1. PDMP & Health IT Integration All-Hands Meeting May 27 th, 2014

2. 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 2

3. Agenda TopicTime Allotted General Announcements5 minutes PDMP & HITI Standards and Harmonization Summary of outcomes from Solution Planning Workgroup 5/22 Determine minimum dataset requirements 50 minutes Next Steps/Questions5 minutes

4. General Announcements… We hosted a Concert Series presentation “Prescription Drug Monitoring Programs and the PMIX Architecture” on May 21st at 3pm ET – The recording and slides can be found on the Past Meetings wikipage.Past Meetings The Solution Planning Work Group meets Thursdays, 12:00 – 1:00 pm ET. – https://siframework1.webex.com/siframework1/onstage/g.ph p?t=a&d=667584401 https://siframework1.webex.com/siframework1/onstage/g.ph p?t=a&d=667584401 – Dial In: 1-650-479-3208 – Access code: 667 584 401 4

5. 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 http://wiki.siframework.org/PDMP+%26+Health+IT+Integration +Homepage 5 To subscribe to our mailing list, simply complete the PDMP & Health IT Project Signup Form: http://wiki.siframework.org/PDMP+%26+Health+IT+Inte gration+Join+the+Initiative http://wiki.siframework.org/PDMP+%26+Health+IT+Inte gration+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+Art ifacts http://wiki.siframework.org/PDMP+% 26+Health+IT+Integration+Meeting+Art ifacts Note: Please check the meeting schedule weekly to get the most up-to-date meeting information

6. PDMP & Health IT Integration Standards and Harmonization May 27 th, 2014

7. Review: Solution Planning Workgroup Session 5/22 Current-State Transaction: Standards Landscape

8. Transactions Scope FromViaTo 1a 1b  EHR Pharmacy -In-State PDMP 2a 2b  EHR Pharmacy HIE Ph. Int In-State PDMP 3a 3b  EHR Pharmacy HubIn-State PDMP 4  -Out of State PDMP 5a 5b  HIE Ph. Intermediary -Out-of-State PDMP 6  Hub-Out-of-State PDMP 7a 7b  HIE Ph. Intermediary HubIn-State PDMP 8  HubOut-of-State PDMP 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 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 HIE/ Pharmacy Intermediar y In-State PDMP Out of State PDMP Hub EHR or Pharmacy System 1 2 3 3 4 2 3 3 6 5 7 7 7 7 Hub 88

9. Summary of Transactions Data Flow Transactions Reviewed on 5/15 & 5/22 SPWG TransactionSystem - OutboundSystem Intermediary 1System Intermediary 2System Inbound 1aEHR-- PDMP 1bPharmacy IT-- PDMP 2aEHRHIE--PDMP 2bPharmacy ITPharm. Int. / Switch--PDMP 3aEHR--PDMP HubPDMPs 2a+7a+6EHRHIEPDMP HubPDMPs Data Flow Transactions To Be Reviewed on 5/29 SPWG TransactionSystem - OutboundSystem Intermediary 1System Intermediary 2System Inbound 3bPharmacy ITPDMP HubPDMPs 2a + 2b + 7a + 7b + 6 Pharmacy ITPharm. Int. / Switch or HIE PDMP HubPDMPs

10. TransactionSummary from SPWG 5/15Items Required for Further Clarification 1a: EHR System to PDMP (Direct) EHRs don’t generally query PDMPs directly Ohio connectivity model is a direct connection to OARRS via PMIX Kansas leverages HIEs and PMPi data hub for all of their connections Illinois and Ohio use a direct connection – need further clarification on standards used Jinhee Lee to gather information on transactions occurring in Illinois, Kansas, Indiana – In progress Jean Hall to confirm Ohio connectivity model – Complete 2a: EHR System to PDMP via HIE HL7 messaging relatively uncommon in EHRs for PDMP connections Kentucky using QRY^T12 as request and DOC^T12 as acknowledgment and response message – CCD structure Some states that cannot make interstate connections might have no other option but to use this model Washington, Maryland, Maine, Oklahoma use this model Washington response – PMIX-NIEM is mapped to NCPDP SCRIPT and responding with NCPDP SCRIPT message ADT used as trigger in Ohio, Indiana, Illinois, Kansas Jean Hall to further clarify what the query/message pairing used to engage EHR system to HIE – Complete 1b: Pharmacy IT System to PDMP (Direct) Transaction 1b is not currently in use ASAP Web Services standard was developed specifically with this transaction in mind NCPDP Medication History might be suitable for this purpose but is not used currently Jean Hall to further clarify standards currently in use – Complete

11. TransactionSummary from SPWG 5/15Items Required for Further Clarification 2b: Pharmacy IT System to PDMP via Pharmacy Intermediary/ Switch NCPDP SCRIPT Medication History is being used today but not for the purposes of querying PDMP data Real-time query for claim to be dispensed through switch via Telecommunication standard Not yet in use but is possible via claim submission SureScripts to enable this transaction (Intermediary to PDMP) in the future Lynne Gilbertson to verify if standards are currently being used (Nebraska) – Complete TransactionSummary from SPWG 5/22Items Required for Further Clarification 3a: EHR System to PDMP via Hub Ohio, Kansas uses PMIX to connect to PMPi data hub PMP Gateway will be used in the future to centralize translations, where endpoints can communicate with gateway EHR provides translation from HL7 (V2/ADT?) to PMIX in Kansas pilots Hub functions as aggregator, depending on arrangements Clay Rogers and Jeff McGonigal to verify translation/EHR generating PMIX request 2a + 7a + 6: EHR System to HIE to Hub to PDMP Indiana and North Dakota provides translation to PMIX from the HIE to the Hub HIE translates using NCPDP SCRIPT with PMIX wrapper for Hub Jinhee Lee to verify how Indiana performs translation from HIE to Hub Danna Droz and Chad Garner to confirm third party software functionality of NARxCheck via NABP

12. Summary of Current Standards Landscape What we know: – Several states utilize the EHR  HIE  PDMP transaction Some states that cannot make interstate connections might have no other option but to use this model – PMIX-NIEM is the standard used for the Hub to PDMP transaction Translation from HL7 messaging to PMIX must occur prior to Hub to PDMP transaction – Thus, translations can occur from the EHR system to the HIE, the HIE to the Hub, the EHR system to the Hub, or the HIE to the PDMP – HL7 ADT is used as a trigger in several states – Currently, EHR systems and Pharmacy IT systems do not generally query the PDMP directly ASAP Web Services standard was developed specifically for this purpose

13. Questions to be answered: 1.Differences in pharmacy and clinician workflows / data systems and expectations in PDMP data transmitted? 2.How do we define intermediaries and their relationships to Health IT systems? 3.What components of PDMP report are extracted for decision support? 4.Can EHR and Pharmacy IT systems handle the proposed standards (in the context of PDMP systems)? 5.What standard(s) fit into message and workflow configuration per transaction type? 6.Are transactions collapsible in terms of capability of leveraging same standard? 7.Are all transactions necessary? 8.What is the cost associated with the proposed solutions? 9.How do we define an aggregator? (collection of response from different PDMPs back to recipient) 10.Parking lot item: Differences in care settings - Ambulatory vs. Acute; In-hospital pharmacies vs. retail pharmacies. Are different standards needed for different EHR systems?

14. Data Element Analysis

15. Implementation Guide – Data Elements and Attributes

16. Data Requirements Analysis - PDMP & HITI Use Case Request Transaction Data Elements GeneralAuthorized UserPatient 1.Request Date 2.Request Timestamp 3.State of Request 4.Requestor Location 5.Requested State(s) [if applicable] 6.Authenticator 7.System authentication 8.Initiating requestor’s routing ID 9.Responder ID 10.Message ID 11.Requestor’s Internal Patient ID 12.Start Date 13.End Date 1.First Name 2.Last Name 3.Generational Suffix [if applicable] 4.Address Information 5.Optional Address Information 6.City Address 7.State Address 8.ZIP Code Address 9.Email Address 10.Phone Number 11.Authentication Credentials [DEA, NCPDP/NABP Provider ID, NPI, License #, Delegate ID 12.Type of User 1.First Name 2.Last Name 3.Address Information 4.Optional Address Information 5.City Address 6.State Address 7.ZIP Code Address 8.Phone Number 9.Patient Gender 10.Country 11.Date of Birth 12.Identification Qualifier of Patient Identifier 13.Identification of Patient

17. Data Requirements Analysis - PDMP & HITI Use Case Response Transaction Data Elements GeneralPatientPrescriptionPrescriberDispenser 1.Response Date 2.Response Timestamp 3.Response Time 4.State of Response 5.Response Identifier 6.Message ID 7.Summary 8.Create Time 9.Intended Recipient 10.Status of Request 1.First Name 2.Last Name 3.Address Information 4.Optional Address Information 5.City Address 6.State Address 7.Zip Code Address 8.Country 9.Date of Birth 10.Identification Qualifier of Patient Identification 11.Identification of Patient 12.PDMP Patient Reference Number 13.Gender Code 14.Species Code 15.Phone Number 1.Name of Drug 2.Strength 3.Form 4.Quantity Dispensed 5.Days Supply Dispensed 6.Date Written 7.Refills Authorized 8.Refill Number 9.Partial Fill 10.Prescription Number 11.Date Prescription Filled 12.Date Prescription Sold/Dispensed 13.Drug Identifier 14.Payment Method 1.First Name 2.Last Name 3.Address Information 4.Optional Address Information 5.City Address 6.State Address 7.Zip Code Address 8.Phone Number 9.DEA # 10.Authentication Credentials 11.PDMP Prescriber Reference # 1.Pharmacy or Dispensing Prescriber’s Name 2.Address Information 3.Optional Address Information 4.City Address 5.State Address 6.ZIP Code Address 7.Phone Number 8.DEA # 9.NCPDP/NABP Provider ID 10.NPI 11.PDMP Dispenser Reference #

18. Consolidated Standard Data Set– PDMP & HITI Use Case PDMP & HITI Use Case Data Elements GeneralPatientPrescriptionAuthorized User* 1.Request Date 2.Request Timestamp 3.State of Request 4.Requestor Location 5.Requested State(s) [if applicable] 6.Authenticator 7.System authentication 8.Initiating requestor’s routing ID 9.Responder ID 10.Message ID 11.Requestor’s Internal Patient ID 12.Start Date 13.End Date 14.Response Date 15.Response Timestamp 16.Response Time 17.State of Response 18.Response Identifier 19.Summary 20.Create Time 21.Intended Recipient 22.Status of Request 1.First Name 2.Last Name 3.Address Information 4.Optional Address Information 5.City Address 6.State Address 7.Zip Code Address 8.Country 9.Date of Birth 10.Identification Qualifier of Patient Identification 11.Identification of Patient 12.PDMP Patient Reference Number 13.Gender Code 14.Species Code 15.Phone Number 1.Name of Drug 2.Strength 3.Form 4.Quantity Dispensed 5.Days Supply Dispensed 6.Date Written 7.Refills Authorized 8.Refill Number 9.Partial Fill 10.Prescription Number 11.Date Prescription Filled 12.Date Prescription Sold/Dispensed 13.Drug Identifier 14.Payment Method 1.First Name 2.Last Name 3.Address Information 4.Optional Address Information 5.City Address 6.State Address 7.Zip Code Address 8.Phone Number 9.DEA # 10.Authentication Credentials 11.PDMP Prescriber Reference # 12.Pharmacy or Dispensing Prescriber’s Name 13.NCPDP/NABP Provider ID 14.NPI 15.PDMP Dispenser Reference # 16.Type of user *Includes Physician and Dispenser

19. Standard Data Set– MITRE WG Recommendation MITRE Standard Data Elements PatientPrescriberDispenserPrescription 1.First name 2.Last name 3.Street address 4.City 5.State 6.ZIP code 7.Date of birth 8.Identification (ID) qualifier and/or patient identifier (situational) 9.Gender code (situational) 10.Species code (situational) 11.Phone number (situational) 1.First name 2.Last name 3.Street address 4.City 5.State 6.ZIP code 7.Phone number (situational) 8.Drug Enforcement Agency (DEA) number (situational) 1.Pharmacy or dispensing prescriber name 2.Street address 3.City 4.State 5.ZIP code 6.Phone number (situational) 7.DEA number (situational) 8.National Council for Prescription Drug Programs (NCPDP)/National Association of Boards of Pharmacy (NABP) Provider ID (situational) 9.National Provider Identifier (NPI) (situational) 1.Name of drug 2.Strength 3.Form 4.Quantity dispensed 5.Days’ supply dispensed 6.Date prescription filled 7.Date written 8.Refills authorized 9.Refill number 10.Refill status to indicate a full or partial refill 11.Prescription number

20. Next Steps Review: Minimum Dataset Requirements Next Solution Planning WG meeting is Thursday, May 29 from 12:00pm – 1:00pm ET Next All Hands meeting is Tuesday, June 3 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 http://wiki.siframework.org/PDMP+%26+Health+IT+Integration +Homepage

21. Contact Information – Initiative Coordinators: Johnathan Coleman jc@securityrs.comjc@securityrs.com Sherry Green sgreen@namsdl.orgsgreen@namsdl.org – ONC Leads: Mera Choi mera.choi@hhs.govmera.choi@hhs.gov Jennifer Frazier Jennifer.Frazier@hhs.govJennifer.Frazier@hhs.gov Helen Caton-Peters Helen.Caton- Peters@hhs.govHelen.Caton- Peters@hhs.gov – SAMHSA Leads Jinhee Lee Jinhee.Lee@samhsa.hhs.govJinhee.Lee@samhsa.hhs.gov Kate Tipping Kate.Tipping@samhsa.hhs.govKate.Tipping@samhsa.hhs.gov – Support Team: Project Management: Jamie Parker jamie.parker@esacinc.com jamie.parker@esacinc.com Ali Khan Ali.Khan@esacinc.com (Support)Ali.Khan@esacinc.com Use Case Development: Ahsin Azim Ahsin.Azim@accenturefederal.com Ahsin.Azim@accenturefederal.com Presha Patel presha.patel@accenture.com presha.patel@accenture.com Standards Development Support: Alex Lowitt alexander.s.lowitt@accenturefederal.com alexander.s.lowitt@accenturefederal.com Harmonization Support: Divya Raghavachari divya.raghavachari@accenturefederal.com divya.raghavachari@accenturefederal.com Atanu Sen atanu.sen@accenture.comatanu.sen@accenture.com Implementation Guide Development: Rita Torkzadeh rtorkzadeh@jbsinternational.com rtorkzadeh@jbsinternational.com Vijay Shah vshah@jbsinternational.comvshah@jbsinternational.com Vocabulary and Terminology Subject Matter Expert: Mark Roche mrochemd@gmail.commrochemd@gmail.com For questions, please feel free to contact your support leads:

22. Appendix

23. Current In-State EHR Workflow (Direct) EHR System In-State PDMP PMIX? Request Response Legend Transaction 1a PMIX?

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

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

26. Current In-State Pharmacy Workflow (Pharmacy Int. / Switch) Pharmacy System Pharmacy Intermediary / Switch In-State PDMP Request Response Legend NCPDP SCRIPT (Medication History) ? ? Transaction 2b

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

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