US Prescription Drug Monitoring Program (PDMP), published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-pdmp/ and changes regularly. See the Directory of published versions

Use Cases

Abstract Use Case

This guide centers around a single use case, in which a PDMP Requestor (prescriber or pharmacist) accesses a Patient’s PDMP history from a PDMP Responder (a state PDMP or related system(s))

All other interactions between the parties above–such as a prescription being sent from the prescriber to the dispensing pharmacy, or the pharmacy submitting dispensations to the PDMP–are critical to the overall PDMP process but are not in-scope for this IG (see Scope).

Use Case 1 - A simple PDMP request/response

Sam August comes into the Highview Clinic complaining about his right hand and wrist pain after he fell from a ladder. He is seen by Dr. Adam Amster. After examining Mr. August, Dr. Amster’s assessment is a sprained wrist and a broken right ring finger. Mr. Amster is provided a wrist brace and his affected finger is immobilized with a splint. Dr. Amster determines that a pain medication is appropriate, and

1. Dr. Amster enters a prescription for Acetaminophen with Codeine 325 mg / 30 mg into the Highview Clinic EHR.
2. EHR workflow checks determine a PDMP review is needed.
3. Dr. Amster is presented with a prompt to request Mr. August’s PDMP history.
4. Dr. Amster responds to the prompt to request the PDMP History.
5. The EHR creates a pdmp-bundle-request.
6. The EHR sends the request to the State PDMP (PDMP Responder).
7. The PDMP receives and processes the request.
8. The PDMP responds with a pdmp-bundle-response to the EHR.
9. The EHR receives the pdmp-bundle-response, formats it appropriately, and presents it to Dr. Amster.
10. Dr. Amster reviews and acknowledges the PDMP report.

Use Case 2 - Illustrating a pre-stage PDMP request/response

Sam August presents at the Highview Medical Center Emergency Department complaining of severe pain in his right hand, wrist, and forearm after falling off of a ladder.

1. Mr. August is admitted to the ED’s EHR and triaged into the care service.
2. Per ED policy, the ED EHR submits a pre-stage PDMP request
   1. The EHR creates a pdmp-bundle-request with the input parameter pre-stage-only= true.
   2. The EHR send the request to the State PDMP (PDMP Responder).
3. The PDMP receives and processes the request.
4. The PDMP responds with a pdmp-bundle-response with the retrieval key in the output parameter pre-stage-retrieval-key to the EHR.

Mr. August is subsequently seen by Dr. Amster. Dr. Amster’s assessment is one or more fractures in the hand, wrist, and forearm. Subsequent radiology images confirm fractures of the lower right ulna and multiple metacarpal and phalanges. Dr. Amster orders casting of the right forearm and hand, and

1. Dr. Amster enters a prescription for Acetaminophen with Codeine 325 mg / 30 mg into the ED’s EHR.
2. The EHR workflow checks determine a PDMP review is needed.
3. The EHR presents Dr. Amster with a prompt to request Mr. August’s PDMP history.
4. Dr. Amster responds to the prompt and requests the PDMP History.
5. The EHR creates a pdmp-bundle-request and includes the pre-stage-retrieval-key, previously received, as an input parameter.
6. The EHR sends the request to the State PDMP (PDMP Responder).
7. The PDMP uses the pre-stage-retrieval-key to retrieve the previously generated PDMP history.
8. The PDMP responds with a pdmp-bundle-response, based upon the previously generated PDMP history, to the EHR.
9. The EHR receives the pdmp-bundle-response, formats it appropriately, and presents it to Dr. Amster.
10. Dr. Amster reviews and acknowledges the PDMP report.

Use Case 3 - Illustrating a PDMP response including a URL

The pdmp-bundle-response can include the PDMP history as discrete FHIR-formatted data, a URL link to a fully formatted PDMP history report, or both the discrete data and the link. If discrete is sent, it can support additional Clinical Decision Support services in the EHR. However, the EHR may not necessarily support visual formatting the PDMP may be required to follow (e.g., regulatory presentation requirements). Thus, the PDMP may only send (or may be required to only send) a URL link to ensure that regulatory presentation requirements are enforced.

The use case sequence is the same as above, except for Use Case 1 step 9 and Use Case 2 step 13. Instead of presenting the discrete data received in the pdmp-bundle-response, the EHR redirects the Dr. Amster via the URL link to the formatted PDMP History on the State PDMP (PDMP Responder)’s web server. This alternate flow is shown in the follow diagram.