Final Current Standards
Landscape Analysis
June 3rd, 2014
HIE/Ph.
Interm.
2
7
EHR or
Pharmacy
System
5
2
4
In-State
PDMP
1
3
3
7
8
Hub
8
Out of
State
PDMP
6
Scope
Hub
From
Via
To


EHR
Pharmacy
-
In-State PDMP
2a
2b


EHR
Pharmacy
HIE
Ph. Int
In-State PDMP
3a
3b


EHR
Pharmacy
Hub
In-State PDMP
4

In-State PDMP
-
Out of State PDMP
5a
5b

HIE
Ph. Intermediary
-
Out-of-State PDMP
6

Hub
-
Out-of-State PDMP
7a
7b

HIE
Ph. Intermediary
Hub
In-State PDMP
8

In-State PDMP
Hub
Out-of-State PDMP
Transactions
1a
1b
PMP/HITI User Stories with Alternate Workflows
EHR 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 Hub
EHR 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
Summary of Transactions
Data Flow Transactions Reviewed on 5/15 & 5/22 & 5/29 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
3b
Pharmacy IT
PDMP Hub
PDMPs
2b + 7a / 7b + 6
Pharmacy IT
PDMP Hub
PDMPs
Pharm. Int. / Switch
or
HIE
Transaction
1a: EHR
System to
PDMP (Direct)
Summary from SPWG 5/15
•
•
•
EHRs don’t generally query PDMPs directly
Ohio connectivity model is a direct connection to OARRS via
NARxCheck to PMIX
Illinois and Ohio use a direct connection
Items Required for Further
Clarification
•
•
2a: EHR
System to
PDMP via HIE
•
•
•
•
•
•
•
1b: Pharmacy
IT System to
PDMP (Direct)
•
•
•
Jinhee Lee to gather
information on transactions
occurring in Illinois, Kansas,
Indiana – Complete
Jean Hall to confirm Ohio
connectivity model –
Complete
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
Kansas leverages HIEs and PMPi data hub for all of their
connections
•
Jean Hall to further clarify
what the query/message
pairing used to engage EHR
system to HIE – Complete
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
2b: Pharmacy
IT System to
PDMP via
Pharmacy
Intermediary/
Switch
Summary from SPWG 5/15
•
•
•
Transaction
3a: EHR
System to
PDMP via Hub
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
Items Required for Further
Clarification
•
Summary from SPWG 5/22
•
•
•
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
Lynne Gilbertson to verify if
standards are currently being
used (Nebraska) – Complete
Items Required for Further
Clarification
•
Clay Rogers and Jeff McGonigal
to verify translation/EHR
generating PMIX request–
Complete
Transaction
2a + 7a + 6:
EHR System to
HIE to Hub to
PDMP
Summary from SPWG 5/22
•
•
•
•
•
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 and Emdeon used by EHR Systems to obtain
medication history data – not yet used for controlled
substance history
• Emdeon does not support HL7
• SureScripts predominantly supports SCRIPT
Ohio EHR Systems leverages NARxCheck as an interface
to in-state PDMP
• Does not go through HIE or Hub (PMPi)
• HL7 ADT used as a trigger to send query
• NARxCheck handles transformation of HL7 to PMIX
architecture
• Message received by PMP: PMIX-NIEM
NARxCheck does not act as a hub but may get
information from PMPi
• Does not go through interconnect directly
Items Required for Further
Clarification
•
•
Jinhee Lee to verify how Indiana
performs translation from HIE to
Hub – Complete
Danna Droz and Chad Garner to
confirm third party software
functionality of NARxCheck via
NABP – Complete
Transaction
3b: Pharmacy
IT System to
PDMP via Hub
Summary from SPWG 5/29
•
•
2b + 7a/7b + 6:
Pharmacy IT
System
Interstate
Workflow
•
•
Items Required for Further
Clarification
Hub to PDMP available for use but is not currently in
production
• Pharmacy IT System to hub not currently in use
• Technology may be used in the future
Ohio to possibly pilot for a pharmacy chain to go through
hub (one of 16 states that is a part of SAHMSA grant)
•
Support Team to determine
what standards these
transactions are based on – In
progress
Not currently in use but Pharmacy IT System
• May be able to go through intermediary in the future
Pharmacy workflow using controlled substance medication
history through a Pharmacy Intermediary could be a future
use case
• PDMP checking on a claim vs. query of history for
controlled substances
•
N/A
Relevant Workflows
Current Landscape
Proposed Solution Set
1
EHR  In-State PDMP
Pharmacy  In-State PDMP
EHR  Intermediary  In-State PDMP
Pharmacy  Intermediary  In-State PDMP
EHR  In-State PDMP
Pharmacy  In-State PDMP
2
EHR  Intermediary*
Pharmacy  Intermediary
EHR  Intermediary  Hub  PDMP(s)
Pharmacy  Intermediary  Hub  PDMP(s)
3
EHR  Hub  PDMP(s)
Pharmacy  Hub  PDMP(s)
EHR  Hub
Pharmacy  Hub
1. Aligns to in-scope Use Case scenarios
EHR  In-State PDMP  Hub  PDMP(s)
Pharmacy  In-State PDMP  Hub  PDMP(s)
*Intermediary - An entity (service, or set of services) that routes the transaction
to a receiving entity. May perform value added services such as translating data
from one format to another
Legend
2. Approach may require
translation mapping
Proposed
between ASAP, NCPDP SCRIPT Medication History,
and H L7 V2 Messaging
Potentialto PMIX Architecture
3. Implementation Guide
will have to include data
Remove
element modifications/additions to fully support
PDMP & HITI Use Case requirements
Summary Analysis
Health IT System Standard
Translation
PDMP Standard
ASAP Web Services
Intermediary
HL7 V2 Messaging
PMIX-NIEM
Architecture
PDMP Hub
NCPDP SCRIPT Medication History
Strategy Details
 Implementation Guide focus will shift to those organizations providing
transformations/translation/ ETL services
 ASAP can provide point-to-point PDMP data exchange for Pharmacies
and EHRs a like – can be transformed into PMIX Architecture via
Appriss, Inc. (PMPi)
 Intermediaries provide translation service or metadata transformations as
“wrappers”
 Data elements will need to be modified or added, specified within the
PDMP & HITI Implementation Guide
Example Container/Payload
Configuration
PMIX
Architecture
SCRIPT Med
History
(Patient Data)
(Authentication)
Transaction Workflows
Current In-State EHR Workflow (Direct)
Transaction 1a
NARxCheck
In-State
PDMP
EHR System
NARxCheck
Legend
Request
Response
Current In-State EHR Workflow (HIE)
Transaction 2a
EHR System
HL7 ADT feeds
NCPDP SCRIPT
(Med History)
HL7 QRY^T12
HL7 OBX
XML Report
NCPDP SCRIPT (Med History)
HL7 DOC^T12 - CCD
HIE
HL7 A04
NCPDP SCRIPT with PMIX
Wrappers
Third Party Software
HL7 QRY^T12
In-State
PDMP
XML Response
NCPDP SCRIPT with
PMIX Wrapper
HL7 DOC^T12
Legend
Request
Response
Current In-State Pharmacy Workflow (Direct)
Transaction 1b
NARxCheck
Pharmacy IT
System
In-State
PDMP
NARxCheck
Legend
Request
Response
Current In-State Pharmacy Workflow (Pharmacy Int. / Switch)
Transaction 2b
?
?
Pharmacy
Intermediary
/ Switch
Pharmacy
System
?
SCRIPT used for medication history but
does not currently pull Controlled
Substance history from Intermediaries
using SCRIPT standard.
In-State
PDMP
?
Legend
Request
Response
Current In-State EHR Workflow (Hub)
Transaction 3a – Not Effective Workflow? Currently Active?
PMIX
HL7
EHR System
Interface
PMIX
PMIX
In-State
PDMP
PDMP Hub
PMIX
Legend
Request
Response
Current In-State Pharmacy Workflow (Hub)
Transaction 3b – Not Effective Workflow? Currently Active?
Translation?
Translation?
Pharmacy
System
PMIX
In-State
PDMP
PDMP Hub
?
PMIX
Legend
Request
Response
Current Interstate EHR Workflow
Transaction 2a + 7a + 6
EHR System
NCPDP SCRIPT
(Medication
History)
HIE
Third Party Software
PMIX-NIEM
PMIX-NIEM
XML
PMIX-NIEM
Legend
Request
Response
PDMP Hub
In-State
PDMP
PMIX-NIEM
Out-ofState
PDMP
Current Interstate Pharmacy Workflow
Transaction 2a + 2b + 7a + 7b + 6
Pharmacy
System
NCPDP SCRIPT
HIE
NCPDP SCRIPT
Request
Response
In-State
PDMP
PMIX-NIEM
XML
PMIX-NIEM
PDMP Hub
Out-ofState
PDMP
Pharmacy
Int. /
Switch
?
Legend
Third Party Software
PMIX Wrappers
?
PMIX-NIEM
System Transaction-Relationship Flow
System Relationships: Transactions
Legend
Known
To Confirm
1. EHR to In-State PDMP
2. EHR to HIE
3. EHR to PDMP Hub
4. EHR to Ph Int./Switch
5. Ph IT to In-State PDMP
6. Ph IT to Ph Int./Switch
7. Ph IT to PDMP Hub
8. Ph IT to HIE
9. HIE to PDMP Hub
10. HIE to In-State PDMP
11. HIE to Out-of-State PDMP
12. PDMP Hub to In-State PDMP
13. PDMP Hub to Out-of-State PDMP
14. In-State PDMP to Out-of-State
PDMP