Implementation Geographies WG Call

Wednesday, March 02, 2011
12:00 PM EST

Doug Arnold - (MPS and CGC), Parag More (MedAllies), Mark Bamberg (MEDfx), Noam Arzt (HLN Consulting, LLC), Andy Heeren (Cerner Corporation), Gary Christensen (RIQI), Greg Chittim (RIQI), Kim Long (MedPlus), Bruce Schreiber (MaxMD), Will Ross (Redwood MedNet), Arien Malec

Arien -
Let's just do a simple tour around the pilots for a quick status. The HIMSS demos were really great. Everyone appreciated seeing all of your hard work.

MPS
Doug -
We are continuing recruiting actively for physicians. We've also had some requests to join. Navinet wants to come on board and be a HISP with our pilot and potentially other pilots. They have a lot of connectivity which may help facilitate clinical messaging. Quest / MedPlus has completed their work with Microsoft HealthVault. We're still waiting on Covisint and eCW. I should have more information next week.

I hope everyone saw the article in the NYTimes the other day.

Arien -
I guess between Care360 and HealthVault you're quasi-live. Any idea when the other first transactions will be?

Doug -
I think over the next couple of weeks.

MedAllies
Arien -
We had a lot of great demonstrations. I think the MedAllies demo showed deep EHR connectivity and the live demonstrations that were done on stage were very interesting.

Parag -
Thank you for everyone's strong showing at HIMSS. As far as our status goes: we are hoping that we'll have this up and running in Albany before mid-next week. We have a target of the 9th. We'll follow that with some administrative and clinical users live usage testing and expanded to the bigger group thereafter. I think we're definitely looking for as much feedback as possible.

CareSpark
Arien -
People saw the VA demo with CareSpark.

Redwood MedNet
Will-
Regarding HIMSS, I really enjoyed when a user started asking questions about some of the technical decisions we made. For example, we were using WiFi, iPads. We weren't featuring the e-mail client we were feeding an embedded messaging service as part of our HIE fabric. It was also great to be able to pass people back and forth to the other demos.

We are continuing to press for the first production instance. We have a new site that wasn't on our project calendar that saw the demo and we have a meeting scheduled with them next week to build out an end-to-end delivery route through Redwood MedNet's HISP to HealthVault. One thing that was underfeatured in our demo was that we were able to push to HealthVault starting on Wednesday at HIMSS. We'll see where that leads next week. One of the other features that I wanted to mention: in a lot of cases, Direct enables us to stage the in query and in some cases the SMTP backbone is not the optimal solution that we identify at the end of the discovery process with the site. I don't want to miss that feature of Direct as an enabler of interoperability even if you don't end up adopting the Direct protocol.

Arien -
The key to me is not what edge protocol you're using. The MedAllies pilot demonstrates that really beautifully. The key is that you've got broad network connectivity that stitches together the providers that you've got in the last mile in your area, but also enables interoperability with providers that are on a different network. It's not so much that you're using SMTP, it's that you can send/receive with anyone else that's using Direct.

Will -
We are trying to pull out all of the stops so that we're one of the live sites when you go before the committee.

VisionShare (Ability)
[No representative]

Health Information Network of South Texas
[No representative]

Cerner
Andy -
Just a quick update as of last Friday (25th), we had production: clinical information being shared between Heartland Regional Medical Center and Living Community of St. Josephs (LTC facility). Our next steps are approaching and connecting additional endpoints: a urologist, a family practitioner, etc.

Arien -
Get me the details. I'd love to highlight that.

MEDfx
Mark -
I just wanted to say that we're expecting to send our first production message soon. We were able to demonstrate Direct messaging to HISPs that were in the Verizon cloud on virtual machines and send messages and attachments back and forth. We've integrated it into our portal software which we expect to be in production next week. We'll be demonstrating the medical home user story that we were demonstrating at HIMSS.

Arien -
That is excellent. One thing that we've been discussing is that this community, the stuff that you guys are learning is incredibly valuable and I'd like to find a way to keep this group up and running after the end of March. If we can learn what patterns work, what are the workflow/technology patterns that work, what doesn't work, what do we need to address. I'd like to gauge interesting in keeping the meeting going monthly or biweekly.

For organizations that are live, it would also be useful to collect usage statistics. We can think about utilization tracking and metric tracking and we could provide some support in terms of pulling all of that together.

Doug -
Have you or ONC had any discussions about the AAFP Physicians Direct that was announced a few weeks ago in Washington?

Arien -
As you know, Farzad was at the launch. We've been having follow up discussions regarding that and other projects that have Direct connectivity built in. They got an award to build out 500 hospitals for ELR for public health.

Doug -
Is ONC keeping any kind of a database on EHR vendors that have agreed to embed the Direct protocol into future versions?

Arien -
If you look at the Ecosystem page on the Direct project, you can see the organizations that have made some indication that they will incorporate Direct. We're not keeping track of exactly which versions, etc., but you can see that there are over 65 organizations right now that have plans to roll out Direct.

Doug -
Is ONC pushing the state HIEs in any kind of a coordinated fashion regarding implementing Direct protocols?

Arien -
ONC has a set of instructions for the HIE programs that need to address Stage 1 MU in the short term. ONC also has a set of principles that include openness, so one of the strong requests to states is that their State HIEs include directed exchange, and many states have addressed those requirements through incorporating some aspect of Direct in their State plan. If you look at that ecosystem page, you'll see about 20+ states right now.

There is no "thou shalt use Direct" at this point. There is a set of policy rules and principles that are leading administrations to incorporate Direct.

Doug -
I was on a call a couple weeks ago and heard some horror stories about what some of the state HIEs are looking to charge physicians to join, and I was just floored.

Arien -
Right, I think we're seeing price point of $15/ month for basic clinical messaging. My experience in previous roles is that for the basic for clinical activity that's about the right price point. I think organizations that don't have a value-based approach to how they roll out solutions, markets are going to tell them what pricing models work and don't work.

Gary-
Physicians are starting to forward to us communications that are coming out of vendors and people are starting to call themselves HISPs. It's funny because that term is getting adopted and it's already confusing doctors.

Arien -
We're trying right now to create the conformance document that essentially describes what you need to show to be Direct compliant. The basics of that are the ability to send and receive to any other Direct compliant solution. If you call yourself a HISP and you can't address physicians outside of your network and physicians outside your network can't message your physicians, that's just not going to fly.

Will -
It's great for the compliance document to describe that, but the term HISP is out there in the wild.

Arien -
What that document does is define universal addressing and the principles of openness. I do believe we can take that and use it as an RFP test, for example. Are some people going to buy solutions that are proprietary and locked in believing that they're buying open solutions? Yes. My belief is that physicians want and need open networks in order to meet clinical quality goals. Closed networks are going to have competitive pressures.

Will-
We're still not talking about the escape of the acronym into the wild and it's use as anything that the marketers want it to mean.

Arien -
We'll work on the leverage that we can.

Gary -
I was bringing it up because I'm more worried about physicians' confusion.

Arien -
The reasonable inference is "it's a HISP, therefore it's open and not proprietary."

Gary -
We're in the middle of doing planning around getting some education out to the physician community that kind of hits this topic in some way shape or form.

RIQI
Greg -
Now that we've already proven the point-to-point production, it's how do we role that out statewide. That's a combination of getting a HISP marketplace so providers can chose the right HISP based on price, volume, etc.

Gary -
And we're doing that through our vendor marketplace.

Greg -
We're starting that process and also developing the training for providers.

The other track of the EHR to state HIE connectivity: we've got our gateway up and running in an environment that we're doing final integration testing on. Then we're working with our EHR partner who is in the process of upgrading one of their practices to the latest version with Direct.

Gary -
I think our first launch for CurrentCare HIE, with all of this activity, I actually think our 2nd data sharing partners are going to be physicians.
The other thing is that we've got 3 or 4 other platforms in various conversations and levels of commitment on making their platforms compatible with the HIE, focusing on Beacon. The adoption question hasn't been a major roadblock, but thus far we've had some positive response.

Arien -
I've got 2 "asks" for you: 1) Are there best practices for REC integration that you can share with other RECs across the country. 2) As you know, there are many states that have this model that says if everything doesn't flow through me then how can I improve quality statewide? I always say "from a patient privacy and HISPs perspective you can't do that secondly that you don't need to do that" and point at you guys.

I'm still waiting for the very first CT -> RI transition of care...

Gary -
We're all stuck with this portion of grant money that is required to be for interstate transactions.

Doug -
Let's talk about a bi-state pow-wow on this.

Arien -
I'm almost positive that the answer about promoting this with the Direct strategy is going to be "well, sure."

Gary -
I'm not sure if everyone has put 2 and 2 together yet.

Greg -
To repeat my call, if there are not HISPs that have been actively involved and are interested in working in the Rhode Island market they should get in touch with Gary and/or I -->

Arien -
That's definitely going on the best practices list.

Doug -
How many docs have you signed up in RI?

Gary -
Around 500.

Greg-
The director of our REC got a call yesterday from an ultrasound tech in a hospital in Nebraska whose boss had heard about Direct and asked her to research it, and she ended up finding her way to us. It really is amazing how far reaching the Direct Project is already.

Arien -
Great work, great news, thanks everyone.

[end of meeting]