Meeting
AG Leadership Group Planning Meeting
Date &
Time
Purpose
AG Leadership Group weekly meeting.
Location
ONC
Erica Galvez - ONC
BAH Team Members
Lynda Rowe (BAH) Rowe
Greg Dengler
Eunice Choi
Attendees
Beacon Community Members
Alex Alexander – Southeast Minnesota
Chethan
Bob Kraninsky - WNY Beacon
Mark Bean - Utah
Bruce Weigand - Southeast Michigan
Kim Chaundy - Keystone
Jo Walker – Tulsa
Trudi Mathews – Cincinnati
Monday, May 6, 2013, 2-2:30 PM
Webex
Vendors
Ed Donaldosn – Success EHS
Alan Uhl - Vitera
George Cole - Allscripts
1 Agenda
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Roll call – Lynda Rowe (BAH)
User Stories Update
o VDT User Story review – Kim & Alan (Displayed on Webex)
Outline MU 2 Numerator/Denominator Tracking Responsibilities – Lynda Rowe (BAH)
Pilot Scenario Discussion – Lynda Rowe (BAH)
Outline of Possible Pilots – Lynda Rowe (BAH)
Beacon Pilot Form (Displayed on Webex) – Lynda Rowe (BAH)
Identification of Beacons/Vendors that will fit into each Transport Use Case – Lynda Rowe (BAH)
Paul Tuten Presentation Update – Chuck Tryon (Tulsa)
HealtheWay Update – Chuck Tryon (Tulsa)/Lynda Rowe (BAH)
WIKI Development Update – Greg Dengler (BAH) (Displayed on Webex)
Work Plan Progress – Chuck Tryon (Tulsa)
Wrap up/Next Steps – Lynda Rowe (BAH)
2 Notes
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Chuck Tryon (Tulsa) - We have a really packed agenda today, let’s get started
Chuck Tryon (Tulsa) – Alan Uhl (Vitera) and Kim Chaundy (Keystone) have been working on the
VDT user story, it was revised and sent out, we are hoping for final approval today
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Alan Uhl (Vitera) - I know this document by heart, Ed Donaldson (Success EHS) has offered
several revisions, to break out the View, Download, and Transmit options. There was also
changes in the diagram itself which were made, we also changed CCD to consolidated clinical
summary
o The story itself/narrative has not changed, I removed the MLLP transport option from
the list of transports because it caused some confusion within the group
Chuck Tryon (Tulsa) – MLLP Is still included in transitions of care, but not at the patient level
where we are focusing, so I think that was the justification for pulling it out of this use case
Chuck Tryon (Tulsa) – Any comments or questions on the VDT user stories? I believe the next
step is approve this and add it to the other user stories
o Ed Donaldson (Success EHS) – The only concern I had was the focus of this document,
the VDT user story is more focused and necessary for the EHR, I do not know how we
could integrate that for a provider using the EHR and making it available to the client
through the Beacon
o Alan Uhl (Vitera)- Good point we have this all available for the patient portal as well, the
tie between the portal and the Beacon is the hard part
o Lynda Rowe (BAH) - Only way this may work as a pilot is with a practice, creating a test
user account in the portal, then testing that transmit using DIRECT to another testing
EHR, we need any endpoint where we could push a document out of an EHR, maybe to
an HIO
o Ed Donaldson (Success EHS) - My impression of this, is it is mostly patient focused, what
the patient can do with this information, would the beacon portal act as an EHR for the
patient?
 Yes
 Kim Chaundy (Keystone) actually has an EHR that acts in this way
o Maybe there is a need for 2 diagrams here, one that recognizes the exchange service
and another that is the patient dealing more directly with the EHR
 Ed Donaldson (Success EHS) - You may want to move what we are discussing in
between the EHR and the endpoint HIO, you would have the transmit going to
the HIO
 Maybe this could reflect the Beacons pulling information from multiple sources?
 Yes they were pulling from multiple sources then allowing this data to be stored
separately
 Would this be additional data available to the patient in the bigger
sense versus achieving MU for VDT?
 Chuck Tryon (Tulsa) – Ed Donaldson (Success EHS) this is a good point,
we are trying to show what is available for MU2, being able to channel
what an EHR has for a patient
 Does it have to be from the EHR, or does it have to be from the Beacon?
 Lynda Rowe (BAH) – It could be from the Beacon if they went through
modular certification
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Chuck Tryon (Tulsa) – Moving the summary of care document from the
EHR to make it available to the patient, when the patient downloads it
could be a CCDA if they wanted to transmit it from there it would have
to go by DIRECT
o Chuck Tryon (Tulsa) - Are we representing the patient pulling
down a community wide EHR summary or just a summary from
a single EHR?
o The idea here is we are working with the Beacons, how are we
incorporating the Beacons and using them to make value in the
pilots?
o We need the diagram to show multiple EHRs feeding into the
cloud
o Alan Uhl (Vitera) – That would not be a bad idea
o I think a patient has to initiate this process
o Chuck Tryon (Tulsa) – Did we mention a modular certification is
required for this?
 Alan Uhl (Vitera) – No there is no mention of this in the
document, but it can be added
 Lynda Rowe (BAH) – I think there are 2 dominant use
cases for transmit, one is from a tethered EHR portal to
a destination to hopefully another care setting
 The other use case is to certify your HIO
community portal, then the patient initiating
DIRECT push to another provider which would
give them a broader set of data which they
could share with their provider
 Trudi Mathews (Cincinnati ) – It would be
helpful to differentiate anything you are
developing on modular certification, to explain
when the Beacon community conducts the
certification verses their vendor, this is an area
of confusion, under which circumstances we
need to be certified verses our vendor
 Alan Uhl (Vitera) - You want to go ahead and
highlight the requirements for the process
around modular certification of a Beacon?
 Trudi Mathews (Cincinnati ) – There was a
question about our existing syndrome
surveillance capability, since we do this using
HL7 but it is our team that is implementing the
interface, there was a lot of questions in stage
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one whether we or our hospitals needed to be
certified
 I have some experience with that in south
Carolina, there you send us the CCD with
immunization information and the HIE takes out
the immunization information and sends it to
the registry, because they are certified to do
the immunization records, they can take the
information out in HL7 and send it
 Chuck Tryon (Tulsa) – In the interest of the
schedule is this something we should pick up on
Monday or Tuesday to make some small tweaks
on this document? Let’s pull Adele Allison
(Success EHS) into this discussion as well?
 Lynda Rowe (BAH) – Yes this makes sense
Lynda Rowe (BAH) – I put together some slides around numerator denominator computation,
Can someone please read through these slides to give the context of what we are really talking
about.
SLIDES WERE READ, CAN BE FOUND IN MEETING MATERIALS FROM 5/20/13 (Slide 5)
Lynda Rowe (BAH) – Let me explain the minimal denominator, this talks about what counts, the
provider has to direct the ToC summary to the receiver of care, this is what is counted, if you do
not want to include self-referrals, you do not have to, that it is not required for the rule, what
they do allow for is if you want to include self-referrals, the record keeping and tracking of this
may become much more complex, they are allowing this in case the EP has a large base of
people who self-refer, all this is saying is that however you define the denominator, your
numerator has to use the same set of criteria, you cannot mix and match criteria
Lynda Rowe (BAH) - What this slide shows is a version of query with a linkage (Slide 5) If you
cannot make the linkage in the numerator that the document went from A to B then it cannot
count, it must appear in both the numerator and the denominator
Lynda Rowe (BAH) – The date the document was pushed must be before the date it was viewed
in order for the transfer to count
Lynda Rowe (BAH) – Some of the options in our list need to be calculated by the HIO or the HIO
needs to provide documentation back to the provider
Lynda Rowe (BAH) – This is why having an HIE vendor at the table would be important
Chuck Tryon (Tulsa) – There will be multiple discussions on this going forward
o Lynda Rowe (BAH) - If I send a ToC from a specialist to a hospital, if within the hospital 3
providers look at the document, it would only count as one in the numerator, not three
referrals
o Chuck Tryon (Tulsa) – If there are multiple contributors in an HIE environment for a
record that is used in a downstream providers, all the contributors can count this data
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Lynda Rowe (BAH) – Yes anyone contributing to the CCDA can get credit when
the document is pulled, if it is in the providers denominator
Chuck Tryon (Tulsa) - Even if I am not part of doing the referral the fact that I
gave data that is used in the CCD I can count it
Lynda Rowe (BAH) – there may be many contributing physicians, but only the
primary care physician may be doing the referral
Erica Galvez (ONC) -It is critical to remember that nothing can go into the
numerator if it is not in the denominator, In the event someone contributed to
the longitudinal record there has to be a EP transition that puts the referral into
the system, it does get a little tricky. A given patient could be in an EPs
denominator many times
Chuck Tryon (Tulsa) – That is a little confusing now, it sounds like this is a little
different than what we discussed before
 Ed Donaldson (Success EHS) - We are looking at a workflow. The only
other thing I can think of to track additional people contributing to a
CCD is to have a selector for an associated provider, to make the
contribution show up in the associated providers denominator so that
when that CCDA is pulled the contributing provider is listed and can get
credit
 Trudi Mathews (Cincinnati) - In order for anything to count in the
numerator there needs to be a transition that puts it in the
denominator, remember it is a transition or a referral, the unit of
measure is the transfer not the patient, anytime a CCDA is transferred
and somebody gets it, that transition can be counted in your numerator
 Chuck Tryon (Tulsa) - I think there are people a lot smarter and a lot
more involved, there are some questions in my mind, I do not want to
bog this discussion down
 Ed Donaldson (Success EHS) – I am wondering how we do the bare
bones, a provider initiates a transfer going to one of our Beacons,
obviously with Direct we know it is going to someone, how do we track
these transfers with other scenarios
 Bruce Weigand (Southeast Michigan) – In Detroit our predominant
catchment area, patients almost never go to where they are referred,
wherever they go the query is available, in a perfect world where they
go where they are supposed to go it is easier to track, we need to figure
out how to track the query when they do not go to the place they were
referred
 Ed Donaldson (Success EHS) - This sounds like there is a general referral
made and you need to close the loop on that, lets figure out the basic
use case then we can work from there
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Bruce Weigand (Southeast Michigan)– Lets figure out the basic use case
and work from there
 Lynda Rowe (BAH) – It is likely an HIO will not have easy access to the
denominator, unless the HIO is also the EHR vendor, unless a list is
provided of the referrals between the two organizations
o In other words, somebody has to do some work to get the
information between the two entities
 There is work involved whether it is the EH/EP or the HIO to match up
the patients and referrals, some of the options we have in our list, the
numerator/denominator needs to be calculated by the HIO or the HIO
needs to provide documentation back to the EP
 Chuck Tryon (Tulsa) – When you select a pilot for transport you are also
selecting a test ground for this transport and the documentation
involved, when we looked at the transport side it was not that
complicated, this element will really push where the pilots will be
 This is why having an HIE vendor at the table would be needed
Lynda Rowe (BAH) – We really need to know what vendors can support in these environments, I
want the Beacons to go through and see what the vendors can support in their pilots, you want
to think end to end, to select the pilot for your community, we would be very lucky if each
community can find one pilot that works, along with an HIE/HISP etc. that can work in their
environment
Lynda Rowe (BAH) – I still need validation from other EHR vendors
Lynda Rowe (BAH) – You are not limited to the vendors in the spreadsheet column, if there are
vendors a Beacon is working with now, we can add these to this list, we need to think practically
about how all of this will fit together
Chuck Tryon (Tulsa) – we will circulate this internally and nail down by the end of the month
what Beacons and vendors will participate in each pilot, the challenge will be to use this as a
vehicle to work through these pilots options
Lynda Rowe (BAH) – Any questions about the table and how it is laid out?
o No Questions
Lynda Rowe (BAH) - I know Allsripts information is up to date in the spreadsheet, I have not
heard back from some of the other EHR vendors, I know NextGen will be populating this any day
Chuck Tryon (Tulsa) - We can talk about missing Beacons on our call on Monday, maybe get
Janhavi Kirtane (ONC) on the call to stimulate and motivate this, we need to look for these
resources and be able to work through some of this information
Chuck Tryon (Tulsa) -I know Ed Donaldson (Success EHS), you wanted to reach out to us to see
how we may work together with Success EHS in Tulsa
Chuck Tryon (Tulsa) – A quick update on the Paul Tuten talk, Lynda Rowe (BAH) we are getting
three or four possible dates Paul can do this, we will put out the dates then select the one that is
most attractive to everyone, I think with what we have heard since then, this may want to be a
talk you make available to resources in your community
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Lynda Rowe (BAH) – I actually have 3 dates and times in front of me, the first is 5/22 2pm or
later, 5/29 between 2 and 4 5/31 between 2 and 3, these dates are all Eastern time
We will do the doodle poll and figure out what will work the best and we will work with Paul and
the team to set it up, we may want to broaden the audience beyond Beacon that would be
another thought as well.
Erica Galvez (ONC) - Next week is the Beacon main meeting, so May 22nd would not be a good
option, most Beacons will be at Beacon week in Washington DC, we may need to come up with
one more option with Paul
Chuck Tryon (Tulsa) – When we respond to the doodle poll there may be an option to only have
one person respond from each organization
Chuck Tryon (Tulsa)- HealtheWay update - there is a great deal of commonality with some of the
things they are working on, I think they are interested in what we are doing and how that may
come together with their organization, I am very intrigued in what they are doing with the
bridge C32 specifications, they are seeing this as a stepping stone to the consolidated CDA, they
built test tools as part of this, Lynda Rowe (BAH) what major takeaways did you have from this
discussion?
Lynda Rowe (BAH) – My major take away, I think they are doing a lot of good work around
content and collaborating on setting up certifications processes for transport in eHealth
exchange, they are doing DIRECT as well as query pull/push, they want to learn the on the
ground lessons from our group to incorporate into their structure
Alex Alexander (Southeast Minnesota) - Was there any discussion around shared services like
content management?
o Chuck Tryon (Tulsa) - We did not go into that level of detail, we were trying to figure
out where they were going as an organization, and how would that benefit the Beacons
o Chuck Tryon (Tulsa) – Where there are possibilities for collaboration we will discuss
these in the future
Beacon Vendor Affinity Group WIKI was discussed
Beacon Vendor Affinity Group Work plan progress was outlined
Wrap up – Next steps would be take the information we shared today and start pulling together
pilots
3 Action Items
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Discussion with Lynda Rowe, Chuck Tryon, Adele Allison around modular certification – Greg
Dengler
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Beacon Communities review spreadsheet containing vendor capabilities to match pilot
opportunities – All participating Beacon Communities
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Obtain technical capability validation from additional vendors – Lynda Rowe
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Speak to Janhavi Kirtane about garnering additional Beacon involvement with transport pilots –
Chuck Tryon
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Setup Doodle Poll about best time for Paul Tuten’s Presentation – Greg Dengler
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 “Follow-up 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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