Meeting Etiquette• Remember: Please 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 o Hold = Elevator Music = frustrated speakers and
participants• This meeting is being recorded
o Another reason to keep your phone on mute when not speaking
• Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know.o Send comments to All Panelists so they can be
addressed publically in the chat, or discussed in the meeting (as appropriate).
From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute
All Panelists
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Agenda
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Topic Presenter TimeOpening Remarks Doug Fridsma, MD, PhD Director, Office
of Standards and Technology, ONC5 Minutes
The Standards & Interoperability Framework
Doug Fridsma, MD, PhD Director, Office of Standards and Technology, ONC
5 minutes
Prescription Drug Abuse Prevention
Cecelia Spitznas, PhD, Office of National Drug Control Policy – White House
5 minutes
PDMP Overview Federal Efforts
H. Westley Clark, MD, JD, MPH, SAS, FASAM, Director, Center for Substance Abuse Treatment, SAMHSA
15 minutes
Next Steps and Logistics Doug Fridsma, MD, PhD Director, Office of Standards and Technology, ONC
15 Minutes
Q & A Team 15 Minutes
Teams convened
to solve problems
Solutions& Usability
R&D
Curate a portfolio of standards, services, and
policies that accelerate
information exchange
Support Innovation through SHARP
program, Innovation/Challenge
Grants, and interfacing with International
Standards community
Enable stakeholders to come up with simple, shared solutions to common information exchange challenges
Office of Science & Technology
Coordinate Federal
Partners
Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture
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ONC’s Interoperability Strategy• Leverage government as a platform
for innovation to create conditions of interoperability
• Health information exchange is not one-size-fits-all; create a portfolio of solutions that support all uses and users
• Build in incremental steps – “don’t let the perfect be the enemy of the good”
What is the S&I Framework?
* As of October 2013, 2000+ people had registered on the S&I Framework wiki, and 750+ members representing 550+ organizations had committed to the S&I Framework
• The Standards and Interoperability (S&I) Framework represents one investment and approach adopted by the Office of Science & Technology (OST) to fulfill its charge of prescribing health IT standards and specifications to support national health outcomes and healthcare priorities
• The S&I Framework is an example of “government as a platform”– enabled by integrated functions, processes, and tools – for the open community* of implementers and experts to work together to standardize
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S&I Framework Coordination
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ONC Programs & Grantees
Community S&I Framework
FACAs
SDOs
• State HIE Program & CoPs• SHARP Program• REC Program & CoPs• Beacon Program
• Technology Vendors• System Integrators• Government Agencies• Industry Associations• Other Experts
• HL7• IHE• CDISC• NCPDP• ASC X12• ASTM• WEDI
• HIT Standards Committee• HIT Policy Committee• Tiger Team
• ISO/TC 215• IHTSDO• NLM• NQF• Regenstrief• Other health IT
standards related organizations
• Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: http://wiki.siframework.org
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• Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system
• An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services
S&I Framework Overview
PRESCRIPTION DRUG ABUSE PREVENTION
THE NATIONAL PERSPECTIVE
Dr. Cece Spitznas Office of Research and Data AnalysisOffice of National Drug Control Policy
November 14, 2013
S&I PDMP Kickoff
The U.S. Prescription Drug Abuse Problem
• 6.8 million Americans reported current non-medical use of prescription drugs in 2012.1
• Approximately 1 in 4 people using drugs for first time in 2012 began by using a prescription drug non-medically.2
• Of the 38,329 drug overdose deaths in 2010, approximately 22,100 involved prescription drugs. o 16,651 involved opioid painkillers (vs. 4,183 for cocaine
and 3,038 for heroin)3
• $55.7 billion in costs for prescription drug abuse in 20073 including $25 billion in direct health care costs and $5.1 billion in criminal justice costs.4
• Studies have found that individuals abusing opioids generate, on average, annual direct health care costs 8.7 times higher than non-abusers.5
1, 2. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services. [September 2013]. Available: http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm3. CDC, National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database. Extracted May 1, 2012. 4. Birnbaum HG, White, AG, Schiller M, Waldman T, et al. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. Pain Medicine. 2011;12:657-667. 5. White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005
19801982198419861988199019921994199619982000200220042006200820100
5
10
15
20
25Motor Vehicle Traffic Poisoning Drug Poisoning (Overdose)
Dea
ths
per
100,
000
popu
lati
on
Source: NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data
U.S. Death Rate Trends, 1980-2010
National Drug Control Strategy
• The President’s science-based plan to reform drug policy:1)Prevent drug use before it ever begins
through education2)Expand access to treatment for
Americans struggling with addiction3)Reform our criminal justice system4)Support Americans in recovery
• Coordinated Federal effort on 112 action items
• Signature initiatives:– Prescription Drug Abuse– Prevention– Drugged Driving
• Coordinated effort across the Federal Government
• Four focus areas:1) Education2) Prescription Drug
Monitoring Programs
3) Proper Medication Disposal
4) Enforcement
Prescription Drug Abuse Prevention Plan
1999200020012002200320042005200620072008200920100
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000Opioids Heroin Cocaine
Num
ber
of D
eath
sOverdose Deaths, Specific Drugs,
1999-2010
Source: CDC/NCHS National Vital Statistics System, CDC Wonder. Updated with 2010 mortality.
Source of Prescription Pain Relievers
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2009-2010
• The number of primary admissions among 18- to 24-year-olds for heroin treatment services increased from 34,000 in 2000 to 60,000 in 2011.1
• The number of persons who were past-year heroin users has been rising steadily, increasing approximately 50 percent since 2008 (445,000 to 669,000 in 2012).2
• Injection-drug users report prescription opioid use predates heroin use and tolerance motivates them to try heroin.3
1. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data extracted as of September 2013.
2. Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.linked to 2/13/2013 http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresultsAlts2011.htm#Fig2-4 pending citation/cleared data
3. Lankenau SE, et al. (2012). Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012 Jan;23(1):37-44. Epub 2011 Jun 20.
Emerging Issues: Prescription Opiates and Heroin
State Overdose Death Rates, 2010
10.9
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2000-2010 on CDC WONDER Online Database. Extracted October, 2012.
— U.S. National Rate: 12.3 per 100,000 —
Goalso PDMP in every state and interoperability among states.o Use of the system by prescribers to identify patients
potentially at risk for or engaged in prescription drug misuse or at risk for medication interaction.
Main Actionso Secured language for Department of Veterans Affairs to
share prescription drug data with state PDMPs.o Currently 16 states can share data across state lines.o Pilot projects with ONC and SAMHSA in Illinois,
Indiana, Kansas, Michigan, Nebraska, North Dakota, Ohio, Oklahoma, Tennessee, and Washington state.
Monitoring
PDMP Overview and Federal Efforts
H. Westley Clark, MD, JD, MPH, SAS, FASAMDirector
Center for Substance Abuse TreatmentSubstance Abuse and Mental Health Services
Administration
PDMP & Health IT Integration Initiative Launch Webinar
November 14, 2013
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Many states established PDMPs to reduce prescription drug abuse and diversion.• Statewide electronic databases:
–Collect data on controlled substances dispensed by pharmacies (and dispensing physicians in some states).
–Distribute patient health information from the database to individuals authorized under state law.
What are PDMPs?
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Data collected varies by state, may include:
• Schedules II-IV (some V)• Prescriber• Dispenser• Patient• Date dispensed• Drug
PDMP Data Fields
• Strength• Quantity• Refills• Method(s) of
payment
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PDMPs may be used for:• Clinical support • Regulatory Oversight• Surveillance and Evaluation • Law Enforcement
Reporting Types: Passive vs. Proactive• Solicited Reporting (Pull model)• Unsolicited (Push model)
PDMP Applications & Reporting Types
1
2
DIRECT protocol
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State Snapshot: PDMPs
49 States have legislation authorizing PDMPs.
47 States have operational PDMPs.
In MO, privacy concerns are 1 reason for push back on legislation.*http://www.pdmpassist.org/pdf/
pmpprogramstatus2013_a.pdf *http://www.komu.com/news/prescription-drug-monitoring-program-may-curb-state-drug-abuse/
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State Snapshot: PDMP Interoperability
20 States are engaged in interstate data sharing (9/19/13).
A PDMP may be sharing data with one or more other PDMPs.
http://www.pdmpassist.org/pdf/PDMP_interoperability_status_21030919.pdf
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The Story So Far
Stakeholders
Organizations
White House Roundtable on
Health IT & Prescription
Drug AbuseJune 3, 2011
Federal & State Partners
State Participants
Action Plan: Improving Access to PDMPs
through HIT
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Action Plan Implementation
SAMHSA provided funding for implementation of the Action Plan through the “Enhancing Access to PDMPs through Health IT Project”.• SAMHSA partnered with ONC, ONDCP, & the
CDC.• ONC has management oversight of the effort.
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Goal: Increase timely access to PDMP data in an effort to reduce prescription drug misuse and overdoses.• Explore ways to use HIT to link prescribers and
dispensers with the valuable data in PDMPs.• Main issue: How to make this information more
available to three key groups of clinical decision makers:
Enhancing Access to PDMPs through Health IT Project
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Improve clinician workflow by connecting
PDMPs to health IT
Support timely decision-making at the
point of care
Establish standards for facilitating information
exchange
Provide recommendations and pilot input
Test the feasibilityof using health IT to
enhance PDMP access
Reduce prescription drug misuse and overdose in the United States
Work Groups
Pilots
Enhancing Access to PDMPs through Health IT Project
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Inclusion of prescribing data from Federal dispensers
Providing technical assistance to states and othersPDMP evaluationsPlanning, Implementation, and Enhancement
grantsHealth Information Technology and PDMP Pilot
programsPDMP EHR Grant Programs
Current Federal PDMP Initiatives
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Improve real-time access to PDMP via existing technologies like EHRs (FY12,13).
Strengthen operational state of PDMPs by increasing interoperability between states (FY12).
Evaluate the impact of the enhancements on Rx drug abuse (FY12).• FY 12: 2 year funding for 9 states (FL, IL, IN, KS,
ME, OH, TX, WA, WV)• FY 13: 2 year funding for 7 states (KY, MA, ND, NY,
RI, SC, WI)
SAMHSA’s PDMP EHR Grants
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State End User Pilot Summary
Illinois Emergency Department
• Automated query via intermediary and interstate hub to PDMP upon patient admission to ED
• PDMP data integrated into EHR as a PDF via a Direct message
Indiana Emergency Department
• Automated query via HIE to multiple states’ PDMPs upon patient admission to ED• Patient risk score and PDMP data integrated into EHR
Kansas Providers • Unsolicited report of at-risk patients sent via Direct to EHR-integrated mailboxes
Michigan Providers • Automated query via e-Prescribing software to multiple states’ PDMPs and result integrated in patient’s medication history
Nebraska Emergency Department
• Automated query via HIE to PDMP upon patient admission to ED• Easy access to PDMP with SSO• PDMP data integrated into EHR
Oklahoma Emergency Department
• Established PDMP access directly though an HIE• Developed a SSO from the EHR through the HIE to the PDMP• Alert flag representing the PDMP data
Tennessee Pharmacy • Real-time reporting of dispensing controlled substance data to the PDMP using an existing network
SAMHSA’s PDMP EHR Grants:Overview of Phase 2 Pilots
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Integrating into provider workflow reduces barriers to PDMP access and increases utilization.
Type of integration can vary:• Value increases with degree of automation;• But even basic integration (hyperlink to
PDMP, return PDF) is valued.When available, the PDMP is valuable as a
clinical decision support tool.
Key Takeaways of Enhancing Access Project
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Enhancing Access Pilot White Papers: 8 papers detailing each pilot’s design, technical configuration, outcomes, and plans for expansion.
The Road to Connectivity: A roadmap for connecting to PDMPs through health IT.
Workgroup Recommendations Final Report: Stakeholders identified challenges and recommended solutions to increase timely use of PDMP data by clinicians.
Videos: Pilot participants detail their individual battles against prescription drug abuse, recalling how they used health IT to connect providers to PDMPs.
Enhancing Access Project Accomplishments: Phases 1 & 2
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PDMP Connect Web Site: Developed to allow members of the PDMP community to share valuable experiences, information, and resources: http://www.healthit.gov/pdmp/pdmpconnect
Abbreviated S&I Initiative: Conducted Jan – March 2013:• It provided valuable feedback from stakeholders, but
only identified where standards were needed and the potential standards that could be used.
• It did not identify, evaluate, and harmonize standards for the exchange of information from PDMP to EHRs or HIEs, which we will address in Phase 3…
Enhancing Access Project Accomplishments: Phases 1 & 2 (cont.)
Situation Today• Low utilization of PDMPs among healthcare providers:
– Lack of awareness/utility– Many PDMPs are stand alone systems / No system-to-system
interface– Outside of the clinical workflow – Time and complexity required to access– Lack integration – Untimely data
• EHR Adoption: – As a result of the increased use of EHRs, integrating PDMP data into
EHRs is critical to improving PDMP access and utilization.– Opportunity to leverage PDMP to improve patient safety, by
integrating PDMP information into clinical decision support, medication reconciliation, and quality improvement
PDMP & Health IT Integration Initiative moving forward• While there are data exchange standards in place to share
information– PDMP to PDMP– Pharmacy to PDMP– EHR to Pharmacy (eRx)
• Currently there is not a national uniform approach to the exchange of data between an EHR and a PDMP.
Slide 40
PDMP Ecosystem
Pharmacy
PMPi / RxCheck PDMP
Other State PDMPs
NCPDP Script
PDMP
Por
tal
Switches
NCPDP Telecom
ASAP
Pharmacy Benefits Mgmt
Provider
EHR System
NIEM-PMP NIEM-PMP
Provider
EHR System
Provider
EHR SystemData Out
Needs for consistent harmonized standards (data format and content; transport and security protocols)
Interoperability Challenges
• One of the current technical barriers to interoperability is the lack of harmonized standard methods to exchange and integrate the prescription drug data available in PDMPs into health IT systems.
– Lack of harmonized technical standards and vocabularies to enable PDMPs to share computable information with the EHR that providers can use to support clinical decision-making.
• To achieve interoperability, consistent and standardized electronic methods need to be established to enable seamless data transmission between PDMPs and health IT systems.
Now and ThenEnhancing Access to PDMPs using Health IT project – Phases 1 & 2
• September 2011 - March 2013• Pilots demonstrated proof of concept. • Various non-standard approaches were also used that need to be refined or harmonized
with the existing portfolio of standards and implementation specifications. • Abbreviated S&I Initiative (Jan – March 2013)
Did not identify, evaluate and harmonize standards for the exchange of information from PDMP to EHRs or HIEs.
Valuable feedback from stakeholders but only identified where standards were needed and the potential standards that could be used.
PDMP & Health IT Integration Initiative – Phase 3• November 2013 – TBD• Full S&I Framework Initiative • Assess the current PDMP infrastructure (e.g., interfaces, data formats, data transport
and data security protocols) and available standards that could be harmonized to allow interoperable communications between PDMPs and health IT systems.
• Initiative Coordinator: Johnathan Coleman• Co-Coordinators: TBD• ONC Sponsors:
– Jennifer Frazier– Mera Choi– Scott Weinstein
• SAMHSA Lead– Jinhee Lee– Kate Tipping
• Project Management: Jamie Parker• Project Support: Ali Kahn• Use Case Lead: Presha Patel• Use Case Support: Ahsin Azim• Vocabulary and Terminology Subject Matter Expert: Mark Roche
PDMP & Health IT Integration Initiative Support Team
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PDMP & Health IT Integration DRAFT Notional Project 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 ConsensusStandards and Harmonization Kick Off
Pilot Kick Off
• We will be meeting as a community every week on Tuesdays 12:00-1:00 pm ET.
• All Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and General PDMP & Health IT Integration information will be posted on PDMP & Health IT Integration Initiative: • http://wiki.siframework.org/PDMP+%
26+Health+IT+Integration+Homepage
Logistics
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PDMP & Health IT Integration Wiki Home Page
47PDMP & Health IT Integration Wiki
• Join us for our next Work Group Meeting November 19th, 2013• See the wiki page for the meeting updates• http://wiki.siframework.org/PDMP+%
26+Health+IT+Integration+Homepage
• The PDMP & Health IT Integration Initiative is open for anyone to join
• This community will meet frequently by webinar and teleconference
• We use Wiki pages to facilitate discussion. Information on how to join the Community can be found on the PDMP & Health IT Integration Initiative: • http://wiki.siframework.org/PDMP+%
26+Health+IT+Integration+Homepage
• In order to ensure the success of our initiative and the subsequent pilot, we encourage broad and diverse participation from the community. • This is your chance to have an impact on the creation and implementation
of a pilot program in this important area of health IT development
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Next Steps…
• Please comment on the Proposed Project Charter• Review the Project Charter:
– http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charter+and+Members
• Complete the PDMP & Health IT Charter Comment Form (scroll to the bottom of the page):
– http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charter+and+Members
• Join us for our next meeting November 19, 2013 from 12:00-1:00 pm ET• The time and meeting information will be available on the PDMP & Health IT
Integration wiki page: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage
• Details on the PDMP & Health IT Integration launch including web meeting access and call in information are posted on the wiki: • http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage
Next Steps continued
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Support TeamONC Lead
• Mera Choi -- [email protected] • Jennifer Frazier -- [email protected] • Scott Weinstein – [email protected]
SAMHSA Lead• Jinhee Lee -- [email protected] • Kate Tipping -- [email protected]
Project Management• Jamie Parker -- [email protected]
Project Support• Ali Khan -- [email protected]
Use Case Lead• Presha Patel-- [email protected]
Use Case Support• Ahsin Azim -- [email protected]
Vocabulary and Terminology Subject Matter Expert• Mark Roche -- [email protected]
Resources
• PDMP & Health IT Integration Wiki Homepage: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Homepage
• PDMP & Health IT Integration Charter: http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charter+and+Members
• PDMP & Health IT Integration Past Meeting (materials): http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Meeting+Artifacts