PDMP & Health IT Integration

All-Hands Meeting November 26th, 2013

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

Review of Project Charter 45 Minutes

Next Steps/Questions 10 Minutes

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General Announcements

• The PDMP & Health IT Integration All-Hands meets every Tuesday from 12:00-1:00 PM EDT– To participate please see the “Weekly Meetings” Section

of the PDMP & Health IT Integration Wiki Homepage:http://http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage

Note: Please check the meeting schedule weekly to get the most up-to-date meeting information

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Join the Initiative • We encourage all

members to “sign up” or join the initiative. By joining this ensures you stay up-to-date with the work being done, communications and any initiative activities.

• Simply complete the Join Form on the Join Wiki Page: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Join+the+Initiative

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Initiative Support Leads

• For questions, please feel free to contact your support leads:

– Initiative Coordinator: Johnathan Coleman jc@securityrs.com– ONC Leads:

• Mera Choi mera.choi@hhs.gov• Jennifer Frazier Jennifer.Frazier@hhs.gov• Scott Weinstein Scott.Weinstein@hhs.gov

– SAMHSA Leads• Jinhee Lee Jinhee.Lee@samhsa.hhs.gov• Kate Tipping Kate.Tipping@samhsa.hhs.gov

– Support Team:• Project Management:

– Jamie Parker jamie.parker@esacinc.com– Ali Khan Ali.Khan@esacinc.com (Support)

• Use Case Development: – Presha Patel presha.patel@accenture.com – Ahsin Azim Ahsin.Azim@accenture.com (Support)

• Vocabulary and Terminology Subject Matter Expert: – Mark Roche mrochemd@gmail.com 6

Phase Planned Activities Pre-Discovery Development of Initiative Background

Development of Initiative Charter Definition of Goals & Initiative Outcomes

Discovery Creation/Validation of Use Cases, User Stories & Functional Requirements Identification of interoperability gaps, barriers, obstacles and costs Review of Vocabulary

Implementation Creation of aligned specification Documentation of relevant specifications and reference implementations such as

guides, design documents, etc. Validation of Vocabulary Development of testing tools and reference implementation tools

Pilot Validation of aligned specifications, testing tools, and reference implementation tools Revision of documentation and tools

Evaluation Measurement of initiative success against goals and outcomes Identification of best practices and lessons learned from pilots for wider scale

deployment Identification of hard and soft policy tools that could be considered for wider scale

deployments

S&I Framework Phases & PDMP & Health IT Integration Activities

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We are Here

PDMP & Health IT Project Charter

Background…• Prescription drug misuse and overdose is one of the fastest

growing health epidemics in the United States. One of the most promising clinical tools to address prescription drug abuse are prescription drug monitoring programs (PDMPs). PDMPs are state-run electronic databases – functioning in 48 U.S. states and territories – that track the prescribing and dispensing of controlled prescription drugs to patients.

• Information within PDMPs is intended to enhance providers’ understanding of their patients’ controlled substance history. When available at the point of care and point of dispensing, PDMP information can help prescribers and dispensers discern between patients who may need a controlled substance for legitimate medical treatment and those who may be seeking to misuse prescription drugs. It also provides an opportunity to intervene if there are signs of misuse and abuse.

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PDMP & Health IT Project Charter

Background continued

• While PDMPs collect a considerable amount of important clinical data which prescribers and pharmacists see as a valuable clinical decision support tool, they often do not use PDMPs because they are “stand alone” systems which are cumbersome and time consuming to access.

• Currently, most prescribers and dispensers must either interrupt their workflow and log on to a separate system to access the PDMP or write/dispense prescriptions without consulting the PDMP - potentially leaving providers without the information needed to make important clinical decisions.

• One way to improve PDMP access is it to incorporate it as part of the normal clinical workflow. Health IT systems (e.g., EHRs, HIEs, and pharmacy systems) can accomplish this by querying PDMPs for prescription information and presenting this information to prescribers and dispensers when they access an electronic medical record or pharmacy.

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PDMP & Health IT Project Charter

Challenge• While there are data exchange standards in place to share information between

PDMPs and standards to exchange information between EHRs and a Pharmacy there are no widely adopted standards for the exchange of data between an EHR and a PDMP. As PDMP systems have evolved outside the health IT ecosystem, significant barriers to interoperability have resulted.

• Current technical barriers to interoperability:– Lack of standard methods to exchange and integrate the prescription drug

data available in PDMPs into health IT systems. – Lack of common technical standards and vocabularies to enable PDMPs to

share computable information with the EHR that providers can use to support clinical decision-making.

– Currently there is no standard set of data elements collected by states.

• To achieve interoperability, consistent and standardized electronic methods need to be established to enable seamless and secure data transmission between PDMPs and health IT systems.

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PDMP & Health IT Integration – Project Charter

Purpose & Goals• The purpose of this initiative is to bring together the PDMP and health IT

communities to standardize the data format, and transport and security protocols to exchange patient controlled substance history information between PDMPs and health IT systems (i.e., EHRs/HIEs/Pharmacy Systems). Doing so would enable health care providers to make more informed clinical decisions through timely and convenient access to PDMP data in an effort to reduce prescription drug misuse and overdose in the United States.

• The specific goals are:

– Identify existing stakeholders and methodologies for accessing PDMP data (how they access this will help with pilots)

– Identify, evaluate, and harmonize the data format(s) sent from PDMPs to EHRs/HIEs.

– Evaluate and select transport protocol(s) systems support.– Evaluate and select security protocol(s) systems support.– Map selected health IT standards to standards already in use for PDMP-to-

PDMP interstate exchange.

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PDMP & Health IT Integration – Project Charter

Scope Statement• To allow system integrations that arms providers with PDMP data as part of their

normal clinical workflow by:– Connecting PDMPs to health IT systems (e.g. EHRs and HIEs, and pharmacy

Systems) using existing standards;– If standards do not exist, establishing standards for facilitating information

exchange between PDMPs and health care providers; and– Improving timely and convenient access to PDMP data by health care

providers.• Out of Scope

– Defining method for how the PDMP is contacted or initiated by provider (e.g., hyperlink while ordering, pressing a button, automatic trigger, etc.); and Addressing delegation of rights to individuals not legally authorized to prescribe medications – this is an implementation specific decision – this may vary by implementation and pilot sites.

– PDMP to PDMP transactions– Third party access this is an implementation specific decision – this may

vary by implementation and pilot sites

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PDMP & Health IT Integration – Project Charter

Value Statement• The feedback received from health IT community on

interoperability between PDMP and EHRs will influence data format, application programmatic interface, and transport protocol for interfaces for extracting data from PDMP instances;

• The outcome will be a specification describing the data interface for extracting prescription information from a PDMP instance for use by health IT systems; and

• The ability for prescribers and dispensers to access prescription drug data for patients at the point of care to make informed decisions to reduce prescription drug misuse and overdose

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PDMP & Health IT Integration – Project Charter

Potential Standards for Consideration

• The below standards are a starting list for consideration and will be updated based on community feedback during Charter discussions and as use case requirements are further fleshed out and we begin the harmonization process.

• This is not a full list of all possible standards.– Content and Structure: C32, CDA R2, FHIR, HL7 V.2.X, XML– Transport and Security: NCPDP SCRIPT, hData, SOAP, ASAP

Webservices, XDR and XDM (Direct) *– Other: NIEM IEPD, PMIX– Other references: NarxCheck, OpenSearch, Rcopia, RHEx, RPC,

Surescript, Zero Report Standard (by ASAP)– Vocabulary Standards: RxNorm

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* Security and Transport standards will be dependent on the architecture/environment considerations

PDMP & Health IT Integration – Project Charter

Potential Risks• Risk: If data is intercepted en route between a PDMP and a

prescriber, patient confidentiality may be compromised.– Mitigation: Employ secure protocols to encrypt and protect

data in transit and prevent unauthorized disclosure.• Unintended access to data not requested by the prescribers• Patient mismatch• Financial challenges of a new standards requirement• accepted time for data download – currency of the data has

impact on use of data

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This is not a comprehensive list of risks – it is meant to identify the most immediate risks and to acknowledge those things which require further consideration and thought as we work through the PDMP and HIT initiative

PDMP & Health IT Integration – Project Charter

Stakeholders• Prescription Drug Monitoring Programs• Prescription drug prescribers and dispensers• Patients and patient advocates• EHR/EMR vendors• State HIEs• Local, State, Federal Government• Health Organizations• Standards Organizations• Healthcare Payers

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PDMP & Health IT Integration – Project Charter

Proposed Timeline

Kick-off (11/14)

Pre-Discovery, Call for Participation

Jan 14June 14

Discovery

Initiative End

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Nov 13 July 14Mar 14

Implementation Pilot

User Stories, Use Cases, Functional Requirements

Standards Gap Analysis

Harmonized Specifications

Technology Evaluations Reference Model Implementation

& Validation

Use Case Kick Off

Use Case Consensus

Standards and Harmonization Kick Off

Pilot Kick Off

Providing Charter Comments

1. Review the Project Charter– http://wiki.siframework.org/PD

MP+%26+Health+IT+Integration+Charter+and+Members

2. Fill out the comment form1. wiki.siframework.org/PDMP

+%26+Health+IT+Integration+Charter+and+Members#Comment

– All fields are required

3. Submit your comments

4. A Message is displayed verifying your comment was submitted

5. Once you receive the message your comment has been submitted you will be able to view your comment

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Next Steps

• Provide comments on PDMP & Health IT Integration Charter

• Attend weekly “PDMP & Health IT All Hands Meetings” taking place every Tuesday from 12:00-1:00 PM EDT– Next Meeting December 3rd, 2013

• Visit PDMP & Health IT Integration Wiki page – All Announcements, Meeting Schedules, Agendas, Minutes,

Reference Materials, Project Charter and General Data Access Framework information will be posted on the PDMP & Health IT Wiki page located at: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage

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NOTE: Please be sure to check the PDMP & Health IT Integration wiki homepage for the most up-to-date meeting information

Proposed Community Call Schedule

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Date Meeting Topics

Nov. 19th, 2013 • Community Kick off Meeting• Meet the support team• Review Project Charter

Nov. 26th , 2013 • Continue Review of Project Charter

Dec. 3rd , 2013 • Conduct final group review of the project charter• Begin end to end review of the project charter

Dec. 10th, 2013 • Review end to end comments• Fall concert series – Presenter TBA• Begin Consensus process

Dec. 17th, 2013 • Review Consensus Comments• Fall Concert Series – Presenter TBA

Dec. 24th, 2013 • Meeting Canceled – Consensus will be announced

Dec. 31st, 2013 • Meeting to be determined• Fall Concert Series wrap up

Questions

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PDMP & Health IT IntegrationResources• Initiative Wiki Homepage

– http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage

• Become a Community Member– http://wiki.siframework.org/PDMP+%26+Health+IT+Integratio

n+Join+the+Initiative• Project Charter

– http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charter+and+Members

• Standards and Interoperability(S&I) Framework– http://wiki.siframework.org/Introduction+and+Overview

• S & I Calendar of Events– http://wiki.siframework.org/Calendar

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