WG11 eprescribing & Related Transactions Meeting Minutes February 8-9, 2012

Transcription

1 WG11 eprescribing & Related Transactions Meeting Minutes February 8-9, 2012 Wednesday, February 8, 2012 I. Welcome and Call to Order A meeting of WG11 eprescribing & Related Transactions was held in San Diego, CA on February 8, Co-Chairs Tim McNeil of Surescripts, Rick Sage of Emdeon, and Michele Davidson of Walgreens were present. Michele Davidson called the meeting to order at 8:05 a.m. II. Reading of the Antitrust Statement Michele Davidson read NCPDP s Antitrust Statement. III. Housekeeping Items and Announcements Michele Davidson welcomed new NCPDP members and first time Work Group attendees. In addition, NCPDP Buddies were recognized. She noted the following: 1. Badges must be worn at all times. 2. The CMS Discussion originally scheduled for Thursday, February 9, 2012 from 7:30 8:30 a.m. is cancelled. CMS apologizes for any inconvenience. The Thursday morning work group meetings will begin at 8:00 a.m. 3. Handouts are available for: a. February Work Group meeting schedule b. Work Group Attendee Roster c. Task Group Listing d. Calendar of Events e Annual Conference Sponsor and Exhibitor Prospectus f. Annual Conference Registration Reminder Postcard i. Register for the Conference and if you do before February 10 th, you will be entered to win a $200 gift card. g. Annual Conference Speaker Program h. Nomination Forms: i. Benjamin D. Ward Distinguished Member Award Form ii. Rising Star Award Form iii. TIME Award Form iv. Work Group Co-Chairs Nomination Form i. Networking Reception flyer j. Acetaminophen Best Practices Webinar flyer IV. Agenda Michele Davidson reviewed the agenda with the attendees. Under Housekeeping was a note that New Project Diabetes Supplies will be discussed in MC. Under Old Business DERF will be discussed with the Demographic Field Length Task Group. Under New Business DERF Sig Guide enhancements was noted - WG11 is encouraged to attend WG10. Updated to Refill Processes was removed; it was from last meeting. The Formulary and Benefit Version 3.0 timeline was added under the task group. Prescription Requirements Task Group has two items Extended Character Set and DEA Schedule questions were added. A request to form a new task group for prescription transfers was added. A motion was made to approve the agenda as modified. The motion was seconded and carried. V. Minutes Michele Davidson requested a motion to approve the minutes of the November WG11 meeting. The motion was moved and seconded. The motion carried. WG11 EPrescribing & Related Transactions Page 1 February 2012

2 VI. Old Business Tim McNeil presented Old Business. A. Ballots Ballot WG SCRIPT 2011XX# (DERF 1033, 1034, 1035, 1036). The ballot was valid at 60% of the consensus group voting. There were no negative and no affirmative comments. The ballot reached 75% approval. The ballot will proceed to the Board of Trustees for approval after the appeal period. B. Pended DERFs There were none. C. Task Group Reports 1. Formulary and Benefit Task Group Bruce Wilkinson, CVS Caremark and Michele Davidson, Walgreens Co-Task Group leads provided the report. Task Group Name: Formulary and Benefits Date Task Group Formed: A while ago Task Group Leader(s): Bruce Wilkinson and Michele Davidson Parent Work Group: WG 11 Goal of Task Group: Improve F & B Standards to support the evolving needs of payers, prescribers & pharmacies. 10/24, 1/11 Old Item: Reviewed differences between F & B 1.0 and version 3.0 to determine if the task group wanted to submit a letter to CMS recommending the use of version 3.0 in the future. Surescripts reviewed F&B v3.0 and concurred that the changes were minor. F&B task group voted to move forward with the new standard. iii. It is already an approved NCPDP version, so industry via NCPDP would need to write a letter to CMS recommending they adopt version 3 as the next version of F&B. Timeframes would need to be included. Lynne checked with Drew Morgan, OESS. Drew will check to see if there needs to be a public hearing and recommendation from letter from NCVHS before moving forward. The industry (NCPDP) should be able to send a formal request letter to OESS and copy NCVHS on it. The task group was in agreement to move to version 3.0. The recommendations in the details need to be taken to the work group for approval. Next Regulation to be published by: June 2012 though timelines need to be agreed upon by WG 11. Group discussed a 12 month or 18 month compliance window and date to sunset F&B v1.0. There was general agreement that sunset date should be completed by or before 12/31/ Choice 1: a. Effective date: August 2012 (60 days from publication) i. Entities may use version 1.0 or 3.0 during the period of August 2012 December 31, 2013 (18 months) b. Compliance Date: January 1, Must support only version 3.0. Version 1.0 is sunsetted as of December 31, Choice 2: c. Effective date: January 1, 2013 (6 months from publication) i. Entities may use version 1.0 or 3.0 during the period January 1, 2013 December 31, 2013 (12 months). d. Compliance Date: January 1, Must support only version 3.0. Version 1.0 is sunsetted as of December 31, WG11 EPrescribing & Related Transactions Page 2 February 2012

3 The responses: 1. Do you agree with a January 1, 2013 compliance date? If No, why and what is your suggested compliance date? yes 7 no 4 June 1, 2013, this is basically right on top of Would like to see this farther out in 2013 since there is little benefit to the provider here. I am okay with the January1st Compliance Date, but suggest option 3 instead: Choice 3: a. Effective date: January 1, 2013 (6 months from publication) i. Entities may use version 1.0 or 3.0 during the period January 1, 2013 June 30, 2014 (18 months). b. Compliance Date: January 1, Must support only version 3.0. Version 1.0 is sunsetted as of June 30, I agree with a January 1, 2013 effective date with a January 1, 2014 compliance date. January 1, Do you wish a 12 month transition period or an 18 month transition period? (Choice 1 or Choice 2 on TG notes) 12 month 5 18 month 6 We need to realize that this is not on any development roadmaps for 2012, if the date it not published until June of this year, the development will not get slotted on roadmaps until 2013, we need to allow time for development, implementation and roll-out to end users. I also encourage sunset dates to align with other regulatory deadlines. Task Group Action Items/Next Steps (bullets or text): Agreement for Work Group to move forward, with dates. Draft letter to CMS. Andrew Morgan of CMS noted that for this version upgrade the industry does not need to testify to NCVHS. A letter is not needed to NCVHS; just to CMS. A straw poll was asked of moving forward with a compliance date of June 30, Approximately 15 approved; there was no opposition. Lynne Gilbertson will draft a recommendation letter to CMS. 2. WG7 F&B Task Group Terri Bernacchi (and Kathleen Shoemaker), Task Group leads of the WG7 Formulary-E-Prescribing & Tracking provided an update on the work they are doing from the Rebate perspective. They are creating a white paper that would be used by pharmaceutical manufacturers. They are looking for electronic prescribing expertise to help pharmaceutical manufacturers understand the standards and the workflow. Members of WG11 were asked to join the WG7 TG to provide that expertise. The TG has met a couple of times and has volunteers for chapters. 3. WG14 LTPAC eprescribing Task Group Frank McKinney, Frank McKinney Group, LLC and Lauri Holder, PharMerica provided the report. See the presentation. 4. XML Task Group Tim McNeil, Surescripts, Task Group lead, provided the report. Task Group Name: XML Date Task Group Formed: 02/2007 Task Group Leader(s): Tim McNeil Parent Work Group: WG11 Date: 02/08/2012 Goal of Task Group Support the XML format only going forward. Assist with the foundational structure of other XML WG11 EPrescribing & Related Transactions Page 3 February 2012

4 transactions for other message types besides the SCRIPT eprescribing transactions. Work with the MC Modeling Task Group. 12/12, 1/23 None Working on Communication Number design Reviewing Structured SIG changes Task Group Action Items/Next Steps (bullets or text): Complete review of SIG changes Work with modeling group on question. Code lists with qualifiers and descriptions; do both need to be sent in the message. Will work on clarifying observation element. Need to decide on coding system for unit of measure. NCI codes like CXXXXX which the current drug element uses or UCUM. Proposed list of fields: 1. What Vital Sign (LOINC subset list) 2. Version of the Code System (LOINC) 3. Measurement Value 4. Unit of Measure (UCUM) 5. Version of the Code System (UCUM) 6. Date 7. Notes 5. Clinical Health Information Exchange Task Group Steve Franko, CVS Caremark was not present to give the report. The task group did not meet. They will meet in the future to discuss additional use cases. 6. NCPDP/HL7 Pharmacist Functional Profile Task Group This group was formed to provide support for "Standalone eprescribing systems" and for "Pharmacist/Pharmacy Provider systems" by creating two functional profiles of the HL7 EHR-System Functional Model. These two new functional profiles will help define the EHR System-related functions. Shelly Spiro, Spiro Consulting provided the report. Date: Task Group Name: NCPDP-HL7 Pharmacist EHR Functional Profile Task Group Date Task Group Formed: November 2011 Task Group Leader(s): Shelly Spiro Parent Work Group: WG11 Goal of Task Group: This task group scope is to work on a joint NCPDP WG11 and HL7 EHR-S WG project is to update the EHR-S Pharmacist/Pharmacy Provider Functional Profile to conformance with the EHR-S Functional Model Release 2 with the possible inclusion of additional functionality ; proposed and Since the TG had so many new members, Lenel James (BCBS and HL7-EHR-S co-chair) provided the project team members with a HL7 Birds of a Feather presentation (see attached) on the conference call. The presentation is an overview of the HL7 EHR-S Functional Model changes from Release 1.1 to Release 2. None The HL7 EHR-S WG approved the project scope statement (see attached) with the following scope: The scope of this project is to update the EHR-S Pharmacist/Pharmacy Provider Functional Profile to conformance with the EHR-S Functional Model Release 2 with the possible inclusion of additional functionality. WG11 EPrescribing & Related Transactions Page 4 February 2012

5 None Task Group Action Items/Next Steps (bullets or text): Sue Thompson is mapping the HL7 Pharmacist/Pharmacy Provider EHR Functional Profile (PP-EHR) Release 1.1 o the HL7 EHR-S Release 2 Functional Model. The project team participants are starting with Direct Care section. 7. Prescription Requirements Task Group Mike Menkhaus, The Kroger Co, Task Group lead, provided the report. Date: Jan 19, 2012 Task Group Name: Prescription Requirements Date Task Group Formed: August 2009 Task Group Leader(s): Mike Menkhaus Parent Work Group: WG11 Goal of Task Group: THE PURPOSE OF THIS TASK GROUP IS TO ASSURE THAT IN ELECTRONIC MESSAGES, PHARMACIES RECEIVE THE INFORMATION REQUIRED BY REGULATIONS TO COMPLY WITH THEIR STATE PHARMACY ACTS. THE FOLLOWING THREE SUBJECTS ARE UNDER REVIEW: 1. Partial Fill and REFRES What Disp Qty is sent in a REFREQ if the last fill was a Partial Fill 2. Guidance for processing prescription messages for state scheduled drugs 3. Spanish Sigs Is there a more appropriate character set that would provide for messaging in Spanish (Sigs and names) We met six times during this quarter: 12/09/11 12/16/11 01/06/12 01/13/12 01/20/12 02/03/12 1. Processing REFREQs when the last fill was a partial fill\. 2. NEWRX and REFRES messages for state scheduled drugs a. Product is a schedule in prescriber state b. Product is a schedule in pharmacy state 1. For a partial fill, the prescription has a remaining amount available; should the patient not pick up the balance due for the prescription but request a refill, the pharmacy should either: a. Convert the partial fill to a short fill and refill an amount up to the amount remaining on the prescription b. Convert the partial fill to a short fill and send a REFREQ to the prescriber for the prescribed quantity and including the last dispensed amount filled with the date dispensed 2. Ideally, the prescriber and pharmacy management systems should house the state schedule information by state and process any state scheduled drugs in the same manner as a DEA scheduled drug. a. If the drug was scheduled in the prescriber state, the prescriber system would treat the prescription as any other scheduled drug prescription i. The pharmacy could process it as a non-scheduled prescription but will not be able to accept it if they are not EPCS certified due to syntax b. If the drug is not scheduled in the prescriber state, but IS scheduled in the pharmacy state, the prescriber system should process the prescription as a scheduled drug i. The pharmacy must process the prescription as a scheduled drug 3. When a prescriber sends a NEWRX or REFRES approval as a non-scheduled drug to a pharmacy in which the drug is scheduled, the pharmacy system should reject the message initially, or, if the drug schedule status is not determined until the message is fully interpreted in workflow, a free-standing error should be returned a. In this case, since the prescription was received, the record would be archived with the other scheduled drug records 4. The DEA Schedule field should be populated with the state schedule value if that is more restrictive than the DEA schedule per the guidance in Script Because the Script standards use the same character set as the Telecom standards, a change to the character set in Script would necessitate consensus from WG1. Shall we pursue a joint meeting with WG1 to determine whether we should proceed with the selection of a new or expanded character set to meet the needs of non-english names and phrases in electronic messages and claims? Task Group Action Items/Next Steps (bullets or text): We will finish the guidance on the processing of state scheduled drugs in electronic prescriptions and proceed as guided by this WG on investigating the use of a new or expanded character set. It was requested that NCPDP or Surescripts keep a national database of schedules. It was noted there are some initiatives started. The switch may assist with EPCS but there may be different WG11 EPrescribing & Related Transactions Page 5 February 2012

6 sophistication. A motion was made to add some work flows and add to the SCRIPT Recommendations document. It was seconded. The motion carried with no opposition. Extended Character Set for NCPDP Standards? WG11 Prescription Requirements Task Group with WG11 FAQ Task Group Ability to allow the exchange of Spanish character set in electronic prescribing. Possible use of UTF-8 extended character set Scope could include other language characters sets (do it once, rather than for each language). Original scope was just for Sigs (instructions) to include Spanish character set. However, Spanish names may also be in scope. If expanded to more than just Sig, other standards are now impacted (Telecom, Post Adjudication, PDMP, Rebates, etc.) o Sig is in English, per the guide. The grammar is too difficult in different languages. Request: 1. Need volunteers who are knowledgeable about editing and support of character sets in standards. a. Possible questions: Do we use one character set only in one field or group of fields (example only Sig allows special characters)? Requires special programming. May depend where the valid character set is edited in a system. If a system tests the character set before even knowing the type of message, so it wouldn t know where to edit for a different character set. b. 7 bit Even Parity requirement for VISA dial up a factor? c. UTF-8 appears to not step on delimiters because they are lower character values <1C> <1D> <1E>. d. Will databases accept special characters? 2. Is this Sig or all fields in a transaction? a. Possible impact: Special characters in names and whether it will be a hit on an eligibility file? See additional information in the WG11 zip file. One entity noted they used a short term solution. XML supports UTF-8. The EDIFACT syntax may be affected. Telecom may be affected. What about a new field for another language sig? CA has requirements of 5 languages. A suggestion was made to look at other standards, including ID Card. Can you constrain to one field? The implementation guide would need to constrain. Is constraining too limiting? Expand to more than one Sig? What about only the medication fields? A motion was made to create a separate task group for the extended character set discussion. It was seconded. Mike Menkhaus, Kroger, agreed to be task group leader. Should multiple languages be supported within just SCRIPT? Should this also include the label? XML does have a primary language field. What is the purpose? To process prescription if other characters appear in Sig. This affects failover fax logic as well. There is a concern with errors. The motion carried with no opposition. The task group will need technical expertise and will need to define their scope. 8. Central Fill Task Group Shelly Lynn Renkvish-Abo, AmerisourceBergen Corporation, Task Group lead, was not able to attend and did not provide a report. Teresa Strickland, NCPDP reported that the task group is still working. They will be sending the schema to the XML Task Group for review and plan to submit a DERF for May WG. 9. REMS and eprescribing Task Group Michele Davidson, Walgreens, and Mike Menkhaus, Kroger, task group leaders provided the report. Date: February 2012 Task Group Name: erx REMs Task Group Date Task Group Formed: November 2010 WG meeting Task Group Leader(s): Michele Davidson & Mike Menkhaus Parent Work Group: WG 11 Goal of Task Group: To develop a registration verification transaction with the switch as a REMS administrator using the SCRIPT Standard 11/30 12/14 1/18 and 2/1 Currently working on the use cases so that we can make sure that we have included all the steps. Have reviewed all the Elements to Assure Safe Use Safe Use Conditions completed WG11 EPrescribing & Related Transactions Page 6 February 2012

7 Use Cases being identified How to handle a pharmacy that is not covered by REMS Task Group Action Items/Next Steps (bullets or text): Once we are satisfied that our use cases are complete we will begin on the schema and document. Michele noted the question of how does the prescriber know what pharmacies are REMS? If a pharmacist can go through the REMS enrollment process quickly, the pharmacy can accept the prescription and process. Other programs may take long for enrollment. Some REMS programs the pharmacy cannot take the product before enrollment. There are multiple options with different actions. 10. Update from WG10 Industry Sig Task Group Laura Topor, RxEOB, Task Group lead, provided the report. Date: January 9, 2012 Task Group Name: Structured and Codified Sig Date Task Group Formed: August 2004 Task Group Leader(s): Laura Topor Parent Work Group: WG 10 Professional Pharmacy Services Goal of Task Group: The development of a structured and codified Sig format is an industry-wide initiative emanating from testimony given to, and the recommendations promulgated by, the National Committee on Vital and Health Statistics (NCVHS). The committee s 2ØØ4 and 2ØØ5 meetings focused heavily on the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2ØØ3, specifically the electronic prescribing requirements that will enforce the use of standardized messaging between prescribers and pharmacists. The national emphasis on electronic prescribing (eprescribing) was reinforced in the initial report from the Office of the National Coordinator for Health Information Technology (July 21, 2ØØ4). Standardizing the Sig has been a discussion topic for many years and in 2ØØ4 NCPDP agreed to convene and facilitate an industry-wide task group to create a set of consistent fields and values for conveying instructions to the patient (the Sig) in an electronic prescription. The NCPDP Structured and Codified Sig task group (the task group) was formed to develop an approach that utilizes standardized codes to assist the members of the health care industry who are using electronic prescribing tools by creating a method of sharing patient instructions that will not be misinterpreted, misread or mis-keyed when prescriptions are filled. Conceptually, standardizing the expression of the Sig is a natural extension of using electronic transactions to relay product information from prescribers to pharmacists. November 4, 2011, December 2, 2011, December 16, 2011, and January 6, 2012 No new business cases were reviewed. Finalized document and turned over to Modeling & Methodology and XML task groups for development of XML schema. Relying on these groups for technical structure and consistency with other NCPDP standards, i.e. use of code descriptions. Completed updates to document, including examples and FAQs. Coordinated with M&M and XML TG to develop documentation for DERF to support changes to SCRIPT. Task Group Action Items/Next Steps (bullets or text): Laura reviewed DERF Sig Guide enhancements WG11 is encouraged to attend WG10. Laura noted also to see WG10 information on limited English proficiency and universal medical scheduling discussions. There will be Sig Focus Group March 8, 2012 at NCPDP headquarters to discuss next steps of pilots for the sig enhancements. 11. Demographic Field Lengths Task Group Patrice Kuppe, Surescripts, Task Group lead provided the report. Date: 01/10/2012 WG11 EPrescribing & Related Transactions Page 7 February 2012

8 Task Group Name: Demographic Field Length Task Group Date Task Group Formed: November 2011 Task Group Leader(s): Patrice Kuppe Parent Work Group: WG11 Goal of Task Group: This task group is taking the recommendations from the MC Demographic Field Length Task Group and bringing forward DERFs to modify the WG11 and WG10 standards appropriately. 12/7/11, 12/8/2011 Vote Reviewed MC Demographic Field Length recommendations Name-Organizational field size now Recommend Green = Change Red = No Change BusinessName NB Client Name ClinicName F Destination Name FacilityName Q Facility Name GroupName PayerName P Pharmacy Name V Processor Name SD Sender Name JK Source Name Name-Individual field size now 312-CC Cardholder First Name CD Cardholder Last Name SX First Name SY Last Name CA Patient First Name CB Patient Last Name FirstName LastName Street Address field size now AddressLine AddressLine SR Address Line SS Address Line Telephone Number field size now 732-DB Telephone Number 10 add 8 digit extension field CommunicationTypeNumber 80 NEW TAGS Suggest to make explicit tags with sizes for each value. Note: the XML Task Group is already looking at modifications to the schema for this field and qualifiers. They will recommend a total solution to the CommunicationTypeNumber using the input from this task group. BN Beeper Recommend two fields. 10 digit phone; 8 digit extension CP Cellular two fields. 10 digit phone; 8 digit extension EM Electronic Mail separate field of 80 FX Fax two fields. 10 digit phone; 8 digit extension HP Home two fields. 10 digit phone; 8 digit extension NP Night two fields. 10 digit phone; 8 digit extension TE Telephone two fields. 10 digit phone; 8 digit extension WP Work two fields. 10 digit phone; 8 digit extension Bringing forward recommendations noting that XML TG is working on communication number DERF. Task Group Action Items/Next Steps (bullets or text): WG11 EPrescribing & Related Transactions Page 8 February 2012

9 None. Work moves to group that owns DERF The recommendations of the task group are supported for MC to discuss the DERF. A motion was made to disband the task group since their work is done. It was seconded. The motion carried with no opposition. 12. FMT Code List Mapping Task Group Patrice Kuppe, Surescripts, Task Group lead, provided the report. Task Group Name: FMT - Taxonomy Date Task Group Formed: 9/26/2011 Task Group Leader(s): Patrice Kuppe Parent Work Group: WG11 Date: 01/10/2012 Goal of Task Group: : Review mapping for the FMT codes as well as the Provider Specialty Codes and have NCPDP review/approve and publish. This is only for entities that need to map between SCRIPT 8.1 to 10.6 transactions on behalf of someone and need to have industry rules on the mapping of the code sets. Other entities will pull the code sets from their compendia files. This task group will review the original mapping of NCPDP old proprietary code sets for 4 fields to FMT, to provide mapping consistency when needed. In addition it is mapping old AMA codes to new 10.6 Taxonomy codes. Nov 14, 2011 Dec 5, 2011 Reviewed list of FMT and Taxonomy Codes for version 8.1 and 10.6 Created cross walk recommendations for forward and backward mapping. Recommend we post the spreadsheet to appropriate place on NCPDP site. Ask the WG for approval to post on eprescribing public section of website with some instructional usage. Task Group Action Items/Next Steps (bullets or text): None. A motion was made and seconded to post the spreadsheet on the eprescribing public section of website with some instructional usage. The motion carried with no opposition. The task group will remain in place until May, in case questions are asked, and then possibly disband in May. 13. RxFill Task Group Bruce Wilkinson, CVS Caremark, Task Group lead provided the report. Task Group Name: RxFill Date Task Group Formed: 2/2011 Task Group Leader(s): Bruce Wilkinson Parent Work Group: WG11 Date: 11/10/2011 Goal of Task Group: How can the industry use RxFill to provide value to all stakeholders? 11/28, 1/23 None Final Review and edits of the RxFill White Paper. Goal is for the RxFill White paper to be available for the May NCPDP meeting. Updating RxFill white paper (in process) WG11 EPrescribing & Related Transactions Page 9 February 2012

10 Task Group Action Items/Next Steps (bullets or text): Verify the assumptions as they stand in the Implementation Guide. Resubmit DERF based on White Paper 14. Drug Description Task Group Anne Johnston, Medco Health Solutions, and Rick Sage, Emdeon, Task Group leads provided the report. Date: February 4, 2012 Task Group Name: WG2/11 Joint Drug Description Task Group Date Task Group Formed: November 2011 Task Group Leader(s): Anne Johnston, Rick Sage Parent Work Group(s): WG2 and WG11 Goal of Task Group: To address the inconsistencies in the use of drug identification fields in the NCPDP SCRIPT message format used to create electronic prescription messages. These messages include new prescriptions, refill/renewals, fill status notifications, medication history, etc. Drug identification inconsistencies have a potential to cause confusion at the pharmacy for drugs that are electronically prescribed. The inconsistencies in the use of the drug description fields can lead to inefficiencies and potential patient safety issues. This Task Group will be making recommendations and clarifications that support the current SCRIPT standard and address immediate needs for improvements. We met five times during this quarter: 12/09/11 12/16/11 01/06/12 01/13/12 01/20/12 The inconsistencies in the use of the drug description fields can lead to inefficiencies and potential patient safety issues. For example, the extended release dose form of glipizide has been transmitted in prescriptions as: GlipiZIDE 5 MG Tablet Extended Release 24 Hour GLIPIZIDE 5 MG TB24 GLIPIZIDE 5MG TAB OSM 24 GlipiZIDE Extended Release 5 mg tablet, extended release GLIPIZIDE ORAL TABLET 24 HR 5 MG GlipiZIDE XL 5 MG Oral Tablet Extended Release 24 Hour Glipizide Tab,Sust Rel Osmotic Push 24hr 5 mg We discussed many other examples similar in nature to the examples above. 1. Most confusion comes from prescribing vendors not using industry compendia as source data for drug descriptions or allowing physicians to modify the drug description before transmitting the electronic prescription. 2. We believe that we can make significant improvements by simply ensuring that all prescribing software uses one of the industry recommended drug compendia without modifications. 3. Add to SCRIPT Recommendations document that summarizes the issues and gives recommendations a. Recommend using drug compendia or RxNorm for source data b. Work with all known compendia to identify appropriate drug name fields as a reference c. Give direction to not include drug identifier if user enters or modifies source drug information, or agree on a manual text NDC number (i.e ) (no!) i. Consideration for how to accurately portray the prescription? ii. If it is modified, what is the receiver to do with this? d. Address the drug description containing free text. e. Show examples. 4. Run the recommendations through a sample to see if accomplishing what was expected. Currently working on modifications to the SCRIPT IMPLEMENTATION RECOMMENDATIONS document (current version 1.11). 1. We are looking for agreement on the direction that the TG is taking. 2. We are looking for ways to get more involvement from the electronic prescribing software vendors. We have created an to send to all known contacts but still working on compiling a list of addresses. Task Group Action Items/Next Steps (bullets or text): 1. We will finish the SCRIPT IMPLEMENTATION RECOMMENDATIONS document and present for approval at the next workgroup meeting. 2. Run the recommendations through a sample to see if accomplishing what was expected. WG11 EPrescribing & Related Transactions Page 10 February 2012

11 The vendor letter has been approved by the Standardization Committee. The task group is waiting on more addresses before sending. 15. epa Workflow to Transactions Task Group Tony Schueth, Point of Care Partners, Task Group lead provided the report. He thanked the participants in the subgroup Bruce Wilkinson, CVS Caremark, Victor Beraja, Ibeza, LLC, Sri Swarna, Agadia Systems, Inc, Ron Fine, CoverMyMeds, LLC, David Fidler, Medco Health Solutions, for the work they have done on the flows and sharing solutions with the task group. The task group held two sessions as overview during which they reviewed and further refined the flows (recorded and available at The draft standard is being evaluated and the subgroup is discussing gaps. They will bring forward recommendations in a later February call. D. Industry Update 1. National Committee of Vital and Health Statistics (NCVHS) (Subcommittee on Standards) Update 1. NCVHS Subcommittee on Standards has recommended CORE and NACHA be the operating rules entities for EFT and ERA. Regulation for operating rules are expected in Acknowledgements: A letter was approved by NCVHS to send to the Secretary of HHS. NCVHS recommends the adoption of the 3 X12 transactions (TA1, 999, 277CA), define under which conditions they will be used, adopt the CAQH/CORE ACK OR for eligibility and claim status. NCPDP reviewed the letter and submitted comments/corrections to NCVHS. 3. NCVHS full committee meeting March 1-2, 2012, June 21-22, 2012, September 20-21, 2012, and November 13-14, NCVHS Subcommittee on Standards will hold hearings TBD. 2. HIPAA Update 1. HIPAA implementation - 01/2012 live. Medicaid Subrogation for small health plans only 01/ Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (OESS) will not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the HIPAA transactions. 3. Health Plan ID Notice of Proposed Rule Making (NPRM) is scheduled to be released in March Compliance and Certification NPRM will be released in Interim Final Rule (IFR) for naming the standard for EFT as well as operating rules for EFT and remittances released January 10, Comment period is 60 days. MC Task Group and WG45 Task Group are building the NCPDP response. 6. Eligibility and Claims Status transactions operating rules compliance date 01/01/ ICD-10 compliance date 10/01/ CMS/HHS Update The final rule regulation for Telecom D.0 and ASC X for electronic prescribing functions is due any day. The regulation sunsetting of SCRIPT version 8.1 and LTC exemption NPRM is planned to be published in June 2012 in the physician fee schedule regulation. There was discussion if NCPDP should recommend another sunset date of SCRIPT 8.1, since the regulations have taken so long. The original suggestion from this WG and NCPDP (in 2010) was 12/31/2012. When the regulation is published will the industry be ready? Surescripts noted they are sunsetting SCRIPT 8.1 as of 10/31/2013. A motion was made to send a letter to CMS to sunset SCRIPT 8.1 as of 10/31/2013; that as of 11/01/2013 only SCRIPT 10.6 is to be used. It was seconded. The motion carried with no opposition. 4. DEA Update (eprescribing) The DEA has published some guidance/overview information - specifically under Outreach, Questions, and Answers at i. Report on Implementation Status It was noted there will be DEA EPCS presentation at Annual Conference. There is continued movement to implementation. Surescripts noted a limited availability rollout to vendors willing to implement and go through auditing requirements. There are 3 prescribing systems and 3 pharmacy WG11 EPrescribing & Related Transactions Page 11 February 2012

12 systems. The details are not public. They looked at the concentration of users for overlap (VA, CA, TX, MD, maybe MI) for exchanges. Volume is very low; it is taking time for operational issues. Surescripts may announce when available for all interested. They have been checking with states for statuses on EPCS. ii. NCPDP MOU with SAFE-BioPharma The SAFE-BioPharma standard is used by large and small organizations to verify and manage digital identities and to apply SAFE-BioPharma digital signatures. Developed by a consortium of biopharmaceutical and related companies with participation from US Food and Drug Administration and European Medicines Agency Managed by the non-profit SAFE-BioPharma Association Participation in the standard, obtaining SAFE-BioPharma digital identities and use of SAFE- BioPharma digital signatures require signing a membership contract with SAFE-BioPharma Association and abiding by the association s rules. Lynne Gilbertson noted that the MOU allows 4 representatives from NCPDP to participate with SAFE- BioPharma. We are looking for NCPDP members with expertise in this area who would like to participate and collaborate on calls. E. Medication Reconciliation This item is on the agenda just for monitoring; to see if questions might arise. Laura Topor, RxEOB will monitor. There will be a presentation at Annual Conference. F. NCPDP eprescribing Website Page Updates Lynne Gilbertson updates as items of interest come by. Members are encouraged to review and submit information that is relevant. The page and documents were recently updated. G. Meaningful Use Registration is now open for Medicare and Medicaid EHR Incentive Programs. Learn more about how to become a meaningful user of EHRs. NIST Update Ken Gebhart, NIST noted the following. MU Stage 1 recap In July 2010 ONC published the final rule for stage 1 of the meaningful use program. Criteria (b) defined ONC s eprescribing requirements (send new prescription from EHR to pharmacy; include RxNorm/source vocab in the message) In August 2010 NCPDP formed a task group to collaborate with NIST on developing an eprescribing test procedure based on the requirements in the ONC final rule. Testing scope was on validating the NEWRX message using a manual inspection testing process, with test data provided by the NCPDP task group Test procedure was published September 2010 and technical corrections issued in December ONC approved the test procedure for use by their accredited testing labs to validate the ONC requirements for electronic prescribing. Testing laboratories are using the approved test procedure as the basis for their detailed test scripts. NIST does not do the testing. MU Stage 2 We are anticipating that ONC will publish their NPRM for MU 2 later this month (February) which will include some updates to their eprescribing requirements At the May 2012 NCPDP meeting, NIST will request that WG11 re-activate the task group to collaborate with NIST on developing the MU 2 test procedure, test scenarios, test data, etc. In advance of the May meeting, NIST will provide an initial summary of ONC s eprescribing requirements for MU 2 and ask for NCPDP guidance on the scope of testing that seems appropriate given ONC s requirements as well as industry expectations. WG11 EPrescribing & Related Transactions Page 12 February 2012

13 NIST is also considering ways to provide some automated conformance testing tools to assist the EHR developers and testing laboratories evaluate conformance to the ONC requirements. H. DSMO Change Requests Pending There were none. VII. Motion to Suspend Tim McNeil asked for a motion to suspend the meeting. The motion was moved and seconded. The motion carried. The meeting suspended at 11:57 a.m. Thursday, February 9, 2012 I. Welcome and Call to Order A meeting of WG11 eprescribing & Related Transactions was held in San Diego, CA on February 9, Co-Chairs Tim McNeil of Surescripts, Rick Sage of Emdeon, and Michele Davidson of Walgreens were present. Tim McNeil called the meeting to order at 1:35 p.m. A request was made to add DERF Diagnosis Code Qualifier and ICD and use of Decimal Point from WG1 discussions. II. New Business Rick Sage led New Business. A. New DERFs There were none. B. New Frequently Asked Questions There were none. C. Electronic Transfer of Prescriptions between Pharmacies Adam Souza, CVS Caremark requested discussion of forming a task group to build a SCRIPT-based transaction for the transfer of prescriptions between pharmacies. Previously there was an ad hoc group looking at this, but resources were a factor. Adam volunteered to be the task group leader. A motion was made to create a new task group. It was seconded. It was asked what was different than the two exchanges in the Prescription Transfer Standard? The NCPDP Prescription Transfer Standard Implementation Guide is to be used for bulk transfers of open refills, such as from one mail service pharmacy to another, and transfer of open and historical prescriptions due to closure/change in ownership or system conversion in the retail or long-term care pharmacy settings. Another example might be a pharmacy chain situation where multiple stores are closing, individual stores may create their own file, or the chain headquarters may create one file containing information from the various stores, and send them to one receiving pharmacy. It was noted the task group needs to clarify the use of the Prescription Transfer Standard and this new transaction. The motion carried with no opposition. D. DERF from WG1 DERF This DERF requests Diagnosis Codes that can be sent in a SCRIPT NEWRX, REFRES or CHANGERES should be limited to ICD-9 or ICD-10. This would remove Medical Economics, Medi-Span and First DataBank as valid qualifiers as they are not as widely used and known by all. In November, this DERF was assigned to WG11, but WG11 discussed making all diagnosis code use consistent, which impacts Telecom and other standards. WG1 was asked to review and provide a recommendation. WG1 pended the DERF in November with a formation of a task group to look at this more closely. In February, the WG1 Diagnosis Qualifier Task Group recommended approving the modified DERF. After discussion, WG1 pended the DERF to the submitter and WG11. SNOMED can be used for diagnosis. The original request was to add SNOMED and remove proprietary diagnosis code sets. ICD-9 and ICD-10 are the named HIPAA code sets; SNOMED is expected to be named in the future in other regulation. If the standards do not support SNOMED, the industry will be behind. SNOMED has been named in Meaningful Use. ICD-9/10 were not intended WG11 EPrescribing & Related Transactions Page 13 February 2012

14 for some of the purposes they are being used. The industry needs to be thinking broader than just claims billing. The DERF establishes consistency in the standards. WG1 concerns - What if a prescription has a SNOMED code? SNOMED cannot be used in the claim. WG1 asked if SCRIPT can be structured to only use ICD-10. WG11 discussed the DERF. It was noted that there are some crosswalks available. A motion was made to approve the DERF as modified from WG1. It was seconded. It was asked why not remove SNOMED as a value in SCRIPT since the claim needs ICD. This was felt to be shortsighted as SNOMED has use and the industry needs to be prepared. Could the prescriber send both? SCRIPT does support two occurrences of a primary and secondary diagnosis. It was noted the SCRIPT 10.6 schema is published and should not be updated for this; it will be in a future version. One entity said they rarely see diagnosis codes; one entity said they see approximately 20%. If pharmacy has the code list, the text can be displayed. A friendly amendment was not accepted to state if SNOMED is sent, ICD should be sent, as this is more than an ECL change. It was noted the DERF could move from an ECL to a DERF. There was a concern with clinical use versus billing use. The motion carried with 6 opposed. E. ICD and Decimal Point From WG1 the Telecom FAQ Task Group discussed question D-Seventy-Five ICD Format. Awhile ago we tried to get consensus in WG1 over the format of ICD in transactions. There were some who wanted the decimal, others who didn t. At that point, since consensus wasn t reached, the imp guide was changed to state Implied Decimal Points Decimal points in dollar fields are implied. Diagnosis code fields must adhere to the owner s code set rules and formats. NCPDP has received a couple of concerns over some processors rejecting for decimal; others not. I went to the ICD-10 Industry Group and the CDC (owners) asking for assistance. The recommendation is: As we discussed the ICD codes do have a decimal, however, for transaction/submission of the codes the decimal is not included in the code. Below is information from the UB-04 manual regarding the reporting of ICD-9-CM diagnosis codes. I believe the same language is used in the 837 as well. The language appears at Form Locator (FL) 67, principal diagnosis and at FL 67A-Q, for Other diagnoses. "The reporting of the decimal between the third and fourth characters is unnecessary because it is implied". (Of note the XML file from CDC has the decimal point; their printed materials may include the decimal point. It is however not to be transmitted. Other standards also support this same rule.) It is recommended that for consistent application in NCPDP standards, each imp guide that uses a Diagnosis Code explicitly state that The ICD codes do have a decimal; however, for transaction/submission of the codes the decimal is not included in the code. The reporting of the decimal between the third and fourth characters is unnecessary because it is implied. This would be a DERF submitted for any NCPDP standards that use a Diagnosis Code, for a future version. WG1 will submit a DERF for the May WG to request that the External Code List be updated to state that a decimal point is not to be used in transactions. There was a question of impact to SCRIPT and electronic prescriptions. An entity noted that decimals do appear on ICD diagnoses in SCRIPT. The SCRIPT Recommendations document would need to be updated to provide guidance about no decimals in the transmission to be in alignment with the Telecom implementation. It was recommended WG1 proceed. F. Webinars Michele Davidson noted the rest of the agenda. The following NCPDP webinars were noted: Acetaminophen Best Practices White Paper Findings February/March 2012 Rebate Standard March 2012 Workers' Compensation March, Date and Time TBD G. Annual Conference The NCPDP Annual Conference is May 7-10, 2012 at Arizona Biltmore Resort, Phoenix, AZ. H. Next Quarterly Work Group Meeting The next NCPDP quarterly work group meeting will be held on May 6-7, 2012 at the Arizona Biltmore WG11 EPrescribing & Related Transactions Page 14 February 2012

15 Resort, Phoenix, AZ. Agenda Items Include: Old Business Year in Review Re-circulation Ballot New Ballot (if applicable) Pended DERFs (if applicable) Task Groups: o F&B TG o WG14 LTPAC eprescribing TG o WG10 Sig TG o XML TG o Clinical Information TG (CHIX) o NCPDP/HL7 Pharmacist Functional Profile Task Group o Prescription Requirements TG o Central Fill TG o REMS and eprescribing TG o FMT Code Mapping o RxFill TG o epa TG o DrugDescription TG o Expanded Character Set TG o Pharmacy to Pharmacy Transfer TG NCVHS Update CMS Update DEA Update o (incl implementation update) FAQs DSMO CRS New Business New DERFs WG11 asked for 1 day to not conflict with WG1, 14, 10, and 2. I. Ballot Documentation Ballot documentation is due to Patsy McElroy by Thursday, February 23, J. Submission of new DERFs and New Project Development Forms Submission of new DERFs and Project Development Forms are due Friday April 6, 2012 to Kittye Krempin. III. Motion to Adjourn Rick Sage asked for a motion to adjourn the meeting. The motion was moved and seconded. The motion carried. The meeting adjourned at 2:21 p.m. Action Items: Prepare ballot, re-circulation documentation (if Lynne Gilbertson necessary) Task Group Work All Attachment (available on the website or by contacting the Council office): WG11 EPrescribing & Related Transactions Page 15 February 2012

16 Attendee Roster Ballot Comments Spreadsheet(s) Recap reports from each of the task groups Yearly agenda item on next eprescribing versions to stay ahead of the regulatory process. Update NCVHS subcommittee when eprescribing versions are official. Lynne Gilbertson Lynne Gilbertson Staff Liaison WG11 EPrescribing & Related Transactions Page 16 February 2012