PDMP & Health IT Integration Initiative

Initiative LaunchNovember 14th, 2013

Meeting Etiquette• Remember: Please 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 o Hold = Elevator Music = frustrated speakers and

participants• This meeting is being recorded

o Another reason to keep your phone on mute when not speaking

• Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know.o Send comments to All Panelists so they can be

addressed publically in the chat, or discussed in the meeting (as appropriate).

From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute

All Panelists

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Agenda

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Topic Presenter TimeOpening Remarks Doug Fridsma, MD, PhD Director, Office

of Standards and Technology, ONC5 Minutes

The Standards & Interoperability Framework

Doug Fridsma, MD, PhD Director, Office of Standards and Technology, ONC

5 minutes

Prescription Drug Abuse Prevention

Cecelia Spitznas, PhD, Office of National Drug Control Policy – White House

5 minutes

PDMP Overview Federal Efforts

H. Westley Clark, MD, JD, MPH, SAS, FASAM, Director, Center for Substance Abuse Treatment, SAMHSA

15 minutes

Next Steps and Logistics Doug Fridsma, MD, PhD Director, Office of Standards and Technology, ONC

15 Minutes

Q & A Team 15 Minutes

Teams convened

to solve problems

Solutions& Usability

R&D

Curate a portfolio of standards, services, and

policies that accelerate

information exchange

Support Innovation through SHARP

program, Innovation/Challenge

Grants, and interfacing with International

Standards community

Enable stakeholders to come up with simple, shared solutions to common information exchange challenges

Office of Science & Technology

Coordinate Federal

Partners

Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture

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ONC’s Interoperability Strategy• Leverage government as a platform

for innovation to create conditions of interoperability

• Health information exchange is not one-size-fits-all; create a portfolio of solutions that support all uses and users

• Build in incremental steps – “don’t let the perfect be the enemy of the good”

What is the S&I Framework?

* As of October 2013, 2000+ people had registered on the S&I Framework wiki, and 750+ members representing 550+ organizations had committed to the S&I Framework

• The Standards and Interoperability (S&I) Framework represents one investment and approach adopted by the Office of Science & Technology (OST) to fulfill its charge of prescribing health IT standards and specifications to support national health outcomes and healthcare priorities

• The S&I Framework is an example of “government as a platform”– enabled by integrated functions, processes, and tools – for the open community* of implementers and experts to work together to standardize

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S&I Framework Coordination

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ONC Programs & Grantees

Community S&I Framework

FACAs

SDOs

• State HIE Program & CoPs• SHARP Program• REC Program & CoPs• Beacon Program

• Technology Vendors• System Integrators• Government Agencies• Industry Associations• Other Experts

• HL7• IHE• CDISC• NCPDP• ASC X12• ASTM• WEDI

• HIT Standards Committee• HIT Policy Committee• Tiger Team

• ISO/TC 215• IHTSDO• NLM• NQF• Regenstrief• Other health IT

standards related organizations

• Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: http://wiki.siframework.org

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• Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system

• An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services

S&I Framework Overview

PRESCRIPTION DRUG ABUSE PREVENTION

THE NATIONAL PERSPECTIVE

Dr. Cece Spitznas Office of Research and Data AnalysisOffice of National Drug Control Policy

November 14, 2013

S&I PDMP Kickoff

The U.S. Prescription Drug Abuse Problem

• 6.8 million Americans reported current non-medical use of prescription drugs in 2012.1

• Approximately 1 in 4 people using drugs for first time in 2012 began by using a prescription drug non-medically.2

• Of the 38,329 drug overdose deaths in 2010, approximately 22,100 involved prescription drugs. o 16,651 involved opioid painkillers (vs. 4,183 for cocaine

and 3,038 for heroin)3

• $55.7 billion in costs for prescription drug abuse in 20073 including $25 billion in direct health care costs and $5.1 billion in criminal justice costs.4

• Studies have found that individuals abusing opioids generate, on average, annual direct health care costs 8.7 times higher than non-abusers.5

1, 2. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services. [September 2013]. Available: http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm3. CDC, National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database. Extracted May 1, 2012. 4. Birnbaum HG, White, AG, Schiller M, Waldman T, et al. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. Pain Medicine. 2011;12:657-667. 5. White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005

19801982198419861988199019921994199619982000200220042006200820100

5

10

15

20

25Motor Vehicle Traffic Poisoning Drug Poisoning (Overdose)

Dea

ths

per

100,

000

popu

lati

on

Source: NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data

U.S. Death Rate Trends, 1980-2010

National Drug Control Strategy

• The President’s science-based plan to reform drug policy:1)Prevent drug use before it ever begins

through education2)Expand access to treatment for

Americans struggling with addiction3)Reform our criminal justice system4)Support Americans in recovery

• Coordinated Federal effort on 112 action items

• Signature initiatives:– Prescription Drug Abuse– Prevention– Drugged Driving

• Coordinated effort across the Federal Government

• Four focus areas:1) Education2) Prescription Drug

Monitoring Programs

3) Proper Medication Disposal

4) Enforcement

Prescription Drug Abuse Prevention Plan

1999200020012002200320042005200620072008200920100

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000Opioids Heroin Cocaine

Num

ber

of D

eath

sOverdose Deaths, Specific Drugs,

1999-2010

Source: CDC/NCHS National Vital Statistics System, CDC Wonder. Updated with 2010 mortality.

Source of Prescription Pain Relievers

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2009-2010

• The number of primary admissions among 18- to 24-year-olds for heroin treatment services increased from 34,000 in 2000 to 60,000 in 2011.1

• The number of persons who were past-year heroin users has been rising steadily, increasing approximately 50 percent since 2008 (445,000 to 669,000 in 2012).2

• Injection-drug users report prescription opioid use predates heroin use and tolerance motivates them to try heroin.3

1. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data extracted as of September 2013.

2. Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.linked to 2/13/2013 http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresultsAlts2011.htm#Fig2-4 pending citation/cleared data

3. Lankenau SE, et al. (2012). Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012 Jan;23(1):37-44. Epub 2011 Jun 20.

Emerging Issues: Prescription Opiates and Heroin

State Overdose Death Rates, 2010

10.9

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2000-2010 on CDC WONDER Online Database. Extracted October, 2012.

— U.S. National Rate: 12.3 per 100,000 —

Goalso PDMP in every state and interoperability among states.o Use of the system by prescribers to identify patients

potentially at risk for or engaged in prescription drug misuse or at risk for medication interaction.

Main Actionso Secured language for Department of Veterans Affairs to

share prescription drug data with state PDMPs.o Currently 16 states can share data across state lines.o Pilot projects with ONC and SAMHSA in Illinois,

Indiana, Kansas, Michigan, Nebraska, North Dakota, Ohio, Oklahoma, Tennessee, and Washington state.

Monitoring

PDMP Overview and Federal Efforts

H. Westley Clark, MD, JD, MPH, SAS, FASAMDirector

Center for Substance Abuse TreatmentSubstance Abuse and Mental Health Services

Administration

PDMP & Health IT Integration Initiative Launch Webinar

November 14, 2013

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Many states established PDMPs to reduce prescription drug abuse and diversion.• Statewide electronic databases:

–Collect data on controlled substances dispensed by pharmacies (and dispensing physicians in some states).

–Distribute patient health information from the database to individuals authorized under state law.

What are PDMPs?

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Data collected varies by state, may include:

• Schedules II-IV (some V)• Prescriber• Dispenser• Patient• Date dispensed• Drug

PDMP Data Fields

• Strength• Quantity• Refills• Method(s) of

payment

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PDMPs may be used for:• Clinical support • Regulatory Oversight• Surveillance and Evaluation • Law Enforcement

Reporting Types: Passive vs. Proactive• Solicited Reporting (Pull model)• Unsolicited (Push model)

PDMP Applications & Reporting Types

1

2

DIRECT protocol

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State Snapshot: PDMPs

49 States have legislation authorizing PDMPs.

47 States have operational PDMPs.

In MO, privacy concerns are 1 reason for push back on legislation.*http://www.pdmpassist.org/pdf/

pmpprogramstatus2013_a.pdf *http://www.komu.com/news/prescription-drug-monitoring-program-may-curb-state-drug-abuse/

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State Snapshot: PDMP Interoperability

20 States are engaged in interstate data sharing (9/19/13).

A PDMP may be sharing data with one or more other PDMPs.

http://www.pdmpassist.org/pdf/PDMP_interoperability_status_21030919.pdf

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The Story So Far

Stakeholders

Organizations

White House Roundtable on

Health IT & Prescription

Drug AbuseJune 3, 2011

Federal & State Partners

State Participants

Action Plan: Improving Access to PDMPs

through HIT

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Action Plan Implementation

SAMHSA provided funding for implementation of the Action Plan through the “Enhancing Access to PDMPs through Health IT Project”.• SAMHSA partnered with ONC, ONDCP, & the

CDC.• ONC has management oversight of the effort.

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Goal: Increase timely access to PDMP data in an effort to reduce prescription drug misuse and overdoses.• Explore ways to use HIT to link prescribers and

dispensers with the valuable data in PDMPs.• Main issue: How to make this information more

available to three key groups of clinical decision makers:

Enhancing Access to PDMPs through Health IT Project

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Improve clinician workflow by connecting

PDMPs to health IT

Support timely decision-making at the

point of care

Establish standards for facilitating information

exchange

Provide recommendations and pilot input

Test the feasibilityof using health IT to

enhance PDMP access

Reduce prescription drug misuse and overdose in the United States

Work Groups

Pilots

Enhancing Access to PDMPs through Health IT Project

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Inclusion of prescribing data from Federal dispensers

Providing technical assistance to states and othersPDMP evaluationsPlanning, Implementation, and Enhancement

grantsHealth Information Technology and PDMP Pilot

programsPDMP EHR Grant Programs

Current Federal PDMP Initiatives

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Improve real-time access to PDMP via existing technologies like EHRs (FY12,13).

Strengthen operational state of PDMPs by increasing interoperability between states (FY12).

Evaluate the impact of the enhancements on Rx drug abuse (FY12).• FY 12: 2 year funding for 9 states (FL, IL, IN, KS,

ME, OH, TX, WA, WV)• FY 13: 2 year funding for 7 states (KY, MA, ND, NY,

RI, SC, WI)

SAMHSA’s PDMP EHR Grants

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SAMHSA’s PDMP EHR Grants:Overview of Phase 1 Pilots

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State End User Pilot Summary

Illinois Emergency Department

• Automated query via intermediary and interstate hub to PDMP upon patient admission to ED

• PDMP data integrated into EHR as a PDF via a Direct message

Indiana Emergency Department

• Automated query via HIE to multiple states’ PDMPs upon patient admission to ED• Patient risk score and PDMP data integrated into EHR

Kansas Providers • Unsolicited report of at-risk patients sent via Direct to EHR-integrated mailboxes

Michigan Providers • Automated query via e-Prescribing software to multiple states’ PDMPs and result integrated in patient’s medication history

Nebraska Emergency Department

• Automated query via HIE to PDMP upon patient admission to ED• Easy access to PDMP with SSO• PDMP data integrated into EHR

Oklahoma Emergency Department

• Established PDMP access directly though an HIE• Developed a SSO from the EHR through the HIE to the PDMP• Alert flag representing the PDMP data

Tennessee Pharmacy • Real-time reporting of dispensing controlled substance data to the PDMP using an existing network

SAMHSA’s PDMP EHR Grants:Overview of Phase 2 Pilots

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Integrating into provider workflow reduces barriers to PDMP access and increases utilization.

Type of integration can vary:• Value increases with degree of automation;• But even basic integration (hyperlink to

PDMP, return PDF) is valued.When available, the PDMP is valuable as a

clinical decision support tool.

Key Takeaways of Enhancing Access Project

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Enhancing Access Pilot White Papers: 8 papers detailing each pilot’s design, technical configuration, outcomes, and plans for expansion.

The Road to Connectivity: A roadmap for connecting to PDMPs through health IT.

Workgroup Recommendations Final Report: Stakeholders identified challenges and recommended solutions to increase timely use of PDMP data by clinicians.

Videos: Pilot participants detail their individual battles against prescription drug abuse, recalling how they used health IT to connect providers to PDMPs.

Enhancing Access Project Accomplishments: Phases 1 & 2

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PDMP Connect Web Site: Developed to allow members of the PDMP community to share valuable experiences, information, and resources: http://www.healthit.gov/pdmp/pdmpconnect

Abbreviated S&I Initiative: Conducted Jan – March 2013:• It provided valuable feedback from stakeholders, but

only identified where standards were needed and the potential standards that could be used.

• It did not identify, evaluate, and harmonize standards for the exchange of information from PDMP to EHRs or HIEs, which we will address in Phase 3…

Enhancing Access Project Accomplishments: Phases 1 & 2 (cont.)

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THANK YOU!Westley.clark@samhsa.hhs.gov

Phase 3: Next Steps & Call for Participation

Doug Fridsma, ONC

Situation Today• Low utilization of PDMPs among healthcare providers:

– Lack of awareness/utility– Many PDMPs are stand alone systems / No system-to-system

interface– Outside of the clinical workflow – Time and complexity required to access– Lack integration – Untimely data

• EHR Adoption: – As a result of the increased use of EHRs, integrating PDMP data into

EHRs is critical to improving PDMP access and utilization.– Opportunity to leverage PDMP to improve patient safety, by

integrating PDMP information into clinical decision support, medication reconciliation, and quality improvement

PDMP & Health IT Integration Initiative moving forward• While there are data exchange standards in place to share

information– PDMP to PDMP– Pharmacy to PDMP– EHR to Pharmacy (eRx)

• Currently there is not a national uniform approach to the exchange of data between an EHR and a PDMP.

Slide 40

PDMP Ecosystem

Pharmacy

PMPi / RxCheck PDMP

Other State PDMPs

NCPDP Script

PDMP

Por

tal

Switches

NCPDP Telecom

ASAP

Pharmacy Benefits Mgmt

Provider

EHR System

NIEM-PMP NIEM-PMP

Provider

EHR System

Provider

EHR SystemData Out

Needs for consistent harmonized standards (data format and content; transport and security protocols)

Interoperability Challenges

• One of the current technical barriers to interoperability is the lack of harmonized standard methods to exchange and integrate the prescription drug data available in PDMPs into health IT systems.

– Lack of harmonized technical standards and vocabularies to enable PDMPs to share computable information with the EHR that providers can use to support clinical decision-making.

• To achieve interoperability, consistent and standardized electronic methods need to be established to enable seamless data transmission between PDMPs and health IT systems.

Now and ThenEnhancing Access to PDMPs using Health IT project – Phases 1 & 2

• September 2011 - March 2013• Pilots demonstrated proof of concept. • Various non-standard approaches were also used that need to be refined or harmonized

with the existing portfolio of standards and implementation specifications. • Abbreviated S&I Initiative (Jan – March 2013)

Did not identify, evaluate and harmonize standards for the exchange of information from PDMP to EHRs or HIEs.

Valuable feedback from stakeholders but only identified where standards were needed and the potential standards that could be used.

PDMP & Health IT Integration Initiative – Phase 3• November 2013 – TBD• Full S&I Framework Initiative • Assess the current PDMP infrastructure (e.g., interfaces, data formats, data transport

and data security protocols) and available standards that could be harmonized to allow interoperable communications between PDMPs and health IT systems.

• Initiative Coordinator: Johnathan Coleman• Co-Coordinators: TBD• ONC Sponsors:

– Jennifer Frazier– Mera Choi– Scott Weinstein

• SAMHSA Lead– Jinhee Lee– Kate Tipping

• Project Management: Jamie Parker• Project Support: Ali Kahn• Use Case Lead: Presha Patel• Use Case Support: Ahsin Azim• Vocabulary and Terminology Subject Matter Expert: Mark Roche

PDMP & Health IT Integration Initiative Support Team

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PDMP & Health IT Integration DRAFT Notional Project Timeline

Kick-off (11/14)

Pre-Discovery, Call for Participation

Jan 14June 14

Discovery

Initiative End

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Nov 13 July 14Mar 14

Implementation Pilot

User Stories, Use Cases, Functional Requirements

Standards Gap Analysis

Harmonized Specifications

Technology Evaluations Reference Model Implementation

& Validation

Use Case Kick Off

Use Case ConsensusStandards and Harmonization Kick Off

Pilot Kick Off

• We will be meeting as a community every week on Tuesdays 12:00-1:00 pm ET.

• All Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and General PDMP & Health IT Integration information will be posted on PDMP & Health IT Integration Initiative: • http://wiki.siframework.org/PDMP+%

26+Health+IT+Integration+Homepage

Logistics

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PDMP & Health IT Integration Wiki Home Page

47PDMP & Health IT Integration Wiki

• Join us for our next Work Group Meeting November 19th, 2013• See the wiki page for the meeting updates• http://wiki.siframework.org/PDMP+%

26+Health+IT+Integration+Homepage

• The PDMP & Health IT Integration Initiative is open for anyone to join

• This community will meet frequently by webinar and teleconference

• We use Wiki pages to facilitate discussion. Information on how to join the Community can be found on the PDMP & Health IT Integration Initiative: • http://wiki.siframework.org/PDMP+%

26+Health+IT+Integration+Homepage

• In order to ensure the success of our initiative and the subsequent pilot, we encourage broad and diverse participation from the community. • This is your chance to have an impact on the creation and implementation

of a pilot program in this important area of health IT development

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Next Steps…

• Please comment on the Proposed Project Charter• Review the Project Charter:

– http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charter+and+Members

• Complete the PDMP & Health IT Charter Comment Form (scroll to the bottom of the page):

– http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charter+and+Members

• Join us for our next meeting November 19, 2013 from 12:00-1:00 pm ET• The time and meeting information will be available on the PDMP & Health IT

Integration wiki page: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage

• Details on the PDMP & Health IT Integration launch including web meeting access and call in information are posted on the wiki: • http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage

Next Steps continued

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Questions and Open Discussion

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Support TeamONC Lead

• Mera Choi -- mera.choi@hhs.gov • Jennifer Frazier -- jennifer.frazier@hhs.gov • Scott Weinstein – scott.weinstein@hhs.gov

SAMHSA Lead• Jinhee Lee -- Jinhee.Lee@samhsa.hhs.gov • Kate Tipping -- Kate.Tipping@samhsa.hhs.gov

Project Management• Jamie Parker -- jamie.parker@esacinc.com

Project Support• Ali Khan -- Ali.Khan@esacinc.com

Use Case Lead• Presha Patel-- Presha.Patel@accenture.com

Use Case Support• Ahsin Azim -- Ahsin.Azim@accenture.com

Vocabulary and Terminology Subject Matter Expert• Mark Roche -- mrochemd@gmail.com

Resources

• PDMP & Health IT Integration Wiki Homepage: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage

• PDMP & Health IT Integration Charter: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charter+and+Members

• PDMP & Health IT Integration Past Meeting (materials): http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Meeting+Artifacts

THANK YOU