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PDMP & HITI Solution Planning Workgroup Session I

PDMP & HITI Solution Planning Workgroup Session I. May 15 th , 2014. Solution Planning Workgroup. Purpose: Interdisciplinary work group (WG) comprised of PMP, Pharmacy, and EHR to develop technical architecture across actors and system functions to accelerate solution planning.

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PDMP & HITI Solution Planning Workgroup Session I

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  1. PDMP & HITI Solution Planning Workgroup Session I May 15th, 2014

  2. Solution Planning Workgroup 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?

  3. Current State: What We Know… 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

  4. Current State: What We Don’t Know 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

  5. Solution Planning Work Group Approach *Goal is to prescribe a solution that would mitigate impact to the way PDMPs share data today.

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

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

  8. Current In-State HIT Integrated System Workflows

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

  10. 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 • 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 Legend Request Response

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

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

  13. 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) ? • 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) Legend Request Response

  14. Current In-State Pharmacy Workflow (Hub) Transaction 3b – Not Effective Workflow? Currently Active? In-State PDMP Pharmacy System ? ? PDMP Hub ? ? Legend Request Response

  15. Current Interstate HIT System Workflow

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

  17. 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 ? Legend Request ? Response

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

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

  20. Appendix

  21. System Transaction-Relationship Flow Legend Known To Confirm

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