Notes from Communications WG
Date: September 7, 2010
Time: 1:00pm - 2:00pm EST
Attendees: Richard Elmore, Didi Davis, David Kibbe, Janet Campbell, Noam Arzt, Karen Donovan, John Blair, Susan Leonelli, Brian Ahier, Michele Darnell, Arien Malec, Uvinie Hettiaratchy, Caitlin Ryan

Actions

Actions for This Week


#
Date
Action
Status
Owner
Due Date
22
09/07/10
Bring consent question back to Documentation and Testing WG to agree on language around consent for NHIN Direct Overview document and all Communications WG documents.
Open
Janet Campbell, Rich Elmore
09/14/10
23
09/07/10
Simplify “What is NHIN Direct?” presentation, incorporating feedback from 09/07/10 WG meeting.
Open
Rich Elmore
09/14/10
24
09/07/10
Edit “Physicians” presentation, incorporating feedback from 09/07/10 WG meeting.
Open
David Kibbe
09/14/10
25
09/07/10
Finalize “Vendors” presentation for discussion at 09/14/10 WG meeting.
Open
Michele Darnell
09/14/10
26
09/07/10
Read through one-pager “Overview” document (posted to Agenda, below).
Open
Team
09/10/10


Actions from Last Week



#
Date
Action
Status
Owner
Due Date
16
8/31/10
Distinguish difference between NHIN Exchange, NHIN Connect, and NHIN Direct in the NHIN Direct Overview 2.0.
Open
Janet Campbell
9/7/10
17
8/31/10
Create one slide of the spec and how it all fits together.
Open
Team
9/7/10
18
8/31/10
Decide offline how to divide between RECs and individual providers.
Open
David Kibbe and Brian Ahier
9/7/10
19
8/31/10
Finalize small sized deck available for consumption before next Tuesday, by boiling down decks to a couple slides each.
Open
Brian Ahier, David Kibbe, Michele Darnell, Rich Elmore
9/7/10
20
8/31/10
Create format for one-page fact sheet.
Open
Uvinie Hettiaratchy and Caitlin Ryan
9/1/10
21
8/31/10
Create first draft of one-page fact sheet.
Open
Brian Ahier, David Kibbe, Michele Darnell, Rich Elmore
9/7/10

Agenda








AMANews http://www.ama-assn.org/amednews/2010/09/06/bisa0906.htm




Notes

David Kibbe
· Presented the “Physicians” PowerPoint deck (found in Agenda, above).
· Explained that he posted more rather than less content.
· After last Communications WG meeting, thought it was important to message early that each provider has his/her own NHIN address, because people said they weren’t sure what Direct was and how it worked.
· Also thought he needed to stress the flexibility Direct would offer providers:
o Direct may be used stand alone or in conjunction with HIEs.
o Had read an American Medical Association news article that explained that physicians needed to join an HIE in order to comply with MU.
§ Can make it clear that if providers don’t have an HIE nearby or if they are not sure they want to be part of an HIE, Direct is an alternative.
· Questions, comments?


· Stressed to be careful with using “Connect to your colleagues and patients anywhere, anytime, using smart phones and mobile devices,” because it sounds as though one can only connect using a smart phone or mobile device.
· “Compatible with a broad range of EHRs” makes a statement about something we hope is true in the future. We need to be careful about overstating, sweeping statements.

David Kibbe
· Has same level of discomfort with overstating what Direct can do.
· But on the other hand, if WG is communicating about the benefits of Direct, it might be appropriate to make the assumption that broad compatibility will be achieved.

Arien Malec
· Instead WG can make a factual statement about the degree of current participation.

Noam Arzt
· This may be just a wording issue, but WG needs to be straightforward about it.
· àWill try to think of alternative language.

Comment
· Can keep the vendor language neutral.
· Or could say Direct “will be compatible.”

Noam Arzt
· “Will be compatible” is better than “is compatible.”
· Expressed that he is new to this group, so wasn’t in the conversation last week that focused on state-level messaging, but wants to emphasize that WG should remain sensitive to keeping the state-level thread throughout all of the messaging segments.
o For example, the last sentence in the section, “Does not require membership in a Health Information Exchange or RHIO” might touch on a sore spot.
§ He realizes that states are still confused and concerned that some of their stakeholders will see Direct as an alternative to their services.

David Kibbe
· Asked members of Communications WG to read AMA news article (found in Agenda, above).
· Saw the tone of the article as a warning telling physicians they have to go out and take one more complicated step to be connected to others.
· Stressed that if AMA is taking that point of view, then the WG ought to pay attention and provide appropriate messaging.

Brian Ahier
· Agreed that WG should continue to look at each of the key stakeholder groups through the lens of the other groups.
· Important to note that messaging talks about the providers meeting “Stage One MU,” not just “MU.”
· Can emphasize that beyond Stage One providers will need to have a more robust capability that Direct cannot provide.
· Direct can bridge Stage One MU but doesn’t supplant statewide HIE services.

David Kibbe
· àWill add “Stage One” to the MU point.
· On the next page, “how does Direct differ?”
o His questions: from what? What is the comparison to?
· Fourth point explicitly mentions NHIN Direct does not require membership and allows physicians to make the decision about whether or not they will be a part of an HIE.
o Physicians can join HIEs but if they want other options, Direct is an alternate option.

Noam Arzt
· WG needs to watch use of terminology.
· Using “RHIO” and then “HIE/HIO” later. Need to be consistent.
· Would be more comfortable with “may not require membership” rather than “does not require membership” because users may need HISP services, and HISP services may require membership or payment.

David Kibbe
· Agreed.
· àCan change to “may not require membership.”
· How do other people feel?

Susan Leonelli
· First bullets on Slide 1 make Direct sound like a national program, not unlike a national patient identifier number they are all required to have.
· Sounds like one would apply to the government, mostly likely through the ONC, obtain a unique identifier, and then proceed to use the protocols.
· Right now the messaging doesn’t suggest that you might require HISP services.
· Next, let’s break down “easy and affordable.”
o Affordable catches someone’s eye.

David Kibbe
· Important points.
· He just had a conversation with a physician who is a poster child for how MU can get expensive.
o The physician’s vendor wants to charge her an additional $500/month to install module in her legacy electronic health record system that will enable her to meet MU standards.
· He sees Direct, instead, as a set of capabilities that can be offered for free or for as little as $19/month, for example, to do the same thing she is paying $500/month for.

John Blair
· Clarifying: $500/month?

David Kibbe
· Yes, $500/month to upgrade a legacy electronic health record to be able to perform the activities necessary to meet MU standards, not only for patient portal but additional quality reporting activities as well.
· If those services are valuable maybe they are worth $500/month, but his sense is that if NHIN Direct is successful, it can offer services that meet several of the MU criteria and will be nowhere near that cost.
· If WG doesn’t want to make the assumption NHIN Direct can offer this level of service that’s all right, but he’d rather err on the side of promising.

Arien Malec
· WG can make factual statements like “Direct is designed to be easy to implement” and “the project involves many of the leading EHR and HIE technology vendors.”
· Both statements are true, but lead audiences in a certain direction.

David Kibbe
· Good point.
· “Designed to be easy and affordable…” might be better than as it is written.

Round the Room: Comments on “Physicians” slides
Didi Davis
· Seconds the statement that users “may need” connectivity or support from an HIE.
· Example: in TN, all physicians will need to be part of a “qualified organization” in the form of an HIO, HIE, RHIO, for example, for Medicaid incentives.
· Using this language will appeal to different audience segments.
David Kibbe
· Question, what if I choose to get my HISP services through one of the big laboratory systems?
· In TN, would I also have to have a membership with one of the “qualified organizations,” or how does that work?
Noam Arzt
· Possibly the lab would qualify as a “qualified organization.”
Didi Davis
· Right, different states have different definitions.
Noam Arzt
· Uncomfortable with the category of “how does Direct differ?”
o Feels the question is ambiguous.
· For “what do you need?” in the bottom left a HISP is described but it is not noted in the section above.
· Whether you need email software or a compatible EHR system is unclear in the bottom left.
· Also, bottom left: “If you already use an EHR technology, then be certain your vendor is using the NHIN Direct protocols” does not make sense.
Karen Donovan
· On the first page it says provider has his/her own NHIN Direct address.
· Does this mean each person is provided with an address?
Susan Leonelli
· Need to make it clear that it is one address for one provider.
Brian Ahier
· “How does Direct differ?” could be changed to “What makes Direct unique?”
Michele Darnell
· For “How does Direct differ?” WG could elaborate that Direct is about connecting to colleagues and patients anytime, anywhere.
o Replaces paper faxes and courier services.
o Also thinks an emphasis on the affordable is important.
John Blair
· No comment.
Janet Campbell
· Sees “Help your practice meet Meaningful Use” on Slide 1 and worries this will be interpreted as Direct = meets Stage One MU.
Uvinie Hettiaratchy
· Echoed Michele’s comments: “how does Direct differ?” is trying to show what Direct does that cannot be done currently.
· WG should tell a physician what they can do through Direct that they cannot already do, by explaining the security concerns involved.
· “How is Direct unique?” is better than “how does Direct differ?”
Arien Malec
· Agreed.


Rich Elmore
· Some of the conversation got back to “what is NHIN Direct?” so proposed to move on to the general framing document, “What is NHIN Direct?”(found in Agenda, above).
· Slide 1 shows an overview of what NHIN Direct is, on the most basic level, which is being able to send secure internet-based point to point messages without boundaries.
· To Noam’s question of whether a HISP is required, he found out after asking the Documentation and Testing WG that a HISP is not always required. HISPs will likely be used in reference implementation but some of the work done in a HISP can be done within a system before it is sent out to another user.
· Slide 2 simulates some of the info Arien summarized about Stage One MU.
· Slide 3 displays some of the technology behind Direct and includes assumptions about what is out of the bandwidth of Direct.
· Slide 4 frames up NHIN Direct in the context of the greater NHIN.
· Slide 5 shows the implementations underway and the potential in terms of millions of stakeholders reached by Direct.

Round the Room: Comments on “What is NHIN Direct?” slides

Didi Davis
· Great work.
· Noted that there are so many volunteer organizations involved and somehow WG needs to incorporate who is involved into general messaging.
Arien Malec
· Document could link to the wiki where all of that information is publicly available.
Didi Davis
· Right. The scale of the mass group of people involved is what gets others interested.
· And on the last slide where the real world pilots are described it again could link to the wiki.
Janet Campbell
· Slide 2 should clearly indicate that Direct can provide the tools for sending the information but not the actual electronic summary at the other end.
· Concerned about “boundaryless” on Slide 1 because for a while a user won’t be able to send to just anyone’s NHIN Direct address. The user on the other end at first will not trust me because they won’t know who I am so I cannot just send to them.
· Need to include more about when and how the average user might expect to use Direct.
· Assumptions on Slide 3: might also want to mention the interoperability assumption and that Direct does not provide translation from one EHR to another.
· “E-mail” should always have a hyphen.
Arien Malec
· Stressed the importance of the content assumption, that the receiver can interpret the content at the other end of the relayed message. This is not necessarily true.
Noam Arzt
· Echoes some of the earlier comments.
· On Slide 2: notion that we can’t really control anything about the content.
o Maybe slide needs to be reduced to 6-8 relatively simple bullet points that say what the items are.
o Slide is too text heavy.
· Slide 3: assumptions glide by like ads on TV for auto financing or something with all the little writing on the bottom which is really important but everyone ignores.
o Dense, shaded box of assumptions.
o WG should think about tone and feeling of the Assumptions section.
· On Slide 5, what is the map trying to say?
· Is it saying our hope is that its x number of hospitals and providers will be connected through Direct? Because when he looks at this slide now he sees that right now NHIN Direct has all of these actors already actively committed.
· If this is a potential or a hope, it should be presented as such.
Karen Donovan
· No comment.
John Blair
· Is Assumption 1 on Slide 3 accurate? “As required by law or policy, the Sender has obtained the patient’s consent…”
Arien Malec
· The ONC HIT Policy Committee has endorsed that directed messaging doesn’t require separate consent.
John Blair
· Suggested to take out consent comment.
Rich Elmore
· àProposed to refer consent question back to Documentation and Testing WG through Janet, because the content on the slide was pulled from the NHIN Direct Overview Document.
· Expressed desire to stay in sync with the language of the Documentation and Testing WG.
· After the Documentation and Testing WG has reviewed the point, the change can be made to the slide.
Janet Campbell
· Suggested offline discussion because the consent assumption appears correct as written.
John Blair
· Does not think consent is required by law.
Janet Campbell
· Certain consent measures may be required by state law and in other circumstances under which Direct is used.
Rich Elmore
· àAgain proposed to refer back to Documentation and Testing WG and for Janet to let Communications WG know what decision is made.
· Explained that the Documentation and Testing WG is the authoritative source on what Direct is and the job of the Communications WG is to make sure the message gets framed well for the right target audiences.
Susan Leonelli
· On Slide 1: liked the overview, but thought that “sending secure emails” sounded like something providers can do on their own after they get their HISP address. Yet in reality communicating could have 2 different aspects.
o Direct can help upload the payload of info a provider wants to send, and help him/her find who they want to send it to (Phase 1), but what Direct cannot do is disarticulate it and put it into all the right places in the EHR they view every day.
· On Slide 4 in describing what NHIN Direct is in the context of the wider NHIN, there is no explanation as to how they will be working together in the future, if they will be working together or side by side in the future.
Brian Ahier
· Covered well.
· In the Assumptions on Slide 3 the first two bullet points are legal and policy questions more than the others. Agrees that it sounds like something people will gloss over.
Michele Darnell
· Great start.
· Comment is similar on Slide 2: volume of information is too much.
· Suggested to include the bold points but break down the rest.
· All included info is great but needs to be simplified.
Didi Davis
· No further comment.
Arien Malec
· Liked conversation about the deck and the content of the deck.
· Identified next step: simplify the presentation.
· Might be a personal style difference, but he prefers to present simple slides and leave the words for the notes and talking.
· Found need to simplify overall visual.
· Understands that sometimes folks prefer the words on the page to talk to.

Rich Elmore
· Great feedback.
· Noted that WG needed to get to conversation on messaging to vendors, but given the time, proposed to push that conversation to next week’s meeting.
· Asked for feedback on next priorities for the WG.
o Should WG now focus on one-page pamphlets or something else?

Arien Malec
· Thinks WG is working in the right direction.
· Next steps should be to:
o àSimplify and get clear on “What is NHIN Direct?”
o àFinalize key messages for providers.
o Then move toward developing more communications materials.

Rich Elmore
· Asked Arien how he wants to start using the communications materials so WG can be proactive with regards to upcoming key events.

Arien Malec
· Is doing a presentation on Thursday, but will probably use his own material.
· As mentioned earlier, he tends to use spare slides and talk more from notes.
· There is a key need from the overall Implementation Group, mentioned by David Tao and Doug Arnold, to have materials with answers to “what is Direct” and “how does Direct impact x organization?” when they have different opportunities to talk with stakeholders.
· IG members will run with any communications materials the WG can provide them, so it is important that they can deliver consistent messages to stakeholders in their area.
· Turned question back to the WG: If all WG members agree the produced materials are solid and compelling, where would they use it?

Round the Room: Prioritizing Communications WG next steps and how would you use Communications WG materials?

David Kibbe
· Noted the importance of getting the communications documents in good shape, and then getting IG members to commit to using them.
· When he gives talks about NHIN Direct or incorporates Direct into another talk he is giving, he wants to have these slides available. He would not go over the deck slide by slide but wants to have them on hand.
Didi Davis
· Introduced an upcoming Southeast HIE summit where she would have a chance to discuss Direct.
· Also is part of a “lunch and learn” series with members of the TN REC, where she can help them understand what Direct is as they work with providers.
· Suggested keeping a library of slides for members to contribute to and borrow from as they adapt the deck for presenting at their respective events.
Janet Campbell
· Likes pretty one-pagers.
· Foresees no reason to use the slides personally, but thinks most people could tweak and use them.
· Noted that most text can be bumped to notes rather than including on the slide.
Noam Arzt
· Can think of a million ways he could use the slides.
Karen Donovan
· No additional comments.
John Blair
· Has already used the content of the slides.
Susan Leonelli
· Using “every day” and as a vendor is challenged to try to educate their sales people.
· Timing of implementation, not just what Direct is, is an important part of the message.
· Stressed keeping an eye on the ball with branding and the Direct name.
· This WG has an opportunity right now for education and marketing.
Brian Ahier
· The one-page PDF (in Agenda, above) is the best document we have right now because it includes a simple explanation.
· He will certainly use himself.
· It is very popular on the wiki, as many people are downloading.
· Agreed that WG needs to figure out a brand name soon or will lead to the necessity of a re-education of stakeholders after the name changes.
· The sooner WG agrees on a name, the better.
Michele Darnell
· Agreed on importance of naming, branding.
· Also thinks a consistent message is important.
Uvinie Hettiaratchy
· Offered a word of caution: all of messaging should be as consistent as possible in addition to keeping the brand consistent.
· Will be called “The Direct Project” in all messaging for now, at least until there is another name.


Rich Elmore
· Janet has prepared the one-pager that Brian referenced it (in Agenda, above).
· àEncouraged WG members to take a look through it.
· Thanked everyone for their great work.