PDMP & Health IT IntegrationAll-Hands Meeting
June 24th, 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
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Agenda
Topic Time Allotted
General Announcements 5 minutes
PDMP & HITI Standards and Harmonization•Summary of outcomes from Solution Planning Workgroup 6/19•Minimum dataset requirements analysis
50 minutes
Next Steps/Questions 5 minutes
General Announcements…
• 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
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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
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• 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
June 24th, 2014
Agenda
Topic Time Allotted
General Announcements 5 minutes
PDMP & HITI Standards and Harmonization•Summary of outcomes from Solution Planning Workgroup 6/19•Minimum dataset requirements analysis
50 minutes
Next Steps/Questions 5 minutes
PDMP Harmonization Timeline
March April May June July
3/25 Harmonization Kick-off
Stan
dard
s Ev
alua
tion
Candidate Standards List
UCR-Standards Mapping
Gap Mitigation Plan
Solu
tion
Plan
ning
IG
Dev
elop
men
t
Solution Plan
Create IG Template
IG Development
End-to-end Review & Community Consensus
(Today)
7/29 Harmonization Close
Week Target Date (2014) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page
due following Monday @ 12 noon
1 3/25 Harmonization Kick-Off & Process OverviewIntroduce: Overview of UCR-Standards Mapping Review: N/A
2 4/1 Introduce: Candidate Standards List & UCR-Standards Mapping Review: Candidate Standards List
3 4/8 Finalize: Candidate Standards ListReview: UCR-Standards Mapping Review: UCR-Standards Mapping
4 4/15 Review: UCR-Standards Mapping Review: UCR-Standards Mapping
- 4/22 Cancelled for National Rx Summit
5 4/29 Finalize: Outcome of UCR-Standards MappingIntroduce: Gap Mitigation Plan Review: Gap Mitigation Plan
6 5/6 Review: Gap Mitigation Plan Review: Gap Mitigation Plan
7 5/13 Finalize: Gap Mitigation PlanIntroduce: Solution Planning Workgroup Review: N/A
8 5/20 Review: Outcomes of Solution Planning WorkgroupIntroduce: Implementation Guide (IG) Template Review: Implementation Guide Template
9 5/27 Review: Outcomes of Solution Planning WorkgroupIntroduce: Minimum Dataset Requirements
Review: Minimum Dataset Requirements & IG Template
10-11 6/3 – 6/10 Review: Outcomes of Solution Planning Workgroup & Minimum Dataset Requirements Review: Minimum Dataset Requirements
12 6/17 Review: Outcomes of Solution Planning Workgroup & Minimum Dataset Requirements Review: Minimum Dataset Requirements
13-15 6/24 – 7/8 Review: Dataset Requirements; Solution Plan Finalization; Implementation Guide Development
Review: Minimum Dataset; Solution Plan; Implementation Guide Content
16-17 7/15 – 7/22 End-to-End Community Review of Implementation Guide End-to-End Review of Implementation Guide
18 7/29 Consensus Vote
Harmonization Weekly Timeline
Review: Solution Planning Workgroup
Session (6/19)
Solution Plan Workflow Analysis
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
Solution Planning Work Group Approach
1. Overlay standards currently in general use per transaction - focus on transactions for integrated solutions
3. For prioritized workflow, propose solutions for harmonizing standards in order to pull PDMP information into EHR or Pharm. IT Systems synchronously
2. Document pros and cons for each proposed solution and prioritize in terms of technical feasibility
Dev
elop
Tec
hnic
al A
rchi
tect
ure
C
an E
HRs
and
Ph
arm
acy
ITs
hand
le p
ropo
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Stan
dard
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Repo
rt fi
ndin
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Co
mm
unity
Solution Planning Approach
1. How to take HL7 V2, NCPDP SCRIPT, ASAP and transform to PMIX Architecture-NIEM Standards?
2. What gaps have been identified to perform necessary query out of HIT specific to PDMP?
3. Define technical architecture of total solution.
Variant 1: Intermediary provides translation functionality
Variant 2: Translation is handled at EHR, providing mapping to PMIX from native EHR standards
Variant 3: Interface engine at EHR-level provides functionality to send PMIX message derived from native EHR standards.
EHR /Pharmacy
Ph. Interm.
HIE
PDMP Hub
PDMP
Most preferred workflow
Translation / Routing
EHR Origin Standard:HL7 V2 (acute)NCPDP SCRIPT (ambulatory)
Alternative: ASAP Web Service
PDMP StandardPMIX
Pharmacy Origin Standard:HL7 V2 (in hospital)NCPDP SCRIPT (retail)
Begin detailing solution and
technical details
(standards)
PrioritizeEHR/Pharm Hub
Solution
Develop holistic solutions for Hub, Intermediary, and Direct workflows
Leverage Hub Solution for EHR/Pharm Intermediary
workflow guidance
Defer direct connection workflow model due to limited scalability and restriction of interstate data
sharing
Develop IG content based on PDMP Hub solution
Develop IG content based on PDMP
Intermediary solution
Develop IG content based on PDMP Direct solution
Deferment does not equate to elimination of workflows from
inclusion in future solution plans and iterations/updates to the
Implementation Guide
EHR Prioritization
# Workflow Model Prioritization Justification
3a EHR to PDMP Hub to PDMPs High
• Capable of facilitating interstate data exchange with reduced complexity• PDMP Hubs are compliant with state regulations regarding access and routing of
PDMP-data• Future hub capabilities support efficient workflow model• Interstate data exchange drives organized data sourcing and in turn, is critical
element to most interoperable state of data flow
2a EHR to Intermediary to PDMP (PDMP Hub to PDMP)
Medium
• Scalable• Provides flexibility in accommodating multiple standards • Ability to leverage existing connections for clinical data• Increased complexity due to additional connections and implication of
policy/regulations on third party use
1a EHR to In-State PDMP Low
• Supports unique implementations and PDMP infrastructure• Restrictive in expanding efficient interstate data sharing• Reduced complexity, though not as highly scalable• Perhaps necessary where policy hinders use of third parties for
translation/transformation
Pharmacy IT Prioritization
# Workflow Model Prioritization Justification
3b Pharmacy IT to PDMP Hub to PDMPs High
• Same as transaction 3a• Existing pilots established using workflow
2b Pharmacy IT to Intermediary to PDMP (PDMP Hub to PDMP)
Medium
• Same as transaction 2a• Concern regarding cost to participate• May allow for future-state PDMP-data access through third parties
1b Pharmacy IT to In-State PDMP Low
• Same as transaction 1a• Pharmacies typically leverage third party for medication history• Limited perceived interest from user community
Data Element Analysis
Data Element Analysis
Minimum Required Data Elements Analysis - Status
Solution Plan Workgroup Transaction Analysis
Data Category Transaction Mode Status Community Determination
Patient Information
Request Complete First NameLast NameDate of Birth
Response To Be Completed
General Request In Progress Request Date/TimestampRequester Location
Response To Be Completed
Authorized User Request Complete Authentication CredentialsType of User
Prescription Information
Response To Be Completed
Prescriber Response To Be Completed
Dispenser Response To Be Completed
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 Dispenser
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, June 26 from 12:00pm – 1:00pm ET
• Next All Hands meeting is Tuesday, July 1 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
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?
Initiative Progress & Current Status
Implementation GuideDevelopment
Solution Planning
•Narrowed down candidate standards via mapping to Use Case Requirements
• Identified and analysed gaps for all narrowed down standards in the Gap Mitigation Plan
•Develop Implementation Guide (IG) based on selected solution
Standards Evaluation
•Determining standards currently in general use per transaction workflow
•Select harmonized standard solution based on current and recommended standards landscapes