1. S&I Framework Prescription Drug Monitoring Program & Health IT Integration Initiative Use Case & Functional Requirements January 14, 2014 1

2. Agenda 2 TopicTime Allotted General Announcements5 minutes PDMP & HITI Use Case Development Use Case Timeline Definitions, In/Out of Scope, Assumption, Scenario Introduce: User Stories 50 minutes Next Steps/Questions5 minutes

3. 1.0 Preface and Introduction 2.0 Initiative Overview –2.1 Initiative Challenge Statement** 3.0 Use Case Scope –3.1 Background** –3.2 In Scope –3.2 Out of Scope –3.3 Communities of Interest (Stakeholders)** 4.0 Value Statement** 5.0 Use Case Assumptions 6.0 Pre-Conditions 7.0 Post Conditions 8.0 Actors and Roles 9.0 Use Case Diagram Use Case Outline Tailored for each Initiative 10.0 Scenario: Workflow –10.1 User Story 1, 2, x, … –10.2 Activity Diagram o 10.2.1 Base Flow o 10.2.2 Alternate Flow (if needed) –10.3 Functional Requirements o 10.3.1 Information Interchange Requirements o 10.3.2 System Requirements –10.4 Sequence Diagram 11.0 Dataset Requirements 12.0 Risks, Issues and Obstacles Appendices –Privacy and Security Considerations –Related Use Cases –Previous Work Efforts –References ** Leverage content from Charter 3

4. PDMP & HIT Integration Initiative Proposed Use Case & Functional Requirements Development Timeline 4 Week Target Date (2014) All Hands WG Meeting Tasks Review & Comments from Community via Wiki page due following Monday @ 12 noon 11/7 Use Case Kick-Off & UC Process Overview Introduce: In/Out of Scope, Context Diagram and Scenario Concert Series Presentation: ASAP Review: In/Out of Scope, Assumptions, Context Diagram 21/14 Review: In/Out of Scope, Context Diagram, Assumptions, Scenario Introduce: User Stories Review: User Stories, In/Out of Scope, Assumptions, Context Diagram 31/21 Review: User Stories Introduce: Pre/Post Conditions, Actor and Roles Review: Pre/Post Conditions, Actors and Roles, User Stories 41/28 Review: Finalize User Stories, Pre/Post conditions, Actors and Roles Introduce: Activity Diagram and Base Flow Concert Series Presentation: OneHealthPort & WADOH Review: Activity Diagram and Base Flow 52/4 Review Activity Diagram and Base Flow Introduce: Functional Requirements and Sequence Diagram Review: Functional Requirements, Sequence Diagram, Activity Diagram and Base Flow 62/11 Review Functional Requirements and Sequence Diagram Introduce: Data Requirements and Issues and Risks Review: Data Requirements and Issues and Risks 7 2/18 (To be rescheduled) Review: Data Requirements and Risks & Issues Begin End-to-End Review End-to-End Review by community 2/25HIMSS Meeting 83/4End-to-End Comments Review & dispositionEnd-to-End Review ends 93/11Finalize End-to-End Review Comments & Begin ConsensusBegin casting consensus vote 103/18Consensus Vote*Conclude consensus voting

5. Note- Below sections will be reviewed within the separate Use Case word document: 1.Discuss and review the following sections: 1.Definitions 2.Scope Items 3.Assumptions 4.Context Diagram 2.Introduce and review the following sections: 1.Draft User Stories Section Review 5 Click the icon to open the Word Document

6. Definitions Healthcare Professional- A medical practitioner or provider of care who has legal authorization to access prescription drug data for patients at the point of care to make informed clinical decisions and appropriate treatment recommendations This may include: Prescribers, dispensers, nurses, etc. Health IT System – An information system that is used by a Healthcare Professional to collect and store patient information including demographics, medicine, etc. (i.e. EHR, HIE, Pharmacy System) PDMP & HIT Integration – Definitions To be reviewed in Word Document

7. PDMP & HIT Integration – In and Out of Scope In Scope 1.Connecting PDMPs to Health IT systems using existing standards; (technical mechanism for actual exchange of data)** 2.If standards do not exist, identifying the gap in the current standards and working with the Standards Organizations (SDOs) to address the gaps** (Refers to harmonization activity) 3.Improving effective and efficient access to PDMP data by Healthcare Professionals** 4.Health IT system has ability to view query response from PDMP 1.Healthcare Professional querying PDMP for a known patient through a Health IT system 2.Healthcare Professional querying a state PDMP connected to the same hub as the state they are located in 5.Safety notifications/ automated alerts from PDMP 6.Define standard set of data elements used to submit queries each time 7.Define system /technical requirements for Healthcare Professionals to be able to access patient information already stored in a PDMP 1.Accessing a PDMP through a Health IT system (i.e. EHR system) instead of another portal 8.Define system/technical requirements that allow applications to access data in a consistent manner across the local Health IT system 1.Method of extraction Out of Scope 1.Defining the trigger event for how the PDMP is queried or initiated by the user (e.g., hyperlink while ordering, pressing a button, automatic trigger, etc.)** 2.Addressing delegation of rights to individuals not legally authorized to prescribe medications (this is an implementation specific decision and may vary by implementation and pilot sites)** 3.Third party access - (this is an implementation specific decision and may vary by implementation, pilot sites and state statues and law)** 4.Reporting patient prescription information from dispensers to state PDMP 5.Policy-based decisions on how PDMPs are managed, accessed, and updated that vary from state to state 6.Timeliness of PDMP: Currency of Data 7.Storing query response from PDMP 8.Health IT system’s structure of display for the query response 7 **Leveraged from Charter To be reviewed in Word Document

8. PDMP & HIT Integration – Use Case Assumptions 1.Health IT system is capable of querying a PDMP 2.All Healthcare Professionals have appropriate legal authority based on state regulations to request and receive information from state PDMP 3.Healthcare Professionals accessing the PDMP follow state guidelines as appropriate, including any privacy and security requirements as required by each individual state PDMP authority 4.The PDMP returns high positive matches to the Healthcare Professional 1 5.The Healthcare Professional accesses information that already exists within the PDMP at the time of querying 8 To be reviewed in Word Document 1 Question for Community: What are the responses you receive when querying a PDMP?

9. Generic Scenario & Context Diagram Pre-Step: Healthcare Professional logs into Health IT System 1. Sends query to state PDMP Healthcare Professional receives requested information PDMP & HIT Integration Use Case Scope 2. PDMP sends query response Pre-Step: Healthcare Professional logs into Health IT System 1. Sends query to state PDMP Healthcare Professional receives requested information PDMP & HIT Integration Use Case Scope 2. PDMP sends query response Interstate Hub AND/OR 9 To be reviewed in Word Document

10. User Story 1: A legally authorized provider queries PDMP before writing a prescription for a patient Trigger: Patient needs medication for chronic back pain 1. Healthcare Professional logs into Health IT System 2. Sends query to state PDMP to check if patient has been prescribed narcotics/controlled substance in past X weeks 4. Healthcare Professional makes an informed decision to prescribe medication based on information received Use Case Scope 3. PDMP sends query response 10 Draft User Story: A patient arrives at the doctor’s office for chronic back pain. The Healthcare Professional logs into his Health IT system and enters his credentials. After diagnosis, the Healthcare Professional sends a query to the State PDMP through his Health IT system to see if the patient had been prescribed a controlled substance in the past X weeks. The PDMP processes the request and identifies the appropriate response to send back to the requestor. After receiving the query response from the PDMP, the Healthcare Professional makes an informed decision of whether or not to prescribe the medication or modify the dosage based on the information received. To be reviewed in Word Document

11. User Story 2: Pharmacist queries PDMP prior to dispensing opioids to a patient Trigger: Patient arrives at pharmacy and drops off prescription to be filled 1. Pharmacist logs into Pharmacy Dispensing System 2. Sends query to state PDMP to check if patient has received narcotics/controlled substance in past X weeks 3. PDMP sends query response 4. Pharmacist makes an informed decision to dispense medication based on information received Use Case Scope 11 Draft User Story: A patient arrives at the pharmacy to have his prescription filled. The pharmacist logs into the Pharmacy Dispensing system, and she enters her credentials. After, she sends a query to the State PDMP through her Pharmacy Dispensing system to see if the patient had filled a prescription for a controlled substance in the past X weeks. The PDMP processes the request and identifies the appropriate response to send back to the requestor. 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. To be reviewed in Word Document

12. Next Steps Review: User Stories, In/Out of Scope, Assumptions, and Scenario sections Next Meeting is Tuesday, January 21 from 12:00pm - 1:00pm 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+ Homepagehttp://wiki.siframework.org/PDMP+%26+Health+IT+Integration+ Homepage 12

13. Contact Information For questions, please feel free to contact your support leads: – 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.comjamie.parker@esacinc.com – Ali Khan Ali.Khan@esacinc.com (Support)Ali.Khan@esacinc.com Use Case Development: – Ahsin Azim Ahsin.Azim@accenturefederal.comAhsin.Azim@accenturefederal.com – Presha Patel presha.patel@accenture.compresha.patel@accenture.com Vocabulary and Terminology Subject Matter Expert: – Mark Roche mrochemd@gmail.commrochemd@gmail.com 13