Presentation:

Notes from the NHIN Direct Implementation Group


Date: August 3, 2010
Time: 3pm - 4:30pm
Attendees
: Amedisys, American Academy of Family Physicians, Argonne National Laboratory, CareSpark/Anakam HIE Tech, Center for Democracy & Technology, Cerner, Clinical Groupware Collaborative, eClinicalWorks, Emdeon, Epic, FEI, Gartner, GE, Greenway Medical Technologies, Healthcare Information Xchange of NY, High Pine Associates, HLN Consulting, IBM, Inpriva, Kaiser, Kryptiq, Massachusetts eHealth Collaborative, MedAllies, MedPATH Networks, MedPlus/Quest Diagnostics, Microsoft, Mirth Corporation, Misys Open Source Solutions (MOSS), NYC Dept. of Health and Mental Hygiene’s PCIP, NoMoreClipboard.com, ONC, Oregon HIE Planning Team, Redwood MedNet, RelayHealth, Rhode Island Quality Institute, Secure Exchange Solutions, Siemens, Sujansky Associates, SureScripts, Techsant Technologies, VA, VisionShare


Notes:
Arien Malec
  • Intend to take standards and specifications development activity and transfer for review to standards committee.
  • Three broad things that ONC can go do:
    • ONC can recognize a standard or specification – mandates its use by federal partners. Many of the current specifications used through NHIN Exchange has gone through that process.
    • Evaluation for inclusion into health information network.
      • That will have to be done through interim governance process post rulemaking.
    • Evaluation for inclusion for future revision of standards certification rule.
      • All three activities will be governed by standards and interoperability framework process.
    • The bigger picture items we control inside NHIN Direct project. Set of real world implementation activities. We’ll talk about pre-planning for that.
    • We’ll also have draft specifications, review it internally, then transition to an SDO.
  • Intent for initial pilot activity to be expanded to wide scale deployment.
    • Not looking for proof of concepts but seeds.
Wes Rishel
  • Question on timing for first triangle for real-world implementation.
Arien Malec
  • First triangle should be in November timeframe. Intended to be the initial real-world implementation.
  • Should be governed by advice of HITPC.

David Yakimischak

  • Timeframe and process for arriving at governance model?
Arien Malec
  • Process for pilots is what I can speak to – organizations in the pilots are participating on voluntary basis and will voluntarily adhere to follow whatever rules are appropriate.
  • We hope that they will adhere to recommendations from HITPC and the Tiger team.
  • Suspect we will have an initial NRPM sometime in 2011.
  • The HITECH Act provides a provision for NHIN governance. That governance needs to go through rule-making process.
  • Much of the work going on now by Tiger team and HITPC as a whole will preliminarily draft those rules.
  • So this is the wider set of project work.
  • If you break this down, there’s a whole set of documentation activity and reference implementation work.
  • Going down to the narrow timeline – what we’re hoping to achieve before the Face to Face meeting is enough progress on the specification(s) and associated documentation and on reference implementation so we can provide useful set of tools for implementers.
  • Lot of work to do on conformance, code writing and specification writing.
  • Much of the work we’re doing in next couple of weeks is critical. We do anticipate that there will be another Face to Face meeting prior to first start of pilots.
  • We will let pilot implementation work group advise us on when the appropriate timing should be.
  • Statements of Commitment – You’ll see here the set of organizations contributing a HISP.
    • Excited about participation.
    • Large set of organizations contributing code. Some organizations are in dual camps.
    • Another set of organizations for pilot testing and documentation.
  • We’re going to limit participation in workgroups to those who have published.
  • Publish on wiki whose going to be part of Implementation Group.
  • The short hand that we started with for the vision is:
    • Every provider and every patient in the country can send and receive clinical information.
    • If you break that down, we have set of work we’re doing.
    • The key success metrics are:
      • % of providers with reachable address
      • % of providers with reachable address
      • Volume of transactions per user address
    • Key leading indicators are:
      • Number of leading HIE providers who have Direct specifications incorporated as part of their technology
      • Number of leading service providers who have Direct specifications in their products
      • One of the reasons we’re focused on reference implementation, is that high quality open source reference implementation is fastest way to have it embedded into product
    • If step back and look at this, the vision is correct and the goal is right. Just need to get those leading indicators focused correctly.
  • Currently planning agenda for the meeting. Should be action packed and fun-filled. Theme for this meeting is that this is real.
  • The key thing to take from this slide is that we have a wiki link.
  • Please add in name and contact information to that wiki link by August 6th, if you’re not on the list, we’re not on the list at that point.
  • Security and Trust WG is on hiatus right now. We’ve completed most of the work. A little bit more work done on threat models. As soon as Sean comes back, we’ll get this back into action.
Brian Behlendorf
  • Making progress on CSharp side of the world, not so much on the Java side.
  • Have bits and pieces on the Java side, not so much on the complete set for the pilot.
  • Would like to make a call out to participants in the community. If Java is important to you, we could really use some help.
  • In particular, one big ask is somebody to act as a leader to project. Similar role as what Umesh played on the project and help organize other contributors.
  • If participants who can do code for Java – willing to help with organizing open source development community.
  • Looking at two different kinds of sprints. One along the same time of face to face meeting. And another during a virtual meeting for a week.
  • We’re at a point where we can focus resources
Arien Malec
  • Amazing one-time special offer for one on one with Brian Behlendorf.
  • We really need that support. If your organization signed up for coding, this is a great way to show your commitment.
  • Hoping to have a Code-a-thon during that.
Janet Campbell
  • We’ve been focusing on the overall NHIN Direct Overview document. Has all the pieces of NHIN Direct.
  • Our goal is to collect this and now in the revision stage.
  • Goal is to continue to refine and have it ready for Face to Face meeting.
  • Certification test list, Security overview, and MIME specification also being done.
  • It’s very easy for us to know what we know – what we’re looking for is things you’ve heard as you talked to other people, misconceptions about NHIN Direct, or what you find yourself always explaining – provide this on the wiki. Compiling a list of this.
Uvinie Hettiaratchy
  • We are starting up the Communications workgroup. The goal of the Communications workgroup is to provide clarity about what NHIN Direct is and how it fits into the health information and transformation ecosystem. Key audiences include State HIEs, RECs, HIOs, health systems, providers, and the larger general health community and media. Foundational work on the NHIN Direct Overview has been developed by the Documentation and Testing Workgroup.
  • We will start meeting on August 11th. The workgroup meets on Wednesdays from 1-2pm EST. Would like to make some progress before the Face to Face, so this will be fast paced.
  • Please email me at uhettiaratchy@deloitte.com if you are interested in joining.
Keith Boone
  • Question about being a pilot – what are the requirements for being a pilot for the NHIN Direct project?
  • Any wiki page that lists out what they’re required to do.
  • Are we using test patient data?
Arien Malec
  • Intent is real patients and real providers. I will take that action to make sure we got a good statement of what we actually mean by implementation geography and what we mean by that.
  • Happy to discuss and help that out.
Keith Boone
  • Are there opportunities for those who want to test but not with real patients?
Arien Malec
  • Yes, the correct membership there would be the reference implementation. Would like organizations to help in constructing conformance document, test scripts, and code.
Lin Wan
  • Does the new workgroup get a new wiki page?
Arien Malec
  • This workgroup will get a wiki page. The primary function is to put together right messages for constituencies and audiences – much more around outbound communication.
Lee Jones
  • Trying to clarify about Java team. Are you asking just for a leader? Or also need coders for SMTP piece?
Arien Malec
  • Often times, the open source group is organizing the lead developer role. Need a strong project manager is just what we need to get all the individual Java developers organized and moving in the right direction.
  • We are farthest along on the SMTP side.
  • We have initial implementation on SMTP code and refactoring of SMTP code will be done.
  • Our biggest need in the Java world is overall coordination of all the work and then implementation on IHE side.
  • On the .NET side, it’s implementation on the XD* side of the world.
Barry Greene
  • Do we have a good idea of number of providers needed to be successful?
Arien Malec
  • One of the key factors in that group is to analyze natural information flows. If you automate a high volume flow, you’ll be relevant for providers.
  • The only danger of that is that if it’s not relevant for the provider, by relevant, means delivers workflow efficiencies and establish MU for the provider, then satisfaction won’t be high.
  • Need to see enough volume, enough relevant for the provider to see this as successful.
John Moehrke
  • One of the things I’m frustrated at is that being a member of the NHIN Exchange, I know Connect is done. I’m still asking them to engage in NHIN Direct. Even though they have already filled the gap on the NHIN Exchange.
  • We need linkage with NHIN Exchange.
Arien Malec
  • I will take that back.