Geographies Meeting 2010-11-03

Status of Notes: DRAFT
Date: November 3, 2010
Time: 12:00pm-1:00pm EDT
Attendees: Doug Arnold, Mark Bamberg, Robert Barker, Greg Chittim, Gary Christensen, Tim Cromwell, Karen Donovan, Hank Fanberg, Andy Heeren, Eric Heflin, Uvinie Hettiaratchy, Jack Kemery, Kim Long, Umesh Madan, Arien Malec, John Moehrke, Parag More, Will Ross, Jas Singh, John Williams

Current Actions

#	Date	Action	Status	Owner	Due Date
39	2010/08/25	Update the Technology Providers x Pilots Crosswalk with Deployment Models	Open	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	CLOSED	Will Ross, Susan Torzewski, 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
63	2010/11/03	Upload clinical scope document to the MA Shared Documents and Pilot Planning Shared Documents	CLOSED	Parag More	2010/11/10
64	2010/11/03	Review Pilot Planning High-Level Roadmap and provider feedback on the Wiki page's discussion tab	CLOSED	Entire WG	2010/11/10
65	2010/11/03	Upload any documents that can be shared with other pilots in the Pilot Planning Shared Documents	Open	Pilot Leads	Ongoing

Actions from Two Weeks Ago

#	Date	Action	Status	Owner	Due Date
39	2010/08/25	Update the Technology Providers x Pilots Crosswalk with Deployment Models	Open	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	CLOSED	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	CLOSED	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	CLOSED	Parag More (MedAllies) and Susan Torzewski (CareSpark)	2010/11/03

Agenda

1. Pilot Updates
2. Round on the Pilot Planning High-Level Roadmap
3. Discussion on Pilot Planning Shared Documents
4. Open Discussion

Pilot Updates

Rhode Island Quality Institute (RIQI)
Greg Chittim

• Reported RIQI is preparing their testing plans
  • Details about these coming up soon
  • Going on Wiki and RIQI Pilot Shared Documents page
  • HISP was able to get their web-mail and edge protocol components tested
    • InterSystems - subbed out for interfacing testing
    • They are working on the back end
• Reported that their EHR Vendors have their back-end work running
  • Integration Testing
    • By the end of the month
    • Webmail working

Arien Malec

• Asked if InterSystems is doing an independent implementation

Greg Chittim

• Responded they are not a HISP
  • Building basic modules - going out to a mailbox

Arien Malec

• Responded that he now understood - they are not getting encrypted messages

Greg Chittim

• Responded exactly
• Finally also indicated that RIQI was addressing the complex Rhode Island consent issues

Medical Professional Services (MPS)
Doug Arnold

• Reported that MPS was working to incorporate SonicCare
  • Largest homecare provider in the state
  • Trying to incorporate their homecare monitoring device
• Further reported that MPS' physician team has a had a couple phone calls
  • Still working with Middlesex Hospital
    • Sharing lab data through EHR vendors
• Passed the technical update on to Kim Long from Medplus/Quest

Kim Long

• Highlighted that both Chris Moyer and Mark Stine were present at the Code-a-thon
  • During the Code-a-thon they connected with VisionShare and Microsoft HealthVault
• Added that Medplus/Quest has since made their HISP available to the participants in their pilot
  • Not available for production
  • But going through testing on wider scale amongst partners

MedAllies
Parag More

• Reported that MedAllies also had some exciting news to report to the WG
• Shared that MedAllies will have two shared exchanges with all the participants
  • Confirmation that one of their pilot sites is moving ahead (Scarsdale)
• Indicated that MedAllies is moving forward with their clinical workflow capabilities
  • Trying to manage the expectations
  • Questions about how they consume the data after the exchange
    • Out of scope of Direct Project
    • Still achieving MU criteria though
    • Will be posting a scope document on the Wiki
• Stated that Kryptiq will be participating on one of the pilot sites
  • Between the XD and SMTP capabilities

Arien Malec

• Asked if MedAllies was planning to incorporate providers using basic e-mail

Parag More

• Deferred question to Kryptiq

Karen Donovan

• Indicated she was present on behalf of Kryptiq
• Responded to the question that it is too early to comment

Parag More

• Highlighted that Vince Lewis was at the Code-a-thon
  • Internally debriefed some issues, but was really excited

Arien Malec

• Responded that it was great to have him there

CareSpark
Tim Cromwell

• Indicated that he was present on behalf of the Carespark pilot
  • He dropped off to come to this call
• Informed WG that the CareSpark folk were on a call with VA all day addressing their clinical design
  • Transferring technology requirements to the business shop
  • Susan Torzewski, Didi Davis and Chris Voigt were all listening to that

Arien Malec

• Stated there has been good progress with this pilot, just need to move to the next level
  • The gateway model that Umesh Madan and Sean Nolan created should fit well with the VA
    • The SMTP gateway sitting on the DMZ
    • Take messages from a particular sub-domain and send to a back-end box
      • The back-end machine will be running the Java stuff

Tim Cromwell

• Responded then that the CareSpark and VA will do their next round on that

Redwood MedNet (RWMN)
Will Ross

• Agreed with forwarded comments from Vince Lewis about the success of the Code-a-thon
• Reported that on the funding side for RWMN:
  • The pitch was delivered, but funder still needs a couple weeks to decide if they will swing at it
  • Looking for other funding opportunities in the interim
• Further reported that RWMN is moving forward on the production side (Will Ross donating his time)
  • His technology participant attended the face to face meeting (Mirth Corporation)
    • Dealing with addressing issues
    • Drafting the specifications and other documents
  • Official provider announced: Santa Rosa Memorial Hospital (SRMH)
    • SRMH going live with HealthVault next month
    • Ready to move forward with Direct afterward if it includes a HealthVault component
    • Populated with data from the St. Joseph's chain of hospitals

Arien Malec

• Expressed his joy in working with this WG on their pilot implementations
  • Stated that if they get the certificates right and the distribution right, then things should work out

VisionShare/Public Health
Arien Malec

• Informed WG that Paul Tuten was not present because he was mid-travel
• Asked Uvinie Hettiaratchy to provide Paul Tuten's update

Uvinie Hettiaratchy

• Provided Paul Tuten's update:
  • VisionShare successfully achieved PHINMS connectivity at the Code-a-thon
    • Paul Tuten feels good about going live in 2010
  • Getting close to announce the first official provider on-board in OK
  • Announced that Microsoft HealthVault is on-board

Umesh Madan

• Indicated that he had an update, but needs to talk to Paul Tuten

Arien Malec

• Suggested that it would be amazing if an IZ update goes to a patient as well

Pilot Planning High-Level Roadmap

Uvinie Hettiaratchy

• Explained that a number of potential pilots have reached out to them
  • Important to keep track of everything and capture it all
    • Success metrics
• Recognized that there were three phases:
  • Pre-Planning
  • Planning
  • Pilot Implementation
• Suggested the WG to definitely contribute to those questions to get captured here
  • Asked if they should give people a week to review

Arien Malec

• Suggested doing a slightly deeper dive
  • Doing a first round, understanding people need to do a dive

Uvinie Hettiaratchy

• Went through the Pilot Planning High-Level Roadmap
  • Governance
    • Each pilot will have different partners and technologies
    • Policy adherence (HITPC recommendations)
  • Clinical Design
    • What info will be exchanged?
    • Less technical, but what are you offering your customer/participants
  • Policy
    • Questions being raised in the best practices WG
    • In addition to legal agreements, security policy
    • Any issues in the pilots are being funneled up
  • Technical Design
    • Going from the clinical design
    • What are some of the things that need to be changed?
    • Status of the overall technical work-flow
  • Vendor, Systems Integration
    • Individual pilot calls
    • HISP integration, Vendor integration
    • Testing, etc.
  • Training
    • Anything necessary for the user?
    • How will new participants move in and out of the pilot
  • Pilot Implementation
    • Key outcomes?
    • What is the benefit?

Arien Malec

• Commented on the feedback from the Pilot Implementation section:
  • None of this is going to be transport related, but work-flow related
  • Really useful lessons
  • Feedback will be focused on your work-flow things

Uvinie Hettiaratchy

• Continued covering the Pilot Planning High-Level Roadmap
  • Feedback
    • Was your pilot successful?
    • If so, why?
    • What can we do to change that?
  • Lessons Learned
    • Security risks?
    • Technical risks?
    • How can we do that before our second wave of expansion?
      • Collecting and distributing those is very important
    • Be mindful of the HIT Policy Committee
• Discussed the key takeaways of the document
  • It essentially capturing previous WG/IG discussions
  • But it is also forward looking:
    • How can we help you through that process?
    • What can we do to help each other through the process?
    • What are some questions you have that we did not include in the mapping?

Andy Heeren

• Responded that he likes the visual components of the Roadmap
  • Will be easy to follow along for planning

Doug Arnold

• Responded that the Roadmap looks good
• Asked: If there are going to be some national HISPs, is there going to be documentation?
  • Access their capabilities?

Arien Malec

• Indicated that he would love to have SureScripts participate

John Williams

• Indicated that he liked the Roadmap
  • Especially likes the governance section of the roadmap

John Moehrke

• Responding that he likes how the Roadmap is adding value
• Expressed that he likes where this going now

Karen Donovan

• No longer present on the call

Jack Kemery

• Responded that the Roadmap is "great stuff"

Parag More

• Responded that the Roadmap looks good
  • Asked if existing pilots need to either:
    • Make sure all these details covered?
    • Or reconfigure their existing planning to the roadmap

Arien Malec

• Suggested that the pilots use the Roadmap as a check-list
  • For those already with documents, they do not need to change things now
  • For those starting de novo, this is a helpful guide for starting a pilot

Parag More

• Indicated that he sees some questions they had not considered
  • Thanked the Direct team for the resource

Kim Long

• No longer present on the call
  • Replacement from Medplus/Quest on the call
    • She was unable to look at the document to comment

Umesh Madan

• Responded that the Roadmap is a great checklist
  • Nice template to think about pilot implementations
  • Indicated that there were specific items he had not thought of yet

Bob Barker

• No longer present on the call

Will Ross

• Indicated that he had nothing to add
  • Stated that the Roadmap looks great

Gary Christensen

• Responded that the Roadmap looks good

Greg Chittim

• Responded that the Roadmap looks good

Mark Bamberg

• Introduced himself from MEDfx
  • First call on the WG
• Indicated he had nothing to add

Pilot Shared Documents

Uvinie
 

• Asked Jas to present the Pilot Planning Shared Documents
  • Indicated Jas came up with idea and put together the resource

Jas

• Emphasized that this to foster even greater inter-Pilot collaboration
  • He noticed that each Pilot Project Brief had certain documents shared with the entire WG
  • Thought it would useful to have a central repository/matrix for all shared documents
    • Pilots can easily access all shared documents
    • Individuals can compare technical/clinical work-flows across all pilots

Arien Malec

• Asked for a "round the room" about the Pilot Planning Shared Documents

Rhode Island Quality Institute
Gary Christensen

• Suggested a policy/legal column

Greg Chittim

• Suggested to further breakdown the technical work-flow column into technical and testing possibly
  • Depends on what Arien Malec's expectations
  • Fears that this list may get too long with their specific components

Arien Malec

• Responded they should keep this high-level
  • Can link to your specific pages for the more detailed breakdowns if list gets too long

MPS
Doug Arnold

• Asked if the clinical work-flow column addresses the various use cases

Arien Malec

• Responded yes
  • In the case of the MPS Pilot: What is the work-flow for providers on e-mail systems, or other systems?

Doug Arnold

• Indicated that he will try to contribute more next week

MedAllies
Parag More

• Indicated that he had nothing more to add
  • Suggested that this is excellent
  • Asked if they are going to have a page for those detailed discussions
    • Where do we update those things?

Arien Malec

• Responded they could have pages in the Wiki with the drilled down documents

Parag More

• Stated that he will be on the lookout for that

Doug Arnold

• Asked if it is okay for them to use these templates for each of their own pilots

Arien Malec

• Responded essentially yes
  • By putting the documents on the Wiki, they are shared with every Wiki member because it is under the Creative Commons License

CareSpark
Tim Cromwell

• Responded that he is not able to look into it because he is traveling
  • The CareSpark clinical work-flow is being reviewed all day today

Arien Malec

• Asked if Tim Cromwell has any objections to posting on the Wiki

Tim Cromwell

• No objections

Redwood MedNet
Will Ross

• Responded that he likes the idea of a legal/policy column
• Indicated that he overcame the more technical list problem by simply linking his pilot name to his pilot project brief
  • Jas Singh moved forward to include the legal/policy column and linked all pilots in the matrix to their pilot project briefs

VisionShare

• Not present

HealthVault
Umesh Madan

• Indicated that he would add himself and put links to their pre-production site
  • Jas Singh added HealthVault as well as SureScripts to the matrix
• Stated that next week the HealthVault stuff will be pretty enough to use

Open Discussion

Arien Malec

• Asked the WG to further review both documents