pdmp & hiti solution planning workgroup session
DESCRIPTION
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: - PowerPoint PPT PresentationTRANSCRIPT
PDMP & HITI Solution Planning Workgroup
SessionMay 29, 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 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
System1
2
3
42
36
57
7
Hub8 8
Summary of Transactions
Data Flow Transactions Reviewed on 5/15 & 5/22 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
Data Flow Transactions To Be Reviewed on 5/29 SPWG
Transaction System - Outbound System Intermediary 1 System Intermediary 2 System Inbound
3b Pharmacy IT PDMP Hub PDMPs
2a + 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
PMIX• Kansas leverages HIEs and PMPi data hub for all of their
connections• Illinois and Ohio use a direct connection – need further
clarification on standards used
• Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – In progress
• 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
• 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
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: SCRIPT (predominantly) and HL7 (Emdeon does not support) used to connect to SureScripts for medication history (EHR Intermediary),
• Does not connect to a PDMP• Ohio EHR systems (NARxCheck used as interface, does
not “go through” hub) PDMP (does not use HIE or PMPi)
• ADT used as trigger to send query to PDMP through NARxCheck• PMIX used from NARxCheck to PDMP
• Jinhee Lee to verify how Indiana performs translation from HIE to Hub
• Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP – NARxCheck uses ADT feed and directly connects to OARRs system, which uses PMIX
• NARxCheck does not act as a hub but may get information from PMPi (does not go through interconnect directly)
• What type of message is being sent from NARxCheck
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
Current In-State HIT Integrated System Workflows
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
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)
Translation?
Current Interstate HIT System Workflow
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
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
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 relative 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?
- 12 -
Controlled Substance History Report, Integration Architecture Drivers
TO: Easy, timely, consistent access to reliable
PDMP data
FROM: Pervasive challenges to access data
within clinical workflows
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 systems and evolve to support regulatory/technology changes
Health Information Exchanges
Data harmonization and structuring of a data integration layer
Interstate Data sharing Hubs
Continuous improvement of real
time reporting
Vis
ion
Arc
hit
ectu
reD
rive
rs
Controlled Substance History Information Needs
- 13 -
Integrated PDMP Data Exchange ArchitectureSolution Plan - Multi -Level Standards
State PDMPs
EHR EMR
Use
r In
terf
ace
(Pre
sen
tati
on
)H
ealt
h I
T /
Cli
nic
al
Dat
abas
esD
ata
Har
mo
niz
atio
nS
ou
rce
Sys
tem
s
Recommendation/Notes
Pharmacy IT
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.
Metadata transformations, routing
PDMP Med History Architecture
Pharm. Int / HIEs
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.
Hubs
Translation / Transformation
ePrescribingCDS PMS FunctionsMed History/ Reconciliation
Internal Med Orders
HIE/PDMPs (Nebraska)
Other Medication History Sources
(eg. PBMs)
Data Extraction / Transformation
HL7 SCRIPT
SCRIPT ASAP PMIX
PMIX
Solution Plan Review
Solution Plan
Review Proposed Solutions
Appendix
Context Diagram
HIE/Pharmacy
Intermediary
In-State PDMP
Out of State PDMP
Hub
EHR or Pharmacy
System1
2
3
4
2
6
57
7
Hub8 8
3
16
= In Scope
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
Current In-State EHR Workflow (Direct)
EHR SystemIn-State PDMP
PMIX?
Request
Response
Legend
Transaction 1a
Current In-State EHR Workflow (HIE)
EHR System HIE In-State PDMP
Request
Response
Legend
HL7 OBXXML Report
NCPDP SCRIPT
HL7 ADT feedsNCPDP SCRIPT
HL7 A04NCPDP SCRIPT with PMIX
WrappersThird Party Software
XML ResponseNCPDP SCRIPT with
PMIX Wrapper
Transaction 2a
Current In-State Pharmacy Workflow (Direct)
Pharmacy IT System
In-State PDMP
Request
Response
Legend
Transaction 1b
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
Current In-State EHR Workflow (Hub)
EHR SystemIn-State PDMP
Request
Response
Legend
?
PMIX ?
?
Transaction 3a – Not Effective Workflow? Currently Active?
PDMP Hub
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