PDMP & Health IT Integration

Standards and Harmonization

June 24th, 2014

AgendaTopic Time

Allotted General Announcements 5 minutesPDMP & HITI Standards and Harmonization•Summary of outcomes from Solution Planning Workgroup 6/19•Minimum dataset requirements analysis

50 minutes

Next Steps/Questions 5 minutes

PDMP Harmonization TimelineMarch April May June July

3/25 Harmonization Kick-off

Stan

dard

s Eva

luati

on Candidate Standards List

UCR-Standards Mapping

Gap Mitigation Plan

Solu

tion

Plan

ning

IG

Deve

lopm

ent

Solution Plan

Create IG Template

IG Development

End-to-end Review & Community Consensus

(Today)

7/29 Harmonization Close

Week Target Date (2014) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page

due following Monday @ 12 noon

1 3/25 Harmonization Kick-Off & Process OverviewIntroduce: Overview of UCR-Standards Mapping Review: N/A

2 4/1 Introduce: Candidate Standards List & UCR-Standards Mapping Review: Candidate Standards List

3 4/8 Finalize: Candidate Standards ListReview: UCR-Standards Mapping Review: UCR-Standards Mapping

4 4/15 Review: UCR-Standards Mapping Review: UCR-Standards Mapping

- 4/22 Cancelled for National Rx Summit

5 4/29 Finalize: Outcome of UCR-Standards MappingIntroduce: Gap Mitigation Plan Review: Gap Mitigation Plan

6 5/6 Review: Gap Mitigation Plan Review: Gap Mitigation Plan

7 5/13 Finalize: Gap Mitigation PlanIntroduce: Solution Planning Workgroup Review: N/A

8 5/20 Review: Outcomes of Solution Planning WorkgroupIntroduce: Implementation Guide (IG) Template Review: Implementation Guide Template

9 5/27 Review: Outcomes of Solution Planning WorkgroupIntroduce: Minimum Dataset Requirements

Review: Minimum Dataset Requirements & IG Template

10-11 6/3 – 6/10 Review: Outcomes of Solution Planning Workgroup & Minimum Dataset Requirements Review: Minimum Dataset Requirements

12 6/17 Review: Outcomes of Solution Planning Workgroup & Minimum Dataset Requirements Review: Minimum Dataset Requirements

13-15 6/24 – 7/8 Review: Dataset Requirements; Solution Plan Finalization; Implementation Guide Development

Review: Minimum Dataset; Solution Plan; Implementation Guide Content

16-17 7/15 – 7/22 End-to-End Community Review of Implementation Guide End-to-End Review of Implementation Guide

18 7/29 Consensus Vote

Harmonization Weekly Timeline

Review: Solution Planning Workgroup

Session (6/19)

Solution Plan Workflow Analysis

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

Solution Planning Work Group Approach

1. Overlay standards currently in general use per transaction - focus on transactions for integrated solutions

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

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

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Solution Planning Approach

1. How to take HL7 V2, NCPDP SCRIPT, ASAP and transform to PMIX Architecture-NIEM Standards?

2. What gaps have been identified to perform necessary query out of HIT specific to PDMP?

3. Define technical architecture of total solution.

Variant 1: Intermediary provides translation functionality

Variant 2: Translation is handled at EHR, providing mapping to PMIX from native EHR standards

Variant 3: Interface engine at EHR-level provides functionality to send PMIX message derived from native EHR standards.

EHR /Pharmacy

Ph. Interm.

HIE

PDMP Hub

PDMP

Most preferred workflow

Translation / Routing

EHR Origin Standard:HL7 V2 (acute)NCPDP SCRIPT (ambulatory + optional acute settings)ASAP Web Services

PDMP StandardPMIX

Pharmacy Origin Standard:HL7 V2 (in hospital)NCPDP SCRIPT (large retail pharmacies)ASAP Web Services

Begin detailing solution and

technical details

(standards)

PrioritizeEHR/Pharm Hub

Solution

Develop holistic solutions for Hub, Intermediary, and Direct workflows

Leverage Hub Solution for EHR/Pharm Intermediary

workflow guidance

Defer direct connection workflow model due to limited scalability and restriction of interstate data

sharing

Develop IG content based on PDMP Hub solution

Develop IG content based on PDMP

Intermediary solution

Develop IG content based on PDMP Direct solution

Deferment does not equate to elimination of workflows from

inclusion in future solution plans and iterations/updates to the

Implementation Guide

EHR Prioritization

# Workflow Model Prioritization Justification

3a EHR to PDMP Hub to PDMPs High

• Capable of facilitating interstate data exchange with reduced complexity• PDMP Hubs are compliant with state regulations regarding access and routing of

PDMP-data• Future hub capabilities support efficient workflow model• Interstate data exchange drives organized data sourcing and in turn, is critical

element to most interoperable state of data flow

2a EHR to Intermediary to PDMP (PDMP Hub to PDMP)

Medium

• Scalable• Provides flexibility in accommodating multiple standards • Ability to leverage existing connections for clinical data• Increased complexity due to additional connections and implication of

policy/regulations on third party use

1a EHR to In-State PDMP Low

• Supports unique implementations and PDMP infrastructure• Restrictive in expanding efficient interstate data sharing• Reduced complexity, though not as highly scalable• Perhaps necessary where policy hinders use of third parties for

translation/transformation

Pharmacy IT Prioritization

# Workflow Model Prioritization Justification

3b Pharmacy IT to PDMP Hub to PDMPs High

• Same as transaction 3a• Existing pilots established using workflow

2b Pharmacy IT to Intermediary to PDMP (PDMP Hub to PDMP)

Medium

• Same as transaction 2a• Concern regarding cost to participate• May allow for future-state PDMP-data access through third parties

1b Pharmacy IT to In-State PDMP Low

• Same as transaction 1a• Pharmacies typically leverage third party for medication history• Limited perceived interest from user community

Minimum Required Data Elements Analysis - Status

Solution Plan Workgroup Transaction Analysis

Data Category Transaction Mode Status Community Determination

Patient Information

Request Complete First NameLast NameDate of Birth

Response To Be Completed

General Request In Progress Request Date/TimestampRequester Location

Response To Be Completed

Authorized User Request Complete Authentication CredentialsType of User

Prescription Information

Response To Be Completed

Prescriber Response To Be Completed

Dispenser Response To Be Completed

Data Element Analysis

Data Element Analysis

Implementation Guide – Data Elements and Attributes

Data Requirements Analysis - PDMP & HITI Use Case

Request Transaction Data ElementsGeneral Authorized User Patient

1. Request Date2. Request Timestamp3. State of Request4. Requestor Location5. Requested State(s) [if

applicable]6. Authenticator7. System authentication8. Initiating requestor’s

routing ID9. Responder ID10.Message ID11.Requestor’s Internal

Patient ID12.Start Date13.End Date

1. First Name2. Last Name3. Generational Suffix [if

applicable]4. Address Information5. Optional Address

Information 6. City Address7. State Address8. ZIP Code Address9. Email Address10.Phone Number11.Authentication Credentials

[DEA, NCPDP/NABP Provider ID, NPI, License #, Delegate ID

12.Type of User

1. First Name2. Last Name3. Address Information4. Optional Address Information5. City Address6. State Address7. ZIP Code Address8. Phone Number9. Patient Gender10.Country11.Date of Birth12.Identification Qualifier of

Patient Identifier13.Identification of Patient

Data Requirements Analysis - PDMP & HITI Use Case

Response Transaction Data Elements

General Patient Prescription Prescriber Dispenser

1. Response Date2. Response

Timestamp3. Response Time4. State of Response5. Response Identifier6. Message ID7. Summary8. Create Time9. Intended Recipient10. Status of Request

1. First Name2. Last Name3. Address

Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Country9. Date of Birth10. Identification

Qualifier of Patient Identification

11. Identification of Patient

12. PDMP Patient Reference Number

13. Gender Code14. Species Code15. Phone Number

1. Name of Drug2. Strength3. Form4. Quantity Dispensed5. Days Supply

Dispensed6. Date Written7. Refills Authorized8. Refill Number9. Partial Fill10. Prescription

Number11. Date Prescription

Filled12. Date Prescription

Sold/Dispensed13. Drug Identifier14. Payment Method

1. First Name2. Last Name3. Address Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Phone Number9. DEA #10. Authentication

Credentials11. PDMP Prescriber

Reference #

1. Pharmacy or Dispensing Prescriber’s Name

2. Address Information

3. Optional Address Information

4. City Address5. State Address6. ZIP Code Address7. Phone Number8. DEA #9. NCPDP/NABP

Provider ID10. NPI11. PDMP Dispenser

Reference #

Consolidated Standard Data Set– PDMP & HITI Use CasePDMP & HITI Use Case Data Elements

General Patient Prescription Authorized User*1. Request Date2. Request Timestamp3. State of Request4. Requestor Location5. Requested State(s) [if

applicable]6. Authenticator7. System authentication8. Initiating requestor’s

routing ID9. Responder ID10.Message ID11.Requestor’s Internal

Patient ID12.Start Date13.End Date14. Response Date15. Response Timestamp16. Response Time17. State of Response18. Response Identifier19. Summary20. Create Time21. Intended Recipient22. Status of Request

1. First Name2. Last Name3. Address Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Country9. Date of Birth10. Identification Qualifier of

Patient Identification11. Identification of Patient12. PDMP Patient Reference

Number13. Gender Code14. Species Code15. Phone Number

1. Name of Drug2. Strength3. Form4. Quantity Dispensed5. Days Supply Dispensed6. Date Written7. Refills Authorized8. Refill Number9. Partial Fill10. Prescription Number11. Date Prescription Filled12. Date Prescription

Sold/Dispensed13. Drug Identifier14. Payment Method

1. First Name2. Last Name3. Address Information4. Optional Address

Information5. City Address6. State Address7. Zip Code Address8. Phone Number9. DEA #10. Authentication Credentials11. PDMP Prescriber Reference

#12. Pharmacy or Dispensing

Prescriber’s Name13. NCPDP/NABP Provider ID14. NPI15. PDMP Dispenser Reference

#16. Type of user

*Includes Physician and Dispenser

Standard Data Set– MITRE WG RecommendationMITRE Standard Data Elements

Patient Prescriber Dispenser Prescription1. First name2. Last name3. Street address4. City5. State6. ZIP code7. Date of birth8. Identification (ID)

qualifier and/or patient identifier (situational)

9. Gender code (situational)

10. Species code (situational)

11. Phone number (situational)

1. First name2. Last name3. Street address4. City5. State6. ZIP code 7. Phone number

(situational)8. Drug Enforcement

Agency (DEA) number (situational)

1. Pharmacy or dispensing prescriber name

2. Street address3. City4. State5. ZIP code6. Phone number

(situational)7. DEA number

(situational)8. National Council for

Prescription Drug Programs (NCPDP)/National Association of Boards of Pharmacy (NABP) Provider ID (situational)

9. National Provider Identifier (NPI) (situational)

1. Name of drug2. Strength3. Form4. Quantity dispensed5. Days’ supply dispensed6. Date prescription filled7. Date written8. Refills authorized9. Refill number10. Refill status to indicate

a full or partial refill11. Prescription number

Next Steps• Review: Minimum Dataset Requirements & IG Template

• Next Solution Planning WG meeting is Thursday, June 26 from 12:00pm – 1:00pm ET

• Next All Hands meeting is Tuesday, July 1 from 12:00pm - 1:00pm ET

• Reminder: All PDMP & HIT Integration Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Harmonization materials, Use Case, Project Charter and general information will be posted on the PDMP Wiki page– http://wiki.siframework.org/PDMP+%

26+Health+IT+Integration+Homepage

Contact Information

– Initiative Coordinators: • Johnathan Coleman jc@securityrs.com• Sherry Green sgreen@namsdl.org

– ONC Leads:• Mera Choi mera.choi@hhs.gov• Jennifer Frazier Jennifer.Frazier@hhs.gov• Helen Caton-Peters

Helen.Caton-Peters@hhs.gov– SAMHSA Leads

• Jinhee Lee Jinhee.Lee@samhsa.hhs.gov• Kate Tipping

Kate.Tipping@samhsa.hhs.gov– Support Team:

• Project Management: • Jamie Parker

jamie.parker@esacinc.com• Ali Khan Ali.Khan@esacinc.com

(Support)• Use Case Development:

• Ahsin Azim Ahsin.Azim@accenturefederal.com

• Presha Patel presha.patel@accenture.com

• Standards Development Support:• Alex Lowitt

alexander.s.lowitt@accenturefederal.com

• Harmonization Support:• Divya Raghavachari

divya.raghavachari@accenturefederal.com

• Atanu Sen atanu.sen@accenture.com• Implementation Guide Development:

• Rita Torkzadeh rtorkzadeh@jbsinternational.com

• Vijay Shah vshah@jbsinternational.com• Vocabulary and Terminology Subject Matter

Expert: • Mark Roche mrochemd@gmail.com

• For questions, please feel free to contact your support leads:

Appendix

Questions to be answered:1. Differences in pharmacy and clinician workflows / data systems and expectations in

PDMP data transmitted?2. How do we define intermediaries and their relationships to Health IT systems?3. What components of PDMP report are extracted for decision support?4. Can EHR and Pharmacy IT systems handle the proposed standards (in the context of

PDMP systems)?5. What standard(s) fit into message and workflow configuration per transaction type?6. Are transactions collapsible in terms of capability of leveraging same standard?7. Are all transactions necessary?8. What is the cost associated with the proposed solutions?9. How do we define an aggregator? (collection of response from different PDMPs

back to recipient)10. Parking lot item: Differences in care settings - Ambulatory vs. Acute; In-hospital

pharmacies vs. retail pharmacies. Are different standards needed for different EHR systems?

Initiative Progress & Current Status

Implementation GuideDevelopment

Solution Planning

•Narrowed down candidate standards via mapping to Use Case Requirements

• Identified and analysed gaps for all narrowed down standards in the Gap Mitigation Plan

•Develop Implementation Guide (IG) based on selected solution

Standards Evaluation

•Determining standards currently in general use per transaction workflow

•Select harmonized standard solution based on current and recommended standards landscapes