Geographies Meeting 2010-06-30

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Notes from Implementation Geographies Workgroup
Date: June 30, 2010
Time: 12pm-1pm
Andy Heeren, Douglas Arnold, John Moehrke, Matt Koehler, John Theisen, Marla Kouche, Uvinie Hettiaratchy, Gary Christensen, David Tao, Brett Peterson, Paul Tuten
Actions for this Week
Due Date
Draft template document describing what each of the various implementation geographies pilots will do and upload to wiki
Gary Christensen
Identify which Implementation Geography you are representing, if any, on the main page:
Comment and review template on wiki


  • Discussion
    • Plan of action and methods for promoting/forming/participating in pilots -- suggestions / discussion
    • Identify who's (workgroup members) representing which pilot(s) / implementation geographies

Paul Tuten

  • Brett Peterson will fill in for Paul while he’s out of the country.
  • We have a couple of discussion items on the agenda.
  • Concrete steps need to be taken. We have put in place a reasonable framework in implementation geographies process. It’s an open and voluntary effort that people can participate in.
  • We have the ground rules for use cases.
  • We’re at a place now to start a more actively engaged and more involved pilot program.
  • We need to make sure we have a sufficient number of pilots in place and clear ownership around individual pilots.
  • We should have a sense of participation. How do we engage the floor to gain active stakeholder involvement?
  • A reasonable first step is to go around table.

Doug Arnold

  • We have seen NHIN user story MUSTs and SHOULDs. Will that change given that meaningful use criteria will be coming out soon?

Paul Tuten

  • No line of site if those will change, but at a macro level, the vast majority of them will be unaltered. There might be some prioritization that’s different. I wouldn’t imagine that there would be radical change.

Round the Room
Suggestions and Brainstorming for Next Steps on Deliverables

Rich Elmore
No comment
Douglas Arnold
· We’ve identified a few groups that would be willing to participate in pilots. We want to continue in that effort. We’ve had discussions offline with Quest/MedPlus either serving as a HISP or groups that have already got doctors in place or are using already established EHRs so we can take advantage of the implementations as they exist right now. A lot of these use cases involve physicians using varied level of technology.
· Paul Tuten –Do you have plan to reach out to folks who are not actively engaged?
· My network has about 400 physicians. We have a fairly complete assessment of where everyone is as a target. We’ve identified physicians who either have a current EHR in their office or web based access. We also have doctors who have connection with Quest for Care 360 – bidirectional or unidirectional lab results online. We’ve identified about 150 physicians who have one or more of these technologies. We also have number of physicians who have indicated they want to be involved.
· I’m on board of eHealth Connecticut which is a Regional Extension Center. Would like to dovetail those activities with NHIN Direct to get as many physicians sharing information based on technology they have now or moving rapidly to enhance their portfolio of HIT they’re using in their office.
· Paul Tuten - Given the role of this group, is there anything we can do as a group? List of deliverables that could help in Connecticut?
· We’re hoping some of the groups that are involved in this pilot, such as MedPlus, Microsoft, or Emdeon, will step up and fulfill that HISP role. Look forward to working with them. Our role is really a pilot and a beta site to see if this could work in a fairly technology heterogeneous group of physicians.
Matt Koehler
  • Kyptiq has a national network of physicians that are already connected. I think what would be helpful to understand is where other physicians in other geographies are going to launch into a pilot so we can start mapping our customers. In terms of next steps that would be helpful.
  • Paul Tuten – It sounds like if you could find another HISP in another geography where you already have a provider presence, that would be a good case for HISP-HISP interchange. Given your national footprint, maybe participate in multiple geographies?
  • That would be fair
Gary Christensen
  • In terms of possible next steps, I would suggest that each of us that have envisioned a project in a geography to do a project brief that says the purposes of this pilot is to do X,Y and Z, it will take these steps which involve these people, and these are our assumptions in terms of resources.
  • Other critical factor is the success criteria for the pilot.
  • For example, in our geography, I would describe that I’m going to ask an EHR vendor to integrate their technology. I’m going to ask HIE vendor to integrate into an HIE. We’re also going to have doctors in nearby states in similar platforms to be able to send and receive. Also have doctors that have some sort of viewer capability.
  • I am expecting there would be some reference technology to jumpstart that. I will be looking for a nationwide HISP. We are not interested in being a HISP, we just need to connect to one.
  • I suggest each of us put together project brief to see what they’re going to cover and what they’ll need.
David Tao
  • Like the previous speaker, for the prototype phase, I doubt we could be a full HISP. We would want to participate in a prototype. Some of the user stories are a better fit than others, such as referrals, discharges, and copies to patient. We have customers all over the country, so not leaning towards any particular geography. Given the user stories, we’d want to find some hospitals interested in participating.
  • Paul Tuten – On the discussion group, you had asked question on how to get started from a vendor perspective. Any more clarity around that issue?
  • Not more on that point. I think we’d want to go where the action is, where customers want to communicate. If we had enough customer interest of a particular sort, we could create a geography. The whole idea is to communicate more with small docs. Hope to communicate with customers other than our own.
Marla Kouche
  • I agree with earlier comments about brief. We have a national footprint. We’ve been talking with Doug Arnold, and as we talk to different folks, some of the comments that have come to us is around vendors asking what’s in it for me? What’s the business value? Where does the pilot go from here? Once this is over, how does it proceed? Also questions around user story which aren’t defined at this point in time.
  • Common messaging around that would be helpful. Every implementation is probably learning as we’re going, so a briefing where we could share stories would be helpful as well.
  • Paul Tuten– In terms of participation as a vendor in this space, is it safe to assume that there are geographies that are in particular interest?
  • Yes, we do intend to build a HISP. We have a national infrastructure.
Andy Heeren
  • Agree with previous collection of comments. Communication in a standard way would be helpful. Also would like to extend, because we have clients across the nation, an offer to help in any way in specific geographies.
  • We are looking specifically at an opportunity in Kansas City area which is where we’re based in doing a pilot, but would be interested in reaching out to other implementations in this geographic region.
Brett Peterson
  • I have a couple of comments. I think it would be good to take what Gary said earlier and codify that. One thing the workgroup could do is make a template that could be replicated for those who would participate to have a standard way to share. It would help understand which efforts should come together.
  • It follows the model of concrete implementation workgroup when they created capabilities document . Standard listing of questions for common framework. Create common set of questions that would allow everybody to see the different geographies.
John Moehrke
  • I was excited about what Brett mentioned. I would agree with many of the statements made earlier. GE has health information exchanges, PHRs, and EHRs, and I’ve been working hard to see if there are any customers interested in this pilot and which product lines.
  • One of the problems I’m running up against is that they want to spin up the infrastructure without turning on real patient data. When looking for pilot customers, they say, how about next year when you get it functional. If I’m going to pick up messaging infrastructure, I want it to have some other characteristics that are not part of NHIN Direct interoperability aspects. Or you have issues dealing with real patient data versus test patient data. You’re not really working with real physician workflows, since they are simulated, which goes back to Brett’s comments about what are the situations we want to simulate? It also brings up realization that we have to accept that although we want to make these pilots for NHIN Direct as real as possible, accept that because of patient privacy, hospital uptime, etc. we may have to simulate and get as close as we can. We need to be realistic. Concerns with going forward.
Paul Tuten
· It seems like there was consensus around idea of building a common document to describe what each of the various implementation geographies pilots would do.
· Would someone like to volunteer to draft a template? Ideally I think that would be a nice deliverable for next week’s meeting. Each of the various representatives would be able to fill that out. It seems like one element of that brief should be a needs section which would facilitate interaction within this group. Having this in next meeting would be good because we’re hoping to get more participants.
Gary Christensen
· I will volunteer.
Paul Tuten
· By next Wednesday, reasonable?
Gary Christensen
· Yes, need help to post to wiki.
Brett Peterson
· If you send me word document by July 6, I will post to wiki.
Paul Tuten
· Other topic is to identify whose working in which geographies. I think once we have briefing documents in place, we have some element of that. Doug in Connecticut and Gary in Rhode Island would be helpful. I think that’s the agenda for next week.
· Any other topics?
Rich Elmore
· Could you recap on where we are as a group to proceed forward in terms of number of geographies. What’s the general process?
Paul Tuten
· In terms of numbers, we haven’t felt a strong need to cap participation. We’re more concerned about having robust participation and making sure user stories are covered – by certain geographies. Knowing that public health is a concern, and since we have strong relationships with government agencies, we will reach out there. In terms of requirements of participation, it’s documented on our workgroup for MUSTs and SHOULDs. Pretty much you have to use NHIN Direct Standards.
Rich Elmore
· I’d like to propose to have this conversation at some point. It’s very much about other people’s success to move forward. We would be much better off with a more concentrated effort. I think we can decide which ones we want to engage around and measurable outcomes. I don’t think we can do that across a number of these. Doing it once and real well would jazz up excitement may be better than an open ended approach.
Paul Tuten
· What’s a good number?
Rich Elmore
· I think one may be good, but up to the group
Doug Arnold
· We have a variety of people on the call. Technology companies, vendors within specific location, etc. If you’re going to limit that you’re going to cut out everyone else who’s not a national vendor.
Rich Elmore
· Intent is not to cut everyone out. Just want to have evidence of success and ability of volunteer organization to be successful in supporting this effort. If we make it whoever wants to become a pilot implementation, there may be a higher risk of low performance and it may be harder to demonstrate results being attained.
Paul Tuten
· I guess the way that I had conceptualized it in terms of getting process going is to have a reasonably open process that allows number of organizations to participate is not problematic. I think there’s a requirement for active participation. I could see us raise the criteria or bar for participation. Arien needs to make the call. This is good discussion topic to have for next week’s meeting.
Rich Elmore
· That would be great. Just to clarify, I’m not suggesting that we select, but we decide as a group which ones we want to focus on so there may be a set that we can make visible to show evidence about performance of NHIN Direct.
Paul Tuten
· We’ll take that as a discussion topic for next week.
Doug Arnold
· Could you send out contact information for folks on the workgroup?
Uvinie Hettiaratchy
· If no one objects, I’ll send an email with everyone’s email address out.