PDMP & Health IT Integration Use Case & Functional Requirements

1. PDMP & Health IT IntegrationUse Case & Functional Requirements February 11, 2014 1

2. PDMP & HIT Integration InitiativeProposed Use Case & Functional Requirements Development Timeline

3. Section Review Click the icon to open the Word Document Note- Below sections will be reviewed within the separate Use Case word document: • Discuss and review the following sections: • Context Diagram • User Stories • Pre-Conditions • Post-Conditions • Actors and Roles

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

5. Context Diagram HIE/Pharmacy Intermediary Use Case Scope 5 2 2 7 4 Out of State PDMP In-State PDMP EHR or Pharmacy System Hub 1 8 8 3 3 7 6 Hub

6. User Story 1: A legally authorized provider queries PDMP before writing a prescription for a patient To be reviewed in Word Document Trigger: Patient needs medication for chronic back pain Use Case Scope 1. Healthcare Professional authenticates to Health IT System 2. Sends query to state PDMP to check if patient has been prescribed narcotics/controlled substance in past X weeks 3. PDMP sends query response 4. Healthcare Professional makes an informed decision to prescribe medication based on information received Draft User Story: A patient arrives at the physician’s office or hospital for treatment of chronic back pain. If necessary, the Healthcare Professional authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to the State PDMP 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.

7. User Story 2: A legally authorized provider queries PDMP through a Hub before writing a prescription for a patient To be reviewed in Word Document Trigger: Patient needs medication for chronic back pain Use Case Scope 1. Healthcare Professional authenticates to Health IT System 2. Sends query to state PDMP to check if patient has been prescribed narcotics/controlled substance in past X weeks Interstate Hub 3. PDMP sends query response 4. Healthcare Professional makes an informed decision to prescribe medication based on information received Draft User Story: A patient arrives at the physician’s office for treatment of chronic back pain. If necessary, the Healthcare Professional authenticates to the Health IT system. At the appropriate point in the workflow, the query is sent to a Hub through his Health IT system to see if the patient had been prescribed a controlled substance in the past X weeks. The Hub receives the query, and reroutes the query to the appropriate state PDMP(s) (Note: this transaction implies that a Memorandum of Understanding is already in place between state PDMPs). The PDMP(s) process the request and identify the appropriate response to send back to the requestor. The PDMP(s) send the query response to the Hub involved in the transaction. The Hub reroutes the query response back to the Health IT system where the query originated. After receiving the query response(s), the Healthcare Professional makes an informed decision of whether or not to prescribe the medication or modify the dosage based on the information received.

8. User Story 3: Pharmacist queries PDMP prior to dispensing opioids to a patient To be reviewed in Word Document Trigger: Patient arrives at pharmacy and drops off prescription to be filled Use Case Scope 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 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.

9. PDMP & HIT Integration – Pre/Post Conditions To be reviewed in Word Document Post-Conditions • Health IT System has sent a query • PDMP system has received the query • PDMP system has sent a response to the Health IT system • Health IT system has successfully received the query results from the PDMP system • Health IT system can display/present query response Pre-Conditions • The necessary access controls and authorization protocols based on State and/or Federal regulations (which could include patient consent or privacy permissions) for any of the systems or users described, are in place • The Health IT system application can provide any necessary authorization, authentication or privacy information to the PDMP • An intermediary, such as a Hub, provides necessary technology infrastructure to allow PDMP data exchange from the PDMP to the Health IT system • Query parameters required to create the query in a standardized format by the Health IT system/Hub are recognized and accepted by the PDMP system • The PDMP system can provide a query response in a standardized format recognized and accepted by the Hub/Health IT system • The PDMP system has knowledge about the Hub and the Hub has knowledge about the Health IT system to send a query response (this is in the event a request is parsed out to other states and the other states respond back) • Health IT System and PDMP have a common understanding of the shared vocabulary that is used to create the queries and provide the query results • Health IT System is able to determine which state PDMP(s) should receive the query

10. PDMP & HIT Integration – Actors and Roles To be reviewed in Word Document

11. Next Steps • Review:Pre/Post Conditions, Actors and Roles, and User Stories • Next Meeting is Friday, February 21 from 12:00pm - 1:30pm 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+Homepage

12. Contact Information • For questions, please feel free to contact your support leads: • Initiative Coordinators: • Johnathan Coleman jc@securityrs.com • Sherry Green sgreen@namsdl.org • ONC Leads: • Mera Choi mera.choi@hhs.gov • Jennifer Frazier Jennifer.Frazier@hhs.gov • Helen Caton-Peters Helen.Caton-Peters@hhs.gov • SAMHSA Leads • Jinhee Lee Jinhee.Lee@samhsa.hhs.gov • Kate Tipping Kate.Tipping@samhsa.hhs.gov • Support Team: • Project Management: • Jamie Parker jamie.parker@esacinc.com • Ali Khan Ali.Khan@esacinc.com (Support) • Use Case Development: • Ahsin Azim Ahsin.Azim@accenturefederal.com • Presha Patel presha.patel@accenture.com • Vocabulary and Terminology Subject Matter Expert: • Mark Roche mrochemd@gmail.com