Geographies Meeting 2010-07-14

Notes from Implementation Geographies Workgroup
Date: July 14, 2010
Time: 12pm-1pm
Attendees: Richard Elmore, Chris Voigt, Andy Heeren, Douglas Arnold, Noam H. Arzt, Don Jorgenson, John Theisen, Leroy Jones, Kim Long, Umesh Madan, Arien Malec, Uvinie Hettiaratchy, Brian Behlendorf, Brian Ahier, John Hall, David Tao, Brett Peterson
Actions from this Week

#	Date	Action	Status	Owner	Due Date
22	7/14/10	Review pilot briefs on Implementation Geographies wiki page	Open	WG	7/21/10
24	7/14/10	Fill out briefing template	Open	WG	7/21/10

Actions from last Week

#	Date	Action	Status	Owner	Due Date
22	7/7/10	Edit template to include HISP detail and key success metrics.	Open	Brett Peterson	7/14/10
23	7/7/10	Write-up on process for and description of existing pilots	Open	Brett Peterson	7/14/10
24	7/7/10	Fill out briefing template	Open	WG	7/14/10

Agenda
· Review the changes made to the Pilot Projects section of the main Implementation Geographies page.
· Review the changes made to the Pilot Project Brief Template.
· Introduce and discuss any new Pilot Project Briefing documents.
· Status and discussion around existing pilot projects.
· Setting expectations regarding pilot project timing.
· Do we want "half-baked" (i.e., still tentative) pilot briefing pages?
· Meaningful Use discussion (Arien).

Notes

Brett Peterson

• Agenda found on the wiki page.
• One of the first things I wanted to do is a brief overview of small changes I made. I want to make sure everyone agrees.
• In the Implementation Geographies main page, put pilot project section to submit pilot item. At bottom, three links to pilot project briefs. I just added one from MedAllies.
• I want to make sure everyone saw that.
• I added a note to top of project template asking folks to keep the considerations listed in operational plan in mind when filling it out.
• Explicit request to list HISP also added.
• Also added high level success metrics section.
• Want to ask if any issues with that?

Doug Arnold

• We include five user stories in our pilot. Did you want to limit those to three?

Brett Peterson

• No

Lee Jones

• MedAllies one is not done yet, just started. Happy to go through what’s there, but it’s not much.

Doug Arnold

• Assuming all three pilot briefs are work in progress.
• As we talk to more partners, it’ll be updated.

Umesh Madan

• Are the pilot briefs closed or can we still participate, do we contact individual people?

Brett Peterson

• Yes, contact leader.
• I want to put out two pilot briefs, but they’re not complete, but they would show a specific geography. Do we want those tentative half baked pilot briefs for awareness? Or more complete versions only?

Arien Malec

• What I don’t want to see is half baked briefs that show up and disappear. If high confidence it’ll be real, it’ll help considerably.
• Criteria is if you have high confidence but can’t name names, then list it. If it’s dependent on organizations joining and might disappear, then keep it offline.

Brett Peterson

• Are there any new updates on currently listed briefs? We’re at early side so not expecting a lot, but would like to open it up to leaders of three briefs.

Arien Malec

• One other agenda item which is the impact of final meaningful use regs on NHIN Direct.

Brett Peterson

• Gary not on the line. So lets go to Doug.

Doug Arnold

• Had a lot of meetings. Would like to talk to Microsoft, specifically from HealthVault to get patient involvement.

Umesh Madan

• That’s great, so let’s talk offline.

Arien Malec

• People would love to hear a public statement from Microsoft of that – declaration on wiki.

Umesh Madan

• Yes, we are willing to take any comers, but will double check.

Doug Arnold

• Meeting with Middlesex Hospital and three meetings with Quest and they indicate they are far along with working with Surescripts for potential national HISP.
• Meeting with Emdeon next week.
• Continue to talk with hospitals so momentum is building and partnerships are growing.
• Will make some updates on wiki.
• Would encourage anybody who wants to talk with us.
• Sent out email to Arien asking questions about meaningful use requirements.

Brett Peterson

• MedAllies? High level overview?

Lee Jones

• Would like 6 or 7 hospitals to be involved.
• Involved with push messages and if going to be HISP would like to see what vendors will be using. Currently vendors going down path of XDR and others might come along with prescribed SMTP.
• Question on resources being available – Are these resources we would need from this group or resources we will make available or outstanding to fill?

Brett Peterson

• In Gary’s original document, seeing it more as outside of control of folks in this effort. One of the things Gary put is a national HISP, which he didn’t have at the moment. Here are the things that we haven’t figured out yet, assuming that will be available, but acknowledging the need.
• Helpful to draw people in.

Lee Jones

• On success metrics, have patient centered medical homes stuff going on. Most will lean towards meaningful use. We can define success in many different ways. Success locally, how we know we’ve done what NHIN Direct was intended to do, and success for meaningful use. All of the above?

Brett Peterson

• I would say all of the above. Defer to Arien.

Arien Malec

• I would look at business priorities in region and define success according to local stakeholders. The global definition of success is that we’ve tested out interfaces and specifications do what they’re supposed to do and they generate business value. Business value is relevant need to stakeholders – that may be meaningful use or medical homes or ACO or other kind of payer programs. It may also be clinical quality. That needs to be defined according to business mission and needs of key organizations in the region.

Lee Jones

• I’ll go back with that lens and revise.

Brett Peterson

• I’d like to set or double check expectations regarding timing. Are we looking at trying to drive pilot projects to some type of measurable success criteria as a group by December 31st or a certain date? Some context would be helpful.

Arien Malec

• Two things I care about are - demonstrating either failure or success in setting the stage for broader, national rollout in 2011. That’s the key outcome. If we rush things and go to pilot setting December 31st as deadline, that may be setting us up for failure. We shouldn’t set a deadline that’s not reachable. If we set our deadline for a lot of time that doesn’t meet the goal, that would also not be desirable.
• If it’s first quarter 2011 and that’s a realistic timeline then at this stage, I’m not inclined to say we shouldn’t do that. If there’s way to pull into fourth quarter 2010, I’d be happier. But if that’s not realistic, then not possible. We’re at least 3 weeks if not more off of the upfront milestone. That does have ripple effects downstream.

Brett Peterson

• As I put out briefing document, I want to evolve it as the project evolves.
• I’d like to see from each briefing a project plan that continues to get refined. So that status of what I’m trying to do by certain date would be more specific.
• That would allow me to know where everyone stands.

Doug Arnold

• I think it’s important that decisions that are made at Reference Implementation workgroup get quickly communicated to pilots.

Brett Peterson

• Perhaps periodic briefing from that group would be helpful.

Arien Malec

• Doug reached out to me about final set of meaningful use requirements. The biggest thing that happened is the separation of meaningful use requirements into Core and Menu items. Many of the MU criteria involving substantial amounts of interoperability have been moved to menu set.
• How does that set NHIN Direct and business case?
  • My response is that none of the MU requirements, even in first step in NPRM, required electronic access. You could meet many of them via paper, fax, etc. There was still a business case for doing electronic interoperability and streamlining access for providers.
  • That holds for revised set of MU criteria.
• Menu set, need to get 5 out of 11 in order to meet MU. If I’m a provider and need to jump through lowest barrier, likely that I’m going to have electronic prescribing system that has access to formularies. Then maybe simpler ones, like generate a list. Probably want to hit things that add significant value to project and workflow to project.
  • Receiving labs electronically – productivity win and business win. That should be front and center for NHIN Direct.
  • Transitions of Care – having to send data to providers in any case. Have to do referrals and automating that and making it electronic has a key clinical workflow benefit.
  • Ability to easily incorporate patients into the mix. I appreciate Microsoft’s involvement here. If you can easily send patient summaries that is also a key win.
• In menu set, there is an upfront set of huge value for practice that are facilitated by NHIN Direct.
• I don’t think core and menu degrades business case.
• It does make business case more nuanced, but it’s still strong for NHIN Direct.
• Electronic labs, electronic receipt of discharge summaries and transcriptions have inherent business case as well as drive to MU criteria.
• Interested in hearing response

Rich Elmore	No comment.
Chris Voigt	No comment.
Andy Heeren	I think the use cases make a lot of sense.
Doug Arnold	Appreciate comments. Couple of core sets that involve reporting clinical measures to States or CMS or immunization and public health reporting. There may be opportunity for NHIN Direct or ONC to standardize process involving State HIE and CMS. Hopefully we’ll get more detailed information and enable NHIN Direct project to facilitate that kind of individual provider to large organization reporting (federal/state).
Noam Arzt	No comment.
Don Jorgenson	No comment.
John Theisen	No comment.
Lee Jones	Someone was challenging NHIN Direct’s longevity. Is there any forthcoming connection that ONC might say about NHIN Direct to link to MU to give people incentive? Arien Malec - The use case behind NHIN Direct is always going to be with us. There’s always going to be use case of getting X information to you and need standard to do that. I also believe that capability of universal addressing is a significant win for healthcare system and interoperability. The core mission behind NHIN Direct is valid regardless of how you parse MU rule. In terms of implied or direct tie to MU criteria, there is a standard and well defined process for rulemaking which involves HIT Standards Committee and public process. It would be appropriate for ONC to promote NHIN Direct. That being said, Stage 1, we can make a compelling case to follow standard. There is a more compelling case for Stage 2 where CMS has indicated menu set is likely to be a mandatory set. Don’t see this as having limited shelf-life. The meaningful use benefit will be strong in short term and stronger in medium term. If the project goes away, the need is still there, and will need to be filled by something.
Kim Long	No comment
Umesh Madan	No comment
John Hall	No comment
David Tao	I agree with Arien’s analysis. The core measures do have complete alignment with NHIN Direct – medical exchange, electronic copy, etc. I think the case is still strong for NHIN Direct. I think electronic copy is not just capability, you need to do this.
Brian Behlendorf	No comment
Brett Peterson	No comment

Brett Peterson

• Any other agenda items?

Doug Arnold

• Request to send out emails for the whole group to everyone.

Noam Arzt

• From State HIE Cooperative Agreement, NHIN Direct continues to be an explicit part of the puzzle. In some cases, threatened by it. The technical assistance teams try to participate in NHIN Direct and try to clarify it as much as possible.

Brian Behlendorf

• Gave presentation at Redwood MedNet conference where we talked about NHIN Connect and Direct. There is a lot of outreach continuing on modest level.
• Once we have pilots we can point with real patients and real data, and it becomes more compelling to a reporter.
• In the meantime, are there standard slide decks that we can put together?
• Perhaps a topic for documentation group.

Umesh Madan

• Part of what we did was to do a demo. As people watch systems and actions, they understand it more.

Brett Peterson

• Had conversation with state department and NHIN Direct went from mildly hostile to the greatest thing ever. Putting it in the right context and understanding which actor they are would be very helpful.