clarification
Transaction
Summary from SPWG 5/15
Items 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
Summary from SPWG 5/22
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
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: SCRIPT (predominantly) and HL7 (Emdeon does not support) used to connect to SureScripts for medication history (EHR  Intermediary),
Does not connect to a PDMP
Ohio EHR systems  (NARxCheck used as interface, does not “go through” hub)  PDMP (does not use HIE or PMPi)
ADT used as trigger to send query to PDMP through NARxCheck
PMIX used from NARxCheck to PDMP
Jinhee Lee to verify how Indiana performs translation from HIE to Hub
Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP – NARxCheck uses ADT feed and directly connects to OARRs system, which uses PMIX
NARxCheck does not act as a hub but may get information from PMPi (does not go through interconnect directly)
What type of message is being sent from NARxCheck

6. Summary of Current Standards Landscape
What we know:
Several states utilize the EHR  HIE  PDMP transaction
Some states that cannot make interstate connections might have no other option but to use this model
PMIX-NIEM is the standard used for the Hub to PDMP transaction
Translation from HL7 messaging to PMIX must occur prior to Hub to PDMP transaction
Thus, translations can occur from the EHR system to the HIE, the HIE to the Hub, the EHR system to the Hub, or the HIE to the PDMP
HL7 ADT is used as a trigger in several states
Currently, EHR systems and Pharmacy IT systems do not generally query the PDMP directly
ASAP Web Services standard was developed specifically for this purpose

7. Current In-State HIT Integrated System Workflows

8. Current In-State Pharmacy Workflow (Hub)
Transaction 3b – Not Effective Workflow? Currently Active?
Translation?
Pharmacy System
Translation?
In-State PDMP
PDMP Hub
PMIX ?
PMIX
Notes:
Hub to PDMP available for use but is not currently in production
Pharmacy system to hub not currently in use
May be used in the future; under development
AI: Alex/Divya to follow up with more information
What standards these transactions are based on?
Ohio to possibly pilot for pharm chain to go through hub (one of 16 states that is a part of SAHMSA grant)
Request
Response
Legend

9. Current Interstate HIT System Workflow

10. Current Interstate Pharmacy Workflow
Transaction 2a + 2b + 7a + 7b + 6
HIE
In-State PDMP
Pharmacy System
Third Party Software
PMIX Wrappers
NCPDP SCRIPT
PMIX-NIEM
XML
PMIX-NIEM
XML
PMIX-NIEM
Pharmacy Int. / Switch
NCPDP SCRIPT
PDMP Hub
Out-of-State PDMP
PMIX-NIEM ?
Request
Response
Legend
Notes:
Not currently in use but Pharmacy IT System may be able to go through intermediary in the future
Pharmacy workflow using medication history could be a future use case – PDMP checking on a claim vs. query of history ?

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

12. Controlled Substance History Report, Integration Architecture Drivers
FROM:
Pervasive challenges to access data within clinical workflows
TO:
Easy, timely, consistent access to reliable PDMP data
Vision
As-Is Architecture
Segmented conceptual framework for data exchange
Varying solution practices
Varying state requirements and source ownership (e.g., authorization, authentication protocols)
Flexible interstate data sharing and intermediaries facilitating open data exchange for authorized users
Constraints on cost for Δ in source data architecture
Constraints on ease of implementation of foreign standards in established functional models/frameworks
To-Be Design Principles
Congruent data / message formats across integration sites
Compatible with established PMIX-NIEM architecture
Ability to support various front-end capabilities
Ability to integrate within existing technical systems and evolve to support regulatory/technology changes
Architecture
Health Information Exchanges
Interstate Data sharing Hubs
Data harmonization and structuring of a
data integration layer
Continuous improvement of real time reporting
Drivers
Controlled Substance History Information Needs

13. PDMP Med History Architecture Recommendation/Notes
Integrated PDMP Data Exchange Architecture Solution Plan - Multi -Level Standards
PDMP Med History Architecture
Recommendation/Notes
Out of scope - however…
User access modes important to consider in standards selection. Modules within ambulatory and enterprise in-patient EHRs vary. Where would the interface be most effective?
CDS
Med History/ Reconciliation
ePrescribing
Internal Med Orders
PMS Functions
User Interface (Presentation)
HL7 SCRIPT
EHR
EMR
Pharmacy IT
Define a comprehensive query-response strategy aligned to both EHRs and Pharmacy IT systems compatible with state PDMP architecture/regulations and intermediary capabilities/infrastructure.
Health IT / Clinical Databases
Translation / Transformation
SCRIPT ASAP PMIX
Metadata transformations, routing
Pharm. Int / HIEs
Hubs
Data Harmonization
Establish standard data models and an approach for data harmonization; achieve standard and consistent data in this layer for query-response while addressing the source system layer in parallel. Translations are essential for compatible standards to interoperate.
Data Extraction / Transformation
State PDMPs
PMIX
Source Systems
HIE/PDMPs (Nebraska)
Defined standards architecture based on source data framework: PMIX-NIEM.
Other Medication History Sources (eg. PBMs)

14. Review Proposed Solutions
Solution Plan Review
Review Proposed Solutions

15. Appendix

16. HIE/ Pharmacy Intermediary
Context Diagram
HIE/ Pharmacy Intermediary 2 5 2 7 4
EHR or Pharmacy System
In-State PDMP
Out of State PDMP
Hub 1 8 8 3 3 7
Hub 6
= In Scope

17. System Transaction-Relationship Flow
Known
To Confirm
Legend

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

19. Current In-State EHR Workflow (HIE)
Transaction 2a
HL7 A04
NCPDP SCRIPT with PMIX Wrappers
Third Party Software
HL7 ADT feeds
NCPDP SCRIPT
EHR System
HIE
In-State PDMP
HL7 OBX
XML Report
NCPDP SCRIPT
XML Response
NCPDP SCRIPT with PMIX Wrapper
Request
Response
Legend

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

21. Current In-State Pharmacy Workflow (Pharmacy Int. / Switch)
Transaction 2b
NCPDP SCRIPT (Medication History)
Pharmacy System
Pharmacy Intermediary/ Switch ?
In-State PDMP
NCPDP SCRIPT (Medication History) ?
Request
Response
Legend

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

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