Presentation:
Notes from Implementation Group



Date: November 2, 2010


Time: 3:00 – 3:45pm EST
Attendees: Alere, Axolotl, CareSpark, Cerner, Christus Health, Clinical Groupware Collaborative/Amedisys, Emdeon, Epic, Garden State Health Systems, Gartner, GE, Harris Corporation, High Pine Associates, IBM, Inpriva, Massachusetts eHealth Collaborative, MedAllies, Medical University of SC, South Carolina HIE, Medicity, MedNet, MedPlus/Quest Diagnostics, Microsoft, NextGen Healthcare, Redwood MedNet, Rhode Island Quality Institute, Siemens, VA, VisionShare

Actions


Actions for This Week:

Date
Action
Status
Owner
Due Date
11/2/10
Review, vote, and add any additional comments for the Direct Project Presentation, by November 4th (http://nhindirect.org/Direct+Project+Presentation+Call+for+Consensus+-+Communications+WG)
Open
IG members
11/4/10
11/2/10
Asked WG members to read documents,
Certificate Pilot Recommendations (http://nhindirect.org/Certificate+Pilot+Recommendations+Discussion ) and Direct Project Security Overview (http://nhindirect.org/Direct+Project+Security+Overview), and come to Thursday’s meeting prepared to discuss
Open
Security and Trust WG members
11/4/10
11/2/10
Provide comments for the first cut of the threat model for “XDR and XDM for Direct Messaging”
(http://nhindirect.org/Threat+Model+-+Direct+to+and+from+XDR)
Open
IG members
11/9/10

Actions from Last Week:
Date
Action
Status
Owner
Due Date
10/26/10
Vote on the Direct Project Security Overview, http://nhindirect.org/Direct+Project+Security+Overview+-+IG+Call+for+Consensus by November 1st
Open
IG members
11/1/10
10/26/10
If have a key need or goal you’d like addressed at the Face to Face meeting, please input it here: http://nhindirect.org/message/list/Direct+Project+October+Face-to-Face+Meeting
Open
IG members
10/29/10
10/26/10
Please list any events you are aware of or any events you present on the Communications Events wiki page
Ongoing
IG members
Ongoing
10/26/10
If you are an HIE, EHR, PHR and if you’ve adopted or have plans to adopt Direct standards, you can add your name to the HIT Vendor Self-Attestation list
Ongoing
IG members
Ongoing

Agenda:
  • Reminders
  • Announcements
  • Workgroup Updates
  • Calendar &Participation
  • Q&A
  • Recap

Notes:
Reminder
  • Questions during the meeting can be submitted in the Q&A box in Live Meeting
  • Slide 6 shows an updated timeline that goes out to February
  • Two TBD stars on the timeline are for upcoming face to face meetings, we plan to have one right before implementation go-live, and one in preparation for the March 2011 Standards Committee meeting
  • Would be useful to have a face to face at that time to update specifications and the like before the March meeting with the Standards Committee
  • Will let implementation geographies guide us in planning the first face to face meeting
Announcements
Arien Malec
Direct Project Presentation – Call for Consensus
  • Is clearly not reaching consensus based on the large volume of comments
  • A future edition will go up for consensus
  • Still, please review, vote, and add any additional comments
October Face to Face Meeting
  • Focused on configuring the reference implementation
  • Five additional independent implementations
  • Great turnout and representation from most of the reference implementation team (36 attendees)
  • Goal: Enabling easy access, incorporation and deployment of reference implementation
  • Key Outcomes:
  • Bare Metal Project: http://nhindirect.org/Bare+Metal+Project
  • Goal is to go through all the steps of taking a bare metal machine that is in the Internet and packaging all the steps it takes to get an operational HISP up and running
  • Didn’t get all the way through that work at the F2F meeting, but Beau Grantham and his team have been doing a ton of work since then
  • John Tyson wrote an installer for the CSharp side
  • Currently have at least 2 projects that can get from bare metal operating system to full, operational, deployed interoperable HISP
  • Implementation Interoperability Matrix: http://nhindirect.org/Implementation+Interoperability+Matrix
  • Looking at two ref implementations, two additional implementations, and HISPs
  • Made significant progress on completion of code and documentation
  • Have 5 interoperable implementations
  • Learned about certificate documentation and what can go wrong, how to configure certificates for interoperable exchange
  • Held Blue Button breakout session with input from VA
  • With Peter Levin, CTO from VA
  • Next steps:
  • Now ready for integration testing and supporting implementation geographies


Workgroup Updates

Reference Implementation WG
Arien Malec
  • Close to 1.0
  • Continuing to work on:
  • Bare Metal Project (Java) http://nhindirect.org/Bare+Metal+Project
  • Implementation Interoperability Matrix -http://nhindirect.org/Implementation+Interoperability+Matrix
  • CSharp Implementation
  • Status: Close to 1.0 release for SMTP-Agent; Behind on XD* side
  • Progress: Inter-operability Tests, Config/UI, Debugging
  • Remaining: XD*, Config/UI, Installer, Unit Tests, Documentation
  • Java Implementation
  • Status: Very close to overall 1.0 release (possibly next week)
  • Progress: Bare Metal Project, Config/UI, Unit Tests, Javadoc
  • Remaining: Namespace

Documentation and Testing WG
Janet Campbell
  • Security Overview: Great feedback, some technical implications
  • E-mail client configuration guide: take a look!
  • For people working off their own computer, how do they do that?
  • Bare Metal project leads to draft Java how-to
  • Has led to some good documentation for people who want to stand up a HISP, asking “how do I actually do that?”
  • Starting to come together well
  • Giant SHALL document: almost ready
  • Specs, really important artifact
  • About ready for small group review
  • Testing guides: edge cases identified
  • Looking at things that were breaking, one example, certificates were not sending back and forth, which showed things were working
  • Developing a good sense of what we can expect to work
  • Still a lot of work to do

Doug Arnold
  • Asked about when the e-mail client configuration guide can be shared

Janet Campbell
  • Good question
  • Doesn’t know if it needs to be released to full consensus, maybe will undergo a more technical review to see if it makes sense

Arien Malec
  • Suggested the e-mail configuration guide go through review by the implementation geographies, because it is almost source information for them, they can tell their physicians how to configure, such as “values go here” or “what is the domain for POP3?”

Janet Campbell
  • Took back her previous answer
  • Wants end users to be able to configure based on whichever e-mail client is used

Arien Malec
  • Suggested adding document to the wiki

Implementation Geographies WG
Uvinie Hettiaratchy

Arien Malec
  • Many of the pilot participants have been involved in the development of the reference implementation
  • A number of people at the face to face came from implementation geographies or had an interest in deploying Direct, and were able to get HISP models configured on their laptops
  • Now they can go off and work on bare metal project output
  • Feels we are serving the implementation geographies well
  • Had some of them participating and doing interoperability testing: VisionShare, Quest (HISP for MPS pilot)
  • Note: Didn’t intend to leave anyone else out if he forgot to mention

Question
  • Are any of the implementation geographies planning to use structured data?

Arien Malec
  • Yes, especially around labs
  • Lab interoperability would use structured HL7
  • And PDFs for providers who don’t have EHRs
  • VisionShare will use immunization data
  • MedAllies is doing structured exchange of C32s, CCDs for coordination of care
  • RIQI is doing the same thing, including a model where providers can push to RIQI quality registry
  • Will Ross at Redwood MedNet is using structured data for labs, immunization, continuity of care

Wes Rishel
  • Paul’s VisionShare pilot uses CCD, HL7, PDFs for report of record
  • Another uses radiology reports , RIMs, MDMs

Question
  • Have they already been exchanging the data?
  • Or getting reconciliation?

Arien Malec
  • It is a mixture of both, in some cases already existing
  • In MedAllies, a bunch of EHRs that were not already exchanging structured data will now be exchanging

Comment
  • Would be nice to measure both paths

Arien Malec
  • Clear message came from the face to face meeting that the focus is switching from transport to workflow
  • How do you incorporate the structured content gracefully into the workflow?

Jack Kemery
  • Asked where he could find the presentation

Arien Malec
  • Go to nhindirect.org, Implementation Group, each meeting notes have PDFs linked at the top

Communications WG
Uvinie Hettiaratchy

John Moehrke
  • Asked about status of Direct participation at HIMSS interoperability showcase

Uvinie Hettiaratchy
  • We are working with ONC to reserve some kiosks for Direct and for the pilots
  • Usually those kiosks are for the end user, but the organizers decided having pilots would be a great addition to the interoperability showcase
  • Would depend on who is ready to do demo when HIMSS comes around

Wes Rishel
  • Also would be important to give a presentation

Uvinie Hettiaratchy
  • Planning on having Arien do a presentation

Comment
  • Get to do 4 to 5 times

Arien Malec
  • We did launch at HIMSS last year, so would be fun to give an update a year later

Comment
  • Presumably there will be an ONC presentation for that purpose

Security and Trust WG
Umesh Madan
  • Many WG members were at the face to face meeting last week
  • A focus group is developing a threat model for “XDR and XDM for Direct Messaging” specification
  • Call for Consensus by Security & Trust WG on Certificate Pilot Recommendations (extended for further review)
  • Direct Project Security Overview –2ndReview by S&T
    • WGhttp:nhindirect.org/Direct+Project+Security+Overview+-+IG+Call+for+Consensus
    • IG Consensus comments to be discus
    • Maybe need better links to more technical documents from these more high-level docs
  • Asked WG members to read documents, come prepared

Arien Malec //
  • Usual motto: comment or pass

Umesh Madan
  • Also, don’t comment too late
  • John Moehrke is hard at work at developing the threat model

John Moehrke
  • First pass is posted, http://nhindirect.org/Threat+Model+-+Direct+to+and+from+XDR
  • Anybody who wants to look at it and provide first cut comments, please do
  • It is a short list because it leaves on risk assessment of Direct Project and XDR, which already exists
  • This document was about which risks are presented through conversion
  • Feel free to comment, edit, or e-mail him directly

Umesh Madan
  • Best thing that happened for Security and Trust at the Face to Face was seeing the security stuff work
  • Some pieces were mis-configured, and messages were getting rejected for the right reasons

Doug Arnold
  • Asked about ONC response to Surescripts

Arien Malec
  • In general, the use of standards/specs in developing is very useful, supported by ONC
  • ONC is appreciative of Surescripts, the implementation geographies, and all work being done by this group

Karen Witting
  • Appreciates the homepage news ticker being up to date
  • Asked about the status of the HISPs document

Arien Malec
  • A couple people requested getting their legal teams involved, because the recommendations involved Business Associate Agreements (BAAs), so those organizations requested more time to do the review
  • We would still love to get comments, still think it is a useful document
  • Paused consensus process because a number of organizations wanted to get more people involved
  • Will make sure the Call for Consensus pages are consistent

Karen Witting
  • So there will be another opportunity to provide comments?

Arien Malec
  • Yes, after an additional round of edits, there will be another round of consensus



Calendar &Participation
Arien Malec
  • Introduced calendar of weekly meetings:
WG
Meeting Time
Reference Implementation WG
Tuesdays, 12pm-1pm EST
Communications WG
Tuesdays, 1pm-2pm EST
Implementation Geographies WG
Wednesdays 12pm-1pm EST
Documentation and Testing WG
Wednesdays, 2pm-3pm EST
Best Practices WG
Thursdays, 1pm-2pm EST
Security and Trust WG
Thursdays, 2pm-3pm EST


Verbal Q&A

Karen with MedPlus/Quest Diagnostics
  • Asked about reserving spots at the HIMSS interoperability showcase
  • Do participating organizations need to do IHE protocols?

Arien Malec
  • Goal would be to do Direct implementation, not IHE
  • There is a distinction between the IHE showcase and ONC area