Final Current Standards Landscape Analysis

June 3rd, 2014

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

Summary of TransactionsData Flow Transactions Reviewed on 5/15 & 5/22 & 5/29 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

3b Pharmacy IT PDMP Hub PDMPs

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

NARxCheck to PMIX• Illinois and Ohio use a direct connection

• Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – Complete

• 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• Kansas leverages HIEs and PMPi data hub for all of their

connections

• 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 use 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– Complete

Transaction Summary from SPWG 5/22 Items Required for Further Clarification

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

• SureScripts and Emdeon used by EHR Systems to obtain medication history data – not yet used for controlled substance history

• Emdeon does not support HL7• SureScripts predominantly supports SCRIPT

• Ohio EHR Systems leverages NARxCheck as an interface to in-state PDMP

• Does not go through HIE or Hub (PMPi)• HL7 ADT used as a trigger to send query• NARxCheck handles transformation of HL7 to PMIX

architecture• Message received by PMP: PMIX-NIEM

• NARxCheck does not act as a hub but may get information from PMPi

• Does not go through interconnect directly

• Jinhee Lee to verify how Indiana performs translation from HIE to Hub – Complete

• Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP – Complete

Transaction Summary from SPWG 5/29 Items Required for Further Clarification

3b: Pharmacy IT System to

PDMP via Hub

• Hub to PDMP available for use but is not currently in production

• Pharmacy IT System to hub not currently in use• Technology may be used in the future

• Ohio to possibly pilot for a pharmacy chain to go through hub (one of 16 states that is a part of SAHMSA grant)

• Support Team to determine what standards these transactions are based on – In progress

2b + 7a/7b + 6: Pharmacy IT

System Interstate Workflow

• Not currently in use but Pharmacy IT System• May be able to go through intermediary in the future

• Pharmacy workflow using controlled substance medication history through a Pharmacy Intermediary could be a future use case

• PDMP checking on a claim vs. query of history for controlled substances

• N/A

Relevant Workflows

Current Landscape

Proposed Solution Set

EHR In-State PDMPPharmacy In-State PDMP

EHR Intermediary In-State PDMPPharmacy Intermediary In-State PDMP

EHR Hub PDMP(s)Pharmacy Hub PDMP(s)

EHR Intermediary Hub PDMP(s)Pharmacy Intermediary Hub PDMP(s)

EHR In-State PDMP Hub PDMP(s)Pharmacy In-State PDMP Hub PDMP(s)

EHR In-State PDMPPharmacy In-State PDMP

EHR Intermediary*Pharmacy Intermediary

EHR Hub Pharmacy Hub

1. Aligns to in-scope Use Case scenarios

2. Approach may require translation mapping between ASAP, NCPDP SCRIPT Medication History, and H L7 V2 Messaging to PMIX Architecture

3. Implementation Guide will have to include data element modifications/additions to fully support PDMP & HITI Use Case requirements

1

2

3

*Intermediary - An entity (service, or set of services) that routes the transaction to a receiving entity. May perform value added services such as translating data from one format to another

LegendProposed

Potential

Remove

Summary Analysis

Strategy Details Implementation Guide focus will shift to those organizations providing

transformations/translation/ ETL services

ASAP can provide point-to-point PDMP data exchange for Pharmacies and EHRs a like – can be transformed into PMIX Architecture via Appriss, Inc. (PMPi)

Intermediaries provide translation service or metadata transformations as “wrappers”

Data elements will need to be modified or added, specified within the PDMP & HITI Implementation Guide

SCRIPT Med History

PMIX Architecture

(Authentication)

Example Container/Payload Configuration

ASAP Web Services

HL7 V2 Messaging

NCPDP SCRIPT Medication History

PMIX-NIEM Architecture

PDMP Hub

Intermediary

Health IT System Standard PDMP StandardTranslation

(Patient Data)

Transaction Workflows

Current In-State EHR Workflow (Direct)

EHR SystemIn-State PDMP

NARxCheck

Request

Response

Legend

Transaction 1a

NARxCheck

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

NARxCheck

NARxCheck

Current In-State Pharmacy Workflow (Pharmacy Int. / Switch)

Pharmacy System

Pharmacy Intermediary

/ Switch

In-State PDMP

Request

Response

Legend

?

? ?

?

Transaction 2b

SCRIPT used for medication history but does not currently pull Controlled Substance history from Intermediaries using SCRIPT standard.

Current In-State EHR Workflow (Hub)

EHR SystemIn-State PDMP

Request

Response

Legend

PMIX

Transaction 3a – Not Effective Workflow? Currently Active?

PDMP HubInterface

PMIX

PMIXPMIX

HL7

Current In-State Pharmacy Workflow (Hub)

In-State PDMP

Request

Response

Legend

?

Translation? PMIX

PMIX

Transaction 3b – Not Effective Workflow? Currently Active?

PDMP HubPharmacy

System

Translation?

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

Current Interstate Pharmacy Workflow

HIEIn-State PDMP

Request

Response

Legend

NCPDP SCRIPT

Third Party SoftwarePMIX Wrappers

PMIX-NIEM

PDMP Hub

PMIX-NIEM

XML

PMIX-NIEM

PMIX-NIEMXML

Pharmacy System

Pharmacy Int. /

SwitchOut-of-State PDMP

NCPDP SCRIPT

?

?

Transaction 2a + 2b + 7a + 7b + 6

System Transaction-Relationship Flow

System Relationships: Transactions

1. EHR to In-State PDMP2. EHR to HIE3. EHR to PDMP Hub4. EHR to Ph Int./Switch5. Ph IT to In-State PDMP6. Ph IT to Ph Int./Switch 7. Ph IT to PDMP Hub8. Ph IT to HIE9. HIE to PDMP Hub10. HIE to In-State PDMP11. HIE to Out-of-State PDMP12. PDMP Hub to In-State PDMP13. PDMP Hub to Out-of-State PDMP14. In-State PDMP to Out-of-State PDMP

Known

To Confirm

Legend