Geographies Meeting 2010-10-20

Notes from Geographies Meeting
Date: October 20, 2010
Time: 12:00pm-1:00pm EDT
Attendees: Noam H. Arzt, Robert Barker, Greg Chittim, Gary Christensen, Tim Cromwell, Karen Donovan, Michael Firriolo, Uvinie Hettiaratchy, Leroy Jones, David Kibbe, Kim Long, Umesh Madan, Arien Malec, Parag More, Will Ross, Jas Singh, David Tao, Susan Torzewski, John Williams

Current Actions

#	Date	Action	Status	Owner	Due Date
39	2010/08/25	Update the Technology Providers x Pilots Crosswalk	Open	Pilot Leads: 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	Ongoing	Pilot Leads	Ongoing
45	2010/09/01	Input requests into the Resource and Collaboration Needs for Pilot Projects	Ongoing	Entire WG	Ongoing
57	2010/10/13	Hold side-conversation about CONNECT between Redwood MedNet, CareSpark and the VA	Open	Will Ross, Susan Torzewski, Didi Davis, Tim Cromwell	2010/10/20
58	2010/10/13	Update Resource and Collaboration Needs for Pilot Projects with VisionShare's specific request regarding HISPs operating with providers in Minnesota and Oklahoma	Open	Paul Tuten	2010/10/20
60	2010/10/13	List pilot questions and open issues for the Direct Project October Face-to-Face Meeting under the Discussion Tab	Open	Pilot Leads and Technical Teams	2010/10/25
61	2010/10/13	Ping Mike Berry or someone else from the VA's technology team to attend the October Code-a-thon/Install-a-thon on behalf of the CareSpark pilot	Open	Tim Cromwell	2010/10/25
62	2010/10/20	Determine if specific workflow documents can be shared with group at-large for the purpose of helping others in the development of their pilot implementations	Open	Parag More (MedAllies) and Susan Torzewski (CareSpark)	2010/11/03

Actions from Last Week

#	Date	Action	Status	Owner	Due Date
39	2010/08/25	Update the Technology Providers x Pilots Crosswalk	Open	Pilot Leads: 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	Ongoing	Pilot Leads	Ongoing
45	2010/09/01	Input requests into the Resource and Collaboration Needs for Pilot Projects	Ongoing	Entire WG	Ongoing
46	2010/09/01	Discuss off-line collaboration opportunities between the MPS and MedAllies pilot projects	TABLED	Doug Arnold, Parag More	2010/09/08
57	2010/10/13	Hold side-conversation about CONNECT between Redwood MedNet, CareSpark and the VA	Open	Will Ross, Susan Torzewski, Didi Davis, Tim Cromwell	2010/10/20
58	2010/10/13	Update Resource and Collaboration Needs for Pilot Projects with VisionShare's specific request regarding HISPs operating with providers in Minnesota and Oklahoma	Open	Paul Tuten	2010/10/20
59	2010/10/13	Update Resource and Collaboration Needs for Pilot Projects with MedAllies' specific project management request	TABLED	Parag More	2010/10/20
60	2010/10/13	List pilot questions and open issues for the Direct Project October Face-to-Face Meeting under the Discussion Tab	Open	Pilot Leads and Technical Teams	2010/10/25

Agenda

1. Pilot Updates
2. Round Regarding Goals for October Code-a-thon/Install-a-thon
3. Discussion Regarding User-Stories
4. Open Discussion

Notes

Rhode Island Quality Institite
Gary Christensen

• Passed to Greg Chittim

Greg Chittim

• Explained the general schedule for the RIQI pilot implementation
  • Thinking through currently the installation of the implementation

Arien Malec

• Asked if Inpriva is coming to the October Code-a-thon

Greg Chittim

• Responded that they are already up-and-running
  • Do not know if it is worth attending for Inpriva

Arien Malec

• Asked about use-cases
  • Summary records?

Greg Chittim

• Responded that RIQI has two main use-cases
  • Generating summary from CCD
  • Taking clinical record from EHR and send to State HIE

Gary Christensen

• Added that there are two separate but giant objectives
  • On one side focusing on State HIE
  • Other side looking to the beacon community
    • Continuity of Care messaging

Arien Malec

• Asked through what medium they will would transfer the PHI

Gary Christensen

• Responded that he is not sure yet, but will not incorporate in the EHR yet
  • For part A - yes a more simple version
  • Ultimate goal: Getting data flowing into the EMRs

Arien Malec

• Recognized that three pilot projects are all doing the same thing around "Continuity of Care"
  • Rhode Island Quality Institute
  • MedAllies
  • Redwood MedNet
• Indicated it may be useful to create a community of interest
  • Are likely to run into into the same workflow problems
  • Cited situation Redwood MedNet is addressing

Parag More

• Asked Gary Christensen if this is something they will be publishing in their requirements document

Gary Christensen

• Responded that RIQI is not focusing on the workflow in the near term
  • Currently looking at the technology integration process

Greg Chittim

• Stated that there has been some time set aside for this in their project plan (which they will post soon)
  • They will see RIQI is dedicating time to the process mapping/planning

Arien Malec

• Added that it was just an observation

Gary Christensen

• Stated that they looking for a built-in mechanism to adopt and achieve MU criteria

Arien Malec

• Stated that he completely understands their project plan
  • "Wire first, then map workflow next"

Will Ross

• Commented that he is ready to adopt the great work RIQI has done

MPS
Arien Malec

• Recognized that Doug Arnold was not on the call

Kim Long

• Provided update for pilot project (from Medplus/Quest)
• Stated that the pilot project is progressing forward
  • Dates from eClinicalWorks has been filled in
  • Project schedule planned out
• Indicated that they have begun to discuss their integration approach
• Added that she will attend the October Code-a-thon/Install-a-thon
  • Will try to coordinate with Microsoft for integration of HealthVault
  • Recognized that eClinicalWorks will not be there

Arien Malec

• Clarified the process that Medplus/Quest is using

Kim Long

• Confirmed Arien Malec's suggested approach
  • Quest is pushing to Medplus via SMTP

Will Ross

• Asked if Medplus/Quest is still using the REST code

Kim Long

• Responded yes

MedAllies
Parag More

• Indicated that MedAllies is hashing out the technical and clinical workflow challenges
  • Good forum on the technical integration
  • Trying to create such a forum on the clinical workflow side
• Stated that MedAllies integration partners are aligned in terms of technology
  • Week after the face to face meeting MedAllies should be able to begin integration testing
• Added that MedAllies is looking at another potential vendor

Arien Malec

• Highlighted that MedAllies is in the lead in terms of thinking through their technical workflow
  • Indicated it would be very helpful if MedAllies could make any materials available to the group

Uvinie Hettiaratchy

• Asked Parag More if MedAllies' project management concern had been addressed

Parag More

• Responded yes
  • They were able to align their resources internally to make space for such a need

CareSpark
Susan Torzewski

• Reported that CareSpark is passing workflow storyboards back and forth

Arien Malec

• Highlighted their order tracking workflow
  • General pattern would be great to share

Susan Torzewski

• Responded that she will check with partners to make this available

Tim Cromwell

• Responded that as a partner he is okay with sharing that

Redwood MedNet
Will Ross

• Indicated Redwood MedNet is:
  • Good on providers
  • Good on vendors
  • Good on state agencies
• Highlighted Redwood MedNet's major issue: Funding proposals
  • Explained Redwood MedNet's current back and forth with Cal-eConnect regarding their funding proposal
  • Hopes to hear something by this Friday

VisionShare
Arien Malec

• Recognized that Paul Tuten was not on the call

Jas Singh

• Clarified that Paul Tuten could not make the call because he is travelling
• Shared Paul Tuten's e-mailed update:
  • Established PHIN-MS connectivity in Oklahoma and Minnesota
  • Have their HISP up-and-running for next week's Code-a-thon

Round Regarding Goals for October Code-a-thon

Arien Malec

• Asked everyone to share their key goals for the integrate-a-thon (Code-a-thon)

Susan Torzewski

• Indicated that CareSpark would like to have the connection to CONNECT

Arien Malec

• Indicated they should explore the existing documents mission in terms of the API for CONNECT and DIRECT
• Asked Tim Cromwell if he is still considering the use Microsoft Exchange (outlook)

Tim Cromwell

• Responded yes - that still holds that as a request

Arien Malec

• Indicated that is on the agenda - talked to Umesh Madan
  • Should also get the arc up for that

Umesh Madan

• Stated that HealthVault is an eager participant in all of this
  • Would be fantastic if you are interested in setting it up

David Kibbe

• No response

John Williams

• No comment

Michael Firriolo

• Indicated he is hoping to send as many messages as possible to those present
  • LDAP or DNS
    • Use as many options as possible

Noam Arzt

• Nothing to add

Karen Donovan

• Nothing to add

Leroy Jones

• Nothing to add

Parag More

• Stated that his goal is to achieve a fully-functional HISP
  • XD connectivity
  • Easy path moving forward

Kim Long

• Nothing further to add
  • Already mentioned she is trying to connect to Microsoft HealthVault
• Indicated she would like to ask Mark Stine and Chris Moyer

Arien Malec

• Send this to [[1]]

Umesh Madan

• Indicated he had already said his piece

Bob Barker

• Indicated he is trying to leverage the XD profile
• Stated that he is excited to see where people are in terms of the workflow issues
• Further highlighted proper metadata in the messaging
  • Make the messaging more seamless

Will Ross

• Stated that two people from his pilot will be in attendance
  • His goal is on the documentation and workflow
    • Make sure the use-cases follow
• Preemptively mentioned that one of his sites that he will visit after the Code-a-thon has a HealthVault connection
  • Working on the project planning, workflow, milestone side of it

Gary Christensen

• Not attending

Greg Chiitim

• Nothing to add

David Tao

• Nothing to add

Tim Cromwell

• Asked Arien Malec if he had a confirmation from someone on the technology side from the VA
  • Indicated he would ping Brian Morgan
• Stated that he wants to send the VA's technology team to the Code-a-thon

Discussion on User-Stories

Arien Malec

• Highlighted that the Direct Project user-stories are currently missing patients in the workflow
  • Noticed while examining the User Story x Pilots Crosswalk
  • This is a bad thing within the national discussion - a gaping hole
  • Open up a discussion to get more engagement with the patients
• Raised two questions:
  • Is it possible for such incorporation of patients into your pilot's user-stories?
  • Is there a technology partner you are interested in working with on this?
• Initiated a round with each pilot implementation

Rhode Island Quality Institute
Gary Christensen

• Indicated that RIQI is exploring the retail aspect, but currently deferring this aspect
  • Watching HealthVault at the moment
  • At least for now there are a lot of questions around the population
• Indicated that he held an interesting meeting with a corporation that deals with diabetes patients (Medix?)

Medical Professional Services
Kim Long

• Indicated that MPS has Microsoft HealthVault
  • Stated they are currently not looking beyond that

Arien Malec

• Asked if they are already planning for doctors on the Medplus platform

Kim Long

• Responded that they will be sending from doctors to patients
  • CCD or PDF

MedAllies
Parag More

• Stated that MedAllies is in a similar boat as RIQI
  • MedAllies key priority is to get a pilot up-and-running
  • They are in the "wait-and-watch" boat
• Responded to the preferred vendors question
  • MedAllies is not in a position to answer that yet
  • Depends on what the Direct Project can provide

Arien Malec

• Responded that technically any PHR vendor should work

CareSpark
Kim Long

• Indicated that at the moment they have not been incorporating patients into their workflow
  • Could look into the possibility

Arien Malec

• Expressed interest in the blue button system the VA is familiar with

Tim Cromwell

• Indicated that they could possibly incorporate the Direct Project infrastructure

Arien Malec

• Suggested they could push the Blue Button information to the private sector through the Direct Project

David Tao

• Shared that he had attended his first meeting regarding this (as a substitute)
  • Glad to hear of this and the Direct Project
  • Happy to hear that this is the case

Arien Malec

• Provide context that this was an idea Adam Boswell, whose thinking was:
  • "Lets first get the health info liquid"
  • "Then we can look at the path ways"
  • "If only there was a big Blue Button so that we can download it"
  • "Once it is liquid you can do anything with"
    • Could send a direct message
• Stated that it was a good logical next step

Redwood MedNet
Will Ross

• Responded that Blue Button is far down the list of priorities
• Stated that he liked the way that Gary Christensen put it
  • Came out of the Markle Foundation in New York
  • Provisioning paths to patient data
    • Depends on ways to authenticate it is the patient's archive and the patient wants that
  • Focusing on getting just the clinical data liquid
• Indicated that his pilot would eventually focus on such a PHR system
  • RWMN recognized there is a home-grown PHR in california
  • Emerged because of the migrant workers

Arien Malec

• Suggested that maybe it is a lesser priority for HISPs to connect with PHRs
  • Maybe EHRs are more interested

Umesh Madan

• Disagreed with Arien Malec's suggestion
• Stated that HISPs can definitely connect with PHRs

Gary Christensen

• Likened this model to state HIEs

Will Ross

• Responded that the type is not trivial, consent maybe

Arien Malec

• Responded yes - either in the EHR or the patient portal attached to the EHR
  • Because the patients are there
  • Or it is provider mediated
    • Patient gives the address
    • Provider sends the information to the address

Will Ross

• Highlighted HealthVault briefly

Arien Malec

• Suggested a use-case in one place
  • A couple areas where this can be explored
  • Would like to reach out to the EHR vendors in the IG to discuss this

Gary Christensen

• Stated that he definitely agrees and that Arien Malec is exactly right
  • Natural market forces will make Direct Project integration
    • EHR vendors will want to adopt this
    • They can build into their workflow however
  • RIQI's partner Epichart sees this as a product feature in addition to their current offerings

Tim Cromwell

• Asked if any of this discussion will be coming out next week at the Code-a-thon

Arien Malec

• Stated that he would like to create a community-of-interest around PHRs
  • Asked Uvinie Hettiaratchy and Jas Singh to make sure there is a separate information session about this
    • Directed push to PHRs

David Tao

• Shared that Microsoft (Umesh Madan) and Siemens (David Tao) have been having conversations about this
  • Not sure yet if this is necessarily a Direct Project pilot implementation
  • Have not discussed Blue Button yet

Arien Malec

• Stated that once the other party has been identified we can do that
  • Bunch of things to go into the face to face to next week
• Indicated that this was a great discussion
  • Good takeaways - thanks everyone!