PDMP & HITI Solution Planning Workgroup

Session IMay 15th, 2014

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:1. Differences in pharmacy and clinician workflows / data systems and expectations in

PDMP data transmitted?2. What components of PDMP report are extracted for decision support?3. Can EHR and Pharmacy IT systems handle the proposed standards (in the context of

PDMP systems)?4. What standard(s) fit into message and workflow configuration per transaction type?5. Are transactions collapsible in terms of capability of leveraging same standard?

Solution Planning Workgroup

4 main players and associated systems:

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

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

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

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

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

6. Most EHR integration is currently enabled via HIEs

Current State: What We Know…

Actor System

Clinicians EHR | EMR

Pharmacists Pharmacy IT

PDMP Administrators State PDMP Databases

Intermediaries PDMP Hubs | HIEs | Pharmacy Intermediaries, Switches

1. Full view of Pharmacy IT transaction workflows

2. Reality of certain system-to-system transactionsa. Pharmacy IT to PDMP Hubb. Pharmacy IT to HIEc. 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 Don’t Know

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 De

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

Context DiagramHIE/

Pharmacy Intermediary

In-State PDMP

Out of State PDMP

Hub

EHR or Pharmacy

System1

2

3

4

2

6

57

7

Hub8 8

3

6

= In Scope

Transactions Scope

From Via To

1a1b

EHRPharmacy

- In-State PDMP

2a 2b

EHRPharmacy

HIEPh. Int

In-State PDMP

3a3b

EHRPharmacy

Hub In-State PDMP

4 In-State PDMP - Out of State PDMP

5a5b

HIEPh. Intermediary

- Out-of-State PDMP

6 Hub - Out-of-State PDMP

7a7b

HIEPh. Intermediary

Hub In-State PDMP

8 In-State PDMP Hub Out-of-State PDMP

PMP/HITI User Stories with Alternate WorkflowsEHR 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 HubEHR 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

System1

2

3

42

36

57

7

Hub8 8

Current In-State HIT Integrated System Workflows

Current In-State EHR Workflow (Direct)

EHR SystemIn-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 don’t generally query PDMPs directly

Current In-State EHR Workflow (HIE)

EHR System HIE In-State PDMP

Request

Response

Legend

HL7 OBXXML Report

NCPDP SCRIPT

HL7 ADT feedsNCPDP SCRIPT

HL7 A04NCPDP SCRIPT with PMIX

WrappersThird Party Software

XML ResponseNCPDP 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 SystemIn-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 HubPharmacy

System

Current Interstate HIT System Workflow

Current Interstate EHR Workflow

EHR System HIEIn-State PDMP

Request

Response

Legend

NCPDP SCRIPT Third Party Software

Out-of-State PDMP

PMIX-NIEM

PDMP Hub

PMIX-NIEM

XML

PMIX-NIEM

PMIX-NIEMXML

Transaction 2a + 7a + 6

Current Interstate Pharmacy Workflow

HIEIn-State PDMP

Request

Response

Legend

NCPDP SCRIPT

Third Party SoftwarePMIX Wrappers

PMIX-NIEM

PDMP Hub

PMIX-NIEM

XML

PMIX-NIEM

PMIX-NIEMXML

Pharmacy System

Pharmacy Int. /

SwitchOut-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 workflows

2. Review and clarify System-Transaction Relationship workflow

Appendix

System Transaction-Relationship Flow

System Relationships: Transactions

1. EHR to In-State PDMP2. EHR to HIE3. EHR to PDMP Hub4. EHR to Ph Int./Switch5. Ph IT to In-State PDMP6. Ph IT to Ph Int./Switch 7. Ph IT to PDMP Hub8. Ph IT to HIE9. HIE to PDMP Hub10. HIE to In-State PDMP11. HIE to Out-of-State PDMP12. PDMP Hub to In-State PDMP13. PDMP Hub to Out-of-State PDMP14. In-State PDMP to Out-of-State PDMP

Known

To Confirm

Legend