Geographies Meeting 2010-05-21

Notes from Implementation Geographies Workgroup

Date: May 21, 2010
Time: 2pm-3pm
Attendees: Arien Malec, Jackie Key, Paul Tuten, Douglas Arnold, David Kibbe, Lee Jones, Marla Kouche, Umesh Madan, Brian Ahier, Gary Christensen, David Tao, Andy Harren, Tim Cromwell

Actions for this Week

#	Date	Action	Status	Owner	Due Date
16	5/21/10	Clarify NHIN Direct branding nuances for proposed operating model on wiki	Open	Arien	5/28/10
17	5/21/10	Update Guidelines to clarify coverage of MU exchange components and reflect other WG suggestions (including addition of the NHIN Exchange-NHIN Direct transaction and pilot timelines)	Open	Paul Tuten	5/28/10
18	5/21/10	Review guidelines and provide feedback on the wiki	Open	WG	5/28/10

Actions from last Week

#	Date	Action	Status	Owner	Due Date
11	5/14/10	The NHIN Direct Team and Paul Tuten will create a checklist for the criteria for what these Implementation Geographies this will consist of how geographies represent themselves (i.e., what information should be included)	Open	NHIN Direct Team & Paul	5/21/10
12	5/14/10	Paul Tuten, Doug Arnold and Jeff Cunningham will put together a start of a framework of the Implementation Geographies so we know what it means in a real way and they can also report on what difficulties they ran into	Closed	Paul Tuten, Doug Arnold and Jeff Cunningham	5/21/10
13	5/14/10	WG members who represent certain geographies work to fill out the grid	Closed	WG	5/21/10
14	5/14/10	Jeff Cunningham will come up with a template marking the different capabilities within practices	Closed	Jeff Cunningham	5/21/10
15	5/14/10	Arien will make clear that the success metrics are outcome measures and not screening measures	Open	Arien	5/21/10
16	5/14/10	Marla Kouche’s comments about provider satisfaction will be integrated	Open	Marla Kouche	5/21/10

Agenda

• Review action items from last week
• Discussion
  • Implementation Geographies Participation Guidelines/Check List
  • Workgroup General Operating Model: [1]
• Next Steps

Notes
Comment from Paul Tuten

• Gave description of the proposed Operating Model
  • Proposed model is similar to the concrete implementation workgroup model, with subteams for each pilot and a leader for each of these subteams
• NHIN direct pilot site choices should be driven by an open source, community-driven model
• Instead of selecting pilot sites, the workgroup should define a minimum set of requirements for a geography to participate
• The workgroup is also responsible for facilitating the success of each pilot site and helping them to report on outcomes and lessons learned

Discussion of Operating Model
Comment from Doug Arnold

• No comments on operating model

Comment from David Kibbe

• Likes the model
• Workgroup should set expectations for potential pilots and message this to other groups

Comment from Lees Jones

• Good model, like that no one is excluded

Comment from Paul Tuten

• Should be milestones set for these expectations. There cannot be participation without progress. This will help to cull the herd over time.

Comment from Lees Jones

• In addition to setting minimum criteria, like the idea that each pilot can self organize.
• Is there an end result we are looking for? (tabled for later in discussion)

Comment from Marla Kouche

• Model and guidelines both look good
• Should the guidelines include a timeline? (tabled for later in discussion)

Comment from Umesh Madan

• Agree with proposed model

Comment from Brian Ahier
Model looks good, agree with five components
Comment from Gary Christensen

• May need to limit number of pilots if we have finite resources
• Each of the pilots should prove something
• Each pilot could focus on a particular NHIN Direct user story

Comment from David Tao

• Agree with model, but have a couple of concerns.
• The guidelines say that anyone can be apply to be a pilot, but there is an implication that some entity decides which pilots meet the minimum criteria
• If we let spontaneously allow self-organizing pilots arise, we may not cover all the NHIN Direct user stories that we need to cover
• If there are not enough spontaneous efforts to cover all user stories, we should actively recruit to cover these

Comment from Andy Harren

• Recommendation looks good

Comment from Tim Cromwell

• The VA would like to be able to select a geography and pilot to participate in that would be consistent with the VA’s use case
• Seems like the model would support this

Comment from Paul Tuten

• Yes that is true, with the caveat that the pilot would have to be a suitable fit
• NHIN Direct doesn’t have carrots or sticks to exercise control over the pilots

Comment from Arien Malec

• ONC has been trying to deal with governance for the NHIN Direct pilots
• If we imply that these pilots are part of the NHIN, that would entail a set of governance that would be challenging operationally
• In contrast, voluntary participation would not have these restrictions
  • Need to find an appropriate name for these pilot activities to clarify that they are voluntary activities
  • The model outlines that NHIN Direct has a community of interest coming together because it values the health care benefits of directed exchange and wants to on a voluntary basis test the NHIN Direct specs and report its findings
• We cannot tie NHIN Direct activities to the NHIN or IFR because they are governed by rulemaking
• Arien to clarify these NHIN Direct branding nuances on the wiki

Discussion of Guidelines
Comment from Paul Tuten

• Review of guidelines and checklist
• The guidelines tie selection to things that the pilots ought to demonstrate
• From an operational planning perspective, tried to document what information each participant would need to submit about their pilot

Comment from Doug Arnold

• Should each potential geography address each of these issues?

Comment from Paul Tuten

• The expectation is that these issues should be addressed and documented by each potential geography, including mapping to user stories

Comment from Doug Arnold

• When should this be done by?

Comment from Paul Tuten

• Group should discuss mile markers at some point, but for now would like to focus conversation on whether the criteria seem correct and whether any additional information should be captured
• Information about “other stakeholders” should include partners such as technology vendors, federal agencies, etc
• Should the criteria around having a diverse policy platform be a should or must?

Comment from Lees Jones

• Criteria are fine

Comment from Umesh Madan

• Criteria are fine

Comment from Brian Ahier

• The checklist is a good framework
• We should more clearly prioritize and define demonstrate of HIE defined by user stories
  • The pilots should demonstrate as broad a range of user stories as possible

Comment from Paul Tuten

• While it would be good to see all user stories covered by the pilots, it’s not reasonable to expect every pilot to cover every user story
• Since this is a volunteer effort, we have no carrots/sticks to push the user stories
• Visionshare would be happy to facilitate underserved use cases through pilot efforts

Comment from Doug Arnold

• We should take care to ensure that our guidelines’ musts/shoulds/coulds align with the final MU criteria

Comment from Paul Tuten

• Paul to update the guidelines’ language to clarify coverage of MU exchange components

Comment from Gary Christensen

• Operating model makes pilot participation seem very open, but the checklist imposes a set of criteria for participation
• Important that the pilots cover all user stories, though if two groups are covering the same user story, that isn’t a good enough reason to exclude one from participating

Comment from Paul Tuten

• Just because the NHIN Direct pilots will be voluntary, it doesn’t mean we won’t have standards for participation
• These standards may be based around a timeline defining by when certain things need to happen for the pilots
• Certain experiments could be very narrowly focused but deemed valuable by the group

Comment from David Tao

• The idea of a checklist is compatible with the operating model
• Agree with the selection of musts, but is confused by the selection of shoulds and coulds
  • Implies that these coulds/shoulds that are listed are more important than things are not listed
  • There are criteria that are not listed, such as NHIN Exchange – NHIN Direct transactions, that are also important
  • Paul to add the NHIN Exchange- NHIN Direct transaction to the list of criteria
• Demonstration of multi-vendor use should be preferred or required

Comment from Paul Tuten

• Workgroup to discuss these guidelines on the wiki over the next week
• Paul to update guidelines to include timelines and other suggestions