pdmp & hiti solution planning workgroup session i
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PDMP & HITI Solution Planning Workgroup
Session IMay 15th, 2014
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:1. Differences in pharmacy and clinician workflows / data systems and expectations in
PDMP data transmitted?2. What components of PDMP report are extracted for decision support?3. Can EHR and Pharmacy IT systems handle the proposed standards (in the context of
PDMP systems)?4. What standard(s) fit into message and workflow configuration per transaction type?5. Are transactions collapsible in terms of capability of leveraging same standard?
Solution Planning Workgroup
4 main players and associated systems:
1. EHR/EMR systems are predominantly based off HL7 standards and functional models for internal module connectivity and NCPDP SCRIPT for transmission of e-prescriptions
2. Pharmacy IT systems leverage NCPDP for Rx file transfer, structured sig, claims, and billing
3. PDMPs leverage PMIX Architecture for interstate data exchange of controlled substance medication history
4. Dispensers follow ASAP Reporting Standards for submission of controlled substance medication history reports to state PDMPs
5. Interstate data sharing is currently enabled by passing queries through HIEs and then routing to PDMP Hubs
6. Most EHR integration is currently enabled via HIEs
Current State: What We Know…
Actor System
Clinicians EHR | EMR
Pharmacists Pharmacy IT
PDMP Administrators State PDMP Databases
Intermediaries PDMP Hubs | HIEs | Pharmacy Intermediaries, Switches
1. Full view of Pharmacy IT transaction workflows
2. Reality of certain system-to-system transactionsa. Pharmacy IT to PDMP Hubb. Pharmacy IT to HIEc. 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 Don’t Know
Solution Planning Work Group Approach
1. Overlay standards currently in general use per transaction - focus on transactions for integrated solutions
2. For each alternate workflow, propose solutions for harmonizing standards in order to pull PDMP information into EHR or Pharm. IT Systems synchronously
3. Document pros and cons for each proposed solution and prioritize in terms of technical feasibility De
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*Goal is to prescribe a solution that would mitigate impact to the way PDMPs share data today.
Context DiagramHIE/
Pharmacy Intermediary
In-State PDMP
Out of State PDMP
Hub
EHR or Pharmacy
System1
2
3
4
2
6
57
7
Hub8 8
3
6
= In Scope
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
Current In-State HIT Integrated System Workflows
Current In-State EHR Workflow (Direct)
EHR SystemIn-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 don’t generally query PDMPs directly
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
• 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 SystemIn-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 HubPharmacy
System
Current Interstate HIT System Workflow
Current Interstate EHR Workflow
EHR System HIEIn-State PDMP
Request
Response
Legend
NCPDP SCRIPT Third Party Software
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
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 workflows
2. Review and clarify System-Transaction Relationship workflow
Appendix
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
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