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PDMP & Health IT IntegrationAll-Hands Meeting
May 13th, 2014
Meeting Etiquette
• Remember: If you are not speaking keep your phone on mute
• Do not put your phone on hold – if you need to take a call, hang up and dial in again when finished with your other call– Hold = Elevator Music = very frustrated speakers and
participants
• This meeting, like all of our meeting is being recorded– Another reason to keep your phone on mute when not
speaking
• Feel free to use the “Chat” feature for questions, comments or any items you would like the moderator or participants to know.
NOTE: This meeting is being recorded and will be posted on the Meeting Artifacts Wiki page after
the meeting
From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute
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Agenda
Topic Time Allotted
General Announcements 5 minutes
PDMP & HITI Standards and Harmonization•Finalize Gap Mitigation Plan Outcomes 40 minutes
Introduce Solution Planning Workgroup 10 minutes
Next Steps/Questions 5 minutes
General Announcements…
• We will be resuming the normal timeframe of 12:00-1:00 pm (ET) Tuesdays for our All-Hands meetings.
• We will be hosting a Concert Series presentation “Prescription Drug Monitoring Programs and the PMIX Architecture” on May 21st at 3pm ET– https
://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=665199761
– Dial In: 1-650-479-3208– Access code: 665 199 761
4
General Announcements Continued
• To join our weekly webinars, visit the PDMP & Health IT Integration initiative Homepage for the latest meeting information: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage
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• To subscribe to our mailing list, simply complete the PDMP & Health IT Project Signup Form: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Join+the+Initiative
• To access current and archived meeting materials, visit the Project Meeting Artifacts section: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Meeting+Artifacts
Note: Please check the meeting schedule weekly to get the most up-to-date meeting information
PDMP & Health IT Integration
Standards and Harmonization
May 13th, 2014
PDMP Harmonization Timeline
March April May June July
3/25 Harmonization Kick-off
Stan
dard
s Ev
alua
tion
Candidate Standards List
UCR-Standards Mapping
Gap Mitigation Plan
HITSC Evaluation*
Solu
tion
Plan
ning
IG
Dev
elop
men
t
Solution Plan
Create IG Template
IG Development
End-to-end Review & Community Consensus
(Today)
7/29 Harmonization Close
Week Target Date (2014) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page
due following Monday @ 12 noon
1 3/25 Harmonization Kick-Off & Process OverviewIntroduce: Overview of UCR-Standards Mapping Review: N/A
2 4/1 Introduce: Candidate Standards List & UCR-Standards Mapping Review: Candidate Standards List
3 4/8 Finalize: Candidate Standards ListReview: UCR-Standards Mapping Review: UCR-Standards Mapping
4 4/15 Review: UCR-Standards Mapping Review: UCR-Standards Mapping
- 4/22 Cancelled for National Rx Summit
5 4/29 Finalize: Outcome of UCR-Standards MappingIntroduce: Gap Mitigation Plan Review: Gap Mitigation Plan
6 5/6 Review: Gap Mitigation Plan Review: Gap Mitigation Plan
7 5/13 Finalize: Gap Mitigation PlanIntroduce: Solution Planning Workgroup Review: N/A
8-9 5/20-5/27 Introduce & Review: Solution Plan & Outcomes of Workgroup Sessions Review: Solution Plan
10 6/3 Finalize: Solution PlanIntroduce: Implementation Guide (IG) Template Review: Implementation Guide Template
11-15 6/10 – 7/8 Review: Implementation Guide Review: Implementation Guide
16-17 7/15 – 7/22 End-to-End Community Review of Implementation Guide End-to-End Review of Implementation Guide
18 7/29 Consensus Vote
Harmonization Weekly Timeline
Gap Mitigation Summary Analysis
May 13th, 2014
Standard Reviewed Gap Summary Mitigation Summary Impact on
StakeholdersTechnical Feasibility
Practical Feasibility
Content & Structure Standards
HL7 V2.X ADT / Orders / Query
Broad query response capabilities; not well defined for PDMP controlled medication history report.
Does not address all necessary content.
Supports the transmission of information, not the internal processes of creating the query. Does not perform authentication.
PDMP-specific query response could be developed with moderate effort.
PDMP-specific IG including data attributes would need to be developed.
Structure would need to be developed to define standardized format, as well as develop mechanism to perform authentication.
1. PDMP: Moderate to High
2. HIT: Low
Y N
HL7 FHIR
Container could function as request/response, but does not fit the needs for medication history of controlled substances.
Portions of the container in query/response transactions would have to be customized to fit the needs of PDMP. New concept and draft process with limited knowledge resource as of now, thus requiring heavy modification and development of entirely new set of resources.
1. PDMP: High
2. HIT: Moderate to High
N N
Standard Reviewed Gap Summary Mitigation Summary Impact on
StakeholdersTechnical Feasibility
Practical Feasibility
Content & Structure Standards
ASAP Web Services
No gaps identified for generation of query-response and structure of specified formatting, authentication, and packaging.
Lacks only a few data elements specific to system or transaction identifiers, and information regarding authorized user – specifically:1. Requester Routing ID2. State of request3. Requestor Location4. Requested states5. Authorized user credentials and information 6. Response ID7. Message ID (response)
Add required data elements to request and response categories.
1. PDMP: Low
2. HIT: Low Y Y
PMIX-NIEM
No gaps identified for generation of query-response and structure of specified formatting, authentication, and packaging.
Does not support all data elements required in UC within request transactions – specifically:1. Requestor’s internal patient ID2. State of Request3. Requested state(s)4. Authorized user credentials and information
within payload5. Request/routing ID6. Summary of Response
Modify to include required data elements within payload and/or container (metadata), where appropriate.
1. PDMP: Low
2. HIT: Moderate
Y Y
Standard Reviewed Gap Summary Mitigation Summary Impact on
StakeholdersTechnical Feasibility
Practical Feasibility
Content & Structure Standards
NCPDP SCRIPT
No gaps identified for generation of query-response and structure of specified formatting, authentication, and packaging.
Does not support all data elements required in UC for general request, authorized user request, and general response categories – specifically:1. State of Request2. Requestor’s internal patient ID3. Requested state(s)4. State of Response5. Summary of Response6. Role of Healthcare Professional
Modification to derive requesting state either through SCRIPT or intermediary.
Include Role within Authorized User credentials (could be overcome with use of DEA or license # - burden on registration process)
Modification to derive responding state and summary through SCRIPT or intermediary. 1. PDMP:
Moderate
2. HIT: LowY Y
Gap Mitigation Plan
Click the icon to open the Excel file
Standard Reviewed Gap Summary Mitigation Summary Impact on
StakeholdersTechnical Feasibility
Practical Feasibility
Terminology & Code Value Standards
RxNorm
No gaps identified across information interchange and system requirements.
RxNorm required within EHR system – would have to translate NDC codes received by PDMPs or Intermediaries
EHRs would have to bear burden of converting NDC codes to RxNorm terminology to present drug information
1. HIT: High2. PDMP: N/A Y Y
NDC
No gaps identified across information interchange and system requirements.
N/A N/A Y Y
PDMP & HITI Solution Planning Approach
May 13th, 2014
Recap of Harmonization Progress & Status
PDMP & HITI Initiative Current Status S&I
Harmonization Activity
Purpose Date Completed
Outcome # of Standards Participating Stakeholders
Candidate Standards Analysis
Identify, describe , and categorize all possible standards relevant to PDMP data exchange .
4/8/2014 Full set of seemingly relevant standards, descriptions, and resources for further information. Sets framework for standards evaluation.
15 (C&S, Vocab) PDMP, Pharmacy, HIE, Data Exchange Networks
UCR Standards Crosswalk
Map technically feasible use case requirements to candidate standards, identifying high-level gaps.
4/29/2014 Identify standards that fit the needs of the PDMP&HITI Use Case requirements, eliminating less suitable standards from further analysis.
15 (C&S, Vocab)
Gap Mitigation Plan Explore gaps in detail, determine feasibility of standards, and assess impacts to stakeholders.
5/13/2014 Identified:1. Gaps/issues2. Mitigation plan3. Technical feasibility of
implementation4. Modifications5. Impact to systems
7 (5 C&S, 2 Vocab)1. SCRIPT2. ASAP3. PMIX4. HL7 FHIR5. HL7 V2.x6. RxNorm7. NDC
Process Considerations
Tier 1: 3 Content & Structure Standards | 2 Stakeholder Groups | 3 Use Types
ASAP
Integrated direct access to PMP Portals {EHR, Ph. IT}
PMIX
PMP - PMP Data Exchange | Direct to PMP Portals | Interstate Hubs
SCRIPT
Facilitates prescription data exchange for: 1. EHR – Pharmacy2. Pharmacy - Payers
Tier 2: 2 Content & Structure Standards | 1 Stakeholder Group | 1 Use Type
HL7 V2.x HL7 FHIR
EHRs: Hospital workflows, messaging to support admin, logistic, financial, clinical processing
EHRs: Resources specifying clinical, admin, infrastructure modules
TargetedBroad
Process Considerations
1. Standards analysis has yielded 7 “finalists” from which the initiative can develop a Solution Plan.
2. Of 7, 3 competing standards dominate (PMIX, ASAP, SCRIPT), all providing feasible solutions3. Segmented stakeholder groups makes standard selection complex4. Continuation of standards evaluations via additional S&I analysis tools may not provide for
most effective and holistic outcomes5. Limited EHR Vendor input provides for limited assessment of “technical feasibility”6. Limited perspective of Pharmacy IT system configurations
Formation of interdisciplinary work group focused on creation of technical architecture specific to PDMP <--> Health IT System data exchange, acknowledging:
– UC context diagram and data flow [all transactions]– Currently implemented solutions– Clinical and system-oriented needs across actors– Technology facilitators and impediments– Infrastructure differences between systems
Resolution
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
Next Steps
• Determine meeting time for SPWG:– Thursdays 12:00pm to 1:00pm EDT or IIIIIIII
• Review: Outcomes of Solution Planning Workgroup
• Next Meeting is Thursday May 15th from 12-1 ET• Next Meeting is Tuesday, May 20 from 12:00pm - 1:00pm ET
• Reminder: All PDMP & HIT Integration Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Harmonization materials, Use Case, Project Charter and general information will be posted on the PDMP Wiki page– http://wiki.siframework.org/PDMP+%
26+Health+IT+Integration+Homepage
Contact Information
– Initiative Coordinators: • Johnathan Coleman [email protected]• Sherry Green [email protected]
– ONC Leads:• Mera Choi [email protected]• Jennifer Frazier [email protected]• Helen Caton-Peters
– SAMHSA Leads• Jinhee Lee [email protected]• Kate Tipping
– Support Team:• Project Management:
• Jamie Parker [email protected]
• Ali Khan [email protected] (Support)
• Use Case Development: • Ahsin Azim
[email protected] • Presha Patel
• Standards Development Support• Alex Lowitt
• Harmonization Support• Divya Raghavachari
• Atanu Sen [email protected]• Vocabulary and Terminology Subject Matter
Expert: • Mark Roche [email protected]
• For questions, please feel free to contact your support leads:
