Geographies Meeting 2010-08-25

Notes from the Implementation Geographies Meeting
Date: August 25, 2010
Time: 12pm-1pm
Attendees: Doug Arnold, Noam Arzt, George Beckett, Brian Behlendorf, Gary Christensen, Tim Cromwell, Didi Davis, Karen Donovan, Rich Elmore, Hank Fanberg, John Hall, Andy Heeren, Uvinie Hettiaratchy, Leroy Jones, Don Jorgenson, David Kibbe, Srinivas Koka, Kim Long, Umesh Madan, Arien Malec, John Moehrke, Will Ross, Vidit Saxena, Jas Singh, David Tao, Susan Torzewski, Paul Tuten

Current Actions

#	Date	Action	Status	Owner	Due Date
29	2010/08/11	Update Implementation Geographies Participation Checklist	Open	Paul Tuten	2010/08/18
31	2010/08/11	Bring to Doc & Testing WG: Ensuring that the correct clinical message is being sent to the correct physician e-mail client, given physicians have multiple e-mail addresses at various practices	Open	Arien Malec	2010/08/18
33	2010/08/17	Bring to Doc & Testing WG: Dispelling the mentality of "If it's going through Direct, then we can save a record"	Open	Paul Tuten and Chris Voigt	2010/08/25
34	2010/08/17	Coordinate Reference Implementation WG update for the Geographies WG meetings	Open	Paul Tuten and Susan Johnston	Recurring
35	2010/08/17	Compare user stories v. final rule on MU	Open	Paul Tuten, Arien Malec, Pilot Leads	2010/09/01
37	2010/08/25	Compile list of unresolved issues from the Plan-a-thon and send to concerned bodies for review	Open	Paul Tuten	2010/09/01
38	2010/08/25	Confirm accuracy of Geographies and Reference Implementation items on the Progress Tracker and provide feedback	Open	Brian Behlendorf, Umesh Madan, Paul Tuten	2010/09/01
39	2010/08/25	Fill-in and update the Vendor-Geographies crosswalk	Open	Arien Malec, Paul Tuten, Pilot Leads	2010/09/01
40	2010/08/25	Crosswalk user stories v. pilots	Open	Paul Tuten, Arien Malec	2010/09/01
41	2010/08/25	Update wiki page for each individual pilot project, including the user stories being tested	Open	Pilot Leads: Gary Christensen, Doug Arnold, LeRoy Jones, Susan Torzewski, Frank Clark, Will Ross and Paul Tuten	2010/09/01
42	2010/08/25	Talk off-line about the State of California technology road map and compatibility issues facing NHIN Direct	Open	Will Ross and Arien Malec	2010/09/01

Actions from Last Week

#	Date	Action	Status	Owner	Due Date
29	2010/08/11	Update Implementation Geographies Participation Checklist	Open	Paul Tuten	2010/08/18
30	2010/08/11	Clean up and refresh the NHIN Direct Wiki	Transferred	Arien Malec	2010/08/18
31	2010/08/11	Bring to Doc & Testing WG: Ensuring that the correct clinical message is being sent to the correct physician e-mail client, given physicians have multiple e-mail addresses at various practices	Open	Arien Malec	2010/08/18
32	2010/08/17	Update Geographies WG on outcome of the "Plan-a-thon" and the greater Face to Face meeting	Closed	Paul Tuten and Arien Malec	2010/08/25
33	2010/08/17	Bring to Doc & Testing WG: Dispelling the mentality of "If it's going through Direct, then we can save a record"	Open	Paul Tuten and Chris Voigt	2010/08/25
34	2010/08/17	Coordinate Reference Implementation WG update for the Geographies WG meetings	Open	Paul Tuten and Susan Johnston	Recurring
35	2010/08/17	Compare user stories v. final rule on MU	Open	Paul Tuten and WG	2010/09/01
36	2010/08/17	Create a lessons learned repository for pilot projects	Transferred	Paul Tuten, Janet Campbell	2010/09/01

Notes

Review of Face to Face (F2F) Plan-a-thon

Paul Tuten

• Paul is currently compiling his own list of unresolved items
  • Combing through major topics that need to be addressed
  • Pointed out that some simply cannot be addressed at this time
  • Once compiled, will be sent to the concerned bodies
• Identified high-level themes from the F2F Plan-a-thon
  • There is a need to better understand the following WGs:
    • Reference implementations
    • Documentation and testing
    • Communications
  • Informed that Arien asked the Geographies WG to make themselves a bit more demanding as customers
    • Determine what is needed from each pilot
    • Ask for those relevant items
  • Introduced the new practice of asking for new resource requirements from each pilot project
• Expressed belief that the F2F was productive overall
• Q&A
  • (No questions asked - proceeded to status updates)

Rhode Island Quality Institute (RIQI)

Gary Christensen

• Informed WG that RIQI has brought in their technical manager
  • Currently organizing the first cut of their detailed project plan
  • Once it is completed, will send out to the group for feedback
• Currently reaching out to members of the Reference Implementation WG
  • Specifically members who were met during the F2F

Medical Professional Services (MPS)

Doug Arnold

• Commented that MPS is holding project team meetings currently
• Informed WG that Mark Stine of MedPlus has organized the second cut of their pilot's technical project outline
  • Still waiting on some of the specific technical info from the Reference Implementation WG
  • Reached out to various physicians to inquire into their HIT capabilities
    • Suggested developing a HIT repository
• Asked Kim Long if she needed to add anything

Kim Long

• Nothing to add

Doug Arnold

• Also informed WG that he attended a Connecticut public forum meeting on HIE
  • There were state senators present
    • They have no idea about NHIN Direct
    • Asked for information regarding NHIN Direct
  • Commented that the communication deliverables will be really useful in this regard

Paul Tuten

• Thanked Doug for sharing this information regarding the state-level considerations for the Geographies and Communications WG

MedAllies

Leroy Jones

• Informed group that Parag More attended the F2F on behalf of MedAllies
• Outlined current action plan by MedAllies
  • MedAllies is talking to vendors in the Hudson valley area
  • Meeting with some of the key customers of those vendors in Hudson valley
  • Trying to confirm vendor participation
• Believes they have good mementum
  • Some of the vendors not committed are getting closer to participation
  • However, there are still some who will not participate because their plan to adopt NHIN Direct is further down the road

Paul Tuten

• Asked if MedAllies has any specific need

Leroy Jones

• Asked: What will the XDD piece specifically be?
  • Currently being addressed by the Reference Implementation WG

CareSpark

Susan Torzewski

• Informed that CareSpark is currently concentrated on understand:
  • Work flow of the pilot
  • Business processes
• Intimated their need to confirm plans with the VA
  • Pilot will be on hold until then
  • Deferred to Tim Cromwell

Tim Cromwell

• Clarified progress between CareSpark and the VA
  • After review of their plans, the VA has invited CareSpark into the BPM work
  • A separate Face to Face meeting schedule for September 14th in Johnson City
• Realized that all members need to be caught up to speed

Paul Tuten

• Asked if CareSpark or the VA have any specific needs

Tim Cromwell

• Responded that the VA specifically needs assistance in understanding how NHIN Direct will link into the NHIN Connect gateway
  • This request been raised in past meetings as well

Carolina eHealth Collaborative

• Not Present

Redwood MedNet

Will Ross

• Reported no significant progress since the F2F meeting last week
  • Reminded the Geographies WG that this pilot is entirely volunteer driven itself
    • They have no formal budget
    • There are no dedicated program managers like the other pilot projects

VisionShare/Public Health

Paul Tuten

• Informed WG that VisionShare is still waiting for a final response from some states
  • Still determining where VisionShare's pilot will be active
  • Hence securing the agreement of the state agencies
  • Also beginning to reach out to potential providers

CSharp Reference Implementation Update

Umesh Madan

• Provided update regarding the CSharp Reference Implementation:
  • Raw agent code is stable and fully documented
  • Gateway is up and running, on their own public site
  • Config system
    • The back end is complete
    • Claudio Sanchez is working on the UI System
    • Umesh Madan is working on the gateway
      • Expressed hope that this should be completed today
      • Wants to set-up scripts with the Config systems
  • Unit tests are being conducted
    • The CSharp team wants better scripts such as MSI
    • John Theisen is looking into this
  • Held a call today about "AC"-ing messages
• Commented on their start-up mode
  • Pro: Quick Progress
  • Con: Falling Short

David Tao

• Asked about the XDS/XDR metadata reader included on the Reference Implementation WG wiki page

Umesh Madan

• Responded that the XDS/XDR piece is being developed
  • Commented that the list of components he is referencing is a little outdated
  • Informed WG that Vassil is driving the CSharp team's efforts to develop the XD* piece
• Indicated that given the speed of coding, the documentation will catch up, but may take a little time

Brian Behlendorf

• Encouraged the Geographies WG to not be afraid to ask questions with obvious answers
• Indicated that there is still work occurring on the XD* side of the issue
  • Remarked that the maturity of the code is lagging there
  • Added that specifications are being developed
• Identified the need for security and protocol transmission
• Also commented on the importance of end-user experience and integration
  • Largely remains to be done
  • Need to work with the organizations that plan to be the HISPs (hence end-users of the code)
    • Need to understand where they are in terms of their own capabilities
    • NHIN Direct has its "HISP in a box" framing
    • However, are these reference implementations going to be something which these end-user can build upon and deploy?
• Added that the Java reference implementation is a few weeks behind, but is quickly catching up

Umesh Madan

• Recognized Greg Meyer and Beau Grantham are working hard to get the Java Reference Implementation up to speed

Brian Behlendorf

• Identified common elements between the reference implementations
  • There is a singular repository for code
  • In general they are not as test driven
  • HISPs in particular have similar end point needs

Umesh Madan

• Emphasized that this is an on-going integration between those implementing and those constructing

Paul Tuten

• Asked: "Whats the best way to communicate this information or feedback from respective vendors?"

Arien Malec

• Responded that there are issues lists across the components
• Announced the "Progress Tracker" for higher level wants
  • Jas and Caitlin have organized this progress tracker
  • A good way to see progress across the different WGs and to discuss collaboration

Uvinie Hettiaratchy

• Confirmed that the Progress Tracker is available on the navigation bar, below the individual WGs
  • Let the NHIN Direct support team know what you need updates on
  • Asked that Brian and Umesh make sure this is accurate and provide feedback

Doug Arnold

• Expressed concern to effectively communicate with the end-users
  • 
    
  • Need to communicate correct information
  • Important because many participants in the Geographies WG are end-users
  • Also need to have a ready set of enabled users
  • Important to give feedback to the techno users

Arien Malec

• Expressed strong agreement
  • Encouraged all participants to post any requests they may have for the Reference Implementation WG

Doug Arnold

• Reemphasized the need to collect all the technical information

Discussion

John Moehrke

• Raised three specific points to be considered:
  • It is not clear if the pilots are going to use the NHIN Direct security model, or other security deployment models
    • He does like the deployment model for the reference implementations, but wants to cover all bases
  • It is not clear if some of the implementation geographies need the NHIN exchange interface
    • It appears that same may have this need - wants a discussion on the matter
      • Who needs to be brought into this discussion
      • Need to get the right people talking
    • Cannot simply have three people randomly deciding amongst themselves
  • It is important to consider the use cases where XDR is available and already in use

Arien Malec

• Pointed John Moehrke and Doug Arnold to the Vendor-Geography Crosswalk
  • Realized that this has not been updated in a while (Uvinie Hettiaratchy pointed in right direction)
  • Still commented that this could be very useful to help address some of John's questions
  • Called for the leads to fill out that matrix - would be very useful

Gary Christensen

• Asked Paul if this is something which can actually be delegated

Paul Tuten

• Responded that most concerns will be captured in the action items
  • There will be many items asked of the Geographies WG's pilot projects
    • The owners of these tasks are the pilot project leads
  • There is not a good mechanism to collect the information regarding the action items

Gary Christensen

• Replied that they need to tell Greg to look at the action items, and complete what is up there
  • Realized Greg was on the call

Paul Tuten

• Informed group that the action items are published on the Geographies WG under each meeting's notess

John Moehrke

• Asked a separate question: Is there a certificate authority leveraged in the geographies?
  • Cited as helpful for the builds for which they work
    • Large organizations have them
    • Small organizations need guidance on a recommended set of certificate authorities
  • Learning that would be better earlier rather than later
• Asked: What are the resources you already have that we can leverage and where do you need help?
  • Ex: Many regions have provider directories
  • Do our geographies have such access?

Paul Tuten

• Asked the pilot projects to update their Geographies WG page

Communications Needs

Rich Elmore

• Noted they already have points for the key constituents
• Asked for a right round on specific concerns coming from the Geographies WG for the newly formed Communications WG

Right Round

Susan Torzewski

• No comment

Didi Davis

• No comment

Andy Heeren

• No comment

Hank Fanberg

• No comment

David Kibbe

• Asked them to get the Geographies updated to the user stories
  • It is not useful to talk in the abstract

Doug Arnold

• Believes that each pilot should explain what it is trying to do and the use cases

Vidit Saxena

• Agreed with Doug's comment the they need an explanation by each pilot project

John Moehrke

• No comment

Noam Arzt

• Reminded WG they had already decided to crosswalk the user stories and pilots
  • Did not happen
  • Asked if they are set-up to make that assessment

Don Jorgenson

• No comment

Karen Donovan

• No comment

Leroy Jones

• No comment

Kim Long

• Identified need to communicate with the physicians for direct recruiting
  • Need promotional materials to get the physicians

Umesh Madan

• No comment

Brian Behlendorf

• No comment

John Hall

• No comment

Will Ross

• Further agreed with David Tao
• Added that there is no defined user workflow for Redwood Mednet yet, but is in the works

Gary Christensen

• Current Priority: Getting the technical bit
  • Then they will go broader later
  • Concerned with how to got the project started

David Tao

• No comment

Sri Koka

• No comment

George Beckett

• No comment

Tim Cromwell

• No comment

Paul Tuten

• Added that the Implementation Geographies need to be updated

Further Discussion

Will Ross

• The state of California has released a technical road map inconsistent with NHIN Direct or Exchange
  • Not much can be done right now
  • Wants to talk to Arien offline
  • Will make that info available by forwarding the link

Gary Christensen

• Commented that he has EHR vendors who want to be integrating
  • Asked about the API capability

Arien

• Responded that the client API being addressed
  • Expect a little more in a week or two

Agenda

1. Status of Pilot Projects
   • Resources Needed?
   • Timeline
2. Update from Face to Face Meeting
3. Moving Forward
   • Including a CSHarp Ref Implementation Update
   • Other items?