pdmp & health it integration all-hands meeting may 27 th, 2014
TRANSCRIPT
PDMP & Health IT IntegrationAll-Hands Meeting
May 27th, 2014
Meeting Etiquette
• Remember: If you are not speaking keep your phone on mute
• Do not put your phone on hold – if you need to take a call, hang up and dial in again when finished with your other call– Hold = Elevator Music = very frustrated speakers and
participants
• This meeting, like all of our meeting is being recorded– Another reason to keep your phone on mute when not
speaking
• Feel free to use the “Chat” feature for questions, comments or any items you would like the moderator or participants to know.
NOTE: This meeting is being recorded and will be posted on the Meeting Artifacts Wiki page after
the meeting
From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute
2
Agenda
Topic Time Allotted
General Announcements 5 minutes
PDMP & HITI Standards and Harmonization•Summary of outcomes from Solution Planning Workgroup 5/22•Determine minimum dataset requirements
50 minutes
Next Steps/Questions 5 minutes
General Announcements…
• We hosted a Concert Series presentation “Prescription Drug Monitoring Programs and the PMIX Architecture” on May 21st at 3pm ET– The recording and slides can be found on the
Past Meetings wikipage.• The Solution Planning Work Group meets Thursdays,
12:00 – 1:00 pm ET. – https
://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=667584401
– Dial In: 1-650-479-3208– Access code: 667 584 401
4
General Announcements Continued
• To join our weekly webinars, visit the PDMP & Health IT Integration initiative Homepage for the latest meeting information: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage
5
• To subscribe to our mailing list, simply complete the PDMP & Health IT Project Signup Form: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Join+the+Initiative
• To access current and archived meeting materials, visit the Project Meeting Artifacts section: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Meeting+Artifacts
Note: Please check the meeting schedule weekly to get the most up-to-date meeting information
PDMP & Health IT Integration
Standards and Harmonization
May 27th, 2014
Review: Solution Planning Workgroup
Session 5/22
Current-State Transaction: Standards Landscape
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
Summary of Transactions
Data Flow Transactions Reviewed on 5/15 & 5/22 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
Data Flow Transactions To Be Reviewed on 5/29 SPWG
Transaction System - Outbound System Intermediary 1 System Intermediary 2 System Inbound
3b Pharmacy IT PDMP Hub PDMPs
2a + 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
PMIX• Kansas leverages HIEs and PMPi data hub for all of their
connections• Illinois and Ohio use a direct connection – need further
clarification on standards used
• Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – In progress
• 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
• 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 uses 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
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
• Jinhee Lee to verify how Indiana performs translation from HIE to Hub
• Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP
Summary of Current Standards Landscape
• What we know:– Several states utilize the EHR HIE PDMP transaction
• Some states that cannot make interstate connections might have no other option but to use this model
– PMIX-NIEM is the standard used for the Hub to PDMP transaction• Translation from HL7 messaging to PMIX must occur prior to Hub
to PDMP transaction– Thus, translations can occur from the EHR system to the HIE, the HIE
to the Hub, the EHR system to the Hub, or the HIE to the PDMP– HL7 ADT is used as a trigger in several states– Currently, EHR systems and Pharmacy IT systems do not generally
query the PDMP directly• ASAP Web Services standard was developed specifically for this purpose
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?
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 Case
PDMP & HITI Use Case Data ElementsGeneral 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 DispenserData Element
Analysis
Standard Data Set– MITRE WG Recommendation
MITRE Standard Data ElementsPatient Prescriber Dispenser Prescription
1. 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
• Next Solution Planning WG meeting is Thursday, May 29 from 12:00pm – 1:00pm ET
• Next All Hands meeting is Tuesday, June 3 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 [email protected]• Sherry Green [email protected]
– ONC Leads:• Mera Choi [email protected]• Jennifer Frazier [email protected]• Helen Caton-Peters
– SAMHSA Leads• Jinhee Lee [email protected]• Kate Tipping
– Support Team:• Project Management:
• Jamie Parker [email protected]
• Ali Khan [email protected] (Support)
• Use Case Development: • Ahsin Azim
[email protected] • Presha Patel
• Standards Development Support:• Alex Lowitt
• Harmonization Support:• Divya Raghavachari
• Atanu Sen [email protected]• Implementation Guide Development:
• Rita Torkzadeh [email protected]
• Vijay Shah [email protected]• Vocabulary and Terminology Subject Matter
Expert: • Mark Roche [email protected]
• For questions, please feel free to contact your support leads:
Appendix
Current In-State EHR Workflow (Direct)
EHR SystemIn-State PDMP
PMIX?
Request
Response
Legend
Transaction 1a
PMIX?
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
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
Current In-State EHR Workflow (Hub)
EHR SystemIn-State PDMP
Request
Response
Legend
?
PMIX ?
?
Transaction 3a – Not Effective Workflow? Currently Active?
PDMP Hub
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