Geographies Meeting 2010-09-08

Notes from the Geographies Meeting
Date: September 8. 2010
Time: 12pm-1pm
Attendees: Douglas Arnold, Noam H. Arzt, Bhawna Batra, Greg Chittim, Gary Christensen, Didi Davis, Karen Donovan, Hank Fanberg, Andy Heeren, Uvinie Hettiaratchy, Jack Kemery, Bert Noey, Srinivas Koka, Umesh Madan, Arien Malec, Parag More, Kate Nixon, Pat Pyette, Will Ross, Vidit Saxena, Jas Singh, David Tao, Susan Torzewski, Paul Tuten

Current Actions

#	Date	Action	Status	Owner	Due Date
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
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
39	2010/08/25	Update the Technology Providers x Pilots Crosswalk	Open	Pilot Leads: Gary Christensen, Doug Arnold, LeRoy Jones, Susan Torzewski, Frank Clark, Will Ross	2010/09/01
41	2010/08/25	Update wiki page for each individual pilot project, including the user stories being tested	Open	Remaining Pilot Leads: Doug Arnold, Susan Torzewski, Frank Clark	2010/09/01
43	2010/09/01	Update the User Story x Pilots Crosswalk	Open	Remaining Pilot Leads: Frank Clark	2010/09/08
44	2010/09/01	Update the Meaningful Use x Pilots Crosswalk	Open	Remaining Pilot Leads: Doug Arnold, Frank Clark	2010/09/08
45	2010/09/01	Input requests into the Resource and Collaboration Needs for Pilot Projects	Open	Entire WG	2010/09/17
46	2010/09/01	Discuss off-line collaboration opportunities between the MPS and MedAllies pilot projects	Open	Doug Arnold, Parag More	2010/09/08
52	2010/09/08	Compile and sent list of Geographies FAQs to Doc and Testing lead Janet Campbell	Open	Paul Tuten	2010/09/17

Last Week's Actions

#	Date	Action	Status	Owner	Due Date
29	2010/08/11	Update Implementation Geographies Participation Guidelines - Check List	Closed	Paul Tuten	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
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
39	2010/08/25	Update the Technology Providers x Pilots Crosswalk	Open	Pilot Leads: Gary Christensen, Doug Arnold, LeRoy Jones, Susan Torzewski, Frank Clark, Will Ross	2010/09/01
41	2010/08/25	Update wiki page for each individual pilot project, including the user stories being tested	Open	Remaining Pilot Leads: Doug Arnold, Susan Torzewski, Frank Clark	2010/09/01
43	2010/09/01	Update the User Story x Pilots Crosswalk	Open	Remaining Pilot Leads: Frank Clark	2010/09/08
44	2010/09/01	Update the Meaningful Use x Pilots Crosswalk	Open	Remaining Pilot Leads: Doug Arnold, Frank Clark	2010/09/08
45	2010/09/01	Input requests into the Resource and Collaboration Needs for Pilot Projects	Open	Entire WG	2010/09/17
46	2010/09/01	Discuss off-line collaboration opportunities between the MPS and MedAllies pilot projects	Open	Doug Arnold, Parag More	2010/09/08
47	2010/09/01	Inform all pilot project leads about the agreed framework for addressing a two week plus absence in all facets of NHIN Direct by a pilot project	Closed	Paul Tuten	2010/09/08
48	2010/09/01	Move the "Call for Consensus" to the front page of Documentation and Testing WG	Closed	Uvinie Hettiaratchy	2010/09/01
49	2010/09/01	Rename the "Implementation Geographies and Information Technology Providers" crosswalk to match the de facto naming conventions	Closed	Arien Malec	2010/09/01
50	2010/09/01	Vote regarding the "Call for Consensus" for the final version of the NHIN Direct Overview Document	Closed	All participants of the WG	2010/09/08
51	2010/09/01	Edit the Deployment Models page to reflect XDR specifically	Closed	John Moehrke	2010/09/02

Agenda

1. Pilot Updates
2. Review of actions/decisions from previous meeting
3. Compile FAQs for Documentation and Testing WG

Pilot Updates

Rhode Island Quality Institute
Gary Christensen

• Informed WG that RIQI is conducting HISP selection this week
• Commented that they have worked on their project plan as well
  • Held working sessions with vendor partners
  • Moving along with their work

Paul Tuten

• Pointed WG once more to Greg Chittim's detailed task-list on the WG wiki page
  • Could be of use for the other pilot projects

Gary Christensen

• Added that RIQI is churning out a more detailed project plan

Paul Tuten

• Asked RIQI if they had any needs from the WG

Gary Christensen

• Responded they ultimately need the completion date for the reference implementations

Medical Professional Services (MPS)
Doug Arnold

• Reported that MPS did not have as much progress due the holiday weekend
• Commented that MPS is still surveying provider practices for their pilots
  • MPS' goal is to understand the technical needs of their participating providers
• Also reported that MPS held planning meetings last week
  • Ultimately not a whole lot to report due to the holidays

Paul Tuten

• Asked MPS if they had any resource needs

Doug Arnold

• Echoed Gary Christensen's need for the final reference implementations + specifications

MedAllies
Parag More

• Reported that MedAllies is addressing the following with their vendor partners:
  • Technical capabilities
  • Integration capabilities
• Commented that these capabilities drive the dates
• Identified their next steps
  • Organize and advance a project plan
  • Reported that MPS has updates the matrices on the WG wiki page
• Reported that MPS has no resources needs at this time

CareSpark
Susan Torzewski

• Reported that CareSpark is involved in the VA's process of defining processes
  • Worked eight hours on this already this week
  • Moving into further discussions the coming Friday
• Shared that CareSpark has drafted a version of their work plan
  • Currently only for internal use/viewing

Paul Tuten

• Asked CareSpark if they had any resource needs

Didi Davis

• Responded that they currently do not
• Added that they are waiting for HISP-component requirements from the VA
  • All set on the CareSpark side
• Thanked Paul Tuten for offering

Carolina eHealth Alliance

• Not Present

Redwood MedNet
Will Ross

• Commented that there was not much to report
  • Waiting for some additional assistance
    • Been tasked with extra personal work
  • Trying to free up evenings to address some items
• Reported that Redwood MedNet has no further resource needs from the WG

VisionShare and Public Health
Paul Tuten

• Reported that VisionShare has two really good candidates for participation
  • One state that is close to signing on
  • Be able to announce something in the next week or so
    • Depends on how slow the state bureaucracies move
• Added that VisionShare is willing to collaborate in terms of providers
  • Already have providers in those states
  • Willing to work with providers that other pilots maybe aware of that are interested

David Tao

• Asked Paul Tuten a question with respect to his experience with state agencies:
  • Have you found NHIN Direct competing with other non-NHIN Direct methods that may have already gotten a foothold?

Paul Tuten

• Answered that he has generally received two types of responses:
  • One where NHIN Direct is seen as an addition to what the state agencies are doing
    • In this case to create an additional reach of existing capabilities
  • One where much is not much standardized and NHIN Direct is either a new or conflicting concept
• Expressed hope that states agencies would be willing to standardize across the different states boundaries

Will Ross

• Responded to David Tao that in California the state-run immunization registries are suffering from resources scarcity
  • They do not want to get involved in projects that require a lot of additional resources
  • Added that he is trying to explain that NHIN Direct is low maintenance
    • However the back-end maintenance does become difficult to address

Noam Arzt

• Introduced himself on behalf of HLN consulting
• Added that he works with many immunization registries directly
• Commented that he would be surprised if NHIN Direct gets any coverage in the "immunization registry" world
  • Their most important issue is the ability to extract the health data from different formats
    • Need to be able to absorb the files
  • The forms of transport are not nearly as important
    • The immunization registries rather "walk" somewhere if that location had translatable information

Gary Christensen

• Added that he is kicking this issue around in Rhode Island as well

Noam Arzt

• Suggested talking about this issue off-line

Gary Christensen

• Commented that RIQI is actually thinking about using NHIN Direct for addressing immunization registries

Arien Malec

• Stated that this conversation raises a tangential issue he has been long considering
  • Has been thinking about an HL7 adapter that takes NHIN Direct on one side and HL7 on the other side
    • Can we create an adapter that plugs into the existing pipelines?
      • No need to change any back-end components
      • Simply pick-up files if they match
• Discussed another related issue
  • Asked if there is a way to couple NHIN Direct with an HL7 adapter and transform the file
    • Would this be able to take an HL7 2.5.1 feed and accept an ONC file

Noam Arzt

• Responded that HL7 is not assumed to be the transport mechanism
  • Not aware what Arien Malec was talking about

Arien Malec

• Responded that he is referring to setting up a mechanism to accept HL7 files

Will Ross

• Commented that transport is brilliant
• Added that this would only useful if only they knew the address (non-NHIN Direct)

Paul Tuten

• Added that he has thought about such an element from a VisionShare perspective

Arien Malec

• Asked Paul Tuten if this would be open-source

Paul Tuten

• Answered that VisionShare is definitely interested in it
  • However cannot definitively comment on the matter right now

Noam Arzt

• Stated that he still did not understand what Arien Malec was suggesting

Arien Malec

• Clarified that he suggested the creation of something that allows the immunization registries to simply create NHIN Direct messages
  • The HL7 adapter would identify and capture SMTPs
    • Upon capturing the SMTP messages, it would then unwrap them
• Suggested using either the most common (2.5.1/2.3.1 ) or default (2.4) variant of HL7 in this model
  • Anyone using a different format would have to make some changes regardless of NHIN Direct
• Set aside the item for possible future discussion

FAQs

Summary: Suggested Questions

1. How does NHIN Direct compliment NHIN Exchange?
2. How does NHIN Direct differ from NHIN Exchange?
3. How will NHIN Direct interact with State HIEs?
4. What are the technical requirements for local/rural practices to implement NHIN Direct messaging?
5. Is NHIN Direct a viable stand-alone option for health information exchange?
6. How will I participate in NHIN Direct?
7. When will NHIN Direct go live?
8. Is there a Certificate Authority standpoint?
9. Will there be a new provider directory or it expected that existing structures will be utilized?

Brainstorm
Paul Tuten

• Informed WG that Janet Campbell from the Documentation and Testing WG had requested that the Geographies WG send them a list of FAQs to document

Arien Malec

• Added to think of this as "free service"

Will Ross

• Further asked the WG to think about this in terms of "those questions you always have to answer"

Susan Torzewski

• Question: How does NHIN Direct compliment NHIN Exchange?
• Question: How does NHIN Direct differ from NHIN Exchange?

Didi Davis

• Agreed with Susan Torzewski's suggested question

Andy Heeren

• No comment

Hank Fanberg

• Question: How will NHIN Direct interact with State HIEs?
  • Added that the state of Texas in particular is curious about this question

Doug Arnold

• Question: What are the technical requirements for local/rural practices to implement NHIN Direct messaging?
  • Some may only have a high-speed web connection

Bhawna Batra

• No comment

Vidit Saxena

• No comment

Noam Arzt

• Agreed with Doug Arnold's question about state HIEs
  • Should not only concentrate only NHIN Exchange

Pat Pyette

• No comment

Karen Donovan

• No comment

Jack Kemery

• No comment

Umesh Madan

• Commented that the reference implementations will be considering these questions as well

Arien Malec

• Responded that he will be answering these questions for the FAQs

Will Ross

• Responded that this is a high priority for Redwood MedNet
  • The first question has a lot of aspects to it
    • Includes a whole range of related sub-questions
• Noted that he is also on the Documentation and Testing WG

Gary Christensen/Greg Chittim/Burt Knowey [SP??]

• No comment

David Tao

• Noted that he is also on the Documentation and Testing WG

Sri Koka

• Question: Is NHIN Direct a viable stand-alone option for health information exchange?
  • Does it impact them if them if they have a web-based interface or an EHR (or etc.)??
  • He is addressing this issue in the state of Arizona

Kate Nixon

• Joined late - No comment

Paul Tuten

• General questions:
  • Question: How will I participate in NHIN Direct?
  • Question: When will NHIN Direct go live?
• Technically oriented questions:
  • Question: Is there a Certificate Authority standpoint?
    • Single CA or is everyone responsible for their own?
  • Question: Will there be a new provider directory or it expected that existing structures will be utilized?
• Took responsibility to provide this list to Janet Campbell

Open Discussion

Doug Arnold

• Shared that he had found something in the Connecticut State By-laws that severely limits the exchange of lab data

Susan Torzewski

• Responded that it should not be an issue with directed exchange

Will Ross

• Added that California also has some limits on the transfer of some types of data

Susan Torzewski

• Responded that all states have their own limits
  • In this case, the provider sending the information should already have all the permissions

Paul Tuten

• Added that it is VisionShare's perspective as well that all permissions must already be sought
  • One must continue to conform

Susan Torzewski

• Highlighted the need for each pilot project to check their respective state laws
  • Individual providers are not as careful
  • But a health information department in larger networks should have already checked this

Doug Arnold

• Stated that in CT, licensed providers can send lab data to the ordering provider only if permission is sent in writing
• Provided an example as a reference
  • I am a doctor and ordered results from "Labs-R-Us"
  • I want to send this to Dr. Jones
  • Would not be able to do so in this case
• Added that these regulations fly in the face of MU criteria

Noam Arzt

• Responded that they fly in the face of lab results, not in the face of lab orders

Doug Arnold

• Asked why in this case he (as the doctor) is unable to tell the lab to send the notes to Dr. Jones

Jack Kemery

• Introduced himself as a representative from Labcorp
• Responded that the easiest way to do this exchange is to make sure that the other person is a customer of the lab
• Added that he has had to address this before
  • It is a labor intensive process
  • They have to find the specific provider's contact info and send a fax
• Deals with state and HIPAA regulations

Susan Torzewski

• Responded to a question about state versus federal authority
  • Simplest answer: Whoever is more stringent in regulation/policy trumps the other

Arien Malec

• Shared that he has explored this issue at the ONC level
  • There should be no legal/policy limitations which prevent someone from achieving MU criteria
  • There is an opportunity here to check legal situations state-to-state with some of the policy work
• Commented that, in the short term, there should be no legal or policy obstacles to achieving MU criteria by the ordering providers

Hank Fanberg

• Added that state HIT coordinators were supposed to examine their state laws for these legal issues already

Will Ross

• Commented that there is a similar issue in California
  • If something cannot be done in one step, then do it in two steps
    • Gets the request
    • Then send the referral

Jack Kemery

• Believed that these issues will hopefully get reviewed
• Expressed optimism that common sense will allow for standardization in the next year or two

Susan Torzewski

• Stated that with respect to the disparate state laws, most do not conform with one another
  • Believes that ONC or some federal body will have the most power in trying to achieve this

Arien Malec

• Shared that he would like to bring this to the ONC
• Asked how high this is on their priority list

Susan Torzewski

• Responded that it is not as high a priority for NHIN Direct
  • More a priority for NHIN exchange