Meeting
Full AG Group
Purpose
Full AG Group weekly meeting.
Location
ONC
Christina Markle
BAH Team Members
Eunice Choi
Gregory Dengler
Tim Kwan
Attendees
Date &
Time
Vendors
Ed Donaldson - Success EHS
Tone Southerland - Greenway
Friday, May 3, 2013, 1-2:00 PM
Webex
Beacons
Chuck Tryon - Tulsa
Kim Chaundy - Keystone
Deepthi Rajeev - Utah Beacon
Arvela Heider - WNY
Pam Foyster - Colorado
Bruce Wiegand – Southeast Michigan
1 Agenda
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Roll call – Greg Dengler (BAH)
User Stories Update
Finalized User Story – Bruce Wiegand & Ed Donaldson (Final Acceptance)
VDT User Story review – Kim Chaundy & Alan Uhl (Displayed on Webex)
Update on Having Paul Tuten’s Module from the MU2 Summit Presented to AG – Tone
Southerland & Others
State HIE Joining Affinity Group – Chuck Tryon
Provider Friendly Slick Outlining Transport Pilots Update – Chuck Tryon
Work Plan Progress – Greg Dengler
WIKI Development Update – Greg Dengler
TDG for Beacons Update – Greg Dengler
Wrap up/Next Steps – Tone Southerland
2 Notes
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Chuck Tryon (Tulsa) - Let’s go through the user stories from Ed Donaldson (Success EHS) and
Bruce Weigand (Southeast Michigan). They spent quite a bit of time on these and were going to
go back and make some minor changes
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Chuck Tryon (Tulsa) - My impression, this is a document we can circulate and get great
value from, this clarifies what will happen in respect to transitions of care for
Meaningful Use Stage 2 (MU2)
o Chuck Tryon (Tulsa) - We want to be able to get final acceptance from the affinity group
today, most of the changes should be fairly small
o Ed Donaldson (Success EHS) and Bruce Wiegand (Southeast Michigan) will walk us
through what changed from last week, some small things
Ed Donaldson (Success EHS) - First change is on page 10, data set elements in section 2.2.6
o What we are doing here is saying that the use case supporting the CDR disease registry
does not have specific requirements for Meaningful Use (MU) Stage 1 but it does have
specific requirements for MU stage 2
 The displayed table lists all the data requirements outlined in MU2 and what
this data supports, this is a table taken directly from the S&I documentation
available online, I added the MU2 summary column on the side and went line by
line outlining each data element
o Ed Donaldson (Success EHS) - We can move to section 2.3.6 now
o Tone Southerland (Greenway) – What is the difference between the titles common data
set, and all summaries, is this the same thing?
 Ed Donaldson (Success EHS) - There is a specific data set called common
meaningful use data set which is outlined in S&I documentation, I used this in a
table in use case 1 which is why I titled it, common data set
 Tone Southerland (Greenway) – I understand this, see the sections
labeled provider name and all summaries on the next page? Should this
be labeled common data set, not all summaries?
o Ed Donaldson (Success EHS) - This was not listed, as I could tell,
under common data set so I listed it under all summaries
 Tone Southerland (Greenway) - I am not sure where these tables came
from
 Chuck Tryon (Tulsa) - Do we have references in here so someone will
not take out documentation and think it is from ONC?
o Ed Donaldson (Success EHS) - It is from the S&I framework
documentation, we actually have a URL with an attribution to
where these tables came from, we may want to add a notation
in all the places where these tables appear to note where they
came from
o Ed Donaldson (Success EHS) - In the first use case story there
are two tables, where I referenced where the tables came from
o Ed Donaldson (Success EHS) - I will add references to these
tables stating where they came from in all places they appear
Section 2.3.6 Updates
o Ed Donaldson (Success EHS) - All I did here was copy and paste from the previous use
case then change the wording to query and retrieve for the purposes of this use case
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Chuck Tryon (Tulsa) – Any questions or comments on this document, I have already
passed one along as a pdf to my own staff for review, I think everyone is so caught up in
everything else going on, I do not think MU2 has hit the agendas of anyone except EMR
vendors
 Group - No comments or questions on this document
 Chuck Tryon (Tulsa) - We have never been formal about approval, should there
be another process that is not affirmation?
 Tone Southerland (Greenway) - I think this is fine, we just need to
ensure it was reviewed by the full AG
 Chuck Tryon (Tulsa) - These user stories have been approved and can be
considered final
VDT User story
o Alan Uhl (Viteria) – Developed most of the document, Kim Chaundy (Keystone) helped
some, and will try to walk through it in Alan’s absence
o Chuck Tryon (Tulsa) – Everyone should take this document and read through it so we
can be ready to put this into an approval process by next Friday (5/10/13)
o Kim Chaundy (Keystone) – We covered view download and transmit cases
 Section 2.1 – We identified our actors from a physician’s perspective. This
includes getting information from one EHR to another, we also looked at this
use case from the patients perspective, we involved primary care facilities and
lab systems, highlighting how a patient can send information to a hospital or
EHR, and be able to view personal health information uploaded from either of
these locations
o Kim Chaundy (Keystone) – Section 2.1.4, We are looking at this as a real event, this is
something that our HIE is presently doing at a local university
 The patient is a Bucknell University student, who uses their university patient
portal to request an appointment with their physician. Their request is
acknowledged by the Physicians EHR then an appointment is scheduled, and the
patient is notified, this patient is requesting a checkup because they will be
traveling abroad
 The Doctor realizes there are some abnormalities with patient, and
decides to run additional tests, some of which are sent out to a lab
through the Physicians EHR. Once the lab runs the tests, the results are
transmitted back to primary care physician’s EHR system. There is a 4
day hold before the patient can get access to this information in the
patient portal, so the doctor can call the patient and discuss the results.
The patient was cleared to travel but was asked to update some forms
in the patient portal pertaining to current medication lists and allergies
 The patient has the ability to store their clinical data via a USB drive and
take this information with them while they were traveling
 Kim Chaundy (Keystone) - Any Questions so far?
o Chuck Tryon (Tulsa) - Is this going to summarize the majority of
the cases that we will see around VDT or is there a need for
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other scenarios? Is there going to be a more common scenario
of an everyday patient interacting with their doctor included?
Kim Chaundy (Keystone) - We laid this out using a student in the plot of
the story, but in theory, this could be any patient seen at a family
doctor, we could generalize this to every patient going to a doctor and
having blood drawn and tested by a lab
Kim Chaundy (Keystone) - All the elements are here and correct, and
thus could be applied to any situation
Group Question - Is there any schematic showing the elements of where
data is created and transmitted, and how it is transmitted; is this in the
scope of this document?
 Kim Chaundy (Keystone) - We were thinking
about more of a schematic of the data
elements; where the data travels and how it
gets there
 Chuck Tryon (Tulsa) – There is a diagram on
page 5 that speaks to the data flow
o The only problem I had this use case
was that it focused solely on one type
of scenario. This type of use case can
be applied to broader scenarios, you
may not want to make the reference to
a specific patient portal, we may want
to make this a little more generic for
people using this outside the Beacon
Communities
 Tone Southerland (Greenway) – I thought this
was around Beacon EHR interoperability, maybe
“Beacon portal is available” is how we word it, I
kind of liked the way this was written
o Group Suggestion - Maybe “patient
portal made available by Beacon
Community or EHR”, would make the
comment a little more generic
 This story has all the elements of any view
transmit download scenario, the diagram just
gives you a map of how the story occurred
Chuck Tryon (Tulsa) – Ed and Bruce you made sure not to reference
specifically the CCD document, correct?
o Ed Donaldson (Success EHS) - Yes, we just called it a CDA based
clinical summary
o Chuck Tryon (Tulsa) – I think we may want to make this more
transport agnostic
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Group Question - Do we want to incorporate this into one
document, a combined user story?
• Chuck Tryon (Tulsa) – You mean make a combined user
story so both are in the same document?
• Tone Southerland (Greenway) –I like them separate, as
an EHR vendor, we would look at them separately, a
separate group of developers would look at each of
these scenarios
• Deepthi Rajeev (Healthinsight) - Do we mean personal
health record tethered, as in the patient portal?
 Yes, the one we are referencing is tethered, but
we may become more generic in regards to this
 Deepthi Rajeev (Healthinsight) - Patient portal is
the umbrella term?
o Patient Portal is generic whether it is
from a Beacon Community or an EHR, I
think the idea here is that you can
transmit to it or upload to it your PHR
 We may want to put a definition of PHR
(Personal Health Record) so everyone
understands what we mean
 Tone Southerland (Greenway) - It would be a
good idea to add this information as
clarification, maybe in section 2.1.6 where
other terms are defined
Tone Southerland (Greenway) – I want to be sure we are
aligning with MU2 requirements
• MU2 is DIRECT or SOAP XDR/XDM
• Tone Southerland (Greenway) - I am looking at MU2
and I am just seeing what the applicability statement
outlines
• Ed Donaldson (Success EHS) - For instance, like on the
Health It.gov website, it has outlined the applicability
statement with SOAP + XDR/XDM
• Kim Chaundy (Keystone) - We mentioned LLPs simply
because of the reference of sending the lab results
between the lab and provider, if we feel this does not
need to be here, it can be removed. We are just trying
to be transparent of all possibilities
• Tone Southerland (Greenway) - We are trying to center
around the work being done for MU2 transports, so we
can make our work quicker
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Kim Chaundy (Keystone) - The transmitting of a MDM
via DIRECT is still within the guidelines correct?
 Chuck Tryon (Tulsa) - Tone Southerland (Greenway) are you saying we
already covered this with the original user stories we did with how data
gets moved around and this new work is just around MU2 implications?
 Tone Southerland (Greenway) - Yes
 Tone Southerland (Greenway) - Kim Chaundy (Keystone) you raised an
interesting question, can you use HL7 v2 data over DIRECT and be in line
with MU2, I believe that would be partially compliant, there is the CCDA
piece which will come later since the vendors and beacons are still
working on C83 standards
 Chuck Tryon (Tulsa) – I understood you tried to include these because
some of this data would be moving through other transport
mechanisms not outlined in MU2 which are already in place
 Kim Chaundy (Keystone) – I think we tried to highlight what the Beacon
Communities are using, we don’t have to get rid of everything, we need
to capitalize on what is already being done
o A lot of this exchange is done on the backend as well, so the
data is in the EHR making it available for exchange
o We are looking at data in 2 ways, from the provider to the lab,
and back to the provider
o Chuck Tryon (Tulsa) – When thinking about putting these two documents together into
a single user document, I guess my question is what was the original intent of the
document, if this is just another user story talking about VDT, maybe it will be more
confusing to keep these as 2 separate documents
o Tone Southerland (Greenway) – Yes, I see how it makes sense to combine the two into
one document
o Chuck Tryon (Tulsa) – I recommend we finalize version 2.0 of the ToC and repository
user stories now, then as VDT is finalized it will be combined with this document to
make version 2.1
o Kim Chaundy (Keystone) - I will make changes and send out the VDT user story again
Tone Southerland (Greenway) - Update on the Paul Tuten Module from MU2 Summit
o Quick Update, the MU2 summit was great, a lot of people were in attendance, we
talked about specifics of transport, specifically a lot around DIRECT trust.org and how
that comes into play during transport
 One big takeaway is to not lock yourself into DIRECT SMTP required transport
 You can leverage the query retrieve to meet the transitions of care measure, if
Beacon Communities have a centralized exchange model in place lets figure out
how to use it instead of building something new
 ONC is still throwing around how to flesh out how this type of exchange
is verified, meaning how to prove the receiving system downloaded the
information, but this is still a very viable option for MU2 transport
 Everyone may also have to certify on the optional transport methods
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HIE must be exchanged through eHealth Exchange standards
o In some ways our original affinity group took a lot of templates
from the interoperability work group for their C83 data
elements analysis
o Chuck Tryon (Tulsa) – Are there any of the presentations from the MU2 Summit that
need to be repeated? Specifically the content Paul Tuten presented, I think Lynda Rowe
(BAH) was carrying this.
 Group Response – No answer
Chuck Tryon (Tulsa) – I tried a couple of times to reach to Maryann Yeager (HealtheWays), Lynda
Rowe (BAH) was also going to help, and I know Kim Chaundy (Keystone) is working through her
state HIE to pursue the ehealth exchange, I do not have a lot more information on this right now
Kim Chaundy (Keystone) – The state of PA is making some DRSA changes on how they would like
HIEs within the state to operate, now there are actually 3 types of guidelines we need to follow,
we are offering feedback back to the state this week (5/3/13), offering insight into the eHealth
Exchange certification compared to what the state of PA requires for transport
Chuck Tryon (Tulsa) – State HIEs, if there is a partnership a Beacon Community is already
building with a state HIE we encourage you to get them involved with the AG as soon as
possible
o Efforts are being done by ONC on a one year program headed by Hunt Blair, formerly
the HIE director of Vermont, he is on a one year contract with ONC to maintain some
kind of collaboration between state level HIEs over the long term, they are also inviting
some Beacon Communities who focused on working with HIEs.
 They are putting together a charter, if this is something you are interested in as
a Beacon Community or you feel you have good involvement with your state HIE
you may want to join these calls
 Chuck Tryon (Tulsa) - Was anyone else on this call yesterday, I think
they are concerned with the continuity of the HIT movement after ARRA
funding runs out, they are bringing in the national association of
Governors as well
o Chuck Tryon (Tulsa) – Provider centric slick, I am putting this out there to see the
interest level in completing this task.
 I anticipate that in the near future we will be recruiting participants for these
transport pilots, and I think we will be faced with a lot of questions from
providers
 We need to come up with something that is a little more condensed
that we can give to providers to explain to them what we are doing with
these pilots, a fact sheet or frequently asked questions would work
 We need to tell providers what these pilots will do for them, how will it
help prepare them for MU2
Work plan was reviewed, we are behind schedule in matching Beacon Communities with
vendors for transport pilots
WIKI is being developed to house all of our work products
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3 Action Items, Next Steps
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Make small edits to ToC and Repository user stories to finalize them - Bruce Wiegand & Ed
Donaldson
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Make suggested edits to the VDT user story - Alan Uhl (Viteria) and Kim Chaundy (Keystone)
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Continue to try to get in touch with Maryann Yeager at HealtheWays – Chuck Tryon (Tulsa) &
Lynda Rowe (BAH)
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Continue to collect TDGs from reaming Beacon Communities – Lynda Rowe (BAH)
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Begin to match Beacon Communities with Vendors for transport pilots - Lynda Rowe
(BAH)
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Develop provider friendly slick or FAQ sheet – Chuck Tryon (Tulsa)
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Continue to develop WIKI page – Greg Dengler (BAH)
4 Dial in Information
TO JOIN THE WEBINAR, please log on to https://beaconcommunity.webex.com about 5 minutes before
the call.
Under the list of events, look for “Followup Meeting: ONC Vendor AG - MU Stage 2 TOC transports”
Click on the “Join” link to the right of the session
You will then be asked to enter your email address and your name (Also enter in the Beacon
Community or Vendor you are from)
Your screen will adapt for a few minutes while the session is getting set up on your computer
A grey pop-up box will appear - You’ll want to select “I will call in” from the drop down box
Please dial-in using the teleconference number 1-877-668-4493, follow by the participant access code
664 415 482
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