PDMP & Health IT Integration All-Hands Meeting

PDMP & HITI Solution Planning Workgroup Session I

May 15th, 2014

1

Purpose:

Interdisciplinary work group (WG) comprised of PMP, Pharmacy, and EHR to develop technical architecture across actors and system functions to accelerate solution planning.

SWG will provide recommendations to at-large community based on development of technical architecture and system/business requirements.

Address the following questions:

Differences in pharmacy and clinician workflows / data systems and expectations in PDMP data transmitted?

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?

Solution Planning Workgroup

4 main players and associated systems:

EHR/EMR systems are predominantly based off HL7 standards and functional models for internal module connectivity and NCPDP SCRIPT for transmission of e-prescriptions

Pharmacy IT systems leverage NCPDP for Rx file transfer, structured sig, claims, and billing

PDMPs leverage PMIX Architecture for interstate data exchange of controlled substance medication history

Dispensers follow ASAP Reporting Standards for submission of controlled substance medication history reports to state PDMPs

Interstate data sharing is currently enabled by passing queries through HIEs and then routing to PDMP Hubs

Most EHR integration is currently enabled via HIEs

Current State: What We Know

ActorSystemCliniciansEHR | EMRPharmacistsPharmacy ITPDMP AdministratorsState PDMP DatabasesIntermediariesPDMP Hubs | HIEs | Pharmacy Intermediaries, Switches

1. Full view of Pharmacy IT transaction workflows

2. Reality of certain system-to-system transactions

a. Pharmacy IT to PDMP Hub

b. Pharmacy IT to HIE

c. Direct connection from EHR to PDMP Hub

d. HIE direct connection to Out-of-State PDMP

3. Transaction Standard pairings across all viable interchange functions, focusing on HIT integrated PDMP data access

a. Generally accepted solutions for each transaction involved in the integration of PDMP data within HIT System

Current State: What We Dont Know

Have not yet performed necessary analysis on EHRs capabilities to handle certain standards and implications to existing vendor solutions.

4

Solution Planning Work Group Approach

*Goal is to prescribe a solution that would mitigate impact to the way PDMPs share data today.

1. Overlay standards currently in general use per transaction

- focus on transactions for integrated solutions

Develop Technical Architecture Can EHRs and Pharmacy ITs handle proposed Standards?

2. For each alternate workflow, propose solutions for harmonizing standards in order to pull PDMP information into EHR or Pharm. IT Systems synchronously

Report findings to Community

3. Document pros and cons for each proposed solution and prioritize in terms of technical feasibility

Context Diagram

HIE/Pharmacy Intermediary

In-State PDMP

Out of State PDMP

Hub

EHR or Pharmacy System

1

2

3

4

2

6

5

7

7

Hub

8

8

3

6

= In Scope

TransactionsScopeFromViaTo1a1bEHRPharmacy - In-State PDMP2a 2bEHRPharmacyHIEPh. IntIn-State PDMP3a3bEHRPharmacyHubIn-State PDMP4In-State PDMP-Out of State PDMP5a5bHIEPh. Intermediary- Out-of-State PDMP6Hub-Out-of-State PDMP7a7bHIEPh. IntermediaryHubIn-State PDMP8In-State PDMPHubOut-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 Intermediary

In-State PDMP

Out of State PDMP

Hub

EHR or Pharmacy System

1

2

3

4

2

3

6

5

7

7

Hub

8

8

Current In-State HIT Integrated System Workflows

Current In-State EHR Workflow (Direct)

EHR System

In-State PDMP

PMIX?

Request

Response

Legend

Transaction 1a

Further clarification needed from Chad Garner on use of PMIX AI: Jean Hall

Need information on transactions occurring in Illinois, Kansas, Indiana AI: Jinhee Lee

EMRs dont generally query PDMPs directly

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

Some states that cannot make interstate connections might have no other option but to use this model

Washington, Maryland, Maine, Oklahoma use this model

Relatively uncommon in EHRs

AI: What is the query/message pairing used to engage EHR system to HIE?

Jean Hall to clarify further

Washington response PMIX-NIEM is mapped to NCPDP SCRIPT and responding with NCPDP SCRIPT message

ADT used as trigger in Ohio, Indiana, Illinois, Kansas

Current In-State EHR Workflow (Hub)

EHR System

In-State PDMP

Request

Response

Legend

?

?

?

?

Transaction 3a Not Effective Workflow? Currently Active?

PDMP Hub

Current In-State Pharmacy Workflow (Direct)

Pharmacy IT System

In-State PDMP

Request

Response

Legend

Transaction 1b

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

Transaction 1b is not currently in use

AI: Jean Hall to further clarify standards currently in use

Current In-State Pharmacy Workflow (Pharmacy Int. / Switch)

Pharmacy System

Pharmacy Intermediary/ Switch

In-State PDMP

Request

Response

Legend

NCPDP SCRIPT (Medication History)

NCPDP SCRIPT (Medication History)

?

?

Transaction 2b

SCRIPT Medication History and Telecommunication standards are 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

AI: Lynne Gilbertson to verify where standards are currently being used (Nebraska)

Current In-State Pharmacy Workflow (Hub)

In-State PDMP

Request

Response

Legend

?

?

?

?

Transaction 3b Not Effective Workflow? Currently Active?

PDMP Hub

Pharmacy System

Current Interstate HIT System Workflow

Current Interstate EHR Workflow

EHR System

HIE

In-State PDMP

Request

Response

Legend

NCPDP SCRIPT

Third Party Software

Out-of-State PDMP

PMIX-NIEM

PDMP Hub

PMIX-NIEM

XML

PMIX-NIEM

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

PMIX-NIEM

XML

Pharmacy System

Pharmacy Int. / Switch

Out-of-State PDMP

NCPDP SCRIPT

?

?

Transaction 2a + 2b + 7a + 7b + 6

Considerations:1. Are all transactions necessary? 2. Differences between retail and in-hospital pharmacies workflow/architecture?

Next Steps:1. Confirm relevant transactions-standards pairings for segmented data exchange workflows2. Review and clarify System-Transaction Relationship workflow

Appendix

System Transaction-Relationship Flow

Known

To Confirm

Legend

System Relationships: Transactions

1. EHR to In-State PDMP

2. EHR to HIE

3. EHR to PDMP Hub

4. EHR to Ph Int./Switch

5. Ph IT to In-State PDMP

6. Ph IT to Ph Int./Switch

7. Ph IT to PDMP Hub

8. Ph IT to HIE

9. HIE to PDMP Hub

10. HIE to In-State PDMP

11. HIE to Out-of-State PDMP

12. PDMP Hub to In-State PDMP

13. PDMP Hub to Out-of-State PDMP

14. In-State PDMP to Out-of-State

PDMP