Notes from Implementation Geographies Workgroup
Status of Notes: DRAFT
Date: April 30, 2010
Time: 2pm-3pm
Attendees: Honora Burnett, Arien Malec,
Richard Elmore, Jonah Frohlich, Chris Voigt, David Kibbe, MD, Douglas Arnold, Brian Ahier, Gary Christensen, Paul Tuten, Frank Clark, Jeff Cunningham

Actions for This Week
#
Date
Action
Status
Owner
Due Date
1
4/30/10
Ask VA for participation
Open
Arien/Doug
5/7/10
2
4/30/10
Ask Indian Health Services for participation
Open
Arien/Doug
5/7/10
3
4/30/10
Publish list of potential geographies
Open
Arien
5/7/10
4
4/30/10
Create a starter for operational plan
Open
Arien
5/7/10
5
4/30/10
Work to form a Communications & Outreach Workgroup
Open
Arien
5/7/10

Decision for This Week
#
Date
Action
1
4/30/10
Paul Tuten will be leader
2
4/30/10
Among Other stakeholders, the Action Plan will involve: Key EHR Tech vendors, HIEs/REC, Medical societies & Rural providers
3
4/30/10
The Action Plan will attempt to understand existing referral paths

Notes
Goals:
· Substantiating this in software
· Getting clinicians to use this
· Get buy in from:
· HISPs
· Providers option for other certified EHR who want to participate in continuity
Round about whether we’re missing anything
Comment from Chris Voight
· How can we participate?
Comment from David Kibbe
· Family physicians in small medical practices
· Clinical Groupware Collaborative
o Willing to participate as a community in NHIN Direct project
o Don’t want all of this to end up in
Comment from Jeff Cunningham
· Consider the different geographic environments
· Metro vs. Rural
Comment from Paul Tuten
· Happy to participate
· Certain geographical regions would make more sense
Comment from Rich Elmore
· Strong representation of providers
· Can help coalesce some critical mass for these programs
Comment from Brian Ahier
· Categories of geographies – i.e. rural
Themes:
· 1) Encourage us to think in terms of geographies and physician mix and national connectivity
o Look at referral patterns
o Would like to see:
§ Quest/Medplus bc of lab volume
§ Surescripts
· 2) Rural providers
o Get HIE out to Rural providers

· Mission/Mandate for this group: defining the process and having organizations think through the process for how to do this
Round for Key Actions for template operational plan
Comment from Rich Elmore
· How to handle community outreach
Comment from Chris Voight
· EHR vendors and also states – a lot of intermingling
· David Kibbe
· Engaging with local and national state HIE
· Do a lot of interpreting
· Have a strong influence on the point of view that physicians might take
· Working with state and national
· Part of the action plan: create the right liaisons with the State/National professional societies
Comment from Doug Arnold
· Communication with HIE/REC grantees
· How can they get onboard with this process
· Part of action plan: exploit work that of what the REC’s are doing
Comment from Brian Ahier
· Specific set of guide
Comment from Frank Clark
· Communication with HIE/REC grantees
· CONNECT Gateway & NHIN Direct
· Promulgate & publicize
Comment from Jeff Cunningham
· Appropriate to see what needs to happen at a community level
· Look at communities that tie into a larger state plan
· Part of action plan: Community based operations plan and how that would tie into some of the larger plans
· Bridge between NHIN Direct and broader NHIN – we could lay the groundwork for this
Comment from Jonah Frohlich
· Operational plan needs to consider and reach out
· Communication component to reach out
Comment from Paul Tuten
· Operational plan sounds good
Comment from Gary Christenson
· Operational plan sounds good

· Make sure you involve:
o Key EHR Tech vendors
o HIEs/REC
o Medical societies
o Rural providers
· Understand existing referral paths

Potential Geographical Areas
· Arien: Bay Area
· Early on Provider mix, insurance mix, organizational side, technology stakeholders
o Urban
o Rural
o Underserved
o Commercial patient s
· Arien will find and publish the stakeholder matrix of participation that he’d like to see
· As many as it takes to show what works and provides value – with a manageable value
· Illinois pilot
Comment from Richard Elmore
· San Diego
· NYC
· Raleigh/Durham
Comment from Jonah Frohlich
· Bay Area
Comment from Chris Voight
· Tennessee/VA State Level
· ICA – presence at Vanderbilt
· ICA/Carespark partnership?
· Get VA to participate
Comment from David Kibbe
· Health Share Montana – a lot of support, but not a lot of technology in place (85% of physicians without EHRs)
· Christus Health - underserved
Comment from Douglas Arnold
· Central CN
· Two or three hospitals with FP residency programs with install base with eClinical Works
· Quest/MedPlus in Wallingford CN
· RI – MA
· Pan New England Program?
Comment from Brian Ahier
· Doug & Arien will reach out to Indian Health Services
· Conversation with Tribes
· Haven’t been very active – been on the sidelines
· Wastco Country – Warm Springs Tribes (five tribes)
Comment from Gary Christenson
· RI would be a good place
· Eastern CN region
Comment from Paul Tuten
· Minnesota/Minneapolis/St. Paul
· Florida – Tampa, Sarasota, Orlando
· Seasonal residents
Comment from Frank Clark
· South Carolina
· For profit, not-for-profits, DOD, relay health
· Rural/Urban in Underserved areas
· EHR adoption is about 18%
· Question from David Kibbe: What will the benefit be?
o Standardized
o Make efficient connecting to hundreds of physicians who are located in small rural areas who don’t have EHRs yet
o Don’t forget mother ship players (Academic Medical Centers) – bring the larger organizations into these pilots as well as addressing the rural sections
§ Been difficult to get the competing large players to come together and building the trust around the large CDOs
§ How can we build this up from the ground up – get rural players to join first and then the larger ones would join because they have to access this bolus of providers and bring the value proposition to them
Comment from Jeff Cunningham
· Pilot on how you would be able to pick off providers who sit between communities
· Tennessee would be good
· Client in NW Montana community HIE and set on edge of Reservation
· Arien will publish list of potential geographies
· Arien will do a starter for operational plan
· Paul will be leader
· Communications and outreach workgroup