Implementation Group Meeting 2010-08-31

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Notes from the Implementation Group
Date: August 31, 2010
Time: 3:00pm - 4:00pm
Alere, American Academy of Family Physicians, Axolotl, Cerner, Clinical Groupware Collaborative, Covisint, CSC, eClinicalWorks, Emdeon, Epic, Gartner, Google, GSI Health, Harris Corporation, High Pine Associates, HLN Consulting, IBM, Inpriva, Kryptiq, Massachusetts eHealth Collaborative, MedAllies, Medicity, MedNet, Microsoft, Mirth Corporation, Misys Open Source Solutions (MOSS), ONC, Oregon HIE Planning Team, RelayHealth, Rhode Island Quality Institute, Siemens, Surescripts, Techsant Technologies, VisionShare

Actions for This Week

Due Date
Update the resource collaboration matrix on the wiki. (LINK=[1])
Pilot project participants
Call for Consensus: NHIN Direct Overview document.
Vote on the wiki (Link) by September 8th.
(Remember, no vote is the same as a vote of consent.)
IG members
Let Documentation and Testing WG know if you have a documentation need.
IG members

Actions from Last 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 [[2]] 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: [3])
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 sprint, third week in September.
Developers (with our without experience)
Make requests and ask questions of Documentation and Testing WG: (
All IG members


· Reminders
· Workgroup Updates
· Calendar &Participation
· Recap


Arien Malec (ONC)
· Q&A text box in Live Meeting can be used to submit questions.
· Skipped through “What is NHIN Direct?” slides.
· Looked briefly at timeline, which reveals lots of recent progress.
· There will be a Connect code-thon in September that NHIN Direct coders are welcome to join.
· There might be another code-a-thon in October.
· Current priority: Looking at implementation geographies for guidance going forward.
· The ref implementation is guiding the implementation geographies.
· Skipped over high-level plan, which was talked about last week.

Workgroup Updates

Paul Tuten (VisionShare)
(1) Implementation Geographies WG
· This week the WG received an update from the C* Reference Implementation WG team, which has been helpful for pilot projects.
· WG is in the process of filling out more detailed plans for individual pilot projects.
· They are identifying issues common to different pilot project groups but also the unique issues for each.
o This process helps them identify documenting issues (i.e. what they are doing about certificate authority).
· Meta-level: building crosswalks between projects.
· Looking again at MU criteria.
· Talking with IT vendors.
· -->Call to action: anyone interested in participating in a pilot project, whether actively running a project or wanting to get involved, please use the resource collaboration matrix on the wiki and update accordingly for your respective organization. (LINK=[4])
· Would be helpful to be able to marshal resources to where they are available.

Sean Nolan (Microsoft)
(2) Security and Trust WG
· Two main topics were covered by WG this last week.
· First, there was a final review of the threat models and consolidation of the threat models.
o John Moehrke did some upfront work to consolidate work efforts of the agent-based HISP-based model and the second model, an end-to-end SMTP model.
o Moving to consensus at the WG level.
· The second issue discussed was locking in on the DNS mechanism.
o Some organizations feel that LDAP is the right long-term approach.
o WG reached a working consensus that the spec will still call out DNS as the “should” mechanism, but also will clearly call out that this issue is an item of active discussion and exploratory review, and that organizations are encouraged to implement LDAP-based certificate distribution as well.
· Surescripts has an interest in addressing LDAP as a certificate distribution mechanism.
o Combines certificate distribution and provider directories.
o WG hopes Surescripts or another organization that feels strongly about LDAP can prove that model out in the pilot work.
· Also discussed that there may be bridge mechanisms between DNS and LDAP.
· WG’s main message is that they are open to different models. The team advises moving the current model into pilots, but encourages development of other models and not insisting only one model is used.

Wes Rishel (Gartner)
· The online list of implementation geographies had not changed.
· Are they all definite, still in flux?

Paul Tuten
· Still in flux.
· WG believes most pilot programs represented on the list will happen.
· Yet some may not be listed yet and some may not have a large enough constituency to get off the ground.

Arien Malec
· Everyone listed there has gone through some form of stakeholder review.
· They’ve told us, “I’d like to do a pilot program and I’ve discussed this with the key organizations in my geography.”
· The next step for those organizations would be to come back to us with X number of providers they have had commit to joining them.

Wes Rishel
· Would be interested to have some kind of table timeline for the process.

Arien Malec
· Agreed.

Brian Behlendorf (ONC)
(3) Reference Implementation WG

· C# reference implementation is progressing along very nicely.
· WG is 90% of the way to its baseline goal of being able to send/receive messages and have a basic running system.
· Currently WG is cleaning up the code and documenting it.
· Held a Bug Scrub earlier this week, trying to get through major bugging issues.
· Remaining work includes the “mays” and the “shoulds.”
· Java team is also progressing well. Team is gelling, making progress. They are focusing on agents and gateway pieces.
· Just like C#, Java team is waiting for information on the XDD spec.
· -->A key milestone this month is to reach a feature-ready state for implementation geographies by the end of the month.
o Gut-level feeling that they will meet this goal by the code-a-thon or soon thereafter.
o Partly depends on state of XDD spec.
· Useable code, ready to be wired into systems, should happen this month.
· WG members are attending a code-a-thon hosted by the Connect team on September 21 and 22 in Rochester, MN.
· Hopes the meeting will be a good bridge to the Connect community and the larger NHIN community.
· Possibility of a Face to Face meeting in October which would include an install-a-thon, interchange-a-thon, and setup-a-thon.
· The next step would be pushing the materials to pilot communities.
o Umesh on the C# side has been working with the implementation geographies community.
o The Java side will be there soon.

Arien Malec
· Created graphs (see slides) of simple lines of code count.
o Does not count white space and documentation.
o C# team has been madly adding high quality code, and had a huge code base to start with.
o Getting unit tests in place, getting API documentation in place.
o Neither the Java nor C# team has started adding XDD or XDR.
· Also monitored daily activity of the source code repository.
o Lots of engagement on the development side.
· Over the last couple months we’ve seen the number of active contributors grow. Hoping to see that number continue to grow over time.
o Have had two particularly dedicated developers.
o We need to get a lot of learning out of their heads into the API documents and also into the rest of the team.
o Face to Face helped a ton with information exchange between developers.
· Functional status looks per area at the pieces of functionality.
o The core areas are code complete, such as the end-to-end test.
o This week Umesh and Greg got their respective C# and Java representations running end-to-end, fully interoperable.
o A lot of work has switched to agent configuration.
Good progress, a little more to go before can turn over.
Putting a lot of time, energy, and interest into this area.

Brian Behlendorf
· There are currently 10-12 active contributors.
· About 3 developers are the most active.

Janet Campbell (Epic)
(4) Documentation and Testing WG
· The WG issued a call for consensus on the NHIN Direct Overview document.
o -->All IG members should vote on the wiki (Link) by September 8th.
o Remember, no vote is the same as a vote of consent.
· -->Standing reminder: if you have a documentation need, let the WG know.
· Did some work today on nailing down what the XDD minimal data might look like, as well as working on the S/MIME spec.
· With the NHIN Direct Overview out of the way the WG can focus on other documentation needs.
· This coming week the WG will be picking out more documents to finalize by next week.

Arien Malec
· Another milestone, Greg pushed Java-based API documents.

David McCallie
· Asked about configuring UI scripts

Arien Malec
· Database structure is the same.
· Sees value to organizations that are Java based and also those that are C# based and use .net.
· Configuration scripts and database are as common as possible so we aren’t creating divergent ways of doing things.

Rich Elmore (Allscripts)
(5) Communications WG

· WG met today.
· Zeroing in on key messages for stakeholders.
· “What is NHIN Direct?” overall materials are also underway.
· Decided today to develop much more succinct, concise versions of the materials WG is developing.
· Over the next few weeks the Communications WG will generate useable material for the implementation geographies pilots.

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

· New: Policy WG, still trying to get scheduled.

· Excited about the momentum.
· Changes to the wiki have gone up in the last few weeks.
· Documentation and Testing WG is producing valuable documentation.
· Good materials are coming from the Communications WG.

Q&A Session
Doug Arnold
· Commended Communication WG for the results he has seen from their hard work.

Arien Malec
· This Implementation Group is growing.
· Seeing lots of energy going into the project.

David Kibbe
· Can you give us an update on the name change to NHIN Direct?

Arien Malec
· The name change came up for the first time during the Face to Face meeting.
· Two main motivators for wanting to do a slight re-branding or renaming:
o One, the name for the NHIN will likely change in the next few months. Trademark issues.
o Two, we in this group need to find a way to talk about our product/specs, separate from the project itself.
The product this project produces can be used more broadly by organizations not involved with NHIN.
· At some point policy will help in leverage scale and universal addressing.
· Didn’t have anything more to announce.
· A couple ideas have been floated out.
· Process: names will run through the Communication WG and then to the full IG when there is a good candidate for the name.

Sean Nolan
· What is this new Policy WG and what will their responsibilities will be?

Arien Malec
· Their main responsibility is to interpret the recommendations of the Tiger Team and other accepted recommendations by the HIT Policy Committee that give an overall framework for policy for this project.
· Then there are lower-level policy decisions that need to be made.
o Provider and identification.
o Certificate policies.
· Deferred to Wes Rishel and David McCallie who were both on the Privacy and Security Tiger Team for any additional comments.

Wes Rishel
· Effectively the NHIN Direct project got a pass in the Tiger Team policy recommendations in the sense that the recommendations took out a use case they called “directed exchange” and said no further consent was needed because consent issues were already understood under HIPA, etc.
· There are other recommendations about consent and so forth that could apply to some uses of the technology and we might be faced with some interface there.
· Explained he was not exactly sure what the Policy WG in NHIN Direct was supposed to do other than “talk nice.”

David McCallie
· Has ideas about what the Policy WG would do but had not yet had a chance to float his ideas by other WG members.

Arien Malec
· WG will draw out a policy charter and publish to the wiki.

Sean Nolan
· Is there an expectation the WG would come up with policy all pilots would need to follow?

Wes Rishel
· Did not believe there were any recommendations to come out of the Tiger Team that have any impact on the pilots.
· Thinks Dixie Baker is concerned about the extensiveness of security through the pilots, but doesn’t perceive it will hold up.
· He didn’t see anything that would be a landmine for pilots.

David McCallie
· Also didn’t think anything would go wrong with pilots, policy-wise.
· Sees pilots as a good opportunity to explore, from a bottom-up fashion, what people are comfortable with.
· In the long-run, the policy recommendations are a consensus-driven set of choices.
· People coming to the project fresh can look at the policy recommendations and say, “these choices make sense to us. This is what we’ll do in our network, with abilities to secure in the network and choose who we communicate with or who we don’t communicate with.”
· Policy recommendations would not be mandatory.

Arien Malec
· No organization has any obligation besides voluntary commitment.
· All policy recommendations are therefore voluntarily adhered to.

Wes Rishel
· Policy recommendations can be thought of as “reasonable choices.”

David McCallie
· Most of the discussions to date of the Tiger Team are about patient consent: what are the issues that trigger the need for patience consent?, what constitutes real consent as opposed to forced extent?, and how do those issues play into health information exchange?
· At that level NHIN Direct got a pass because we run “directed exchange” and HIEs wanting to use NHIN Direct got a pass as long as they choose provider-to-provider communications.
· Each of our implementation geographies probably needs some policy that they can make around this.
· We don’t have to make the additional policy mandatory.
· We have the opportunity to work with the policies during implementation of the pilots, and to revise the draft based on the pilot experiences.

Arien Malec
· Other questions?

Will Ross
· Saw a press release about a new Tiger Team created to address provider registries.

Arien Malec
· There is a lot of interest in tying together NHIN Exchange, NHIN Direct and directories and making sure we have the right infrastructure and policies in place.

Will Ross
· The point made in the article was a quote from David Lansky, about “avoiding 50 HIEs developing 50 different addressing schemes.”

Wes Rishel
· Thought that from ONC’s point of view as they enable the rollout of HIEs, there are a whole bunch of edge issues to deal with, and this is just one of them.
· The point of NHIN is to exchange info among HIEs, so ONC has measures they’d like to make based on having position identities.

Arien Malec
· Felt that David Lansky’s comment about 50 different HIEs working independently, not linking together, was not connected to API.

Will Ross
· That’s the same status we’re in with our policy group.

Adrian Gropper (Clinical Groupware 'Collaborative/MedCommons)
· Where do patient to provider and provider to patient communications stand with regard to policy?

Arien Malec
· Tiger Team didn’t touch these use cases.
· NHIN Direct policy group should look at them.
· Should have good support for that use case in the documentation.

Adrian Gropper
· Would patients have certificates?

Wes Rishel
· Currently the policy is so far away from that.
· Tech-minded people would argue that it is not practical.

John Moehrke
· Heard at the Face to Face that there is no need for patients to have certificates.

Wes Rishel
· Deven McGraw is a champion of reasonableness. At that point during the Face to Face she was giving her own opinion because the issue has not been discussed by the committee.

Arien Malec
· Some organizations supporting patients might have certificates on behalf of the patient, but certificates would not be individually held by patients

Gary Christensen
· Who is on the new NHIN Direct Policy WG?

Arien Malec
· Contact us at [[5]] if you want to be considered for involvement with the WG.

John Moehrke
· Are there not EHR providers in some of our implementation geographies?

Arien Malec
· Yes, there are.

Doug Arnold
· Wants to know about other policies in ONC.
· RECs seem to be anxious to be approved by ONC.

Arien Malec
· REC process isn’t something he can comment on.