PMIX ADVANCING PMP DATA SHARING THROUGH STANDARDIZATION AND INNOVATION CARL FLANSBAUM, DIRECTOR, NEW MEXICO PMP CO-CHAIR PMIX WORKING GROUP
PMIX: Past, Current and Future A PMIX Primer What is PMIX? Original PMIX Working Group The National PMIX Architecture PMP Interconnect Current Status States and Hubs New PMIX Working Group Task Example (PMP Roles!) Enhancements needed Going Forward Health IT System Integration Need for Translation services Role of PMIX and PMIX Working Group
A PMIX Primer: What is PMIX? PMP Prescription History of a person of interest is the PMP Data Developed for states to be able to share PMP Data (i.e. request a PMP report on a person in another state) PMIX: Prescription Monitoring Program Information exchange Sharing involves PMP Hubs that route messages between state PMPs Sharing may necessitate Hub to Hub communication
A PMIX Primer: Definitions & Terminology XML (extensible Markup Language): markup language used for encoding data into a format that can be shared over the internet NEIM (National Information Exchange Model): a framework for defining types of data SOAP (Simple Object Access protocol): an XML based web services specification for exchanging structured information (uses a SOAP header, body and envelope format) REST (Representational state transfer): another XML based web services specification for exchanging structured information
A PMIX Primer: Original PMIX Working Group Begun in February of 2005 BJA supported Made up of PMP Vendors, Federal agency personnel, Technical and Standard experts, State agency / PMP members, IJIS Developed the PMIX-NEIM IEPD (Information Exchange Package Documentation) Worked to develop first PMIX hub with initial testing in late 2011 Roles, Routing and Security addressed, but not implemented into prototype hub
A PMIX Primer: The PMIX National Architecture Developed by BJA Contains: 1. Standards to define message content and structure Content in the message body defined in the Information Exchange Package Documentation (IEPD) 2. Specifications on message transport and security Routing (and optionally message body encryption) information in the message header defined in the Service Interface Description Document(s) (SIDDs) 3. Execution Documentation Defines the infrastructure components necessary to form the communication path for data transmission capability
A PMIX Primer: The PMIX National Architecture Requires: 1. End-to-end security (Public Key encryption/decryption; certificate management) 2. Standards based exchange services (using the Global Reference Architecture - GRA) 3. Common exchange data and metadata framework (using NIEM) 4. Hub connections (and hub-to-hub communication capability)
A PMIX Primer: The PMIX National Architecture A PMIX National Architecture Message Uses extensible Markup Language (XML) Data defined in NIEM framework of standard fields nomenclature expanded as needed with PMP specific tags <pmix: > </pmix: > Uses the Simple Object Access Protocol (SOAP) a specification for exchanging structured information
A PMIX Primer: The PMIX National Architecture The IEPD provides details on each data element (both NIEM and PMIX)
A PMIX Primer: The PMIX National Architecture The SIDDs detail data needed regarding the Requestor and Routing Parameter MetaData Requestor Requestor Role RoutingData RequestID RequestingState DisclosingState WS-Addressing Action To From ResponseStatus Description The Requestor Role is used for authorization of search requests RequestID is a unique message identifier Requesting/disclosing state two character postal code The Action is an identifier that uniquely identifies the semantics implied by a message. The wsa:to element identifies the target destination, while the wsa:from identifies the source endpoint. Provided, NotFound, Deferred
A PMIX Primer: The PMIX National Architecture The SIDDs also provides details regarding privacy protection and message security Transport level security that requires static IPs, implements secure socket layer (SSL) and requires certificate authentication WS-Security to provide end-to-end message level security by signing and encrypting the exchanges between the states (using Public Key encryption/decryption) The WS-Security can also optionally contain: Additional XML-Encryption PMPi-Encryption
A PMIX Primer: The PMIX National Architecture PMIX National Architecture PMP Request Message Diagram (SOAP) Role, Routing Info and Message ID WS Addressing SOAP Header WS Security Encrypted with RSA Key XML Message (SOAP Envelope) PMP Data (Payload) Encrypted with WS Security SOAP Body
Code Example: PMIX N. A. Request (truncated header section)
Code Example: PMIX N. A. Request (truncated body section)
A PMIX Primer: PMP Interconnect PMP Hub Based upon specs from the original PMIX Working Group Hub PMIX compliant Uses REST vs. SOAP Uses a different data encryption method First successful testing also in late 2011 API v4 to be released soon Has new Role value set Integrates expanded Request Response values Improved administrative and statistic querying interface
A PMIX Primer: PMP Interconnect PMP Interconnect PMP Request Message Diagram (REST) Role, Routing Info and Message ID AES Key Encrypted with RSA Key Data Field Being Sent XML Message PMP Data (Payload) Encrypted with AES Key
Code Example: PMPi Request (REST)
Code Example: PMPi Response (REST)
PMIX Current Status: States and Hubs 3 PMP Hubs RxCheck Owned/Governed by Steering Committee of participating states; Operated by IJIS 3 states actively sharing (13 state participants) Funded by BJA RxSentry Owned/Operated by PMP Vendor HID for customers Not yet in operation (18 customers) PMP Interconnect Owned/Operated by NABP/Appriss, Governed by Steering Committee of participating states 26 states actively sharing data (32 state participants)
PMIX Current Status: States and Hubs Most states are either actively sharing or in the process of getting agreements in place and/or changing rules/laws to allow Many states are associated with more than 1 PMP Hub Hubs are in various stages of operation. Hub to Hub communication continues to be a challenge (legally and technically)
PMIX Current Status: New PMIX Working Group Reactivated in February 2014 Goal to address updates and enhancements to PMIX Made up of members from 9 states with representation from each hub (with support from BJA and TTAC) Appointed co-chairs; initial discussion regarding enhancements & governance structure; began PMP Role standardized/mapping National meeting set for November
PMIX Current Status: New PMIX Working Group 1 st task reconcile PMP (Health Care) Roles between Hubs PMPs rely upon the Role or Job of the user in providing authorized access (as defined in state laws and/or regulations) Worked to cross-map all existing roles being used by the 3 PMP hubs Currently recommending changes to reconcile roles to Hubs as well as developing definitions & documentation regarding roles in PMP data sharing Has become vitally important in discussions with Health IT System integration (especially within the context of the PDMP-Health IT System Integration Initiative)
PMIX Current Status: New PMIX Working Group Also working to map Roles to Translation Services and Health IT Systems Taxonomy Code Role ID (PROPOSED) PMP Gateway Roles MASTER PMP ROLES (PROPOSED) PMP Interconnect 2014 (NABP) RXCheck (IJIS) RxSentry (HID) Prescribers Dispensing Prescribers 1223* 101 Dentist Dentist Dentist Dentists Dentist IHS Prescribers IHS (Prescribers) Medical Interns 102 Medical Intern under supervising DEA# Medical Intern with NO independent prescriptive authority Medical Intern under supervising DEA# Medical Intern under supervising DEA# 103 Medical Intern with prescriptive authority Medical Intern with independent DEA# Medical Intern with prescriptive authority Medical Intern with independent DEA# Medical Intern with independent DEA# Medical Residents 104 Medical Resident under supervising DEA# Medical Resident with NO independent prescriptive authority Medical Resident under supervising DEA# Medical Resident under supervising DEA# 105 Medical Resident with prescriptive authority Medical Resident with independent DEA# Medical Resident with prescriptive authority Medical Resident with independent DEA# Medical Resident with independent DEA# Military Prescribers 175F00000X 106 Naturopathic physician with prescriptive authority Naturopathic Physician Naturopath with prescriptive authority Naturopathic Physicians Naturopathic Physician 363L* 107 Nurse Practitioner Nurse Practitioner Nurse Practitioner with prescriptive authority Nurse Practitioners/Clinical Nurse Specialist Nurse Practitioner 152W* 108 Optometrist with prescriptive authority Optometrist Optometrist with prescriptive authority Optometrists Optometrist 109 Other Non-Prescriber Other Non-Prescriber Other Non-Prescriber Other Non-Prescriber 110 Other Prescriber Other Prescriber Other Prescriber Other Prescriber 1835P0018X 111 Pharmacist with prescriptive authority Pharmacist with prescriptive authority 207*, 208*, 112 213E* Physician Physician Physician Physicians (MD, DO, DPM) Physician 363A* 113 Physician's Assistant with prescriptive authority Physician's Assistant Physician's Assistant with prescriptive authority Physician Assistants Physician's Assistant 114 Prescriber's Delegate licensed Prescriber's Delegate licensed Prescriber's Delegate licensed Licensed Prescriber's Delegate 115 Prescriber's Delegate unlicensed Prescriber's Delegate unlicensed Prescriber's Delegate unlicensed Unlicensed Prescriber's Delegate 103T* 116 Psychologist with prescriptive authority Psychologist Psychologist with prescriptive authority Psychologists Psychologists VA Prescribers VA (Prescribers) 117 Veterinarian Veterinarian Veterinarians Veterinarian Dispensers 1835* 201 Pharmacist Pharmacist Pharmacist Pharmacists Pharmacist 202 Pharmacy Pharmacy (facility account) Pharmacies Pharmacy 203 Pharmacist Delegate licensed Pharmacist Delegate licensed Pharmacist Delegate licensed Pharmacist Delegate licensed 204 Pharmacist Delegate unlicensed Pharmacist Delegate unlicensed Pharmacist Delegate unlicensed Pharmacist Delegate unlicensed Pharmacy Technicians Pharmacy Tech IHS Dispensers VA Dispensers
PMIX Current Status: Enhancements needed Depending of group decisions and resource availability Facilitate universal consensus on Master Role value set Update of Request Response Status Values Support for Multi-state messaging (Multicasting) Development of an Administrative Management interface Additional security, transport and logging enhancements
PMIX Going Forward: Health IT System Integration Health IT Systems use data standards different from those of PMPs (HL7 and NCPDP vs. PMIX) Reluctance of Health IT Systems to support PMIX due to an US vs. THEM in terms of numbers mentality However factors encouraging moving forward with integration include: More recent knowledge and understanding of importance of PMP data Mandatory PMP use regulations ONC s PDMP Health IT System Integration Initiative 3 rd party conduits to PMP information (NARxCHECK, PMP Gateway)
PMIX Going Forward: Health IT System Integration Need for Translation Services Providers? These services can be the necessary bridge between the data standards of PMPs and Health IT Systems Bottom line is this allows for PMPs to continue to use PMIX as the PMP data sharing standard when integrating with Health IT Systems PMP Gateway (NABP/Appriss) recently debuted to provide this service May be restricted from being used by state laws / regulations if 3 rd party prevented from touching data Alternative is for PMP/Vendor/Health IT System to build own custom translation service
PMIX Going Forward: PMIX and the PMIX WG Issues to discuss Governance, structure, focus and scope of new PMIX working group Current PMP Hub landscape and what can be done to improve How will translation services needed for Health IT System integration affect current requirements of the PMIX National Architecture and how might they need to be changed Need to make decisions on which recommended PMIX enhancements to pursue and where resources will come from to develop and implement Expand group beyond just PMIX and include more data sharing issues?
PMIX ADVANCING PMP DATA SHARING THROUGH STANDARDIZATION AND INNOVATION Carl Flansbaum, RPh. Director, New Mexico PMP Co-Chair PMIX Working Group Member PMP Interconnect Steering Committee Executive Board Member-At-Large Alliance of States with Prescription Monitoring Programs Committed Member ONC PDMP-Health IT Integration Initiative Carl.Flansbaum@state.nm.us (505) 222-9837