August 27, 2008

Version 1.1

HITSP Medication Management Interoperability Specification

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

Provider Perspective Technical Committee

(Formerly Care Delivery Technical Committee)

Document Change History

Version Number	Description of Change	Name of Author	Date Published
0.0.1	Review Copy	Care Delivery Technical Committee	December 7, 2007
0.0.2	Review Copy	Care Delivery Technical Committee	March 19, 2008
1.0	Released for Implementation	Care Delivery Technical Committee	March 27, 2008
1.0.1	Review Copy	Provider Perspective Technical Committee	August 20, 2008
1.1	Released for Implementation	Provider Perspective Technical Committee	August 27, 2008

Table of Contents

1.0 Introduction. 7

1.1 Interoperability Specification Overview. 7

1.2 Interoperability Specification Document Map. 7

1.2.1 List of Constructs. 8

1.3 Copyright Permissions. 9

1.4 Reference Documents. 9

2.0 Interoperability Requirements. 11

2.1 Use Case Synopsis. 11

2.2 Use Case Requirements. 13

2.2.1 Mapping of Use Case Requirements to Interoperability Requirements. 14

2.2.2 Data and Information Requirements Matrix. 26

2.2.3 Identification of Business Actors and Scenarios. 28

2.2.4 High-Level UML Interaction (Business Sequence) Diagram.. 29

3.0 Design. 42

3.1 Scope of Design. 42

3.1.1 Assumptions. 42

3.1.2 Constraints. 42

3.1.3 Pre-conditions. 42

3.1.4 Post-conditions. 43

3.1.5 Process Triggers. 43

3.2 Detailed Design. 43

3.2.1 Technical Actor Role Descriptions. 44

3.2.2 Sequence Diagram for Process Flow. 46

3.2.3 Mapping of Business Actors to Technical Actors and Constructs with Optionality. 60

3.2.4 Construct Dependencies. 68

3.2.5 Additional Constraints on Required Constructs. 69

4.0 Standards Selection. 70

4.1 List of Standards. 71

4.1.1 Regulatory Guidance. 71

4.1.2 Selected Standards. 71

4.1.3 Informative Reference Standards. 74

4.2 Gaps Where There Are No Standards. 77

4.3 Standard Overlaps. 79

5.0 Technical Implementation. 82

5.1 Conformance. 82

5.1.1 Conformance Criteria. 82

5.1.2 Conformance Scoping, Subsetting and Options. 82

5.1.3 Test Methods. 82

6.0 Appendix. 83

6.1 Description of Standards. 83

7.0 Change History. 90

7.1 December 7, 2007. 90

7.2 March 19, 2008. 90

7.3 March 27, 2008. 90

7.4 August 20, 2008. 90

7.5 August 27, 2008. 90

Figures and Tables

Figure 1-1 Interoperability Specification Document Map. 8

Figure 2-1 Business Sequence Diagram - 6.1.1. 30

Figure 2-2 Business Sequence Diagram - 6.1.2. 30

Figure 2-3 Business Sequence Diagram - 6.1.3 and 6.1.4. 31

Figure 2-4 Business Sequence Diagram - 6.1.5, 6.1.6, and 6.1.7. 32

Figure 2-5 Business Sequence Diagram - 6.1.8. 33

Figure 2-6 Business Sequence Diagram - 6.1.9. 34

Figure 2-7 Business Sequence Diagram - 6.2. 35

Figure 2-8 Business Sequence Diagram - 6.3. 36

Figure 2-9 Business Sequence Diagram - 7.1.1 and 7.1.2. 37

Figure 2-10 Business Sequence Diagram - 7.1.3 and 7.1.4. 38

Figure 2-11 Business Sequence Diagram - 7.1.5 and 7.1.6. 39

Figure 2-12 Business Sequence Diagram - 7.2.1 and 7.2.2. 40

Figure 2-13 Business Sequence Diagram - 7.2.3 and 7.2.4. 40

Figure 2-14 Business Sequence Diagram - 7.3.1 and 7.3.2. 41

Figure 2-15 Business Sequence Diagram - 7.3.3 and 7.3.4. 41

Figure 3-1 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Clinician Perspective - 6.1.1 47

Figure 3-2 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Clinician Perspective - 6.1.2 48

Figure 3-3 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Clinician Perspective - 6.1.3 and 6.1.4. 49

Figure 3-4 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Clinician Perspective - 6.1.5, 6.1.6, and 6.1.7. 50

Figure 3-5 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Clinician Perspective - 6.1.8 51

Figure 3-6 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Clinician Perspective - 6.1.9 52

Figure 3-7 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Pharmacist Perspective - 6.2 53

Figure 3-8 Detailed Sequence Diagram Inpatient Medication Reconciliation from a Clinician Perspective - 6.3 54

Figure 3-9 Detailed Sequence Diagram Ambulatory Medication Management from a Clinician Perspective - 7.1.1 and 7.1.2. 55

Figure 3-10 Detailed Sequence Diagram Ambulatory Medication Management from a Clinician Perspective - 7.1.3 and 7.1.4. 56

Figure 3-11 Detailed Sequence Diagram Ambulatory Medication Management from a Clinician Perspective -7.1.5 and 7.1.6. 57

Figure 3-12 Detailed Sequence Diagram Ambulatory Medication Management from a Pharmacist Perspective - 7.2.1 and 7.2.2. 58

Figure 3-13 Detailed Sequence Diagram Ambulatory Medication Management from a Pharmacist Perspective - 7.2.3 and 7.2.4. 59

Figure 3-14 Detailed Sequence Diagram Ambulatory Medication Management from a Consumer Perspective - 7.3.1 and 7.3.2. 59

Figure 3-15 Detailed Sequence Diagram Ambulatory Medication Management from a Consumer Perspective - 7.3.3 and 7.3.4. 60

Table 1-1 List of Constructs. 8

Table 1-2 Reference Documents. 10

Table 2-1 Mapping of Use Case Requirements to Interoperability Requirements - Inpatient Medication Reconciliation, Clinician Perspective. 15

Table 2-2 Mapping of Use Case Requirements to Interoperability Requirements - Inpatient Medication Reconciliation, Pharmacist Perspective. 17

Table 2-3 Mapping of Use Case Requirements to Interoperability Requirements - Inpatient Medication Reconciliation, Consumer Perspective. 18

Table 2-4 Mapping of Use Case Requirements to Interoperability Requirements - Ambulatory Medication Management, Clinician Perspective. 19

Table 2-5 Mapping of Use Case Requirements to Interoperability Requirements - Ambulatory Medication Management, Pharmacist Perspective. 22

Table 2-6 Mapping of Use Case Requirements to Interoperability Requirements - Ambulatory Medication Management, Consumer Perspective. 24

Table 2-7 Data Element and Information Requirements. 26

Table 2-8 Business Actors. 28

Table 3-1 Assumptions. 42

Table 3-2 Constraints. 42

Table 3-3 Pre-conditions. 43

Table 3-4 Post-conditions. 43

Table 3-5 Process Triggers. 43

Table 3-6 Technical Actor Role Descriptions. 44

Table 3-7 Business-Technical Actor Mapping to Transaction and/or Content 61

Table 3-8 Creator Medication and Allergies Information Subset Content Modules. 68

Table 3-9 Construct Dependencies. 68

Table 3-10 Additional Constraints on Required Constructs. 69

Table 4-1 Regulatory Guidance. 71

Table 4-2 Selected Standards Linked to HITSP Constructs. 71

Table 4-3 Informative Reference Standards. 74

Table 4-4 Use Case Events and Associated Gaps. 78

Table 4-5 Standard Overlaps. 80

Table 6-1 Description of Standards. 83