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PDMP & Health IT Integration Use Case & Functional Requirements
February 21, 2014
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PDMP & HIT Integration InitiativeProposed Use Case & Functional Requirements Development Timeline
Week Target Date (2014) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page
due following Monday @ 12 noon
1 1/7Use Case Kick-Off & UC Process Overview
Introduce: In/Out of Scope, Context Diagram and ScenarioConcert Series Presentation: ASAP
Review: In/Out of Scope, Assumptions, and Context Diagram
2 1/14 Review: In/Out of Scope, Context Diagram, Assumptions , ScenarioIntroduce: User Stories
Review: User Stories, In/Out of Scope, Assumptions, and Context Diagram
3 1/21 Review: In/Out of Scope, Context Diagram, Assumptions , ScenarioIntroduce: User Stories
Review: User Stories, In/Out of Scope, Assumptions, and Context Diagram
4 1/28Review: Context Diagram and User StoriesIntroduce: Pre/Post Conditions, Actor and RolesConcert Series Presentation: OneHealthPort & WADOH
Review: Pre/Post Conditions, Actors and Roles, and User Stories
5 2/4 Review: Context Diagram and User StoriesIntroduce: Pre/Post Conditions, Actor and Roles
Review: Pre/Post Conditions, Actors and Roles, and User Stories
6 2/11 Review Pre/Post Conditions, Actors and Roles, and User Stories Review: Pre/Post Conditions, Actors and Roles, and User Stories
7 2/21 Review: User Stories, Post Conditions, Actors and Roles, Activity Diagram and Base Flow Review: Activity Diagram and Base Flow
8 2/25 Review Functional Requirements and Sequence DiagramIntroduce: Data Requirements and Issues and Risks Review: Data Requirements and Issues and Risks
9 3/4 Review: Data Requirements and Risks & IssuesBegin End-to-End Review End-to-End Review by community
10 3/11 End-to-End Comments Review & disposition End-to-End Review ends
11 3/18 Finalize End-to-End Review Comments & Begin Consensus Begin casting consensus vote
12 3/25 Consensus Vote* Conclude consensus voting
Note- Below sections will be reviewed within the separate Use Case word document: 1. Discuss and review the following sections:
1. User Stories2. Post-Conditions3. Actors and Roles4. Activity Diagrams and Base Flows
Section Review
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Click the icon to open the
Word DocumentSections for
Review
PDMP Workflow
• It is understood that there are various workflows that could take place when a Healthcare Professional queries a PDMP and the specific processes may vary depending on the type of user.
• A Healthcare Professional may need to obtain patient history of controlled substances dispensed from a PDMP for a Person of Interest. To do so, the Healthcare Professional may need to authenticate to his/her specific Health IT system. It is also understood that an adjudication process may take place between the Healthcare Professional’s Health IT system and the PDMP to filter which prescriptions belong to the intended patient. At the end of the adjudication process, the Healthcare Professional’s receiving system is hosting a set of prescription records and renders the records. After receiving the query response, the Healthcare Professional could make an informed decision of whether or not to prescribe/dispense the medication or modify the treatment based on the information received.
• A Health IT system (EHR or Pharmacy IT system) can be used to seek out information stored in a PDMP regarding medications dispensed to patients. This Use Case considers 3 possible workflows:
1. HIT to In-State PDMP directly2. HIT to Hub to PDMP3. HIT to HIE/Pharmacy Intermediary to PDMP• For the purposes of this use case, we will be focusing on the transactions originating from the HIT
to the next end point, which would be the PDMP, Hub, or HIE/Pharmacy Intermediary
Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
• Scenario #1 – HIT to In-State PDMP
• Scenario #2 – HIT to Hub
• Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy
System
EHR or Pharmacy
SystemHub
EHR or Pharmacy
System
HIE/Pharmacy
Intermediary
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Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
• Scenario #1 – HIT to In-State PDMP
• Scenario #2 – HIT to Hub
• Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy
System
EHR or Pharmacy
SystemHub
EHR or Pharmacy
System
HIE/Pharmacy
Intermediary
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Scenario #1 – HIT to In-State PDMPUser Story 1.1 – Legally authorized provider queries PDMP before writing a prescription for a PDMP reported controlled substance for a patient
Draft User Story: A patient arrives at the physician’s office or hospital for treatment that may require a controlled substance prescription. If necessary, the physician authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to the State PDMP to obtain patient history of controlled substances dispensed. After receiving the query response from the PDMP, the physician makes an informed decision of whether or not to prescribe the medication or modify the treatment based on the information received.
1. Query is sent to State PDMP to obtain patient history of controlled substances dispensed
2. PDMP sends query response
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Draft User Story: A patient arrives at the pharmacy to have a prescription filled. The pharmacist authenticates to the Pharmacy Dispensing system. After, the pharmacist sends a query to the State PDMP through the Pharmacy Dispensing system to obtain patient history of controlled substances dispensed. 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.
Scenario #1 – HIT to In-State PDMPUser Story 1.2 – Pharmacist queries PDMP prior to dispensing a PDMP reported controlled substance to a patient
1. Query is sent to State PDMP to obtain patient history of controlled substances dispensed
2. PDMP sends query response
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Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
• Scenario #1 – HIT to In-State PDMP
• Scenario #2 – HIT to Hub
• Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy
System
EHR or Pharmacy
SystemHub
EHR or Pharmacy
System
HIE/Pharmacy
Intermediary
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Draft User Story: A patient arrives at the physician’s office or hospital for treatment that may require a controlled substance prescription. If necessary, the physician authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to a Hub through the Health IT system to obtain patient history of controlled substances dispensed. The Hub receives the query. The Hub sends the query response back to the Health IT system where the query originated. After receiving the query response(s), the physician makes an informed decision of whether or not to prescribe the medication or modify the treatment based on the information received.
Scenario #2 – HIT to HubUser Story 2.1 – Legally authorized provider queries PDMP through a hub before writing a prescription for a PDMP reported controlled substance for a patient
1. Query is sent to a Hub to obtain patient history of controlled substances dispensed
2. Hub sends query response
Hub
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Draft User Story: A patient arrives at the pharmacy to have a prescription filled. The pharmacist authenticates to the Pharmacy Dispensing system. After, the pharmacist sends a query to the Hub through the Pharmacy Dispensing system to obtain patient history of controlled substances dispensed. The hub receives the query. The hub sends the query response back to the Health IT system where the query originated. After receiving the query response, the pharmacist makes an informed decision of whether or not to dispense the medication based on the information received.
Scenario #2 – HIT to HubUser Story 2.2 – Pharmacist queries PDMP through a Hub prior to dispensing a PDMP reported controlled substance to a patient
1. Query is sent to a Hub to obtain patient history of controlled substances dispensed
2. Hub sends query response
Hub
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Use Case Scenarios
While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary
• Scenario #1 – HIT to In-State PDMP
• Scenario #2 – HIT to Hub
• Scenario #3 – HIT to HIE/Pharmacy Intermediary
EHR or Pharmacy
System
EHR or Pharmacy
SystemHub
EHR or Pharmacy
System
HIE/Pharmacy
Intermediary
12
Draft User Story: A patient arrives at the physician’s office or hospital for treatment that may require a controlled substance prescription. If necessary, the physician authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to an HIE through the Health IT system to obtain patient history of controlled substances dispensed. The HIE receives the query. The HIE sends the query response back to the Health IT system where the query originated. After receiving the query response(s), the physician makes an informed decision of whether or not to prescribe the medication or modify the treatment based on the information received.
Scenario #3 – HIT to HIE/Pharmacy IntermediaryUser Story 3.1 – Legally authorized provider queries PDMP through an HIE before writing a prescription for a PDMP reported controlled substance for a patient
1. Query is sent to an HIE to obtain patient history of controlled substances dispensed
2. HIE sends query response
HIE
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Draft User Story: A patient arrives at the pharmacy to have a prescription filled. The pharmacist authenticates to the Pharmacy Dispensing system. After, the pharmacist sends a query to the Pharmacy Intermediary through the Pharmacy Dispensing system to obtain patient history of controlled substances dispensed. The Pharmacy Intermediary receives the query. The Pharmacy Intermediary sends the query response back to the Health IT system where the query originated. After receiving the query response, the pharmacist makes an informed decision of whether or not to dispense the medication based on the information received.
Scenario #3 – HIT to HIE/Pharmacy IntermediaryUser Story 3.2 – Pharmacist queries PDMP through a Pharmacy Intermediary prior to dispensing a PDMP reported controlled substance to a patient
1. Query is sent to a Pharmacy Intermediary to obtain patient history of controlled substances dispensed
2. Pharmacy Intermediary sends query response
Pharmacy Intermediary
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PDMP & HIT Integration – Pre/Post Conditions
Pre-Conditions1. The necessary access controls and authorization protocols based on
State and/or Federal regulations (which could include patient consent or privacy permissions) for any of the systems or users described, are in placeo The Health IT system application can provide
necessary/required authorization, authentication or privacy information to the PDMP
o The Health IT system can apply PDMP authorization requirements to restrict access to PDMP data to authorized users
2. If an intermediary, such as a Hub, is used it provides necessary technology infrastructure to allow PDMP data exchange from the PDMP to the Health IT system
3. Query parameters required to create the query in a standardized format by the Health IT system/Hub are recognized and accepted by the PDMP system
4. The PDMP system can provide a query response in a standardized format which is recognized and accepted by the Hub/Health IT system
5. Health IT System and PDMP have a common understanding of the shared vocabulary that are required to initiate the queries and provide the query results
6. In the event a request is parsed out to other states and the other states respond back, the Health IT system, Hub (if applicable) and PDMP systems will have knowledge about the order of succession to provide the response
7. Health IT System or Hub is able to determine which state PDMP(s) should receive the query
To be reviewed in Word Document
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Post-Conditions1. Health IT System has sent a query
2. PDMP system has received the query
3. PDMP system has sent a response to the Health IT system
4. Health IT system has successfully received the query results from the PDMP system
5. Health IT system can display/present query response
PDMP & HIT Integration – Actors and RolesTo be reviewed in Word Document
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Actor System RoleHealth Care Professional
Health IT System Send query Receive query response
PDMP PDMP System Receive query Send query response
Hub Hub ? ?
• An Activity Diagram is a special form of a state transition diagram in which all or most of the states are activity states or action states. An action state represents the fulfillment of associated responsibilities in response to the communication received from the previous step. Most transitions are triggered by completion of activities in the source states.
• The Base Flow presents the step by step process of the information exchange depicted in the activity diagram (above). It indicates the actor who performs the action, the description of the event/action, and the associated inputs (records/data required to undertake the action) and outputs (records/data produced by actions taken).
• The following slides consist of an Activity Diagram and Base Flow for each scenario:1. HIT to In-State PDMP directly2. HIT to Hub to PDMP3. HIT to HIE/Pharmacy Intermediary to PDMP
PDMP & HIT Integration – Activity Diagrams & Base Flows
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Step # Actor Role Event/Description Inputs Outputs1 Healthcare
ProfessionalRequest Sender
HC Professional’s HIT System sends query to obtain patient history of controlled substances
HC Professional identifies patient of interest from his/her HIT System.
Patient history of controlled substances request initiated and sent in standard format and content specification
2 PDMP Request Receiver
PDMP receives the query for patient history of controlled substances through HC Professional’s HIT System
Patient history of controlled substances request
Patient history of controlled substances in standard format
3 PDMP Results Sender
PDMP sends query response to HC Professional through his/her HIT system
Patient history of controlled substances
Patient history of controlled substances in standard format
4 Healthcare Professional
Results Receiver
HC Professional receives query response through his/her HIT System
Patient history of controlled substances
END
Step # Actor Role Event/Description Inputs Outputs1 Healthcare
ProfessionalRequest Sender
HC Professional’s HIT System sends query to obtain patient history of controlled substances
HC Professional identifies patient of interest from his/her HIT System.
Patient history of controlled substances request initiated and sent in standard format and content specification
2 Hub Request Receiver
Hub PDMP receives the query for patient history of controlled substances through HC Professional’s HIT System
Patient history of controlled substances request
Patient history of controlled substances in standard format
3 Hub Results Sender
Hub sends query response to HC Professional through his/her HIT system
Patient history of controlled substances
Patient history of controlled substances in standard format
4 Healthcare Professional
Results Receiver
HC Professional receives query response through his/her HIT System
Patient history of controlled substances
END
Step # Actor Role Event/Description Inputs Outputs1 Healthcare
ProfessionalRequest Sender
HC Professional’s HIT System sends query to obtain patient history of controlled substances
HC Professional identifies patient of interest from his/her HIT System.
Patient history of controlled substances request initiated and sent in standard format and content specification
2 HIE/Ph. Intermediary
Request Receiver
HIE/Ph. Intermediary receives the query for patient history of controlled substances through HC Professional’s HIT System
Patient history of controlled substances request
Patient history of controlled substances in standard format
3 HIE/Ph. Intermediary
Results Sender
HIE/Ph. Intermediary sends query response to HC Professional through his/her HIT system
Patient history of controlled substances
Patient history of controlled substances in standard format
4 Healthcare Professional
Results Receiver
HC Professional receives query response through his/her HIT System
Patient history of controlled substances
END
Next Steps
• Review: Activity Diagrams and Base Flows
• Next Meeting is Tuesday, February 25 from 12:00pm - 1:30pm EST
• Reminder: All PDMP & HIT Integration Announcements, Meeting Schedules, Agendas, Minutes, Reference 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
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Contact Information
• For questions, please feel free to contact your support leads:– Initiative Coordinators:
• Johnathan Coleman [email protected]• Sherry Green [email protected]
– ONC Leads:• Mera Choi [email protected]• Jennifer Frazier [email protected]• Helen Caton-Peters [email protected]
– SAMHSA Leads• Jinhee Lee [email protected]• Kate Tipping [email protected]
– Support Team:• Project Management:
– Jamie Parker [email protected]– Ali Khan [email protected] (Support)
• Use Case Development: – Ahsin Azim [email protected] – Presha Patel [email protected]
• Vocabulary and Terminology Subject Matter Expert: – Mark Roche [email protected]
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