1. PDMP & Health IT Integration All-Hands Meeting November 19th, 2013

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 Announcements & Introductions10 minutes Review of Project Charter40 Minutes Next Steps/Questions10 Minutes 3

4. 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+Integrat ion+Homepage http://http://wiki.siframework.org/PDMP+%26+Health+IT+Integrat ion+Homepage Note: Please check the meeting schedule weekly to get the most up-to-date meeting information 4

5. 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+t he+Initiative http://wiki.siframework. org/PDMP+%26+Health +IT+Integration+Join+t he+Initiative 5

6. Initiative Support Leads For questions, please feel free to contact your support leads: – Initiative Coordinator: Johnathan Coleman jc@securityrs.comjc@securityrs.com – ONC Leads: Mera Choi mera.choi@hhs.govmera.choi@hhs.gov Jennifer Frazier Jennifer.Frazier@hhs.govJennifer.Frazier@hhs.gov Scott Weinstein Scott.Weinstein@hhs.govScott.Weinstein@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: – Presha Patel presha.patel@accenture.compresha.patel@accenture.com – Ahsin Azim Ahsin.Azim@accenture.com (Support)Ahsin.Azim@accenture.com Vocabulary and Terminology Subject Matter Expert: – Mark Roche mrochemd@gmail.commrochemd@gmail.com 6

7. PhasePlanned 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 7 We are Here

8. 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, PDMP information can help providers distinguish between patients who may legitimately need a controlled substance for pain treatment and those who may be seeking to misuse prescription drugs. PDMPs collect a considerable amount of important data, yet providers often do not use them because they are stand alone systems which are difficult and time consuming to access. Currently, most prescribers must either interrupt their workflow and log on to a separate system to access the PDMP or write prescriptions without consulting the PDMP- potentially leaving providers without the information needed to make important clinical decisions. Integrating PDMP data into health IT systems like EHRs and HIEs is one way to improve PDMP access and utilization. 8

9. 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 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. To achieve interoperability, consistent and standardized electronic methods need to be established to enable seamless data transmission between PDMPs and health IT systems. 9

10. 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). Doing so would enable health care providers to make more informed clinical decisions though 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 connections that use PDMP data – Identify, evaluate, and harmonize the data format(s) sent from PDMPs to EHRs. – 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. 10

11. 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) 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 – 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. – PDMP to PDMP transactions 11

12. 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 12

13. 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 13 * Security and Transport standards will be dependent on the architecture/environment considerations

14. 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 14 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

15. 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 15

16. PDMP & Health IT Integration – Project Charter Proposed Timeline Kick-off (11/14) Pre-Discovery, Call for Participation Jan 14 June 14 Discovery Initiative End 16 Nov 13 July 14 Mar 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

17. Providing Charter Comments 1.Review the Project Charter – http://wiki.siframework.org/PDMP +%26+Health+IT+Integration+Chart er+and+Members http://wiki.siframework.org/PDMP +%26+Health+IT+Integration+Chart er+and+Members 2.Fill out the comment form 1.wiki.siframework.org/PDMP+%26+ Health+IT+Integration+Charter+an d+Members#Commentwiki.siframework.org/PDMP+%26+ Health+IT+Integration+Charter+an d+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 17 5 5

18. 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 November 26th, 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+H omepage http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+H omepage 18 NOTE: Please be sure to check the PDMP & Health IT Integration wiki homepage for the most up-to-date meeting information

19. Proposed Community Call Schedule 19 DateMeeting Topics Nov. 19 th, 2013 Community Kick off Meeting Meet the support team Review Project Charter Nov. 26 th, 2013 Continue Review of Project Charter Dec. 3 rd, 2013 Conduct final group review of the project charter Begin end to end review of the project charter Dec. 10 th, 2013 Review end to end comments Fall concert series – Presenter TBA Begin Consensus process Dec. 17 th, 2013 Review Consensus Comments Fall Concert Series – Presenter TBA Dec. 24th, 2013 Meeting Canceled – Consensus will be announced Dec. 31 st, 2013 Meeting to be determined Fall Concert Series wrap up

20. Questions 20

21. PDMP & Health IT Integration Resources Initiative Wiki Homepage – http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Home page http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Home page Become a Community Member – http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Join+t he+Initiative http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Join+t he+Initiative Project Charter – http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charte r+and+Members http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Charte r+and+Members Standards and Interoperability(S&I) Framework – http://wiki.siframework.org/Introduction+and+Overview http://wiki.siframework.org/Introduction+and+Overview S & I Calendar of Events – http://wiki.siframework.org/Calendar http://wiki.siframework.org/Calendar 21