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PDMP & HITI Solution Planning Workgroup Session

PDMP & HITI Solution Planning Workgroup Session. May 29, 2014. 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:

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PDMP & HITI Solution Planning Workgroup Session

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  1. PDMP & HITI Solution Planning Workgroup Session May 29, 2014

  2. 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

  3. Summary of Transactions

  4. 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

  5. Current In-State HIT Integrated System Workflows

  6. Current In-State Pharmacy Workflow (Hub) Transaction 3b – Not Effective Workflow? Currently Active? Translation? In-State PDMP Pharmacy System Translation? PMIX PDMP Hub ? PMIX • Notes: • Hub to PDMP available for use but is not currently in production • Pharmacy system to hub not currently in use • May be used in the future; under development • AI: Alex/Divya to follow up with more information • What standards these transactions are based on? • Ohio to possibly pilot for pharm chain to go through hub (one of 16 states that is a part of SAHMSA grant) Legend Request Response

  7. Current Interstate HIT System Workflow

  8. 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 • Notes: • Not currently in use but Pharmacy IT System may be able to go through intermediary in the future • Pharmacy workflow using medication history could be a future use case – PDMP checking on a claim vs. query of history ? Response

  9. Questions to be answered: Differences in pharmacy and clinician workflows / data systems and expectations in PDMP data transmitted? How do we define intermediaries and their relationships to Health IT systems? 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? Are all transactions necessary? What is the relative cost associated with the proposed solutions? How do we define an aggregator? (collection of response from different PDMPs back to recipient) Parking lot item: Differences in care settings - Ambulatory vs. Acute; In-hospital pharmacies vs. retail pharmacies. Are different standards needed for different EHR systems?

  10. Controlled Substance History Report, Integration Architecture Drivers FROM: Pervasive challenges to access data within clinical workflows TO: Easy, timely, consistent access to reliable PDMP data Vision • As-Is Architecture • Segmented conceptual framework for data exchange • Varying solution practices • Varying state requirements and source ownership (e.g., authorization, authentication protocols) • Flexible interstate data sharing and intermediaries facilitating open data exchange for authorized users • Constraints on cost for Δ in source data architecture • Constraints on ease of implementation of foreign standards in established functional models/frameworks • To-Be Design Principles • Congruent data / message formats across integration sites • Compatible with established PMIX-NIEM architecture • Ability to support various front-end capabilities • Ability to integrate within existing technical systemsand evolve to support regulatory/technology changes Architecture Health Information Exchanges Interstate Data sharing Hubs Data harmonization and structuring of a data integration layer Continuous improvement of real time reporting Drivers Controlled Substance History Information Needs

  11. Integrated PDMP Data Exchange ArchitectureSolution Plan - Multi -Level Standards Internal Med Orders PMS Functions CDS Med History/ Reconciliation ePrescribing Establish standard data models and an approach for data harmonization; achieve standard and consistent data in this layer for query-response while addressing the source system layer in parallel. Translations are essential for compatible standards to interoperate. Out of scope - however… User access modes important to consider in standards selection. Modules within ambulatory and enterprise in-patient EHRs vary. Where would the interface be most effective? Define a comprehensive query-response strategy aligned to both EHRs and Pharmacy IT systems compatible with state PDMP architecture/regulations and intermediary capabilities/infrastructure. Defined standards architecture based on source data framework: PMIX-NIEM. User Interface (Presentation) PDMP Med History Architecture Recommendation/Notes HL7SCRIPT EMR EHR Pharmacy IT Health IT / Clinical Databases Translation / Transformation SCRIPT ASAPPMIX Metadata transformations, routing Pharm. Int / HIEs Hubs Data Harmonization Data Extraction / Transformation State PDMPs PMIX Source Systems HIE/PDMPs (Nebraska) Other Medication History Sources (eg. PBMs)

  12. Solution Plan Review Review Proposed Solutions

  13. Appendix

  14. 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

  15. System Transaction-Relationship Flow Legend Known To Confirm

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

  17. 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 Legend Request Response

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

  19. 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) ? Legend Request Response

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

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

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