PDMP FHIR Implementation Guide

PDMP%20FHIR%20Implementation%20Guide

User Manual:

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4/13/2019 US Meds

hl7.org/fhir/us/meds/2018May/pdmp.html 1/8

(http://hl7.org/fhir) (http://www.hl7.org)

US Meds Implementation Guide STU2 Ballot

(version 1.1.0)

Contents

Introduction

Scope

AbstractModel,Actorsand

Definitions

PDMPDataAccessusingFHIR

UsingFHIRSearchAPIs

UsingFHIRMessaging

APIs

FinalApproachforUS

MedsPDMPFHIRIG

SecurityConsiderations

PDMPDataElementsand

Mappings

PMIXMappingsforPDMP

Request

PMIXMappingsforPDMP

Response

FHIRprofiles

CapabilityStatements

Conformancerequirements

forthePDMPResponder

Behavior

ProfileInteractions:

Security:

Search:

Conformancerequirements

forthePDMPRequestor

Behavior

ProfileInteractions:

Security:

Search:

PatientMatchingConsiderations

DeploymentArchitecture

DeploymentOption1:

DeploymentOption2:

DeploymentOption3:

USMedicationFHIRIG(v1.1.0:STU(https://confluence.hl7.org/display/HL7/HL7+Balloting)2Ballot1).Thecurrentversionis1.0.0(http://hl7.org/fhir/us/meds)basedonFHIR

R3(http://hl7.org/fhir/STU3).SeetheDirectoryofpublishedversions(http://hl7.org/fhir/us/meds/history.cfml)

US Meds Prescription Drug Monitoring Program (PDMP) FHIR Implementation Guide

Introduction

IntheUnitedStates,everystateisdeployingaPrescriptionDrugMonitoringProgram(PDMP)whichtrackcontrolledsubstanceprescriptionswithinthe

state.Overtime,thesePDMPdatabasesstarttoproviderichinformationonproviderandpatientbehaviorswithrespecttoprescribinganduseofcontrolled

substances.EnablingaProvidertoaccessaPatient’sPDMPdataduringcaredeliverywillhelpinavoidingpotentialdrugmisuse,abuseanddiversionalso

commonlyknownasOpioidabuse.Inordertoreduceopioidabuse,somestateshaveimplementedpoliciesmandatingProviderstocheckthestatePDMP

forthePatient’scontrolledsubstancehistorybeforeprescribinganycontrolledsubstances.Tofurtheraddressopioidabusewhichisacurrentnational

priority,theUSMedsPrescriptionDrugMonitoringProgramFHIRImplementationGuide(USMedsPDMPFHIRIG)outlineshowsystemscanaccessPDMP

dataforapatientfromthestatePDMPsystemsusingtheHL7FHIRstandard.ForgeneralbackgroundonstatePDMPs,seetheCentersforDiseaseControl

andPreventionwhatstatesneedtoknowaboutPDMPs(https://www.cdc.gov/drugoverdose/pdmp/states.html).

Scope

ThissectionoutlinesthetransactionswhichareinscopeandnotinscopefortheUSMedsPDMPFHIRIG.AsshownintheFigure1below,thePDMPeco

systemcanbesimplifiedforthepurposeofthisprojecttoconsistofEHRsorClinicalSystems,PharmaciesandtheStatePDMPsystems.

TheUSMedsPDMPFHIRIGdefineshowanEHRoranApporotherClinicalSystemscanaccessaPatient’scontrolledsubstanceprescriptionhistoryfrom

theStatePDMPsystems.ThisisidentifiedbyInteraction3inthediagram.AllotherinteractionssuchasInteraction1and2inthediagrambeloware

importantfortheoverallPDMPecosystem,theyarenotinscopeforthisprojectandIG.

Figure 1: Simpliﬁed View of PDMP eco-system interactions.

Abstract Model, Actors and Deﬁnitions

Thissectiondefinestheabstractmodelwhichisusedtoidentifythespecificactorsandinteractionsthatareinscopefortheproject.TheabstractmodelisasshowninFigure2

belowwhichconsistsoftwoactorsnamelythePDMPRequestorandthePDMPResponder.

PDMPRequestor:PDMPRequestorisahealthITsystemthatisrequestingaPatient’scontrolledsubstancehistory.RealworldexamplesofsuchhealthITsystemsincludeEHRs,

SMARTonFHIRAppsandotherClinicalSystemsusedforcaredelivery.

PDMPResponder:PDMPResponderisahealthITsystemthatacceptsarequestfromaPDMPRequestorandrespondstotherequestwithacontrolledsubstancehistoryforthe

patient.RealworldexamplesofsuchhealthITsystemsincludeintermediarygatewayssuchasAppriss,RxCheck,StateHIEsandStatePDMPsystems.

Note:PDMPResponderswhichareactingasintermediariesprovideadditionalvalueaddservicessuchbeingabletoquerymultipleStatePDMPsystems,analyticswhichprovide

additionalinformationfortheProviderrequestingtheinformation.ThefactthataPDMPResponderisanintermediaryorifitistheactualStatePDMPsystemistransparenttothe

PDMPRequestorandismoreofadeploymentarchitecture.

Figure 2: PDMP Abstract Model and Actors.

PDMP Data Access using FHIR

TheabstractmodelinteractionscanbeimplementedusingFHIRinmultiplewaysnamely

UsingFHIRSearchAPIs

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UsingFHIRMessagingAPIs

TheseAPIsarediscussedfurtherinthenextfewsubsections.

Using FHIR Search APIs

TheFHIRstandardprovidesarichsetofsearchmechanisms(http://hl7.org/fhir/search.html)bywhichspecificFHIRresourcescanbeaccessedfromaFHIRserver.Typicallythe

searchparametersarespecifiedintheRESTfulURLandaccessedusingtheHTTPGEToperation.

ThefollowingisanexampleofhowsearchparameterswillbeusedbyaPDMPRequestortoretrievePDMPdatafromaPDMPResponder.

GET [base]/MedicationDispense?subject:Patient.name.given=peter&subject:Patient.name.family=jacobs&subject:Patient.birthdate=eq1973-11-25&authorizingPrescription.dispenseRequest.v

TheaboveAPIwillfetchallMedicationDispenseresourcesforPatientwithagivennameof“peter”andfamilynameof“jacobs”withabirthdateof“19731125”withaprescription

thatfallswithinina5yearwindowstartingfromJanuary1st2010toDecember31st2015andaspartofthereturnedinformationwillincludeMedicationDispense,

MedicationRequest,Practitioner,Organization,PatientandMedicationinformationaspartofthereturnedbundle.

AlsoaspartoftheSearchAPIonecanspecifytotheservertoincludeadditionalinformationsuchastheprescriberinformation,patientinformation.Thecombinationsthatneedto

beimplementedbytheUSMedsPDMPFHIRIGactorswillbedescribedindetailaspartoftheCapabilityStatements.

Using FHIR Messaging APIs

TheFHIRstandardalsoprovidesAPIsthatresemblemessagingparadigmsimilartoHL7v2.ThesearepartoftheFHIRMessagingAPIs(http://hl7.org/fhir/messaging.html).A

PDMPRequestorcanrequestprescriptionhistoryforapatientbyinvokingthe$processmessage(http://hl7.org/fhir/messageheaderoperations.html)onthebaseURLasfollows:

POST [base-url]/$process-message

NOTE:FHIRMessagingAPIswillrequiretheuseofthePOSToperationeventoaccessdata.

ThebodyofthemessagewillbeaFHIRBundlethatcontainsaMessageHeaderresourceasthefirstentrywiththefollowingminimumdetails:

MessageHeaderResource

MessageHeader.id

MessageHeader.event(AneweventtypeforretrievingPDMPdataneedstobeaddedtothevalueset)

MessageHeader.timestamp

MessageHeader.responsiblecontainingareferencetoPractitionerresourcerequestingtheinformation.

MessageHeader.focuscontainingareferencetothePatientresourceforwhomtheprescriptionhistoryisrequired.

MessageHeader.datacontainingareferencetoParametersresourcetospecifyadditionalparameterssuchasthedaterange.

IncludethePractitionerandPatientResourcesasentriesinthebundle.

IncludetheParametersresourcewiththeparametersofstartDateandendDatewithvaluesfordaterange.

ThePDMPResponderhastobeabletoprocessthismessageandreturnbackaBundlewhichcontainsalltheMedicationDispenseresourcesalongwithPractitioner,Organizationand

Patientresourcesrelatedtothedataset.IncaseoferrorsOperationOutcomewouldbereturnedsimilartoanyregularFHIRAPI.

NOTE:FHIRMessagingoperationscanonlybeinvokedonFHIRServerswhichconformtotheFHIRMessagingoperationsintheircapabilitystatementsandnotonregularFHIR

serversimplementingRESTfulSearchAPIs.

Final Approach for US Meds PDMP FHIR IG

ForthepurposesoftheUSMedsPDMPFHIRIG,theFHIRSearchAPIswillbeusedandwillbespecifiedindetailintheCapabilityStatementsfortheactors.WhileboththeSearch

andMessagingAPIshavetheirownstrengthsandweaknesses,thedecisiontouseFHIRSearchAPIsisbasedonthefollowingfactors

ArgonautprogramhasembracedtheFHIRSearchAPIsforconformingtotheONC2015EditionfortheCommonClinicalDataSet

USCoreandUSMedsImplementationGuidesspecifythesearchAPIsasbasiccapabilitiesforFHIRserversprovidingaccesstodata.

SearchAPIswillberelativelyeasiertobuildonexistingFHIRinfrastructuredevelopedbyvendorcommunity.

SearchAPIsarelimitedtosynchronousoperationsonlyandavoidthecomplexityofthevariousMessageExchangepatternsthatneedtobeaccountedforinaMessaging

system.

Security Considerations

AllimplementersofFHIRserversandclientsshouldpayattentiontoFHIRSecurity(http://hl7.org/fhir/security.html)considerations.InadditiontotheFHIRSecurity

(http://hl7.org/fhir/security.html)considerations,thePDMPrequestsneedtocontainspecificinformationaboutRequestorIdentityandRequestorFacilityinformation.Providingthis

informationusingFHIRSearchAPIsisverycumbersomeandisnotnecessary.ThiskindofinformationcanbecollectedbythePDMPResponder’sAuthorizationServerduring

applicationregistrationandavoidrepeatingtheinformationoneachrequest.ThesemechanismsareoutlinedingreatdetailintheSMARTBackendServicesAuthorizationGuide

(http://docs.smarthealthit.org/authorization/backendservices/).TheUSMedsPDMPFHIRIGwillusetheSMARTBackendServicesAuthorizationGuidetocollectthenecessary

requestorinformationappropriatetomakingthePDMPdatarequest.InadditiontheauthenticationandauthorizationmechanismswillbeusedaspartofrequestingthePDMPdata

usingtheFHIRSearchAPIs.

PDMP Data Elements and Mappings

ThissectiondescribesidentifiesdataelementsthatareusedcommonlyinthePDMPdatarequestsandresponsesandprovidesmappingsofthesedataelementstoFHIR.Basedon

environmentalscansandpriorperformedbyONCacrossaspectrumofPDMPimplementationsthefollowingdatawascollected:

MostoftheexistingEHRimplementationsuseNCPDPscript10.6orASAPwebservicestorequestandreceivePDMPdatafromPDMPResponders(IntermediariesorStatePDMP

systems).

MostoftheStatePDMPsystemsareimplementedusingdataelementsspecifiedbytheNIEMstandardandexposethesedataelementsusingPMIXAPIs.

MostoftheEHRsuseintermediariestorequestdatafromoneormoreStatePDMPsystemsandsendNCPDPbasedrequestsandreceiveresponsesinNCPDPformat.

Basedontheabovefindings,NCPDPRequestandResponsedataelementshavebeenusedasastartingpointtospecifytheFHIRAPIs.Sincethecommunityunderstandsthese

NCPDPdataelements,amappingofNCPDPRequestandResponsedataelementstoFHIRResourceshasbeencreatedandspecifiedbelow.Thisallowsorganizationsalreadyfamiliar

withNCPDPtousethemappingprovidedtodeveloptheirFHIRResourcesandAPIs.SimilarlymappingfromPMIX/NIEMdataelementstoFHIRisalsoprovidedforsystemsusing

PMIX/NIEMtomaptheirdatatoFHIRandexposethemthroughappropriateAPIs.

NCPDP Mappings for PDMP Request

ThissectionincludestheminimalmappingforthePDMPrequestfromanEHRtoastatePDMPusingNCPDP.

PDMPRequestDataElement NCPDPDataElement FHIRDataElement

RoutingInformation

Request

Requestor <LastName><FirstName> Practitioner.name

RequestorRole <Qualifer> PractitionerRole.code

RequestID <MessageID> MessageHeader.id

Requestdate/timestamp <SentTime> MessageHeader.timestamp

Requestor

Identifier

NPINumber* <NPI> Practitioner.identifier

DEANumber* <DEANumber> Practitioner.identifier

Requesting

FacilityID

DEANumber* <DEANumber> Organization.identifier

NCPDPNumber* <NCPDPID> Organization.identifier

NPI* <NPI> Organization.identifier

Requesting

Faciltiy

FacilityName <StoreName><ClinicName> Organization.name

StatecodeofRequestingFacility <State> Organization.address

MessageBody

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Patient

FirstName <FirstName> MedicationDispense.subject(Patient)>Patient.name.given

LastName <LastName> MedicationDispense.subject(Patient)>Patient.name.family

DateofBirth <DateofBirth> MedicationDispense.subject(Patient)>Patient.birthdate

Request

PrescriptionDate

Range

StartDate <EffectiveDate> MedicationDispense.authorizingPrescription.dispenseRequest.validityPeriod

EndDate <ExpirationDate> MedicationDispense.authorizingPrescription.dispenseRequest.validityPeriod

Conditionallyrequireddataelementshave.maptable1terisks(*),meaningatleastonedataelement.maptable1requiredwithinitscategory.For

example,underRequestingFacilityID,oneofthethreedataelements(DEANumber,NCPDPNumberorNPI).maptable1required.

NCPDP Mappings for PDMP Response

ThissectionincludestheminimalmappingforthePDMPresponsefromastatePDMPtoanEHRusingNCPDP.

PDMPResponseData

Element NCPDPDataElement FHIRDataElement

RoutingInformation

ResponseDate/Timestamp <SentTime> MessageHeader.timestamp

ResponsePrescriptionDate

Range(StartDate) <EffectiveDate> MessageHeader

ResponsePrescriptionDate

Range(Enddate) <ExpirationDate> MessageHeader

RequestID <RelatesToMessageID> MessageHeader.response.identifier

MessageBody

Patient

PatientFirstName <FirstName> Patient.name.given

PatientLastName <LastName> Patient.name.family

PatientDateofBirth <DateOfBirth> Patient.birthdate

PatientGender <Gender> Patient.gender

PatientStreetAddress

<AddressLine2> Patient.address.line

PatientCityAddress <City> Patient.address.city

PatientStateCode <State> Patient.address.state

PatientZipCode <ZipCode> Patient.address.potalCode

PatientIdentifier SSN* <SocialSecurity> Patient.identifier

Prescription

PrescriptionFilledDate <LastFillDate> MedicationDispense.whenPrepared

PrescriptionWrittenDate <WrittenDate> MedicationDispense.authorizingPrescription.authoredOn

PrescriptionNumber <SourceReference> MedicationDispense.Identifier

DrugName[1] <DrugDescription> MedicationDispense.medication[x]

DrugStrength[1]

<StrengthValue,Code>

fields Medication.ingredient.itemReference

DosageForm[2] <FormCode> Medication.form

DrugQuantity <Quantity> MedicationDispense.quantity

DaysofSupply <DaysSupply> MedicationDispense.daysSupply

RefillNumber <FillNumber> Medication.requestextension

RefillsAuthorized <Refills> MedicationDispense.authorizingPrescription.dispenseRequest.numberOfRepeatsAllowed

PartialFillIndicator gap MedicationDispense.type

MethodofPayment <Note> MedicationDispense.note

Drug

ProductIDQualifier <CodeListQualifier> MedicationDipense.medicationCodeableConcept.code.system

ProductID <ProductCode> MedicationDispense.medicationCodeableConcept.code.value

Dispenser

Organization

DispenserOrganization

Name(Facility) <StoreName> Organization.name

DispenserOrganization

StreetAddress

<AddressLine2> Organization.address.line

DispenserOrganizationCity

Address <City> Organization.address.city

DispenserOrganization

StateCode <State> Organization.address.state

DispenserOrganizationZip

Code <ZipCode> Organization.address.potalCode

DispenserOrganization

PhoneNumber <CommunicationNumber> Organization.telecom

Dispenser

Organization

(Pharmacy

identifier)

DEANumber* <DEANumber> Organization.identifier

NCPDPNumber* <NCPDPID> Organization.identifier

NPINumber* <NPI> Organization.identifier

Prescriber

PrescriberFirstName <FirstName> Practitioner.name.given

PrescriberLastName <LastName> Practitioner.name.family

PrescriberStreetAddress

<AddressLine2> Practitioner.address.line

PrescriberCityAddress <City> Practitioner.address.city

PrescriberStateCode <State> Practitioner.address.state

PrescriberZipCode <ZipCode> Practitioner.address.potalCode

Prescriber

Identifier

DEANumber* <DEANumber> Practitioner.identifier

NPINumber* <NPI> Practitioner.identifier

StateLicense*Identifier NA Practitioner.identifier

StateofLicense* NA Practitioner.identifier

*Conditionallyrequireddataelementshave.maptable2terisks(*),meaningatleastonedataelement.maptable2requiredwithinitscategory.For

example,underRequestingFacilityID,oneofthethreedataelements(DEANumber,NCPDPNumberorNPI).maptable2required.

PMIX Mappings for PDMP Request

ThissectionincludestheminimalmappingforthePDMPrequestfromanEHRtoastatePDMPusingPMIX.

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PDMPRequestData

Element PMIXDataElement FHIRDataElement

RoutingInformation

Request

Requestor <pmix:Requestor> Practitioner.name

RequestorRole <pmix:RequestorRole> PractitionerRole.code

RequestID <pmix:RequestID> MessageHeader.id

Requestdate/timestamp n/a MessageHeader.timestamp

Requestor

Identifier

NPINumber* <nc:IdentificationID> Practitioner.identifier

DEANumber* <nc:IdentificationID> Practitioner.identifier

Requesting

FacilityID

DEANumber* <nc:IdentificationID> Organization.identifier

NCPDPNumber* <nc:IdentificationID> Organization.identifier

NPI* <nc:IdentificationID> Organization.identifier

Requesting

Faciltiy

FacilityName <nc:OrganizationDoingBusinessAsName> Organization.name

StatecodeofRequesting

Facility <nc:LocationStateUSPostalServiceCode> Organization.address

MessageBody

Patient

FirstName <nc:PersonGivenName> MedicationDispense.subject(Patient)>Patient.name.given

LastName <nc:PersonSurName> MedicationDispense.subject(Patient)>Patient.name.family

DateofBirth <nc:Date> MedicationDispense.subject(Patient)>Patient.birthdate

Request

Prescription

DateRange

StartDate <pmp:RequestPrescriptionDateRangeBegin> MedicationDispense.authorizingPrescription.dispenseRequest.validityPeriod

EndDate <pmp:RequestPrescriptionDateRangeEnd> MedicationDispense.authorizingPrescription.dispenseRequest.validityPeriod

Conditionallyrequireddataelementshave.maptable1terisks(*),meaningatleastonedataelement.maptable1requiredwithinitscategory.For

example,underRequestingFacilityID,oneofthethreedataelements(DEANumber,NCPDPNumberorNPI).maptable1required.

PMIX Mappings for PDMP Response

ThissectionincludestheminimalmappingforthePDMPresponsefromastatePDMPtoanEHRusingPMIX.

PDMP

Response

Data

Element

NCPDPDataElement FHIRDataElement

Routing

Information

Response

Date/

Timestamp

<pmp:ReportExecutionDate><pmp:ReportExecutionTime> MessageHeader.timestamp

Response

Prescription

DateRange

(StartDate)

<pmp:ReportDateRangeBegin> MessageHeader

Response

Prescription

DateRange

(Enddate)

<pmp:ReportDateRangeEnd> MessageHeader

RequestID n/a MessageHeader.response.identifier

Message

Body

Patient

PatientFirst

Name <nc:PersonGivenName> Patient.name.given

PatientLast

Name <nc:PersonSurName> Patient.name.family

PatientDate

ofBirth <nc:Date> Patient.birthdate

Patient

Gender <PersonSexCode> Patient.gender

Patient

Street

Address

<StreetFullText> Patient.address.line

PatientCity

Address <nc:LocationCityName> Patient.address.city

PatientState

Code <nc:LocationStateUSPostalServiceCode> Patient.address.state

PatientZip

Code <nc:LocationPostalExtensionCod> Patient.address.potalCode

Patient

Identifier SSN* <nc:IdentificationID> Patient.identifier

Prescription Prescription

FilledDate <pmp:ReportDateRangeBegin><pmp:ReportDateRangeEnd> MedicationDispense.whenPrepared

Prescription

WrittenDate <nc:Date> MedicationDispense.authorizingPrescription.authoredOn

Prescription

Number <pmp:PrescriptionNumberText> MedicationDispense.Identifier

Drug

Name[1] <pmp:DrugProductNameText> MedicationDispense.medication[x]

Drug

Strength[1] <pmp:DrugStrengthText> Medication.ingredient.itemReference

Dosage

Form[2] <pmp:DrugUnitOfMeasureText> Medication.form

Drug

Quantity <pmp:DispensedQuantity> MedicationDispense.quantity

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Daysof

Supply <pmp:DaysSupplyCount> MedicationDispense.daysSupply

Refill

Number <pmp:DrugRefillNumberCount> Medication.requestextension

Refills

Authorized <pmp:RefillsAuthorizedCount> MedicationDispense.authorizingPrescription.dispenseRequest.numberOfRepeatsAllowed

PartialFill

Indicator <pmp:PartialFillIndicator> MedicationDispense.type

Methodof

Payment <pmp:MethodOfPaymentCode> MedicationDispense.note

Drug ProductID

Qualifier

<pmp:DrugCPDProductIdentifier>

<pmp:DrugDINProductIdentifier></br>

<pmp:DrugHRIProductIdentifier>

<pmp:pmp:DrugNDCProductIdentifier></br>

<pmp:DrugUPCProductIdentifie>

<pmp:DrugUPNProductIdentifier>

MedicationDispense.medicationCodeableConcept.code.system

ProductID <IdentificationID> MedicationDispense.medicationCodeableConcept.code.value

Dispenser

Organization

Dispenser

Organization

Name

(Facility)

<nc:OrganizationDoingBusinessAsName> Organization.name

Dispenser

Organization

Street

Address

<nc:StreetFullText> Organization.address.line

Dispenser

Organization

CityAddress

<nc:LocationCityName> Organization.address.city

Dispenser

Organization

StateCode

<nc:LocationStateUSPostalServiceCode> Organization.address.state

Dispenser

Organization

ZipCode

<nc:LocationPostalCode> Organization.address.potalCode

Dispenser

Organization

Phone

Number

<nc:TelephoneNumberFullID> Organization.telecom

Dispenser

Organization

(Pharmacy

identifier)

DEA

Number* <nc:IdentificationIDgt; Organization.identifier

NCPDP

Number* <nc:IdentificationID> Organization.identifier

NPI

Number* <nc:IdentificationID> Organization.identifier

Prescriber

FirstName <nc:PersonGivenName> Practitioner.name.given

Prescriber

LastName <nc:PersonSurName> Practitioner.name.family

Prescriber

Street

Address

<nc:StreetFullText> Practitioner.address.line

Prescriber

CityAddress <nc:LocationCityName> Practitioner.address.city

Prescriber

StateCode <nc:LocationStateUSPostalServiceCode> Practitioner.address.state

Prescriber

ZipCode <LocationPostalCode> Practitioner.address.potalCode

Prescriber

Identifier

DEA

Number* <IdentificationID> Practitioner.identifier

NPI

Number* <IdentificationID> Practitioner.identifier

State

License*

Identifier

IdentificationID Practitioner.identifier

Stateof

License* IdentificationID Practitioner.identifier

*Conditionallyrequireddataelementshave.maptable2terisks(*),meaningatleastonedataelement.maptable2requiredwithinitscategory.Forexample,under

RequestingFacilityID,oneofthethreedataelements(DEANumber,NCPDPNumberorNPI).maptable2required.

FHIR proﬁles

Thisprojectdoesnotcreateanynewprofiles,butwillreusetheUSCoreprofilesandtheUSMedsprofilestorequestandreceivePDMPdatausingFHIRresources.

Capability Statements

ThissectionidentifiestheCapabilityStatementsdefinedforthisimplementationguide.ThesectionoutlinesconformancerequirementsforeachoftheUSMedsPDMPFHIRIGactors

whichincludesthespecificprofiles,operations,securitymechanismsandsearchparametersthatneedtobesupported.

Note:Theindividualprofilesidentifythestructuralconstraints,terminologybindingsandinvariants.

Conformance requirements for the PDMP Responder

ThesectiondescribestheexpectedcapabilitiesofthePDMPResponderactorwhichisresponsibleforprovidingresponsestothequeriessubmittedbythePDMPRequestor

applications.

Behavior

ThePDMPResponderSHALL:

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SupporttheUSCorePatient,USCorePractitioner,USCoreOrganizationresourceprofiles.

SupporttheUSMedsMedicationRequestandMedicationDispenseProfile.

ImplementtheRESTfulbehavioraccordingtotheFHIRspecification.

whichincludesreturningthefollowingresponseclasses:

(Status200):successfuloperation

(Status400):invalidparameter

(Status401/4xx):unauthorizedrequest

(Status403):insufficientscope

(Status404):unknownresource

(Status410):deletedresource.

SupportjsonresourceformatsforallPDMPinteractions.

DeclareaCapabilityStatementidentifyingthelistofprofiles,operations,andsearchparameterssupported.

ThePDMPResponderSHOULD:

SupportthefollowingUSCoreandUSMedsresourceprofiles:

USCoreMedication

USMedsMedicationAdministration

SupportxmlresourceformatsforallUSMedsinteractions.

IdentifytheUSCoreprofile(s)andUSMedsprofilessupportedaspartoftheFHIRmeta.profileattributeforeachinstance.

ThePDMPResponderMAY:

SupportotherUSCoreandUSMedsresourceprofile

Proﬁle Interactions:

ThePDMPResponderSHALLsupporttheFHIRSearchinteractionforMedicationDispenseprofile.

ThePDMPResponderSHOULDsupporttheFHIRReadprofileinteractionMedicationDispenseprofile.

ThePDMPResponderMAYsupportotherFHIRprofileinteractions.

Security:

ThePDMPResponderSHALLsupporttheSMARTBackendServicesAuthorizationGuideforverifyingauthenticationandprovidingauthorizationtoPDMPRequestors.

ThePDMPResponderSHALLsupporttheHTTPHeaderparameterXRequestIDforrequestcoorelationbetweenthePDMPRequesterandPDMPResponder.

Search:

ThePDMPResponderSHALLsupportthefollowingsearchparametersandcombinationfortheMedicationDispenseresource

ChainedSearchparameters

subject:Patient.name.givenPatient’sfirstname

subject:Patient.name.familyPatient’sfamilyname

subject:Patient.birthdatePatient’sbirthdate

authorizingPrescription.dispenseRequest.validityPeriodTospecifythedaterangeforthePDMPdataretrieval

ThePDMPResponderSHALLsupportthefollowing_includeparametersfortheMedicationDispenseSearchoperations

_include=MedicationDispense:subjectReturnsthePatientResourceinformation

_include:recurse=MedicationDispense:authorizingPrescriptionReturnstheMedicationRequest,PractitionerResourceinformationandOrganizationinformation

_include=MedicationDispense:medicationReturnstheMedicationResourceinformation

Thefollowingisanexampleofthequery.

GET [base]/MedicationDispense?subject:Patient.name.given=peter&subject:Patient.name.family=jacobs&subject:Patient.birthdate=eq1973-11-25&authorizingPrescription.dispenseRequest.v

MedicationRequest,Practitioner,Organization,PatientandMedicationinformationaspartofthereturnedbundle.

AllotherinformationrequiredtoauthenticateandauthorizeaPDMPRequestoriscapturedaspartofregisteringthePDMPRequestorfollowingtheSMARTBackendServices

AuthorizationGuide.

Conformance requirements for the PDMP Requestor

ThesectiondescribestheexpectedcapabilitiesofthePDMPRequestoractorwhichisresponsibleforprovidingresponsestothequeriessubmittedbythePDMPRequestor

applications.

Behavior

ThePDMPRequestorSHALL:

SupporttheUSCorePatient,USCorePractitioner,USCoreOrganizationresourceprofiles.

SupporttheUSMedsMedicationRequestandMedicationDispenseProfile.

ConsumetheRESTfulresponsesaccordingtotheFHIRspecification.

whichincludesreturningthefollowingresponseclasses:

(Status200):successfuloperation

(Status400):invalidparameter

(Status401/4xx):unauthorizedrequest

(Status403):insufficientscope

(Status404):unknownresource

(Status410):deletedresource.

SupportjsonresourceformatsforallPDMPinteractions.

ThePDMPRequestorSHOULD:

SupportthefollowingUSCoreandUSMedsresourceprofiles:

USCoreMedication

USMedsMedicationAdministration

SupportxmlresourceformatsforallPDMPinteractions.

Proﬁle Interactions:

ThePDMPRequestorSHALLsupporttheFHIRSearchinteractionforMedicationDispenseprofile.

ThePDMPRequestorSHOULDsupporttheFHIRReadprofileinteractionforMedicationDispenseprofile.

ThePDMPRequestorMAYsupportotherFHIRprofileinteractions.

Security:

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ThePDMPRequestorSHALLsupporttheSMARTBackendServicesAuthorizationGuideapplicabletoclients.

ThePDMPRequestorSHALLaddtheHTTPHeaderparameterXRequestIDaspartoftheSearchrequestforrequestcoorelationbetweenthePDMPRequesterandPDMP

Responder.

Search:

ThePDMPRequestorSHALLinvoketheSearchoperationonthePDMPResponderincludingthefollowingsearchand_includeparameterswhenrequestingPDMPdatausingthe

MedicationDispenseresource

ChainedSearchparameters

subject:Patient.name.givenPatient’sfirstname

subject:Patient.name.familyPatient’sfamilyname

subject:Patient.birthdatePatient’sbirthdate

authorizingPrescription.dispenseRequest.validityPeriodTospecifythedaterangeforthePDMPdataretrieval

ThePDMPRequestorSHALLincludethefollowing_includeparametersfortheMedicationDispenseSearchoperations

_include=MedicationDispense:subjectReturnsthePatientResourceinformation

_include:recurse=MedicationDispense:authorizingPrescriptionReturnstheMedicationRequest,PractitionerResourceinformationandOrganizationinformation

_include=MedicationDispense:medicationReturnstheMedicationResourceinformation

Thefollowingisanexampleofthequery.

GET [base]/MedicationDispense?subject:Patient.name.given=peter&subject:Patient.name.family=jacobs&subject:Patient.birthdate=eq1973-11-25&authorizingPrescription.dispenseRequest.v

MedicationRequest,Practitioner,Organization,PatientandMedicationinformationaspartofthereturnedbundle.

Patient Matching Considerations

TheUSMedsPDMPFHIRIGdoesnotaddanypatientmatchingrequirementstothePDMPactors,butreliesonexistingpracticesusedforpatientmatchingbasedonthefirstname,

lastnameanddateofbirthprovidedthroughtherequest.

Deployment Architecture

ThefollowingaredeploymentoptionsshowinghowtheUSMedsPDMPFHIRIGcanbeusedtoimplementthevariousactors.

Deployment Option 1:

Inthisdeploymentoption,theEHRs,AppsandClinicalSystemsactasthePDMPRequestorsandinteractwithIntermediaryGatewayssuchasAppriss,RxCheckwhichactasthe

PDMPResponders.ThecommunicationisperformedusingFHIRAPIs.InthiscasethePDMPRequestorsareisolatedfromtheStatePDMPSystemsandtheprotocolstheysupport.

TheIntermediariesmaytranslatetheincomingFHIRrequestfordatatoaPMIX/NIEMrequesttocomplywithexistingstateinterfacesormayuseothermethodstogetthedata

fromtheStatePDMPsystems.AlloftheseinteractionsareisolatedfromthePDMPRequestor.TheIntermediariesmayalsoretrievedatafrommultipleStatePDMPsystems

simultaneously.

Figure 3: Deployment Option using Intermediaries and PMIX/NIEM.

Deployment Option 2:

TheIntermediariesinthiscasewilluseFHIRAPIstorequestdatafromoneormoreStatePDMPSystems.Theadvantagehereitisthesamestandardendtoendhoweveran

Intermediarycanprovidevalueaddedinformationsuchasanalytics,abilitytointegratedatafrommultiplestates.

TheIntermediaryplaystheroleofPDMPResponderforTransactions1and2butplaystheroleofPDMPRequestorforTransactions1aand1bwheretheStatePDMPSystemsplay

thePDMPResponderrole.

Figure 4: Deployment Option using Intermediaries and only FHIR.

4/13/2019 US Meds

hl7.org/fhir/us/meds/2018May/pdmp.html 8/8

Deployment Option 3:

Inthisdeploymentoption,theEHRs,AppsandClinicalSystemsactasthePDMPRequestorsandinteractwiththeStatePDMPSystemswhichactasthePDMPRespondersusingthe

FHIRAPIs

TherearenointermediariesbeingusedinthisdeploymentandStatePDMPSystemshavetosupportthenecessaryFHIRAPIsandSMARTBackendAuthorizationprotocols.

Figure 5: Deployment Option using FHIR and no Intermediaries.

USMedsVersion:1.1.0®©FHIRVersion:3.0.1(http://hl7.org/fhir/STU3)(IGPublisherv3.0.111917)generatedonThu,Apr5,201806:10+1000.|

(http://hl7.org/fhir/STU3/license.html)

PDMP FHIR Implementation Guide

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