Geographies Meeting 2010-09-15

Notes from Geographies Meeting
Date: September 15, 2010
Time: 12pm-1pm
Attendees: Douglas Arnold, Noam H. Arzt, Bhawna Batra, George Beckett, Greg Chittim, Gary Christensen, Karen Donovan, Hank Fanberg, Michael Firriolo, Eric Heflin, Uvinie Hettiaratchy, Srinivas Koka, Arien Malec, John Moehrke, Parag More, Kate Nixon, Patrick Pyette, Will Ross, Vidit Saxena, Jas Singh, David Tao, Susan Torzewski, Paul Tuten, John Williams

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
39	2010/08/25	Update the Technology Providers x Pilots Crosswalk	Open	Pilot Leads: Gary Christensen, Doug Arnold, LeRoy Jones, Susan Torzewski, Will Ross	2010/09/01
41	2010/08/25	Update wiki page for each individual pilot project, including the user stories being tested	Extended	Remaining: All Pilot Project Leads	2010/09/22
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
53	2010/09/15	Create an Open Questions Tracker for the pilot projects	Open	Jas Singh	2010/09/22

Last Week's 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	TABLED	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, 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	CLOSED	Remaining Pilot Leads:	2010/09/08
44	2010/09/01	Update the Meaningful Use x Pilots Crosswalk	CLOSED	Remaining Pilot Leads: Doug Arnold	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

Agenda

1. Pilot Updates
2. Review of actions/decisions from previous meeting

Notes

Rhode Island Quality Institute (RIQI)
Gary Christensen

• Selected EHR Vendor - Polaris Medical Management
• Selected HISP Vendor (point to point) - Inpriva
• Asked: How do we address the CCD specification
• Informed WG they are putting together a project plan
• Highlighted the RIQI's Open Question List on the RIQI Pilot Shared Documents page

Greg Chittim

• Further addressed the list of questions they are encountering
  • Told WG they did not have to answer them during the call
    1. How should certificate expiration and/or duplication be handled?
    2. What do the prototypes for client (EHR) APIs look like?
    3. Is there guaranteed delivery for NHIN Direct messages?
  • Asked what was the best mechanism to address them?

Arien Malec

• Answered or redirected Greg Chittim's questions from the RIQI Pilot Shared Documents (reflected there)
  1. How should certificate expiration and/or duplication be handled?
     • Redirected to the Best Practices WG
       • Should get drafted into the policy considerations document
       • Policy not technology
     • Also referred to the Reference Implementation WG
       • After comments provided by Gary Christensen
  2. What do the prototypes for client (EHR) APIs look like?
     • Currently being addressed by the Reference Implementation WG
       • Bring to the Reference Implementation team to look at the API
  3. Is there guaranteed delivery for NHIN Direct messages?
     • Responded "Yes"
       • Arien Malec has a proposal being developed
       • Goal: 100% Acks for all messages

Paul Tuten

• Updated the Wiki with Arien Malec's responses

Greg Chittim

• Indicated that he has been updating the Wiki with such questions
• Asked: How do we handle such questions?
  • At the pilot level?
  • At the WG level?
• Commented that it was productive that Arien Malec short-circuited the questions, but cannot always do that

Paul Tuten

• Suggested having a running list on the implementation geographies main page
  • Asserted open question lists may not get much visibility on the pilot project pages

Doug Arnold

• Added that it is important that they "air some of these questions in front of the entire group"

Paul Tuten

• Decided to create this for the WG
  • Asked Jas if he can take care of this
    • Asked Jas to simply add one more column to the tracker

Medical Professional Services (MPS)
Doug Arnold

• Indicated that MPS is surveying providers to see the types of e-mail they are using
• Addressed the documentation for the various cross-walks
• Informed WG that MPS held a couple meetings with hospitals about sharing lab data
  • One hospital in the area uses Emdeon for lab data
    • Talking about how to incorporate that lab data into their pilot
  • Big meeting next week with the MedPlus folks

MedAllies
Parag More

• Informed WG that MedAllies held a meeting with vendors
  • Had a good conversation about how to move forward
  • Asked about how to address potential issues
• Plan to move forward from the technical surveying soon
  • Putting together a project plan
  • Should be ready in either a week or two
• Added that MedAllies does not have resource needs at this time from the WG

CareSpark
Susan Torzewski

• No major changes to report to the WG
  • Working on the secure messaging part with the VA
  • Most likely will use the .NET reference implementation
• Indicated they are making progress, albeit slowly because of the ramifications facing the VA

Paul Tuten

• Do you have any resource or collaboration needs?

Susan Torzewski

• Responded that once again CareSpark does not have any current needs
  • Thanked Paul Tuten for asking

Redwood MedNet
Will Ross

• Stated that Redwood MedNet still faces a "resource deadlock"
  • Trying to put resources on the project
  • Unable to dedicate any resources as of now
• Indicated that Redwood MedNet will have "zero problems" with the reference implementation connectivity
  • Their team is working on/assisting the Java reference implementation
• Asked if there are concrete NHIN Direct participation guidelines

Arien Malec

• Asked for a clarification: "Are you referring to an end-user agreement?"

Will Ross

• Responded yes
  • Looking from guidance from the top
    • Maybe the Tiger Team
    • Maybe ONC/Policy
  • Received a suggestion to consider the Best Practices WG

Arien Malec

• Commented regarding the Best Practices WG as an option
  • Would not be able to create a legal agreement
  • The Best Practices WG could list the issues that go into such an agreement

Will Ross

• Clarified that he is speaking about agreements between the HISP vendor and providers
  • One cannot sign an agreement with NHIN Direct
    • NHIN Direct is merely the piping

Arien Malec

• Asked is Will Ross was essentially speaking about an eDURSA?

Will Ross

• Responded yes

Arien Malec

• Asked if Will Ross had applied for funding with respect to this?

Will Ross

• Responded that the "short answer" is yes
  • Working with the CTO of ValleyConnect

Doug Arnold

• Expressed view that they still need an end-user agreement

Gary Christensen

• Asked if they were talking about HISP-provider agreements
  • Point to point disclosure
  • If anything goes wrong, the HISP would be responsible likely
• Expressed view that each HISP would probably want their own language with respect to such an agreement
  • Rhode Island Quality Institute is preparing for such

Paul Tuten

• Recognized the importance of the issue
  • Will be discussed off-line

VisionShare and Public Health
Paul Tuten

• Reported that VisionShare's pilot project is still in limbo
• Highlighted his Catch-22 situation:
  • Difficulty for states to participate in pilot projects
    • VisionShare as a HISP vendor does the pilot in a pro-bono state
      • This may shape what the states want from NHIN Direct
    • In the future, states would be prevented from using VisionShare in the production state
      • VisionShare is willing to take the risk
  • Technology leaders in some states are still worried
    • May want to have VisionShare as their continued HISP when production rolls out
    • State may have to rip something

Gary Christensen

• Commented that he has seen this concern arise before
  • Do not necessarily have the answer
  • More of personal choice issue for the participating state

Noam Arzt

• Asked: What would have to be ripped out?

Paul Tuten

• Responded he is not sure if they let them continue to use the technology
  • There is a demand for ongoing support of that technology
  • States desire ongoing maintenance relationships

Gary Christensen

• Asked what technology the state would actually be using

Paul Tuten

• Responded that VisionShare would be acting as the HISP
  • In the future, the state may have to buy a commercial product
    • In that case VisionShare could not continue this capacity

Gary Christensen

• Expressed RIQI's operating view that "nothing can be customized for the HISP"
• Believes that end-users should not even know you are the HISP

Paul Tuten

• Responded that VisionShare is willing to roll the dice on the issue
  • If another HISP takes on the state during the production stage, VisionShare is okay with that

Gary Christensen

• Suggested that Paul Tuten push back on the people at the state
  • If this project is done right, changes in the HISP vendor should not impact the state
  • Added that in an normal case, when the production stage roles around:
    • The state would do an RFP with competitive bidding
    • Whether or not VisionShare is eligible for that RFP should not make a difference
• Believes the state has not thought through the problem

Open Discussion

Doug Arnold

• Directed a question for Arien Malec/Microsoft HealthVault team
  • Recognized that some of the NHIN Direct user stories involve patients
  • Asked if they need certificates or agreements with patients?
    • MPS is working with patients

Arien Malec

• Recognized that Sean Nolan and Umesh Madan from Microsoft are not on the call
  • They would be the best to answer such a question which relates to PHRs
• Asked Paul Tuten about the status of the cross-walks

Paul Tuten

• Responded that they are mostly done except for the Technology Providers x Pilots Crosswalk
  • Depends on the pilots to complete that one
  • Asked the WG to focus on the Certificate Authorities sub-cross-walk specifically
    • That cross-walk is the most incomplete

John Williams

• Introduced Garden State Health Systems as a participant on the Geographies WG
  • Considering themselves as a pilot
  • Asked about guidelines for participation

Paul Tuten

• Pointed him in the direction of Implementation Geographies Participation Guidelines - Check List

Uvinie Hettiaratchy

• Added to Paul Tuten's comment about the cross-walks
  • Other categories need to be filled in the Technology Providers x Pilots Crosswalk

Paul Tuten

• Responded that other sub-cross-walks do need to be completed
  • Only mentioned that some columns that are blank may be complete
  • The Certificate Authorities sub-cross-walk is simply the least completed
• Noted that everyone has been put on notice for the next meeting

Doug Arnold

• Shared that he has already used some of the communications materials
  • Blasted e-mails to the physicians
  • Found the materials very helpful

Arien Malec

• Asked the WG to definitely send their suggestions to the communications WG

Doug Arnold

• Asked: Are all the materials public?
  • Already sent the materials to 400 providers through a newsletter

Arien Malec

• Stated that the materials on the Wiki under a CreativeCommons licensing agreement
  • Make sure to attribute
    • The NHIN Direct Project
    • Actual author of material whenever possible

Michael Firriolo

• Introduced himself as also from Garden State Health Systems
• Asked if there is a discussion section for NHIN Direct

Arien Malec

• Stated that he would point Michael Firriolo to all that stuff

Doug Arnold

• Inquired to the status of the final reference implementation

Arien Malec

• Responded that they aim to be feature-complete by the end of the month
  • Goal: Organizations can use it at the end of the month
  • Java side - XD* side near feature complete
  • CSharp side - SMTP s/MIME feature complete
    • Biggest problem: XD* side

Paul Tuten

• Other questions?
  • (No further questions)
• See you next week