Implementation Group Meeting 2010-08-24

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Notes from the Implementation Group
Date: August 24, 2010
Time: 3:00 - 4:30pm
Akira Technologies, Inc, Allscripts, Amedisys, Atlas Development, Axolotl, CareSpark/Anakam HIE Tech, Carespark/CGI Federal, CareSpark/Lucent Glow, Cerner, Christus Health, Clinical Groupware Collaborative, CSC, eClinicalWorks, Emdeon, Epic, Gartner, GE, Greenway Medical Technologies, GSI Health, Harris Corporation, High Pine Associates, HLN Consulting, IBM, Inpriva, Intel, Kaiser, Kryptiq, MedAllies, Medicity, MedNet, MedPlus/Quest Diagnostics, Microsoft, Mirth Corporation, Misys Open Source Solutions (MOSS), NYC Dept. of Health and Mental Hygiene’s PCIP, ONC, Oregon HIE Planning Team, Redwood MedNet, RelayHealth, Rhode Island Quality Institute, Siemens, Surescripts, Techsant Technologies, VA

Actions for this Week
Due Date
Add discussion about XPDS, specs, and minimal data required as an agenda item to 08/25/10 Documentation and Testing WG meeting.
Janet Campbell
Write in wiki or send emails to [[1]] with comments or suggestions about how to make IG meetings more effective.
All IG members
Post list of open items complied during the Plan-a-thon.
Imp. Geographies WG
Read Security and Privacy Tiger Team’s recommendations letter: [2])
All IG members
Create list of all components completed by Reference Implementation WG and a schedule for when those will be done across each of the implementations.
Susan Johnson
Attend CONNECT Code-a-thon at Mayo Clinic in Minnesota, September 21 and 22.
Java or .Net team members
Attend virtual coding spring, third week in September.
Developers (with our without experience)
Make requests and ask questions of Documentation and Testing WG: (
All IG members

· Reminders
· Discussion on Next Steps for Implementation Group Meeting
· NHIN Direct August Face to Face Meeting Debrief
· Workgroup Updates
· Calendar &Participation
· Recap

Arien Malec (ONC)
· Going forward, wants the agenda for these IG meetings more about WG updates.
· For duration of this meeting, encourages participants to use the Q&A box to submit questions.
Discussion on Next Steps for Implementation Group Meeting
· There are four to five WGs in full swing, all doing good work.
· NHIN Direct just completed its third Face to Face meeting.
· Focus of August Face to Face was entering into the “real world.”
· Next Face to Face will be planned through the Implementation Geographies WG.
· There will also be some in-person meeting opportunities specifically for the code developers.
· Being together at the August Face to Face last week was very productive in helping people get plugged in and contributing.
· Next milestone should be successful implementation of the pilots.
o The Implementation Geographies WG will let the Implementation Group know when to plan for the next Face to Face meeting.
o The Implementation Geographies WG, in turn, is asking the Reference Implementation WG what stage of progress the code is in and when it will be ready to use in implementation.
o In a wider context, the next step is getting specifications into a state where they can be transferred over to Reference Implementation.
· Arien’s domino theory as a model for next steps:
1) High quality reference implementation code.
2) Successful implementation through pilot projects.
3) Getting standards and specifications incorporated into a wide variety of HIE technology.
4) Policy guidance.
NHIN Direct August Face to Face Meeting Debrief
· What happened during the August Face to Face Meeting?
o The “a-thons” went really well, doing work in smaller groups.
o Recurring theme: need for better communication across WGs.
§ àJas is putting together a clearer “Deliverable Tracker” for the wiki.
§ Requests can and should be made across WGs.
§ Using the IG meeting for Arien to talk less and for WG leads to talk more.
· Asks group, how can we use this Implementation Group and this meeting to better facilitate communication between WGs?
o àPlease write in wiki or send emails to [[3]] with comments or suggestions.

Arien Malec
· How many participants were at the August Face to Face Meeting?

Uvinie Hettiaratchy
· About 45 participants.

Arien Malec
· Introduced new metrics to measure progress.
· Between Friday, August 13 and Friday, August 20, (during the week of the Face to Face), the lines of code count jumped by 30-33% on both JAVA and .Net sides (includes only code and documentation or other text).
· The baseline count was already not bad. So clearly there has been a lot of acceleration.
· Soon will be tracking more metrics, such as number of developers contributing code, etc.

Workgroup Updates

Uvinie Hettiaratchy
(1) Implementation Geographies WG
· WG identified three main themes during Face to Face Plan-a-thon:
1) Had questions about reference implementation project management. When can they start using the reference implementation?
2) Question of scalability; each pilot project is testing locally but there is a need for collaboration across all pilots to determine challenges for wider implementation.
3) Need marketing and messaging materials. What information can this group arm pilot teams with when they go out to tackle this project?
· On the wiki there will be a list of open items compiled during the Plan-a-thon.
· Notes from the Plan-a-thon already on wiki. (
· àSoon there will also be a template for pilot project teams to record lessons learned and best practices.
o Each pilot project is unique but some are facing similar challenges.

Will Ross (Redwood Mednet)
· During Face to Face Deven McGraw of the ONC Privacy and Security Tiger Team outlined the issues of permissions and agreements.
· On Thursday, August 19 the Tiger Team released its recommendations document, which all Implementation Group members should read. (See “Draft letter” from August 16, [4])

Arien Malec
· The HIT Policy Committee endorsed the recommendations on August 19.
· Now the recommendations will go to ONC and HHS for formal consideration.
· These recommendations provide a good grounding for policy work NHIN Direct members need to do to inform pilot projects.
· Good news: The recommendations call out the simpler set of policy issues that are involved in directed messaging and compare those to the higher levels of patient consent needed for other forms of messaging.

Gary Christensen (Rhode Island Quality Institute)
· Where are the detailed notes from the Plan-a-thon?

Uvinie Hettiaratchy(ONC)
· Notes from the Plan-a-thon are on the wiki. (

Mark Stine (MedPlus/Quest Diagnostic)
· Where can you find the Tiger Team recommendations?

Arien Malec
· See “Draft letter” from August 16, [5]).

Doug Arnold (Clinical Groupware Collaborative)
· Is there a potential for inclusion of NHIN Direct protocols in future ONC rulemaking?

Arien Malec
· There are three levels of potential ONC action.
· Note that none of these three are guaranteed to happen.
o Whether or not ONC includes NHIN Direct protocols depends on us continuing to do good work.
1) First action option: Recognition of standards in the Federal Register.
o ONC publishes recommended standards.
o This is non-binding for everyone but Federal agencies.
o Would go first to HIT Standards Committee for review, then HHS for the Secretary to publish in the Federal Register.
2) Second action option: NHIN Direct protocols are related to ongoing work within NHIN governance.
o The HITECH Act gave ONC responsibility for establishing a governance process.
o There will likely by a governance process for standards recognized by NHIN.
3) Third action option: Inclusion of standards into a version of standards and certification rules.

· All the work NHIN Direct members are currently doing make up the key actions from us that will motivate ONC to take any of those steps.
· We need solid reference implementation, successful implementation geographies, and for all of the other work we do to support those two central objectives.
· Feels very strongly that all the work NHIN Direct members are doing is great, but nothing is a sure thing.

Sean Nolan (Microsoft)
(2) Security and Trust WG
· In WG’s last meeting John Moehrke talked about the security and trust threat assessment model and opened the model up for WG review.
· The WG tabled a big discussion about certificate distribution with DNS v. LDAP for their next meeting on Thursday, August 26.

Arien Malec
· Noted that Reference Implementation WG is using LDAP for trust and privacy certificates.
· That work might make this decision a non-decision by providing support across multiple models.
· Might be able to harmonize.

Janet Campbell (Epic)
(3) Documentation and Testing WG
· At Face to Face, WG learned they can be so much more effective in person.
· Documentation WG measures their success by the amount they can cut out of their documents with the end result of concise, clear messages.
· In the future, will try recreating the same in-person WG experience, maybe over Live Meeting.
· Set a goal of completing one document per week or even more if more people want to be engaged.
· 08/25/10 meeting will cover:
o the process for future finalization of documents.
o prioritization of documents.
· Plan going forward is to (1) finalize documents, and (2) bring to the larger group for approval.
· àDocumentation Drop Box off of the Documentation and Testing WG page is available for other WG members to make requests and ask questions (
· Already received request from Implementation Geographies WG to create a FAQ document.
· First priority is NHIN Direct Overview document.

Arien Malec
· Another Face to Face theme was to be pushy and make more demands of the other WGS.
· Do not wait for other WGs to offer their assistance. Approach them if you need something.

Rich Elmore (Allscripts)
(4) Communications WG
· WG’s job is to be able to take the good work from the other WGs and create supporting materials to communicate to stakeholders.
· WG focuses on three key segment areas :
o State HIEs and RECS (Lead=Brian Ahier)
o Health Systems / Individual Providers (Lead=David Kibbe)
o HIT Vendors (Lead=Michele Darnell)
· WG is finalizing those core messages to each stakeholder segment and creating Powerpoint representation of each messaging plan.
· Have a lot to create over the next few weeks.
· Would welcome additional participants with interest or experience in communications and marketing, or with access to vehicles of communication.

Calendar &Participation
Arien Malec
· Introduces calendar of weekly meetings:

Meeting Time
Reference Implementation WG
Tuesdays, 12pm-1pm EST
Communications WG
Tuesdays, 1pm-2pm EST
Implementation Geographies WG
Wednesdays 12pm-1pm EST
Documentation and Testing WG
Wednesdays, 2pm-3pm EST
Security and Trust WG
Thursdays, 2pm-3pm EST

· LapCorp and South Carolina SDE are new members to NHIN Direct project. Welcome!

Brian Behlendorf (ONC)
(5) Ref Implementation WG
· Very active participation on both .Net and Java side.
· The coverage on the Java side has strengthened.
· Momentum from last week has continued.
· Teams are getting over the hump of core functionality and looking at the remaining work, being able to integrate code and make it suitable for pilots.
· Thinks WG is at a point where they can begin sitting down with Implementation Geographies and mapping out technical requirements for the pilots.
o Look for future updates on the IG calls.
· Progress, participation, and process are all in good shape.
· A Connect Code-a-thon will be held September 21, 22 at Mayo Clinic in Minnesota.
o àJava or .Net team members are encouraged to attend.
o That same week the WG wants to run a virtual sprint.
§ à Developers with limited background in open source or health IT are encouraged to help out for even just a few hours.
· Java and teams have been meeting separately each week to get work done.

Arien Malec
· Recognized Susan Johnson for helping with Reference Implementation WG project management.
· àWG needs a list of all components completed and a schedule for when those will be done across each of the implementations.
· Susan is helping the WG get more organized.

Question from Audience
· Will the two parallel implementations follow the block layout that the .net group originally put out, just with a different language implementation?

Arien Malec
· By and large, yes.
· There was discussion at today’s WG meeting about data disfiguration.
· Plan to keep interfaces common across different languages, with similar architectures.

Brian Behlendorf
· Look at Java Components page ([6]), particularly the segment edited by Beau.
· This page provides clarity about Java and .Net.
· Need work done on testing and simplifying testing.
o For instance, providing vendors with the right information on getting their existing resources up to speed.

Question from Audience
· Previously posted a question on the Discussion Board about XPDs, specs, and minimal data required.
· As a process question, how do we resolve and come to consensus about this?
· Can an ad hoc group of people come together to publish this spec?
· Or should it be done through a WG?

Arien Malec
· Will likely be run through the Reference Implementation WG then kicked back out to Documentation and Testing WG.

Question from Audience
· So the actual technical decision would be made within the Reference and Implementation WG?

Brian Behlendorf
· Let’s be agile.
· We are not trying to create the kind of standard IHE would create.
· This group can’t supersede the kind of complicated standards IHE would create.
· This issue could be a task within the Reference Implementation WG.
o As Reference Implementation WG lead, requested assistance in making sure the right people who have been a part of the proposal to date can be involved in developing it into a spec that the developers can work against.

Arien Malec
· Will publish his working proposal to IHE.

Karen Witting (IBM)
· If the task is under Reference and Implementation WG it sounds like it will be kind of a hack.
· Concerned with the approach, because would be leaving issue for IT to decide without input from this group.
· The suggested approach would make it more difficult to reach an acceptable solution.
· Wants to hear some kind of agreement about what this larger group wants first.
· Handing over to IT with no preferences expressed by this group would be a mistake.

Arien Malec
· Describes his proposal to figure out a working model in Reference Implementation WG and then kick it back to Documentation and Testing WG to formalize a spec.

Comment from Audience
· Thinks some higher level discussion needs to happen before that process.

Karen Witting
· Arien’s suggested proposal does not posit an approach. It only presents a problem.
· IHE will just ask this group to come back with an approach.

Arien Malec
· Plans to keep his proposal very general, with a level of metadata conformance.

Comment from Audience
· Was not suggesting we go to IHE with no recommendations.
· Wants a forum to get the right people together to form the proposal.

Arien Malec
· Notices that Documentation and Testing WG people are doing most of the talking on this subject.
· àSuggests adding as an item for the Documentation and Testing WG meeting no 08/25/10.

Karen Witting
· We need to write down direction first, and then give it to the Reference and Implementation WG.

Arien Malec
· Material that is ready to go public may have to go through the ONC first. Uvinie is working with the ONC PR people to find out more.

Gary Christensen
· Recently at a public forum for Connecticut HIE, state senators wanted to know what is going on with NHIN Direct. There is need information.

· There have been lots of requests for info about NHIN Direct.

Arien Malec
· The Documentation and Testing WG is close to finishing the Overview document.
· This will be a good document to give out at such events.

Gary Christensen
· Asked if the Implementation Group list of participants has been shortened.

Arien Malec
· Yes, the IG list was shortened to those who formally submitted a commitment summary.

Question from Audience
· Looking on wiki and trying to find a draft of the specs.

Arien Malec
· The team has some clear wiki cleanup to do.
· Jas and Caitlin are looking for dead and dying pages.
· Going forward, we want to look at making the IG meetings more effective. Please submit your ideas and feedback to [[7]] or directly to the wiki.