PDMP & Health IT Integration All-Hands Meeting
PDMP & HITI Solution Planning Workgroup Session I
May 15th, 2014
1
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?
Solution Planning Workgroup
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
Current State: What We Know
ActorSystemCliniciansEHR | EMRPharmacistsPharmacy ITPDMP AdministratorsState PDMP DatabasesIntermediariesPDMP Hubs | HIEs | Pharmacy Intermediaries, Switches1. 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
Current State: What We Dont Know
Have not yet performed necessary analysis on EHRs capabilities to handle certain standards and implications to existing vendor solutions.
4
Solution Planning Work Group Approach
*Goal is to prescribe a solution that would mitigate impact to the way PDMPs share data today.
1. Overlay standards currently in general use per transaction
- focus on transactions for integrated solutions
Develop Technical Architecture Can EHRs and Pharmacy ITs handle proposed Standards?
2. For each alternate workflow, propose solutions for harmonizing standards in order to pull PDMP information into EHR or Pharm. IT Systems synchronously
Report findings to Community
3. Document pros and cons for each proposed solution and prioritize in terms of technical feasibility
Context Diagram
HIE/Pharmacy Intermediary
In-State PDMP
Out of State PDMP
Hub
EHR or Pharmacy System
1
2
3
4
2
6
5
7
7
Hub
8
8
3
6
= In Scope
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
HIE/Pharmacy Intermediary
In-State PDMP
Out of State PDMP
Hub
EHR or Pharmacy System
1
2
3
4
2
3
6
5
7
7
Hub
8
8
Current In-State HIT Integrated System Workflows
Current In-State EHR Workflow (Direct)
EHR System
In-State PDMP
PMIX?
Request
Response
Legend
Transaction 1a
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 dont generally query PDMPs directly
Current In-State EHR Workflow (HIE)
EHR System
HIE
In-State PDMP
Request
Response
Legend
HL7 OBX
XML Report
NCPDP SCRIPT
HL7 ADT feeds
NCPDP SCRIPT
HL7 A04
NCPDP SCRIPT with PMIX Wrappers
Third Party Software
XML Response
NCPDP SCRIPT with PMIX Wrapper
Transaction 2a
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
Current In-State EHR Workflow (Hub)
EHR System
In-State PDMP
Request
Response
Legend
?
?
?
?
Transaction 3a Not Effective Workflow? Currently Active?
PDMP Hub
Current In-State Pharmacy Workflow (Direct)
Pharmacy IT System
In-State PDMP
Request
Response
Legend
Transaction 1b
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
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
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)
Current In-State Pharmacy Workflow (Hub)
In-State PDMP
Request
Response
Legend
?
?
?
?
Transaction 3b Not Effective Workflow? Currently Active?
PDMP Hub
Pharmacy System
Current Interstate HIT System Workflow
Current Interstate EHR Workflow
EHR System
HIE
In-State PDMP
Request
Response
Legend
NCPDP SCRIPT
Third Party Software
Out-of-State PDMP
PMIX-NIEM
PDMP Hub
PMIX-NIEM
XML
PMIX-NIEM
PMIX-NIEM
XML
Transaction 2a + 7a + 6
Current Interstate Pharmacy Workflow
HIE
In-State PDMP
Request
Response
Legend
NCPDP SCRIPT
Third Party Software
PMIX Wrappers
PMIX-NIEM
PDMP Hub
PMIX-NIEM
XML
PMIX-NIEM
PMIX-NIEM
XML
Pharmacy System
Pharmacy Int. / Switch
Out-of-State PDMP
NCPDP SCRIPT
?
?
Transaction 2a + 2b + 7a + 7b + 6
Considerations:1. Are all transactions necessary? 2. Differences between retail and in-hospital pharmacies workflow/architecture?
Next Steps:1. Confirm relevant transactions-standards pairings for segmented data exchange workflows2. Review and clarify System-Transaction Relationship workflow
Appendix
System Transaction-Relationship Flow
Known
To Confirm
Legend
System Relationships: Transactions
1. EHR to In-State PDMP
2. EHR to HIE
3. EHR to PDMP Hub
4. EHR to Ph Int./Switch
5. Ph IT to In-State PDMP
6. Ph IT to Ph Int./Switch
7. Ph IT to PDMP Hub
8. Ph IT to HIE
9. HIE to PDMP Hub
10. HIE to In-State PDMP
11. HIE to Out-of-State PDMP
12. PDMP Hub to In-State PDMP
13. PDMP Hub to Out-of-State PDMP
14. In-State PDMP to Out-of-State
PDMP