Pdmp 3 lee oneil

Integra(ng PDMP Data into the Clinical Workflow

Dr. Jinhee Lee Public Health Advisor, Division of Pharmacologic Therapies Center, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services

Dr. Michael O’Neil Drug Diversion and Substance Abuse Consultant South College School of Pharmacy

RxSummit 2014

Disclosure Statement

•  Jinhee Lee has no financial rela/onships with proprietary en//es that produce health care goods and services.

•  Michael O’Neil has no financial rela/onships with proprietary en//es that produce health care goods and services.

Objectives

•  Define current tools that are in place for prescribers and dispensers to incorporate PDMPs through electronic health informa/on sources.

•  Evaluate effec/veness of current PDMP programs to op/mally manage pa/ents.

•  Outline opportuni/es to enhance the access and effec/veness of PDMP programs.

3

Over prescribing for various reasons……..

Obj. 2 Evaluate effectiveness of current PDMP programs to optimally manage patients……………………

in the clinical environment.

•  basic clinical applica/ons

•  limita/ons

•  prescriber / pharmacist vs. law enforcement approaches

•  example cases

Clarification of Acronyms

•  Controlled Substance Monitoring Database (CSMD)

•  Controlled Substance Monitoring Program (CSMP)

•  Controlled Substance Monitoring Program Database (CSMPD)

•  Prescription Monitoring Program (PMP)

•  Controlled Substance Database (CSD)

•  Prescription Drug Monitoring Program (PDMP)

CSMD=CSMP = CSMPD = PMP = CSD = PDMP

6

Intent of PDMP

“Two intents depending on the origination of legislation and the state of origination”

•  Practitioner driven with specified allowances to law enforcement / health professional boards

•  Law enforcement driven with specified allowances for specific healthcare professionals

•  The differences are BIG!!!

7

Use of the PDMP

•  The PDMP database is a tool and NOT definitive evidence of a crime!

•  The database should be used to pose further questions to the patients, prescribers or law enforcement.

•  “………then where does the crime come in?”

8

Two Major components of the PDMP

1. pa/ent tracking of records

2. prescriber tracking of records

3. surveillance / monitoring / Research

•  review for today is on pa/ent data

9

Limitations

•  pa/ent names-‐spellings •  addresses •  date of birth •  accurate NDC codes •  accurate prescribers / accurate pa/ents….legal ramifica/ons •  lazy pharmacists / techs •  reversing errors (reversing transac/ons) •  current state interfaces………GeVng beWer! But……. •  diagnosis unknown •  error accountability? •  federal data….. VA Medical Centers? •  repor/ng should go where? •  Internet capabili/es / servers

10

Basic Observations of the PDMP Report

•  early refills

•  multiple pharmacies – (be cautious, many patients swap pharmacies due to financial incentives for every prescription transferred)

•  ?multiple doctors (sometimes hard to tell) -cross cover prescribers -prescription renewals -is it the same address?

•  persistent or continued randomness of similar medications including escalating-deescalating doses, variation in products

•  Combinations (Soma, Oxys, Xanax)

Example: e.g. oxycodone, morphine, hydromorphone, oxymorphone (Indication?)

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Sometimes more importantly…..

What’s not on the report!

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What’s Not on the Report

•  prescriber verbal changes •  is the DEA Valid? •  fixed errors •  controlled substances NOT picked up •  wrong entries •  federal prescrip/ons (VA Medical centers), data waived

•  methadone / buprenorphine under federal programs

13

Optimizing PDMP Report Reviews: Running the PDMP Report

•  In todays busy medical offices and community pharmacies….. unless you get more help…rarely do new processes actually facilitate workflow!

•  Individual prescribers and pharmacist should have their “own” access codes.

•  Most states allow sharing of access codes up to 2-‐3 individuals (nurse manager, pharmacy technician, medical assistant, etc.)

•  As pa/ent records are pulled by assistants for appointments or technicians for filling prescrip/ons. “Flags” should be part of the assistants / techs workflow that prompts running the PDMP.

Strategies to consider

•  The most important factor…..train your staff on how to run the report. If you don’t know…. learn. Designate staff!

•  Request your local/regional professional agencies to provide CEs as part of PDMP training.

•  At LEAST login to the PDMP rou/nely.

-‐forgoWen or expired passwords cost significant loss of /me

-‐familiarity with PDMP formaVng helps!

Facilita(ng Work Flow with the PDMP Tool; When to Run the Report

•  State mandated reports (chronic opioids or benzodiazepines), opioids > than 3 months

•  Annually with chronic controlled substances?

•  The report does not need to be run for every pa/ent!

(unless otherwise mandated by the state)

•  Flags: new pa/ents, unknown pa/ents, pa/ents that travel long distances, unusual cocktail prescrip/ons.

•  Recommended to go back At LEAST 6months….1 year is usually op/mal.

Case Points: Prescribers / pharmacists should not spend lots of /me interpre/ng “gray areas”.

•  Rarely is this ever about 1 or 2 prescrip/ons

•  Occasionally “extra scripts”

•  Den/sts, ER visits

•  Frequently there are “clinically relevant” jus/fica/ons. Clinical judgment is frequently warranted and reports should be confirmed via phone calls, emails, etc.

•  Prescribers and pharmacists are not looking for subtle/es

Everyone is looking at trends or paYerns

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Evaluating the Printout

•  Pick drug

•  Note QTY

•  Note Dates

•  Note Prescribers

•  Note addresses

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State XXX= BOARD OF PHARMACY – PATIENT PROFILE Date 4/15/2012 Date of Birth 12-10-1966 Beginning Date: 04-01-11 =nbsp Ending Date: 04-15-12 First Name: MIKE Last Name: =OWEN

First Name

Address Zip Fill date Rx no. Product Name Strength Qty Doctor Name

Doctor Dea Pharm Name

Pharm Dea Ph Zip

MIKE 319 LOWER 25526 4/2/2011 11222 APAP/HYDRO 500MG-‐10MG

180 SMITH JOE DH0267890 TOM’S PHARM

GF1234567 25526



GF1234567 25526



GF1234567 25526



GF1234567 25526

Case 1

1.  Early Refill? 2.  How many days of medica/on? 3.  Change of prescriber?

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Findings

•  Early Refillers (professional judgment vs. negligence) •  Dr. Shoppers •  Pa/ent cocktails •  Mul/ple medica/ons (polypharmacy) •  Mul/ple prescribers •  Aberrant paWerns of prescribing medica/ons •  Escala/on of doses / de-‐escala/on of doses •  Changes in medica/ons •  Acute medica/ons and Chronic medica/ons •  Disease state knowledge

Frequently requires clinical judgment……..

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Clarification, Verification and Documentation of the Prescription or Whether to Even Prescribe

•  Calling the prescriber(s) - validating patient - validating prescription - quantity - validating indication

•  Questioning the patient - previous prescriptions - other practitioners - indication

•  Documentation of the query / discussion / intervention

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Findings and anomalies should lead to further questions by the prescriber, pharmacist (not technician), or investigator

•  When was last refill for drug X

•  Have you had any other scripts for drug X? •  Indica/ons for drug X / Hx? •  Do the other Drs Know? •  Distance Travelled? •  What other medica/ons do you take…….where are they filled?

•  OK to call prescriber?

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Key Considerations:

Prescribers and pharmacists are making on the spot real /me “clinical decisions” with the PDMP. Law enforcement is not.

Law Enforcement is usually accessing the PDMP AFTER some report, probable cause or inves/ga/on of diversion, etc. has been reported.

Poor PROFESSIONAL judgment by a prescriber is NOT CRIMINAL!

So prosecu/ons are very difficult, labor intensive, last forever and costs big bucks…..open have minimum outcome.

State professional boards MUST step up enforcement for professional “misbehaviors”, poor prac/ces and errors.

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Complications and Barriers……

•  Corporate policies and procedures

•  Lack of training is big across the board!

•  Who to report is some/mes confusing, frustra/ng, difficult

•  Manpower

•  $$$$$

•  …and we haven’t even seen the lawyers yet…..

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Repor(ng Clinical Findings

•  Law Enforcement

•  Prescribers

•  Colleagues

Case 2

First Name Address Zip Fill date Rx no. Product Name Strength Qty Doctor Name Doctor Dea Pharm Name Pharm Dea Ph Zip

MIKE 319 LOWER 25526 4/2/2011 11222 APAP/HYDRO 500MG-‐10MG 180 SMITHJOE 0267890 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 4/9/11 19986 Oxymorphone ER 20MG 60 SMITH JOE CS0267890 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 4/27/2011 23466 APAP/HYDRO 500MG-‐10MG 180 SMITH JOE CS0267890 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 5/4/2011 31111 Oxycodone ER 40 MG 45 SMITH JOE CS0267890 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 5/12/2011 44445 hydromorphone 4mg 80 JONES BILL CJ9839432 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 5/9/11 59986 Oxymorphone ER 20MG 60 SMITH JOE CS0267890 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 5/23/2011 69976 APAP/HYDRO 500MG-‐10MG 180 SMITH JOE CS0267890 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 5/27/2011 23466 Morphine sulf liq 10mg/5ml 100 SMITHJOE CS0267890 TOM’S PHARM FT1234567 25526

MIKE 319 LOWER 25526 5/4/2011 31111 Oxycodone ER 40 MG 45 SMITH JOE CS0267890 TOM’S PHARM FT1234567 25526

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Summary

•  PDMP is an amazing and evolving tool!

•  The PDMP is NOT evidence of a crime!

•  Usually involves blatant, repe//ve, and illegal behaviors.

•  Flags and strategies can be ini/ated that help minimize interrup/on of clinician’s work flow.

•  Enforcement of the PDMP is also s/ll evolving

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Integra/ng PDMP Data Into the Clinical Workflow

Jinhee Lee, PharmD Division of Pharmacologic Therapies Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administra/on

Status of State Prescription Drug Monitoring Programs (PDMPs)

AK

AL

AR

CA CO

ID

IL IN IA

MN

MO

MT

NE1

NV

ND

OH

OK

OR

TN

UT

WA

AZ

SD

NM

VA

WY MI

GA

KS

HI

TX

ME

MS

WI NY

PA

LA

KY NC

SC

FL

NH MA RI CT NJ DE MD

VT

WV

1 The opera/on of Nebraska’s Prescrip/on Monitoring Program is currently being facilitated through the state’s Health Informa/on Ini/a/ve. Par/cipa/on by pa/ents, physicians, and other health care providers is voluntary. 2 The Mayor of D.C. has approved the legisla/on but it is pending a 30-‐day review process by Congress.

States with operational PDMPs

States with enacted PDMP legislation, but program not yet operational

States with legislation pending

© 2014 The National Alliance for Model State Drug Laws (NAMSDL). Headquarters Office: 215 Lincoln Ave. Suite 201, Santa Fe, NM. 87501. This information was compiled using legal databases, state agency websites and direct communications with state PDMP representatives.

D.C.2

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The Story So Far

Stakeholders

Organizations

White House Roundtable on

Health IT & Prescrip(on Drug Abuse June 3, 2011

Federal & State Partners

State Participants

Action Plan

Slide 31

PDMP Workflow Today and in the Future

•  PDMPs today –  primarily standalone

systems –  Separated from rest of

health IT ecosystem –  accessed via web portals –  Human-‐centric process

•  PDMPs tomorrow –  Integrated with other

health IT in the pa/ent workflow

–  Machine-‐centric process

Page 32

Ac(on Plan Implementa(on

•  SAMHSA provided funding for implementa/on of the Ac/on 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.

Slide 33

•  Goal: Increase /mely access to PDMP data in an effort to reduce prescrip/on 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 informa/on more available to three key groups of clinical decision makers:

Enhancing Access to PDMPs through Health IT Project

Improve clinician workflow by connec(ng PDMPs to health IT

Support (mely decision-‐making at the

point of care

Establish standards for facilita/ng informa/on

exchange

Provide recommenda/ons and pilot input

Test the feasibility of using health IT to enhance PDMP access

Reduce prescrip+on drug misuse and overdose in the United States

Enhancing Access to PDMPs through Health IT Project

Phase 1 Pilots: Overview

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Phase 2 Pilots - Overview State End User Pilot Summary

Illinois Emergency Department

•  Automated query via intermediary and interstate hub to PDMP upon pa/ent admission to ED

•  PDMP data integrated into EHR as a PDF via a Direct message

Indiana Emergency Department

•  Automated query via HIE to mul/ple states’ PDMPs upon pa/ent admission to ED

•  Pa/ent risk score and PDMP data integrated into EHR

Kansas Providers •  Unsolicited report of at-‐risk pa/ents sent via Direct to EHR-‐integrated mailboxes

Michigan Providers •  Automated query via e-‐Prescribing sopware to mul/ple states’ PDMPs and result integrated in pa/ent’s medica/on history

Nebraska Emergency Department

•  Automated query via HIE to PDMP upon pa/ent 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 represen/ng the PDMP data

Tennessee Pharmacy •  Real-‐/me repor/ng of dispensing controlled substance data to the PDMP using an exis/ng network

Slide 37

•  Enhancing Access” Pilot White Papers: Eight papers detailing each pilot’s design, technical configura/on, outcomes, and plans for expansion. The white papers also highlight various personal anecdotes from the par/cipants who wrote about how they integrated PDMP data into their clinical workflow and the success it had on their prac/ce.

•  The Road to Connec+vity: A roadmap for connec/ng to PDMPs through health IT.

•  Work Group Recommenda+ons–Final Report: Stakeholders iden/fied challenges and recommended solu/ons to increase /mely use of PDMP data by clinicians. More than 94 people across 53 organiza/ons formed work groups to define barriers and rapidly finalize recommenda/ons to address the problem.

•  Videos: Pilot par/cipants detail their individual baWles against prescrip/on drug abuse, recalling the advantages of their state’s PDMP including real-‐/me repor/ng and how they used health IT to connect clinicians to this important database.

•  PDMPConnect: A website providing a forum for connec/ng members of the PDMP community to share valuable experience, informa/on, and resources wherever they are.

**All resources available at: www.healthit.gov/pdmp

Enhancing Access to PDMP using Health IT

Phases 1&2: Resources

SAMHSA -‐ PDMP EHR Coopera(ve Agreements

•  FY 12 – Provided 2 year funding for 9 states: FL, IN, IL, KS, ME, OH, TX, WA, WV

•  FY 13 – Provides 2 year funding for 7 states: KY, MA, ND, NY, RI, SC, WI

–  Purpose: 1) Improve real-‐/me access to PDMP data by integra/ng

PDMPs into exis/ng technologies like EHRs (FY12,13) 2) Strengthen currently opera/onal state PDMPs by

increasing interoperability between states (FY12) 3) Evaluate whether these enhancements have an impact on

prescrip/on drug abuse (FY12)

Slide 39

PDMP EHR Coopera(ve Agreement State Updates

•  Illinois* –  Currently connected to Anderson Hospital.

•  Over 700 requests per week to IL PMP •  Requests triggered upon pa/ent presenta/on or admission to ER. •  PMP report returned and presented on select worksta/ons in the ER and immediate care

loca/ons

–  Plans to integrate with a EMR sopware company that is used by many opioid treatment programs.

•  Tes/ng to begin within the next 30 days

–  Plans to bring another hospital online within the quarter –  Within the next 6 months, three hospitals fully implemented and five

hospitals in the tes/ng stage

•  West Virginia –  Planning with a clinic, hospital and the West Virginia Health Informa/on

Network con/nues.

Slide 40

*Murzynski, Stanley. “Illinois PMP SAMHSA Grantee Mee/ng on Data Integra/on.” PowerPoint presenta/on. SAMHSA, Rockville, MD. 19 Feb 2014.

PDMP EHR Coopera(ve Agreement State Updates (cont)

•  Kansas* –  Integra/on at Via Chris/ Hospital fully func/onal

•  K-‐TRACS is integrated into the physician’s workflow •  VC currently has 267 users +

–  Integra/on with LACIE (Lewis And Clark Informa/on Exchange) •  Tes/ng successfully completed •  Hospital pilot an/cipated by end of this month •  An/cipate 3-‐4K users in the KC metro

–  Integra/on with major pharmacy chain

•  Ohio** –  Currently integrated into the EMR of 22 hospitals and 6 primary care

prac/ces –  Plans to expand and integrate into over 200 community pharmacies,

addi/onal hospitals, and 15 ambulatory clinics

Slide 41

*Singleton, Marty. “Kansas PDMP Status Update.” PowerPoint presenta/on. SAMHSA, Rockville, MD. 19 Feb 2014. **Garner, Chad. “Bringing Ohio’s PMP Into the Clinician Workflow.” PowerPoint presenta/on. CADCA, Na/onal Harbor, MD. 4 Feb 2014.

Now and Then

Enhancing 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 exis/ng porzolio of standards and implementa/on specifica/ons. •  Abbreviated S&I Ini/a/ve (Jan – March 2013)

  Did not iden/fy, evaluate and harmonize standards for the exchange of informa/on from PDMP to EHRs or HIEs.

  Valuable feedback from stakeholders but only iden/fied where standards were needed and the poten/al standards that could be used.

PDMP & Health IT Integra>on Ini>a>ve – Phase 3 •  November 2013 – TBD •  Full S&I Framework Ini/a/ve •  Assess the current PDMP infrastructure and available standards that could be

harmonized to allow interoperable communica/ons between PDMPs and health IT systems.

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 System Data Out

Needs for standards (data format and content; transport and security protocols)

PDMP Interoperability Challenges

•  One of the current technical barriers to interoperability is the lack of standard methods to exchange and integrate the prescrip/on drug data available in PDMPs into health IT systems.

–  Lack of common technical standards and vocabularies to enable PDMPs to share computable informa/on 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.

45

•  A collabora/ve community of par/cipants from the public and private sectors who are focused on providing the tools, services and guidance to facilitate the func/onal exchange of health informa/on.

•  Creates a open and transparent process where healthcare stakeholders can focus on solving real-‐world interoperability challenges.

•  Is a consensus-‐driven, coordinated, incremental standards process.

Each S&I Ini/a/ve focuses on narrowly-‐defined, broadly applicable challenge, tackled through a rigorous development cycle, and provides input to Federal Advisory CommiWees for considera/on.

The Standards & Interoperability (S&I) Framework:

ONC Standards and Interoperability (S&I) Framework Lifecycle

Our Missions »  Promote a sustainable ecosystem that drives increasing interoperability and standards adoption. »  Create a collaborative, coordinated, incremental standards process that is led by the industry in solving

real world problems. »  Leverage “government as a platform” – provide tools, coordination, and harmonization that will support

interested parties as they develop solutions to interoperability and standards adoption.

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Tools and Services

Use Case Development

and Functional Requirements

Standards Development Support

Certification and Testing

Harmonization of Core Concepts

Implementation Specifications

Pilot Demonstration Projects

Reference Implementation

Architecture Refinement and Management

PDMP & Health IT Integra(on Ini(a(ve Purpose & Goals

•  The purpose of this ini/a/ve is to bring together the PDMP and health IT communi/es to standardize the data format, and transport and security protocols to exchange pa/ent informa/on between PDMPs and health IT systems (e.g., EHRs pharmacy systems).

•  The specific goals are: –  Iden/fy exis/ng connec/ons that consume PDMP. –  Iden/fy, 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.

•  The results of this work would enable health care providers to make more informed clinical decisions though /mely and convenient access to PDMP data in an effort to reduce prescrip/on drug misuse and overdose in the United States.

47

PDMP & Health IT Integra(on Ini(a(ve Stakeholder Community

10%

15%

6%

13%

11%

45%

HIT/EHR, Vendors/PHR and Associa/ons Provider/Provider Organiza/ons

SDOs/Analy/cs/Research

Federal/State/Local Agencies

Other

State PDMP/PMP/Or Affiliate

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•  This is an open government ini/a/ve. To succeed, the S&I Framework works with a set of mo/vated organiza/ons and individuals who share the mission and goals of care delivery transforma/on through improved interoperability.

Stakeholder Par(cipa(on by Industry (n=190)

Phase Planned Ac(vi(es Pre-‐Discovery •  Development of Ini/a/ve Background

•  Development of Ini/a/ve Charter •  Defini/on of Goals & Ini/a/ve Outcomes

Discovery •  Crea/on/Valida/on of Use Cases, User Stories & Func/onal Requirements •  Iden/fica/on of interoperability gaps, barriers, obstacles and costs •  Review of Vocabulary

Implementa(on •  Crea/on of aligned specifica/on •  Documenta/on of relevant specifica/ons and reference implementa/ons such as

guides, design documents, etc. •  Valida/on of Vocabulary •  Development of tes/ng tools and reference implementa/on tools

Pilot •  Valida/on of aligned specifica/ons, tes/ng tools, and reference implementa/on tools •  Revision of documenta/on and tools

Evalua(on •  Measurement of ini/a/ve success against goals and outcomes •  Iden/fica/on of best prac/ces and lessons learned from pilots for wider scale

deployment •  Iden/fica/on of hard and sop policy tools that could be considered for wider scale

deployments

S&I Framework Phases & PDMP & Health IT Integra/on Ac/vi/es

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We are Here

50

•  1.0 Preface and Introduc(on •  2.0 Ini(a(ve Overview

–  2.1 Ini/a/ve Challenge Statement**

•  3.0 Use Case Scope –  3.1 Background** –  3.2 In Scope –  3.2 Out of Scope –  3.3 Communi/es of Interest (Stakeholders)

**

•  4.0 Value Statement**

•  5.0 Use Case Assump(ons

•  6.0 Pre-‐Condi(ons •  7.0 Post Condi(ons •  8.0 Actors and Roles •  9.0 Use Case Diagram

PDMP & Health IT Integra(on Ini(a(ve Use Case Outline

•  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

While it is understood that there are various workflows that can take place when a Healthcare Professional queries a PDMP (see full context diagram), for the purposes of this use case, we will be focusing on the transactions originating from the HIT to the next end point, which would be the PDMP, a Hub, or HIE/Pharmacy Intermediary

•  Scenario #1 – HIT to In-‐State PDMP

•  Scenario #2 – HIT to Hub

•  Scenario #3 – HIT to HIE/Pharmacy Intermediary

EHR or Pharmacy System


Hub


HIE/ Pharmacy

Intermediary

51

PDMP & Health IT Integra(on Ini(a(ve Use Case Scenarios -‐ examples

SDO Ballo(ng, RI & Pilots*

Standards & Harmoniza(on Process

The Harmoniza/on Process provides detailed analysis of candidate standards to determine “fitness for use”

in support of Ini/a/ve func/onal requirements.

The resul/ng technical design, gap analysis and harmoniza/on ac/vi/es lead to the evalua/on and selec/on of drap standards. These standards are

then used to develop the real world implementa/on guidance via an Implementa/on Guide or Technical Specifica/on which are then validated through Reference Implementa/on (RI) and Pilots.

The documented gap mi/ga/on and lessons learned from the RI and Pilot efforts are then incorporated into an SDO-‐balloted ar/fact to be proposed as implementa/on guidance for Recommenda/on.

*Depending on the ini>a>ve the SDO Ballo>ng, RI & Pilot ac>vi>es may occur prior to the recommending a harmonized standard, this also means that ongoing pilots can provide feedback to draK standards or specifica>ons; May not be

applicable to the PDMP & HIT Integra>on Ini>a>ve Leveraged from previous S&I Ini+a+ves

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Implementa(on Guidance for Real-‐World Implementers

Drar Harmonized Profile/Standard

Evalua/on and Selec/on of Standards

Valida/on of Standard

Harmonized Profile/Standard for Recommenda(on

Use Case Requirements

Candidate Standards

Technical Design

Standards & Technical Gap

Analysis

Standardiza(on Development & Harmoniza(on: Workflow

Outputs

1.  Validate candidate standards list

2.  Map UCR to candidate standards

3.  Analyze mapped standards per HITSC criteria to narrow down any conflic(ng standards resul/ng from the UCR-‐Standards mapping

4.  Perform technical feasibility of analysis

5.  Review with community

Use Case Requirements Crosswalk

1.  Develop gap mi/ga/on plan

2.  Drap Solu/on diagram

3.  Validate solu/on plan

2.  Confirm data model approach

4.  Modify/harmonize exis/ng standard(s) to produce final standards

5.  Achieve community consensus or agreement

Final standards

1.  Using final standards, develop Implementa/on Guide document

2.  Document IG Conformance Statements in RTM

3.  Develop Examples to inform implementers

4.  Validate examples 5.  Achieve community

consensus or agreement

Implementa(on Guide

1.  Survey SDO or standards organiza/on op/ons

2.  Select ballo/ng approach

3.  Align /meline with ballot cycles

4.  Submit documents informing SDO of intent to ballot

5.  Submit content to SDO

6.  Conduct ballo/ng cycle & reconcilia/on per SDO guidelines

Balloted standards

Evaluate Standards

Plan for Solu(on and Final standards

Develop Implementa(on

Guide *SDO Ballo(ng

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Harmoniza/on Timeline Week

Target Date (2014)

All Hands WG Mee(ng Tasks Review & Comments from Community via Wiki

page due following Monday @ 12 noon

1 3/25 Harmoniza(on Kick-‐Off & Process Overview

Introduce: Overview of UCR-‐Standards Mapping Review: N/A

2 4/1 Introduce: Candidate Standards List & UCR-‐Standards Mapping Review: Candidate Standards List

3 4/8 Finalize: Candidate Standards List Review: UCR-‐Standards Mapping

Review: UCR-‐Standards Mapping

4 4/15 Review: UCR-‐Standards Mapping Review: UCR-‐Standards Mapping

5 4/22 Finalize: Outcome of UCR-‐Standards Mapping Introduce: Gap Mi(ga(on Plan

Review: Gap Mi(ga(on Plan

6 4/29 Finalize: Gap Mi(ga(on Plan Introduce: HITSC Evalua(on

Review: HITSC Evalua(on

7 5/6 Review: HITSC Evalua(on Review: HITSC Evalua(on

8 5/13 Finalize: Full Review of HITSC Evalua(on, Total Ra(ngs, List of Final Standards for Solu(on Plan Introduce: Solu(on Plan

Review: Solu(on Plan

9 5/20 Review: Solu(on Plan Review: Solu(on Plan

10 5/27 Finalize: Solu(on Plan Introduce: Implementa(on Guide (IG) Template

Review: Implementa(on Guide Template

11-‐15 6/3 – 7/1 Review: Implementa(on Guide Review: Implementa(on Guide

16-‐17 7/8 – 7/15 End-‐to-‐End Community Review of Implementa(on Guide End-‐to-‐End Review of Implementa(on Guide

18 7/22 Consensus Vote

PDMP Project Timeline

Kick-‐off (11/14)

Pre-‐Discovery, Call for Par/cipa/on

Jan 14 June 14

Discovery

Ini(a(ve End

55

Nov 13 July 14 Mar 14

Implementation Pilot

User Stories, Use Cases, Func/onal Requirements

Standards Gap Analysis

Harmonized Specifica/ons

Technology Evalua/ons Reference Model Implementa/on & Valida/on

Use Case Kick Off Use Case Consensus

Standards and Harmoniza(on Kick Off

Pilot Kick Off

Join us!

•  The PDMP & Health IT Integration Initiative is open for anyone to join

•  This community meets each week on Tuesday from 12:00-1:30 pm ET 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 pilots, we encourage broad and diverse participation from the community.

•  This is your chance to have an impact on the creation and implementation of pilots that will use selected standards in transactions between PDMPs and Health IT systems.

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PDMP & Health IT Integra(on Ini(a(ve Resources

57

•  Initiative Wiki Homepage –  http://wiki.siframework.org/PDMP+%26+Health+IT+Integration

+Homepage •  Become a Community Member

–  http://wiki.siframework.org/PDMP+%26+Health+IT+Integration+Join+the+Initiative

•  Project Charter –  http://wiki.siframework.org/PDMP+%26+Health+IT+Integration

+Charter+and+Members •  Standards and Interoperability(S&I) Framework

–  http://wiki.siframework.org/Introduction+and+Overview •  S & I Calendar of Events –  http://wiki.siframework.org/Calendar

PDMP & Health IT Integra(on Ini(a(ve Support Leads

•  For questions, please feel free to contact our support team: –  Initiative Coordinators:

•  Johnathon Coleman [email protected] •  Sherry Green [email protected]

–  ONC Leads: •  Jennifer Frazier [email protected] •  Helen Caton-Peters [email protected]

–  SAMHSA Leads: •  Jinhee Lee [email protected] •  Kate Tipping [email protected]

–  Support Team: •  Project Management:

–  Jamie Parker [email protected] –  Ali Khan [email protected] (Support)

•  Use Case Development: –  Presha Patel [email protected] –  Ahsin Azim [email protected] (Support)

•  Vocabulary and Terminology Subject Matter Expert: –  Mark Roche [email protected]

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Thank you!

Jinhee Lee, PharmD [email protected]

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Substance Abuse and Mental Health Services Administration.

Slide 59

Pdmp 3 lee oneil

Health & Medicine