Notes from Geographies Meeting
Date: September 22, 2010
Time: 12pm-1pm
Attendees: Doug Arnold, Noam H. Arzt, Yvan Charpentier, Greg Chittim, Gary Christensen, Hank Fanberg, Michael Firriolo, Uvinie Hettiaratchy, David Kibbe, Kim Long, Parag More, Patrick Pyette, Will Ross, Vidit Saxena, David Tao, Paul Tuten, Chris Voigt, John Williams, Chris (NextGen)

Current Actions

#
Date
Action
Status
Owner
Due Date
39
2010/08/25
Update the Technology Providers x Pilots Crosswalk
Open
Pilot Leads: Gary Christensen, Susan Torzewski, Will Ross
2010/09/01
41
2010/08/25
Update wiki page for each individual pilot project, including the user stories being tested
Extended
Remaining: All Pilot Project Leads
2010/09/29
45
2010/09/01
Input requests into the Resource and Collaboration Needs for Pilot Projects
Open
Entire WG
2010/09/17
46
2010/09/01
Discuss off-line collaboration opportunities between the MPS and MedAllies pilot projects
Open
Doug Arnold, Parag More
2010/09/08
54
2010/09/22
Coordinate a Reference Implementation WG update for the Geographies WG
Open
Jas Singh
2010/09/28
55
2010/09/22
Insert pilot-related questions into the Open Questions Tracker for Pilots
CLOSED
Parag More, Will Ross
2010/09/24

Last Week's Actions

#
Date
Action
Status
Owner
Due Date
33
2010/08/17
Bring to Doc & Testing WG: Dispelling the mentality of "If it's going through Direct, then we can save a record"
CLOSED
Paul Tuten and Chris Voigt
2010/08/25
39
2010/08/25
Update the Technology Providers x Pilots Crosswalk
Open
Pilot Leads: Gary Christensen, Doug Arnold, LeRoy Jones, Susan Torzewski, Will Ross
2010/09/01
41
2010/08/25
Update wiki page for each individual pilot project, including the user stories being tested
Extended
Remaining: All Pilot Project Leads
2010/09/22
45
2010/09/01
Input requests into the Resource and Collaboration Needs for Pilot Projects
Open
Entire WG
2010/09/17
46
2010/09/01
Discuss off-line collaboration opportunities between the MPS and MedAllies pilot projects
Open
Doug Arnold, Parag More
2010/09/08
52
2010/09/08
Compile and sent list of Geographies FAQs to Doc and Testing lead Janet Campbell
CLOSED
Paul Tuten
2010/09/17
53
2010/09/15
Create an Open Questions Tracker for the pilot projects
CLOSED
Jas Singh
2010/09/22

Agenda

  1. Review of actions from previous meeting
  2. Pilot Updates
  3. Open Questions for Best Practices WG

Notes

Rhode Island Quality Institute
Gary Christensen
  • Reported that RIQI had met with all their vendor partners
    • Distributed in-group "homework" assignments
  • Put presentation up on the wiki for RIQI's Pilot Approach
    • Might prove useful for other pilots

Medical Professional Services (MPS)
Doug Arnold
  • Held conference call with Quest/MedPlus
  • Conducted survey of all their e-mail clients
    • Trying to get as much information as possible
  • Concerned about MedPlus' delay with the HISP
    • May take until late January
  • Asked if there were any decisions about domain names
Paul Tuten
  • Responded there have not been any decision as of yet
    • Waiting on the Best Practices WG

MedAllies
Parag More
  • Held discussions with their integrating partners
  • Finalized individual strategies with 2 of the vendors
  • Informed WG that they had two questions for the Open Questions Tracker for Pilots
    • Paul Tuten had already posted one of their questions
    • Parag More will put the other one up

CareSpark
Chris Voigt
  • Presented on behalf of Susan Torzewski
  • Informed WG that they had captured the data necessary for their modeling
  • Held some conversations with the Connect development team
    • Announced yesterday at the Code-a-thon that they will be able to sync
  • Reported that the CareSpark pilot is currently lining up matters internally
Paul Tuten
  • Asked if they had any resource needs from the WG
Chris Voigt
  • Responded that they are good for now

Redwood MedNet
Will Ross
  • Reported that they are still facing same resource constraints
    • However, Redwood MedNet's main partners are still pushing the project forward
  • Informed WG they are addressing the legal agreements necessary with state officials
Paul Tuten
  • Asked if they had any resource needs from the WG
Will Ross
  • Responded with a question for other pilots about their projected time-lines
    • Has told participants that he would like to aim for end of November for their pilot
    • Before the Christmas holidays
  • Asked if the different pilots were trying to harmonize a broader time-line
Paul Tuten
  • Responded that the WG can talk through that after the VisionShare pilot update

VisionShare
Paul Tuten
  • Reported that VisionShare faces the same contractual problems
    • Informed WG that he is on the road
      • Trying to discuss with the potential pilot candidates in person
  • Responded to Will Ross' question
    • Time preference was similar
      • Aiming for end of November
      • Introduction by 2010

Project Time-lines

Will Ross (Repeat)
  • Asked pilot projects their projected time-lines
  • Summary
    • RIQI: Testing + Production Q4-2010, Pilot Q1-2011
    • MPS: Testing late Q4-2010, Production Q1-2011, Pilot Q1+2-2011
    • MedAllies: Testing late Q4-2010, Production mid/late Q1-2011, Pilot early Q2-2011
    • CareSpark: Testing + Production Q4-2010, Pilot Q4-2010 to Q1-2011
    • RWMN: Testing + Production Q4-2010, Pilot Q1-2011
    • VisionShare: Testing + Production Q4-2010, Pilot Q1-2011
Gary Christensen
  • Responded that their detailed project plan will be ready next week
    • Initial testing in November
    • Test Data Pilot: Going into production in December
    • Live Data Pilot: Real live data with a really small population in first quarter of 2011
    • Limited Roll-out: Planning to role out to the beacon community also in the first quarter of 2011
    • Statewide Roll-out: Planning to role out to Rhode Island at large after that
Doug Arnold
  • Passed MPS response to Kim Long
Kim Long
  • Indicated that the MedPlus HISP should be completed by the end of November/early December
    • Integration testing should take place in early December
    • However, a "code freeze" on MedPlus servers is scheduled from mid-December to January
    • Would not go into production until January then
Parag More
  • Shared that MedAllies is looking to finish integration testing in the late 4th quarter
    • Production will take place after that
      • Targeting mid-to-late first quarter
Chris Voigt
  • Indicated that CareSpark plans to get started in November
    • Rolling out after that
Paul Tuten
  • Asked Jas Singh to arrange for a reference implementation update
Gary Christensen
  • Commented that the HISPs are not a problem
    • The APIs are the concern, because they are what the HISPs need to begin integration, testing and production

"Round the Room" for Open Questions

Paul Tuten
  • Recognized that Uvinie Hettiaratchy had suggested populating the Open Questions Tracker for Pilots
    • David Tao mentioned that there is a document in the Documentation WG that already addresses geographies questions
    • Goal: To ultimately funnel these open questions there
  • Informed WG he had added his own questions as well as those he had encountered in general
    • Good for the Best Practices questions
    • Organized questions into four key areas:
      1. Questions related to HISPs
      2. Questions related to certificates
        • Identity verification
        • Types of providers that are not doctors
      3. Questions related to NHIN Direct addressing conventions
        • Domains
        • Existing e-mail addresses
      4. Questions related to provider directories
        • Should they be centralized?
  • Called for a "Round the Room" on the current Open Questions Tracker for Pilots
    • Asked WG call participants to look at the questions (specifically #4-10)
      • Are they comprehensive?
      • Other questions?
      • Prioritization of questions?
Chris Voigt
  • No comment
Hank Fanberg
  • No comment
David Kibbe
  • No response
Doug Arnold
  • Commented that it looked complete (so far)
Vidit Saxena
  • No comment
John Williams
  • No comment
Michael Firriolo
  • No comment
Noam Arzt
  • Commented that it looked complete (so far)
  • Raised a point for question #6
    • Should ask: "Why should anyone trust the HISP?"
Patrick Pyette
  • No comment
Parag More
  • Commented that it looked complete (so far)
  • Informed WG that he plans to add MedAllies' questions
Kim Long
  • No comment
Yvan Charpentier
  • No comment
Chris (NextGen)
  • No comment
Will Ross
  • Commented that it looked complete (so far)
  • Informed WG that he plans to add Redwood MedNet's questions
Gary Christensen
  • Commented that it looked complete (so far)
Greg Chittim
  • Commented that it looked complete (so far)
David Tao
  • Commented that it looked complete (so far)
    • Don't know what we know
    • New questions will arise
  • Suggested that the Open Questions Tracker for Pilots needs to be a living document
John Moehrke
  • Commented that it looked complete (so far)
    • Looking forward to commenting or adding questions
Paul Tuten
  • Summary: It looked complete (so far)
    • Agrees with David Tao that this needs to be a living document
Uvinie Hettiaratchy
  • Asked Paul Tuten to determine if any were of a higher priority
    • Suggested that the Best Practices WG would want to know the pilots' priorities
Paul Tuten
  • Shared his own perspective on prioritization
    • Higher Priority:
      • Questions related to certificates
      • Questions related to NHIN Direct addressing conventioned
    • Lesser Priority:
      • Questions related to HISPs
        • Will be useful in the longer term
          • Will learn more about this from the pilots
          • Not sure if this is critical for the WG today
      • Questions related to provider directories
        • Not as relevant right now
          • Business card model works for now
          • More important for production

Open Discussion

LeRoy Jones
  • Introduced himself on behalf of MedAllies
  • Asked questions about patients
    • Is it envisioned that the patient's receptacle is like a PHR?
    • Is provider directory a misnomer?
      • Even if it is an endpoint into the PHR
Gary Christensen
  • Responded that he is not sure why we would need a directory for addresses
    • It would look up the address
    • E-mail model works without a centralized provider directory
LeRoy Jones
  • Asked about trying to get the addresses "out-of-band"
    • Or do you just know the addresses?
David Tao
  • Agreed with the "out-of-band" direction
    • Simplifying assumption of NHIN Direct is that there are no directories involved
LeRoy Jones
  • Is that the official answer?
David Tao
  • There is no official answer to this yet
    • Being answered by the Best Practices WG
    • Just find the address "out-of-band"
Paul Tuten
  • Provided example of a government agency
    • May not have the same personal relationship
    • Quiet about whether this is of high importance
LeRoy Jones
  • Posited that it sounds like a provider directory is an optional aim down the line
    • Since we are supporting multiple standards (XDD, etc)
    • Asked question about the HISPs (step-up, step-down)
Paul Tuten
  • Responded that is a fair point
    • Can look at the HISP
    • What is necessary to get this going in the real-world?
      • Goal for the group in the long-run
LeRoy Jones
  • Stated that HISPs can get it
    • However, the destination HISP needs to understand what is necessary (endpoint)
Paul Tuten
  • Commented that VisionShare plans to function as a HISP
    • Know that they have a lot of protocol management and content conversion
    • Whether this is done publicly is up to each HISP
LeRoy Jones
  • Commented that they may have a directory, but does not have to be this way
Gary Christensen
  • Asked for clarification about the HISP needing to understand the endpoint
Paul Tuten
  • Provided VisionShare's perspective on the issue
    • Build a series of on-ramps and off-ramps
      • Plug and play components
      • Would translate between different languages
    • Not sure if this a requirement
      • Not an obligation for all HISPs to do
      • May be a desirable type of functionality
        • Sort of a value-added service
    • Did not want to suggest as a requirement
      • This is what VisionShare plans to do for NHIN Direct
  • Suggested the HISP requires language of the endpoint
Gary Christensen
  • Re-highlighted that doctors are not great at understanding technology
LeRoy Jones
  • Pointed out idea at the end of the day
    • Technology is certified by some method to say it is a valid way to do something
Gary Christensen
  • Commented that this may be an "in-to-the-future synchronization"
LeRoy Jones
  • Added that a HISP could go through its protocols
    • Depends in the vendor product could do more
      • Optionally noted by the HISP
    • Thinks there are ways around it
Paul Tuten
  • Shared that his experience tells it depends on your level of involvement/preference
    • If all vendors can support the same transportation protocols and the same languages (one standard) would make things easier
    • As a practical matter, to get the type of communication expected:
      • Need to offer a menu of options
LeRoy Jones
  • Commented the menu is limited to two options:
    • SMTP
    • XDD
  • Recognized that not everything goes on the edge
    • Provider directories are optional
    • Addressing will be dealt with out-of-band as default
Noam Arzt
  • Asked: Would the type of service be decipherable based on the addressing?
Paul Tuten
  • Responded NHIN Direct aims for universal addressing
Noam Arzt
  • Asked: Would it be easier to not have universal addressing?
    • You would better understand the endpoint
LeRoy Jones
  • Responded that it would not be easier because universal addressing indicates definitive security
Paul Tuten
  • Asked about a routing issue
    • How do you know to send to the translation service?
Noam Arzt
  • Asked for clarification: How to send it?
Gary Christensen
  • Responded that you do not need to know about the internet to send an e-mail
John Moehrke
  • Responded that the sender should know the XDR endpoints it can send to
    • Then it will send to a translation service
    • Need to pull it apart into the specific directions (dealt with separately)
  • Stressed that a HISP is an abstraction
    • Should use NHIN Direct mechanisms
      • They have an address and they just send it
      • Whether that turned out to be a translating service or the actual endpoint does not matter
    • Translation service between NHIN Direct and XDR
LeRoy Jones
  • Asked if the translation service is then a HISP
John Moehrke
  • Responded that the way the question was asked, then yes
  • Pointed everyone to the Deployment Models which he updated recently
    • Addresses some of these points
    • John Moehrke realized he may have to further update it
  • Stated that if one pulls it apart, then it turns out to be okay
    • They will all end up with a common NHIN Direct protocol
LeRoy Jones
  • Remembered one diagram (included source HISP, destination HISP)
John Moehrke
  • Responded that the WG should look at his updated Deployment Models
    • Hopes that is enough guidance
    • Anyone who can send NHIN Direct should be able to receive NHIN Direct
    • Should not matter as long as the protocols in between are okay
LeRoy Jones
  • Expressed view that neither XDR nor XDD should be excluded from the NHIN Direct architecture
    • May be a bit of nuance
  • Stated he will look at the document John Moehrke was referring to
Paul Tuten
  • Stated that it depends on the type of destination or source
    • Some works need to be done by some entity
    • No absolute requirement
    • Would not have to be a HISP, could be some other entity
Will Ross
  • Asked about the page with the links
John Moehrke
Paul Tuten
  • Asked if there are any other topics
    • Then can adjourn for the week
    • Thanked everyone for their participation