July 1 st , 2014

1. Overlay standards currently in general use per transaction
- focus on transactions for integrated solutions
2. Document pros and cons for each proposed solution and prioritize in terms of technical feasibility
3. For prioritized workflow, propose solutions for harmonizing standards in order to pull PDMP information into EHR or Pharm. IT Systems synchronously

Most preferred workflow
EHR /
Pharmacy
PDMP Hub
HIE
Ph. Interm.
PDMP
EHR Origin Standard:
HL7 V2 (acute)
Translation /
Routing
NCPDP SCRIPT (ambulatory + optional acute settings)
ASAP Web Services
Pharmacy Origin Standard:
HL7 V2 (in hospital)
NCPDP SCRIPT (large retail pharmacies)
ASAP Web Services
PDMP Standard
PMIX
1. How to take HL7 V2, NCPDP SCRIPT, ASAP and transform to PMIX
Architecture-NIEM Standards?
2. What gaps have been identified to perform necessary query out of
HIT specific to PDMP?
3. Define technical architecture of total solution.
Variant 1: Intermediary provides translation functionality
Variant 2: Translation is handled at EHR, providing mapping to PMIX from native
EHR standards
Variant 3: Interface engine at
EHR-level provides functionality to send PMIX message derived from native
EHR standards.

Develop holistic solutions for Hub, Intermediary, and Direct workflows
Prioritize
EHR/Pharm  Hub
Solution
Begin detailing solution and technical details
(standards)
Develop IG content based on PDMP Hub
Leverage Hub Solution for
EHR/Pharm  Intermediary workflow guidance solution
Develop IG content based on PDMP
Intermediary solution
Defer direct connection workflow model due to limited scalability and restriction of interstate data sharing
Develop IG content based on PDMP
Direct solution
Deferment does not equate to elimination of workflows from inclusion in future solution plans and iterations/updates to the
Implementation Guide

# Workflow Model
3a
EHR to PDMP Hub to
PDMPs
2a
EHR to Intermediary to PDMP (PDMP Hub to PDMP)
1a EHR to In-State PDMP
# Workflow Model
3b
Pharmacy IT to PDMP
Hub to PDMPs
2b
Pharmacy IT to
Intermediary to PDMP
(PDMP Hub to PDMP)
1b
Pharmacy IT to In-
State PDMP
Prioritization
High
Medium
Low
Prioritization
High
EHR Prioritization
Justification
• Capable of facilitating interstate data exchange with reduced complexity
• PDMP Hubs are compliant with state regulations regarding access and routing of
PDMP-data
• Future hub capabilities support efficient workflow model
• Interstate data exchange drives organized data sourcing and in turn, is critical element to most interoperable state of data flow
• Scalable
• Provides flexibility in accommodating multiple standards
• Ability to leverage existing connections for clinical data
• Increased complexity due to additional connections and implication of policy/regulations on third party use
• Supports unique implementations and PDMP infrastructure
• Restrictive in expanding efficient interstate data sharing
• Reduced complexity, though not as highly scalable
• Perhaps necessary where policy hinders use of third parties for translation/transformation
Pharmacy IT Prioritization
Justification
• Same as transaction 3a
• Existing pilots established using workflow
Medium
Low
• Same as transaction 2a
• Concern regarding cost to participate
• May allow for future-state PDMP-data access through third parties
• Same as transaction 1a
• Pharmacies typically leverage third party for medication history
• Limited perceived interest from user community

Implementation Approach Focus:
HL7 V2.7 Messaging
NCPDP SCRIPT 2014041
ASAP Web Services V1.R1
PMIX
NIEM XML
GRA
Hub-to-Hub
Process:
1. Document PMIX payload + container data elements
2. Map HL7 V2, NCPDP SCRIPT Medication History, and ASAP Web Services message queries to PMIX Standard a. Detail required fields based on PMIX specification b. Identify gaps and optionality of request standards
3. Identify and document appropriate transport protocol that accommodates message content
4. Detail messaging schemas