Final Current Standards Landscape Analysis
June 3rd, 2014
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 2a+7a+6: EHR to out-of-state PMP via HIE + Hub 2b+7a/7b+6: Ph to out-of-state PMP via HIE/Ph. Int + Hub 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/Ph. Interm.
In-State PDMP
Out of State PDMP
Hub
EHR or Pharmacy
System1
2
3
42
36
57
7
Hub8 8
Summary of TransactionsData Flow Transactions Reviewed on 5/15 & 5/22 & 5/29 SPWG
Transaction System - Outbound System Intermediary 1 System Intermediary 2 System Inbound
1a EHR -- -- PDMP
1b Pharmacy IT -- -- PDMP
2a EHR HIE -- PDMP
2b Pharmacy IT Pharm. Int. / Switch -- PDMP
3a EHR -- PDMP Hub PDMPs
2a+7a+6 EHR HIE PDMP Hub PDMPs
3b Pharmacy IT PDMP Hub PDMPs
2b + 7a / 7b + 6 Pharmacy IT Pharm. Int. / Switch orHIE
PDMP Hub PDMPs
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
NARxCheck to PMIX• Illinois and Ohio use a direct connection
• Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – Complete
• 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• Kansas leverages HIEs and PMPi data hub for all of their
connections
• 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
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
Transaction Summary from SPWG 5/22 Items Required for Further Clarification
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– Complete
Transaction Summary from SPWG 5/22 Items Required for Further Clarification
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 and Emdeon used by EHR Systems to obtain medication history data – not yet used for controlled substance history
• Emdeon does not support HL7• SureScripts predominantly supports SCRIPT
• Ohio EHR Systems leverages NARxCheck as an interface to in-state PDMP
• Does not go through HIE or Hub (PMPi)• HL7 ADT used as a trigger to send query• NARxCheck handles transformation of HL7 to PMIX
architecture• Message received by PMP: PMIX-NIEM
• NARxCheck does not act as a hub but may get information from PMPi
• Does not go through interconnect directly
• Jinhee Lee to verify how Indiana performs translation from HIE to Hub – Complete
• Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP – Complete
Transaction Summary from SPWG 5/29 Items Required for Further Clarification
3b: Pharmacy IT System to
PDMP via Hub
• Hub to PDMP available for use but is not currently in production
• Pharmacy IT System to hub not currently in use• Technology may be used in the future
• Ohio to possibly pilot for a pharmacy chain to go through hub (one of 16 states that is a part of SAHMSA grant)
• Support Team to determine what standards these transactions are based on – In progress
2b + 7a/7b + 6: Pharmacy IT
System Interstate Workflow
• Not currently in use but Pharmacy IT System• May be able to go through intermediary in the future
• Pharmacy workflow using controlled substance medication history through a Pharmacy Intermediary could be a future use case
• PDMP checking on a claim vs. query of history for controlled substances
• N/A
Relevant Workflows
Current Landscape
Proposed Solution Set
EHR In-State PDMPPharmacy In-State PDMP
EHR Intermediary In-State PDMPPharmacy Intermediary In-State PDMP
EHR Hub PDMP(s)Pharmacy Hub PDMP(s)
EHR Intermediary Hub PDMP(s)Pharmacy Intermediary Hub PDMP(s)
EHR In-State PDMP Hub PDMP(s)Pharmacy In-State PDMP Hub PDMP(s)
EHR In-State PDMPPharmacy In-State PDMP
EHR Intermediary*Pharmacy Intermediary
EHR Hub Pharmacy Hub
1. Aligns to in-scope Use Case scenarios
2. Approach may require translation mapping between ASAP, NCPDP SCRIPT Medication History, and H L7 V2 Messaging to PMIX Architecture
3. Implementation Guide will have to include data element modifications/additions to fully support PDMP & HITI Use Case requirements
1
2
3
*Intermediary - An entity (service, or set of services) that routes the transaction to a receiving entity. May perform value added services such as translating data from one format to another
LegendProposed
Potential
Remove
Summary Analysis
Strategy Details Implementation Guide focus will shift to those organizations providing
transformations/translation/ ETL services
ASAP can provide point-to-point PDMP data exchange for Pharmacies and EHRs a like – can be transformed into PMIX Architecture via Appriss, Inc. (PMPi)
Intermediaries provide translation service or metadata transformations as “wrappers”
Data elements will need to be modified or added, specified within the PDMP & HITI Implementation Guide
SCRIPT Med History
PMIX Architecture
(Authentication)
Example Container/Payload Configuration
ASAP Web Services
HL7 V2 Messaging
NCPDP SCRIPT Medication History
PMIX-NIEM Architecture
PDMP Hub
Intermediary
Health IT System Standard PDMP StandardTranslation
(Patient Data)
Transaction Workflows
Current In-State EHR Workflow (Direct)
EHR SystemIn-State PDMP
NARxCheck
Request
Response
Legend
Transaction 1a
NARxCheck
Current In-State EHR Workflow (HIE)
EHR System HIE In-State PDMP
Request
Response
Legend
HL7 OBXXML Report
NCPDP SCRIPT (Med History)HL7 DOC^T12 - CCD
HL7 ADT feedsNCPDP SCRIPT (Med History)HL7 QRY^T12
HL7 A04NCPDP SCRIPT with PMIX
WrappersThird Party Software
HL7 QRY^T12
XML ResponseNCPDP SCRIPT with
PMIX WrapperHL7 DOC^T12
Transaction 2a
Current In-State Pharmacy Workflow (Direct)
Pharmacy IT System
In-State PDMP
Request
Response
Legend
Transaction 1b
NARxCheck
NARxCheck
Current In-State Pharmacy Workflow (Pharmacy Int. / Switch)
Pharmacy System
Pharmacy Intermediary
/ Switch
In-State PDMP
Request
Response
Legend
?
? ?
?
Transaction 2b
SCRIPT used for medication history but does not currently pull Controlled Substance history from Intermediaries using SCRIPT standard.
Current In-State EHR Workflow (Hub)
EHR SystemIn-State PDMP
Request
Response
Legend
PMIX
Transaction 3a – Not Effective Workflow? Currently Active?
PDMP HubInterface
PMIX
PMIXPMIX
HL7
Current In-State Pharmacy Workflow (Hub)
In-State PDMP
Request
Response
Legend
?
Translation? PMIX
PMIX
Transaction 3b – Not Effective Workflow? Currently Active?
PDMP HubPharmacy
System
Translation?
Current Interstate EHR Workflow
EHR System HIEIn-State PDMP
Request
Response
Legend
NCPDP SCRIPT (Medication
History)
Third Party SoftwarePMIX-NIEM
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
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