PDMP & HIT Integration Use Case
Definitions, In and Out of Scope, Assumptions, and Context Diagram
Definitions:
1.
Healthcare Professional – A medical practitioner or provider of care (or someone
legally authorized to act on their behalf by relevant state laws, rules or regulations)
who has legal authorization to access prescription drug data for patients at the point of
care to make informed clinical decisions and appropriate treatment recommendations
a.
2.
This may include: Prescribers, dispensers, pharmacists, nurses, etc.
Health IT System – An information system that is used by a Healthcare Professional
to collect and store patient information including demographics, medicine, etc. (i.e.
EHR, Hospital Information System, HIE, Pharmacy System)
In Scope Items
1.
Connecting PDMPs to Health IT systems using existing standards; (technical
mechanism for actual exchange of data)**
2.
If standards do not exist, identifying the gap in the current standards and working
with the Standards Organizations (SDOs) to address the gaps** (Refers to
harmonization activity)
3.
Improving effective and efficient access to PDMP data by Healthcare Professionals**
4.
Health IT system has ability to generate a query and receive a response from the
PDMP system
a.
Healthcare Professional querying additional state PDMP systems through their
state’s existing interstate data exchange infrastructure (i.e. hub)
**Leveraged from Charter
5.
Note to the Community: For this Use Case, the transactions that are initiated by the Health IT
system and the query response is what is in scope. We will not be focusing on Unsolicited
Reporting (PDMP pushing information out to a variety of end users) right now with this Use
Case, but this may be considered at a later time.
If alerts are part of the responses back to the HC Professional we can indicate a data element in
the data requirement sections. We won’t dictate what the alert looks like in the Use Case.
6.
Define standard set of data elements used to submit queries each time
7.
Define system requirements for Healthcare Professionals to be able to access patient
information already stored in a PDMP
a.
Accessing a PDMP through a Health IT system (i.e. EHR system) instead of
another portal
b.
Note: The selection of a security mechanism will be defined during
harmonization
8.
Define system/technical requirements that allow applications to access data in a
consistent manner across the local Health IT system
b.
Method of extraction
Out of Scope Items
1.
Defining the trigger event for how the PDMP is queried or initiated by the user (e.g.,
hyperlink while ordering, pressing a button, automatic trigger, etc.)**
2.
Addressing delegation of rights to individuals not legally authorized to prescribe
medications (this is an implementation specific decision and may vary by
implementation and pilot sites)**
3.
Third party access - (this is an implementation specific decision and may vary by
implementation, pilot sites and state statues and law)**
4.
Reporting patient prescription information from dispensers to state PDMP
5.
Policy-based decisions on how PDMPs are managed, accessed, and updated that vary
from state to state
6.
Timeliness of PDMP: Currency of Data
7.
Storing query response from PDMP within the Health IT system
8.
Health IT system’s structure of display for the query response
9.
Unsolicited reporting (PDMP pushing information out to a variety of users)
**Leveraged from Charter
Assumptions
1.
Health IT system is capable of querying a PDMP
2.
All Healthcare Professionals have appropriate legal authority based on state
regulations to request and receive information from state PDMP
3.
Healthcare Professionals accessing the PDMP follow state guidelines as appropriate,
including any privacy and security requirements as required by each individual state
PDMP authority
4.
The PDMP returns high positive matches to the Healthcare Professional1
5.
The Healthcare Professional accesses information that already exists within the
PDMP at the time of querying
6.
1
Organization has the responsibility to figure out how query response is presented and integrated.
Question for Community: What are the responses you receive when querying a PDMP?
Generic Scenario & Context Diagram
Pre-Step: Healthcare
Professional logs into
Health IT System
PDMP & HIT Integration
Use Case Scope
1. Sends query to state PDMP
Interstate
Hub
Healthcare Professional
receives requested
information
2. PDMP sends query response
AND/OR
Pre-Step: Healthcare
Professional logs into
Health IT System
PDMP & HIT Integration
Use Case Scope
1. Sends query to state PDMP
Healthcare Professional
receives requested
information
2. PDMP sends query response
User Stories
User Story 1: A legally authorized provider queries PDMP before writing a prescription for a patient
Draft User Story: A patient arrives at the doctor’s office for chronic back pain. The Healthcare Professional logs into his Health IT
system and enters his credentials. After diagnosis, the Healthcare Professional sends a query to the State PDMP through his Health IT
system to see if the patient had been prescribed a controlled substance in the past X weeks. The PDMP processes the request and
identifies the appropriate response to send back to the requestor. After receiving the query response from the PDMP, the Healthcare
Professional makes an informed decision of whether or not to prescribe the medication or modify the dosage based on the information
received.
Trigger: Patient needs
medication for chronic back
pain
1. Healthcare
Professional logs into
Health IT System
Use Case Scope
2. Sends query to state PDMP to check if patient
has been prescribed narcotics/controlled
substance in past X weeks
3. PDMP sends query response
4. Healthcare Professional makes an informed
decision to prescribe medication based on
information received
User Story 2: Pharmacist queries PDMP prior to dispensing opioids to a patient
Draft User Story: A patient arrives at the pharmacy to have his prescription filled. The pharmacist logs into the Pharmacy Dispensing
system, and she enters her credentials. After, she sends a query to the State PDMP through her Pharmacy Dispensing system to see if
the patient had filled a prescription for a controlled substance in the past X weeks. The PDMP processes the request and identifies the
appropriate response to send back to the requestor. After receiving the query response from the PDMP, the pharmacist makes an
informed decision of whether or not to dispense the medication based on the information received.
Trigger: Patient arrives at pharmacy
and drops off prescription to be filled
1. Pharmacist logs
into Pharmacy
Dispensing System
Use Case Scope
2. Sends query to state PDMP to check if
patient has received narcotics/controlled
substance in past X weeks
3. PDMP sends query response
4. Pharmacist makes an informed decision to
dispense medication based on information
received
Comments on User Stories
Submitted by Charlie Oltman, Target on 1/17/2014
User Story 3: Pharmacist queries PDMP prior to dispensing opioids to a patient
Draft User Story: A patient arrives at the pharmacy to have his prescription filled. The pharmacist logs into the Pharmacy Dispensing
system, and she enters her credentials. The Pharmacy Dispensing system sends the opioid transaction to their intermediary, the
intermediary sees that the drug is a controlled substance and sends a query to the PDMP database. The PDMP database sends an alert
back to the pharmacy via their intermediary that a Rx History report needs to be requested. She requests the Rx History report and
after receiving the report she is able to make an informed decision of whether or not to dispense the medication based on the
information received.