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Final Current Standards Landscape Analysis

This report provides a comprehensive analysis of the current landscape and proposed solutions for integrating Prescription Drug Monitoring Programs (PDMP) with Electronic Health Records (EHR) and pharmacy systems. It highlights various transaction workflows, both for in-state and out-of-state PDMPs, emphasizing the role of intermediaries and hubs in ensuring efficient data exchange. By examining user stories and alternate workflows, the document outlines essential modifications needed for the successful implementation of these systems, along with future strategies for system alignment with health IT standards.

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Final Current Standards Landscape Analysis

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  1. Final Current Standards Landscape Analysis June 3rd, 2014

  2. HIE/Ph. Interm. 2 5 2 7 4 Out of State PDMP In-State PDMP EHR or Pharmacy System Hub 1 8 8 PMP/HITI User Stories with Alternate Workflows EHR or Ph. to In-State PMP: 1a: EHR to In-state PMP 1b: Ph. to In-state PMP 2a: EHR to In-state PMP via HIE 2b: Ph. to In-State PMP via HIE 3a: EHR to In-state PMP via Hub 3b: Ph. Intermediary to In-State PMP via Hub EHR or Ph. to Out-of-State PMP: 1a+4: EHR to out-of-state PMP via In-state PMP 1b+4: Ph.to out-of-state PMP via In-state PMP 2a+4: EHR to out-of-state PMP via HIE & In-state PMP 2b+4: Ph. to out-of-state PMP via Ph. Int& In-state PMP 2a+5: EHR to out-of-state PMP via HIE 2b+5: Ph. to out-of-state PMP via HIE 2a+7a+6: EHR to out-of-state PMP via HIE + Hub 2b+7a/7b+6: Ph to out-of-state PMP via HIE/Ph. Int + Hub 3a+4: EHR to out-of-state PMP via Hub & In-State PMP 3b+4: Ph. to out-of-state PMP via Hub & In-State PMP 1a+8: EHR to out-of-state PMP via In-State PMP & Hub 1b+8: Ph. to out-of-state PMP via In-State PMP & Hub 3a+6: EHR to out-of-state PMP via Hub 3b+6: Ph. To out-of-state PMP via Hub 3 7 6 3 Hub

  3. Summary of Transactions

  4. Current Landscape Proposed Solution Set Relevant Workflows 1 EHR  In-State PDMP Pharmacy  In-State PDMP EHR  In-State PDMP Pharmacy  In-State PDMP EHR  Intermediary  In-State PDMP Pharmacy  Intermediary  In-State PDMP Legend 2 Proposed EHR  Intermediary* Pharmacy  Intermediary Potential EHR  Intermediary  Hub  PDMP(s) Pharmacy  Intermediary  Hub  PDMP(s) Remove 3 EHR  Hub  PDMP(s) Pharmacy  Hub  PDMP(s) EHR  Hub Pharmacy  Hub • Aligns to in-scope Use Case scenarios • Approach may require translation mapping between ASAP, NCPDP SCRIPT Medication History, and H L7 V2 Messaging to PMIX Architecture • Implementation Guide will have to include data element modifications/additions to fully support PDMP & HITI Use Case requirements EHR  In-State PDMP  Hub  PDMP(s) Pharmacy  In-State PDMP  Hub  PDMP(s) *Intermediary - An entity (service, or set of services) that routes the transaction to a receiving entity. May perform value added services such as translating data from one format to another

  5. Health IT System Standard PDMP Standard Translation Summary Analysis ASAP Web Services PMIX-NIEM Architecture HL7 V2 Messaging Intermediary PDMP Hub NCPDP SCRIPT Medication History • Strategy Details • Implementation Guide focus will shift to those organizations providing transformations/translation/ ETL services • ASAP can provide point-to-point PDMP data exchange for Pharmacies and EHRs a like – can be transformed into PMIX Architecture via Appriss, Inc. (PMPi) • Intermediaries provide translation service or metadata transformations as “wrappers” • Data elements will need to be modified or added, specified within the PDMP & HITI Implementation Guide Example Container/Payload Configuration PMIX Architecture SCRIPT Med History (Patient Data) (Authentication)

  6. Transaction Workflows

  7. Current In-State EHR Workflow (Direct) Transaction 1a NARxCheck EHR System In-State PDMP NARxCheck Legend Request Response

  8. Current In-State EHR Workflow (HIE) Transaction 2a HL7 A04 NCPDP SCRIPT with PMIX Wrappers Third Party Software HL7 QRY^T12 HL7 ADT feeds NCPDP SCRIPT (Med History) HL7 QRY^T12 EHR System HIE In-State PDMP HL7 OBX XML Report NCPDP SCRIPT (Med History) HL7 DOC^T12 - CCD XML Response NCPDP SCRIPT with PMIX Wrapper HL7 DOC^T12 Legend Request Response

  9. Current In-State Pharmacy Workflow (Direct) Transaction 1b Pharmacy IT System In-State PDMP NARxCheck NARxCheck Legend Request Response

  10. Current In-State Pharmacy Workflow (Pharmacy Int. / Switch) Transaction 2b ? ? Pharmacy System Pharmacy Intermediary/ Switch In-State PDMP ? ? SCRIPT used for medication history but does not currently pull Controlled Substance history from Intermediaries using SCRIPT standard. Legend Request Response

  11. Current In-State EHR Workflow (Hub) Transaction 3a – Not Effective Workflow? Currently Active? PMIX HL7 PMIX In-State PDMP EHR System PDMP Hub Interface PMIX PMIX Legend Request Response

  12. Current In-State Pharmacy Workflow (Hub) Transaction 3b – Not Effective Workflow? Currently Active? Translation? In-State PDMP Pharmacy System Translation? PMIX PDMP Hub ? PMIX Legend Request Response

  13. Current Interstate EHR Workflow Transaction 2a + 7a + 6 EHR System HIE In-State PDMP Third Party Software PMIX-NIEM NCPDP SCRIPT (Medication History) PMIX-NIEM XML PMIX-NIEM XML PMIX-NIEM Out-of-State PDMP PDMP Hub PMIX-NIEM Legend Request Response

  14. Current Interstate Pharmacy Workflow Transaction 2a + 2b + 7a + 7b + 6 HIE In-State PDMP Pharmacy System Third Party Software PMIX Wrappers NCPDP SCRIPT PMIX-NIEM XML PMIX-NIEM XML PMIX-NIEM Pharmacy Int. / Switch NCPDP SCRIPT PDMP Hub Out-of-State PDMP PMIX-NIEM ? Legend Request ? Response

  15. System Transaction-Relationship Flow Legend Known To Confirm

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