NHIN IG 05112010.pdf

Notes from NHIN Direct Implementation Group Meeting

Status of Notes: DRAFT
Date: May 11, 2010
Time: 2pm-3pm
Attendees:
Allscripts, CareSpark, Cerner, Clinical Groupware Collaborative, eClinicalWorks, eCertus, EHR Doctors, Epic, Gartner, GE, IBM, ICA, MedAllies, Medicity, MedPlus, Inc./Quest Diagnostics, MedPATH, Microsoft, Mirth Corporation, Oregon Strategic Workgroup for HIT Oversight Council, Redwood Mednet, Relay Health, Social Security Administration, SureScripts, RIQI, VA, VisionShare, Siemens, Atlas Medical and MOSS

Decisions from this meeting
#
Date
Action
Status
Owner
Due Date
20
5/11/10
Karen will write up her contribution on the Wiki about her “Cross” and Arien will blog this at the same time as well
Open
Karen & Arien
5/17/10
21
5/11/10
All members who have feedback on the Face-to-Face Meeting should share their thoughts on the Wiki
Open
All
5/17/10
Decisions from last meeting
Date
Decision
5/6/10
More conversation needed for the Security and Trust WG, specifically around the following: 1) Harmonization of HITPC recommendation language with Security and Trust WG outputs 2) Exploring out the concrete proposals – i.e. how they would work in the real world? And then presenting to the NHIN Workgroup and Privacy & Security Workgroup with technology/policy tradeoffs for each option.
5/6/10
More discussion around the Concrete Implementation WG is needed, including: the addition of a month for completion, not just having one implementation, and also tightening up acceptance criteria.
5/6/10
More conversation needed for the Comprehensive HIE including looking at a mapping between a minimal metadata model and sophisticated metadata model and also ensuring the mandate includes state/regional HIOs where the HIO runs an equivalent set of services to NHIN.
5/6/10
Not ready for consensus on the Content Packaging Spec, more discussion is needed about: the security & trust issue of encryption and signatures, and “Karen’s Cross” – i.e. how do you cross map between a minimal metadata model and sophisticated metadata model.
5/6/10
Reached Consensus on the Abstract Model.
5/6/10
Reached consensus on Addressing Specification with the caveat that Karen Witting’s question should be addressed (change authenticate to double arrow and list/push should be combined into one transaction).
5/6/10
Reached Consensus on User Stories, with the caveat that Individual involvement WG needs to continue work on the patient to provider story.

Notes from Meeting
Timeline
· Not giving organizations a lot of time to do development
· The longer we don’t have specifications, the worse that problem will be
· June 11th – core specifications and service deliverables
Review of the Deliverables for June 11th Meeting
· Some of these will just be updated what we already have or a final first cut
· Well thought through, well documented final specifications
· Aggressively manage those deliverables to make sure we are doing these in parallel
Review of final deliverables
· Core specifications
· Testing, conformance and reference implementation models
· Making sure we can hit our second milestones will be critical to making sure we get this all done
Face-to-Face Meeting
· Appreciate feedback, energy and level of discussion had
· Travelers from near and far
· Key Take Aways
o Policy coordination – policy/technology language needs to be kept in synch and it is hard to separate these two – we had the benefit of having policy/technology experts in the room like Farzad Mostashari and Devon McGraw
o Comfort with Middle and Edge – we tried to take a hard line to choose one as a validated assumption and there was more comfort with HISPs that can talk
o Timeline for Concrete Implementation Group for the week of June 6th (perhaps June 8th)
o Karen’s Cross
§ Comprehensive HIE interoperability
§ Edge to HISP … mechanics of how this gets done
§ Crystallizing our thoughts around metadata (content packaging WG will take this up soon)
o Process to work on
§ Business in the front, discussion in the back
§ Devon/Farzad in the room
§ Barreled into the meeting – define deliverables upfront and be more thoughtful
§ Encourage people who have feedback on the Face-to-Face Meeting to share thoughts at end of the call or on the Wiki
§ Distance
·Organize around face-to-face meetings, but will make things easier for
User Story WG

· To date WG has:
o Developed a set of Use Stories broken down by priority (1, 2 & 3)
· During the Face-to-Face meeting, the WG:
o Voted on consensus for User Stories listed as priority 1
o Reached Consensus on User Stories, with the caveat that Individual Involvement WG needs to continue work on the Patient to Provider story
o Got valuable feedback
o Changed language from must/could/should to priority 1, 2, 3 with the intent that all of these stories are important, but the priority is only when we will do them
o {Peter will be taking a pass to incorporate feedback about User Stories can be laid out in a more clear way
Question from Rich Elmore: what is the priority of "Karen's Cross" (on the 1-3 scale)?
· Grounding the Concrete Scenarios in the User Stories
· Need User Stories that incorporate cross cutting
Question from Karen Witting: User Story concerns regarding patient identifiers and Data Exchange section were also to be addressed
· Will be addressed in the next pass through: User Story concerns regarding patient identifiers and Data Exchange section were also to be addressed
Question from Wes Rishel: Did the changing decision process change the date of the next F2F meeting? Is there thought of making F2F a 1.5- or 2-day meeting? In my experience a REALLY good meeting approach is to pose the hard problems on day 1, let folks go to their rooms or the bar to mull it over informally and then meet the second day.
· Hold the afternoon of the 10th and the 11th
· Meaty challenge, and then social engagement
Question from David Tao: For newcomers (this is my first call) what exactly is "Karen's Cross." I know it has something to do with interaction between edge and HIE, but is this written down anywhere?
· Karen will write up her contribution on the Wiki about her “Cross” and Arien will blog this at the same time as well
Content Packaging
· To date WG has:
o Created a draft proposal: http://nhindirect.org/Content+Container+Specification
· During the Face-to-Face Meeting, the WG:
· Decided it was not ready for consensus on the Content Packaging Specification
· More discussion is needed about:
· The security & trust issue of encryption and signatures
· “Karen’s Cross” – i.e. How do you cross map between a minimal metadata model and sophisticated metadata model.
· Agreed multipart MIME would be supported
· Discussion about restrictions in multipart MIME but no specific agreement
· Agreement on XDM to be imbedded using MIME to transport data
· Didn’t get decision about signing or headers
· Unfinished business:
o Negotiation between minimal metadata and comprehensive metadata and understanding/fleshing this negotiation out
o Encryption and signatures
· Low level detail questions about how we will use MIME but queue up for the future
o Discussion about “reply” to a message can it edit the previous message?
Security and Trust
· To date WG has:
o Created a Basic Trust Model:
§ http://nhindirect.org/Basic+Trust+Model
o Created a Keys for Consensus:
§ http://nhindirect.org/Basic+Trust+Model+-+Keys+for+Consensus
· During the Face-to-Face Meeting, the WG decided:
o Tried to distill principals that we were putting on the table for “must haves” for whatever technology comes together
§ Right ones to be having conversations about
§ Farzad: more explicit about the language – sync with Policy groups to ensure that it was more clear
o Choice about whether these bullets as indicated
§ Ability to ID down to an endpoint, ability to have a non-unique single trust authority
§ Imply a technology to support them
§ Alternative: simplify this with something that can be handled with something like TLS, but that has costs associated with it
§ Attempt to reframe those bullets with discussion points – Fred is doing this
§ Explore what it would look like to actually use these things in the real world, and see how it would look concretely and see what the policy trade offs/technology trade offs were
§ Be prepared that we will be in this policy/technology knot for a while
o More conversation needed around:
§ Harmonization of HITPC recommendation language with Security and Trust WG outputs
§ Exploring out the concrete proposals
· I.e. how they would work in the real world?
· Presenting to the NHIN Workgroup and Privacy & Security Workgroup with technology/policy tradeoffs for each option
Comprehensive HIE Interoperability WG

Question from Sean Nolan: why do we have separate Google group for the IHE implementation group. Is there a reason not to use the wiki for this? I would like to have a history of those discussions if possible and the fewer places to go the better.
· Open for everyone to read
· Allows us to more easily exchange information in the Google group
·Substantive discussion should point to the Wiki discussion links

Individual Involvement WG
· To date WG has:
o Provided guidance to other workgroups around individual involvement
§ User Stories
§ Content Packing
§ Patient to Provider Considerations:
· http://nhindirect.org/Patient+to+Provider+Issues+and+Implementation
· During the Face-to-Face Meeting, the WG:
o Shared updates about their status
o Saw strong support for Provider to Individual communication (MU 2011)
o Saw a strong interest in Individual to Provider communication (MU 2013).
§ Security & Trust framework supports Individual to Provider Communication
§ User Stories exclude Individual to Provider Communication for Priority 1.
§ Optics of explicitly denying patient to provider communication in S&T / HISP not ideal
§ HIT Policy Committee support needed to accelerate
§Priority 1.5?

Addressing & Directories WG
· To date WG has:
o Proposed & reached consensus on the Addressing Specification:
§ http://nhindirect.org/Addressing+Specification
· During the Face-to-Face Meeting, the WG:
o Reached consensus on the Addressing Specification
o Discussed plans to take on directory services to provide these addresses and related information about the end-point to authorized users of NHIN-direct
oDiscussion around including HL7 data type, we decided to take it out

Question from Epic: who is taking on routing?
·Each WG will take this on themselves

Abstract Model WG
· To date WG has:
o Proposed and reached consensus on the 2.2 version of the NHIN Direct Project Abstract Model: http://nhindirect.org/NHIN+Direct+Abstract+Model
· During the Face-to-Face Meeting the WG:
o Reached consensus about the NHIN Direct Project Abstract Model 2.2, with the caveats that
§ “Authenticate” be changed to double arrow
§ “List/push” should be combined into one transaction
o Since the Face-to-Face meeting, these changes have been made
o Went over the difference between 1.1 and 2.1
oUnanimous discussion with caveat that Karen should change and version 2.1 is approved

Concrete Implementation WG

· To date, the WG has:
o Created four implementation groups:
§ REST: http://nhindirect.org/REST+Implementation+Development+Team
§ SMTP: http://nhindirect.org/SMTP+Implementation+Development+Team
§ IHE / SOAP: http://nhindirect.org/IHE+Implementation+Development+Team
§ XMPP: http://nhindirect.org/XMPP+Implementation+Development+Team
· During the Face-to-Face Meeting, the WG:
o Decided that more discussion is needed, including:
§ Major concern about the short timeline
· Addition of a month for completion : materials are now due the week of June 6th
· Now having an interim milestone
· Deliverables will be evolving in parallel with Concrete Implementation
§ The “Minimum Threshold” definition is not crisp enough
· Not concrete enough to get started on
· We will create a much more objective, detailed threshold
§“One implementation,” while appropriate for the backbone, may be overly-restrictive from an edge perspective

Implementation Geographies
· To date, the WG has:
o DRAFT early list of potential geographies: http://nhindirect.org/Potential+Implementation+Geographies
o DRAFT early list of operational considerations
§ http://nhindirect.org/Implementation+Operational+Plan
· During the Face-to-Face Meeting, the WG:
o Shared updates
·Encourage participation – anyone who wants to join, please do so

Future WG
· Testing WG
· Documentation WG
WG Schedule
· User Story Review WG Mondays 11am-12pm EST
· Content Packaging WG Wednesdays 1pm-2pm EST
· Security & Trust WG Thursdays 2pm-3pm EST
· Comprehensive HIE Interop WG Tuesdays 2pm-3pm EST
· Individual Involvement WG Thursdays 1pm-2pm EST
· Implementation Geographies WG Fridays 2pm-3pm EST
· Addressing & Directories WG Wednesdays 3:30pm-4:30pm EST
· Abstract Model Review WG Wednesdays 11am-12pm EST
· Concrete Implementation WG Tuesdays 12pm-1pm EST