Meeting Minutes - August 6, 2019

• NIEM COI Meeting
• Agenda
• Slides
  • FHA Sunset
  • The Future of NIEM Health Interoperability
  • The Future of NIEM Health
  • NIEM Health Deliverable Complete
  • Transition Outreach
  • Lesson Learned
  • NIEM Health Crosses Multiple Domains
  • Recommended Scenarios
  • COI Lead Responsibilities
  • Transition Next Steps
• Q&A Plus Closing Comments
• Upcoming Events
• Action Items

NIEM COI Meeting

Hosts / Presenters:

• Avinash Shanbhag (FHA)
• Cait Ryan (NIEM)
• Brian Handspicker (NIEM)
• Ryan Schultz (NIEM MO)

Participants:

• Avinash Shanbhag (ONC/FHA)
• Sherilyn Pruitt (ONC/FHA)
• John Forrester (FHA)
• Cait Ryan (NIEM)
• Brian Handspicker (NIEM)
• Linda Self (NIEM MO)
• Matt Endreny (NIEM MO)
• Ryan Schultz (NIEM MO)
• Unknown Number (NIEM MO)
• Chris Travers (ACF)
• Nikolay Lipskiy (CDC)
• Suzanne Hassell (Johns Hopkins Univ)
• Jean Hall (Kentucky CHFS/PMIE)
• Diane Graski (NCSC)

Length: 1:05:48 minutes

Venue: Zoom

Agenda

• Welcome and Roll Call (Cait Ryan)
• FHA Sunset (Avinash Shanbhag, Sherilyn Pruitt)
• NIEM MO Remarks for NIEM Health (Ryan Schultz)
• Future of NIEM Health COI (Cait Ryan, Brian Handspicker, All)
• Wrap Up and Next Steps (Cait Ryan)

Slides

FHA Sunset

Avinash Shanbhag

• Avinash clarifies the Office of the National Coordinator for Health IT (ONC) is a staff division within Health and Human Services (HHS)
• Avinash states he will share:
  • The background of the NIEM project including:
    • Hopes for the future of NIEM
    • Activities the NIEM MO is conducting to support the future of the NIEM Health domain
    • Opportunity for Q&A with him and ONC colleague Sherilyn Pruitt
• The Federal Health Architecture (FHA) program electorally funds work supporting the NIEM COI
  • This is the connection between the FHA and the COI
• The FHA was founded as an OMB government line of business
  • This is an activity directed by OMB as the lead agency within HHS and all things regarding Health IT coordination in terms of technology standards and policy
• ONC is the managing partner for FHA
  • Along with HHS, the FHA is funded by the DoD, VA, the main office of HHS, and the SSA
  • The FHA was created in 2004
  • Including NIEM, the FHA funded a substantial number of projects targeting Health IT Interoperability at the national level
  • In early 2018, the FHA Managing Board decided to sunset FHA
    • At that time Avinash Shanbhag and colleague Sherilyn Pruitt joined ONC/FHA and were tasked by the ONC Managing Board to “deliberately and methodically” start transitioning the various programs FHA was funding
  • The sunset of FHA will take place in September 2019 for these reasons:
    • That landscape changed as technologies evolved and new entities arose:
      • Interagency programs such as ONC now exist
      • New agencies and offices that better coordinate federal health IT programs are now established
• NIEM COI is one of the key programs funded by the FHA over the past 2.5 years
• For the past year, the FHA, along with the support of their contracting team led by Cait Ryan of IRIS Health Solutions and Technical Architect Brian Handspicker, worked on a two-pronged approach:
  • Identify new stewards for the COI by:
    • Identifying use cases not currently handled by existing Health IT standards
      • There are many Health IT standards and a Standards Development Organization called HL7 (Health Level 7) that deal with health information and interoperability
      • NIEM has a clear value proposition in edge-cases Cait and Brian worked with the COI to identify:
        • The idea over the past year was to determine if there were valuable use cases identifying appropriate stakeholders and/or agency lead/s who would take on the stewardship of the NIEM COI after the FHA sunsets
  • Make sure COI activity, management, and administration are done in a way that support to keep it going is kept to a minimum
    • Make sure the “lift” and resources needed by federal agencies who may take on stewardship would be kept to a bare minimum
    • Identify key use cases to make sure future stewardship of the COI and possible NIEM Health Domain would require only modest effort
• ONC funded NIEM in the past and looked at internal appropriations to determine if it could continue supporting NIEM but determined:
  • The constraints of funding limited staff
  • The fact that ONC’s limited staff must support the work, including “the purest rule” that has taken on a lot of ONC’s internal efforts, dictates ONC cannot take on the work
• Looking at the work Cait and Brian have done, there are many use cases where NIEM can be used
• Contract support for NIEM ends September 9, 2019
  • The NIEM COI is useful and should continue
  • Due to the program sun setting, it is important the critical work that has been done by the FHA continues
  • Avinash asks anyone interested to please reach out as there is still time to transition
• August 15, 2019: NIEM Symposium hosted by the NIEM MO

The Future of NIEM Health Interoperability

Ryan Schultz

• Ryan emphasizes the importance with which the NIEM MO views the NIEM Health COI
  • Vital work has been done
  • The work is recognized within the NIEM community and leadership
  • Many have expressed the importance of NIEM Health Community
  • Ryan invites discussion to explore what “that way forward might be”
• NIEM Symposium Agenda and Overview:
  • Welcome and introductions
  • NIEM and NIEM Health Historical Overview
  • The Future of NIEM Health
    • Establishing NIEM Health’s Leadership
    • Collaboration Opportunities
    • Prioritizing Initiatives
    • Funding Models
    • NIEM Health Moving Forward: Next Steps
    • NIEM Health Scenarios
    • Wrap-up
    • Adjourn
  • The NIEM Health Symposium will be held in Rosslyn, Virginia
    • DC participants can take the metro
    • There will be dial-in capacity for remote/virtual participants
    • The Symposium registration URL is shown
  • The Symposium will be thought provoking on the value of the Health Community and what it does for interoperability and will explore:
    • The future of NIEM Health
    • What can be worked on and the kinds of things NIEM can contribute
    • How the Symposium can be used as a transition discussion with the larger stakeholder community of NIEM and NIEM Health
    • Those who have raised their hand to talk through various scenarios of how NIEM Health can contribute to interoperability within their area
• Brian Handspicker asks if virtual attendees will have capability to share their screen
  • There will be some combination of a WebX, Zoom, etc.
  • Safest to submit slides to NIEM MO
  • If material needs to be presented, NIEM MO will make sure it gets shared
    • Let NIEM MO drive the slides locally and someone can speak to them over the phone or WebX
• Ryan offers teaming-up with NIEM MO so NIEM MO can do some of the “heavy lifting”
  • It would be inappropriate for NIEM MO to be the lead to represent the health interests
  • A lot can be accomplished as a team if somebody will raise their hand
  • Brian Handspicker explains if multiple agencies/organizations are interested in supporting the NIEM Health COI there are solid examples of governance systems to support and quickly stand up to that kind of collaboration
    • Example: Mill Ops domain is a tri-chair with three organizations that have come together
      • It is not as resource-intensive as a whole, but everybody is doing what they would do naturally from an organizational responsibility perspective
      • Joining forces eases the burden for all
• Nikolay Lipskiy from the CDC Office of Public Health Preparedness and Response expresses strong support for NIEM
  • Specific interest is to support cases for public health emergency preparedness response
  • Wants to talk to someone interested in a collaborative effort
• Happy to support this specific use case or domain and very much wants to participate

The Future of NIEM Health

Brian Handspicker

• Brian Handspicker states work on proof of concepts has begun with the National Interoperability Coalition
  • There are a many people, especially in San Diego, interested in the emergency response aspect of NIEM Health

NIEM Health Deliverable Complete

Cait Ryan and Brian Handspicker

• Cait Ryan confirms the three promised deliverables providing education were delivered to the NIEM office in July 2019 and will be uploaded to the NIEM Health COI Page after NIEM editing and branding:
  • NIEM 101: An Introduction to Health Information Exchange (HIE)
  • NIEM 102: An Introduction to Security and Privacy of Protected Healthcare Information
  • NIEM 201: Architecting NIEM IEPDs Using Health Information Models
• Additional slide commentary:
  • Existing standards
  • How to look up, identify, and use data elements needed for information exchange package documents for IEPDs to align with existing health standards
  • A repeatable process is in place
  • If no one can take this work on immediately, once the documents are reviewed and edited by the NIEM MO for branding, they will be a valuable resource for people to create Health Information Exchanges for NIEM
    • The Team produced a good foundation for this work to build upon further
    • Transition outreach includes discussions with the NIEM MO who have helped send email communications, notify the NIEM Community-at-large about the sun setting of the FHA, and the leadership opportunity for the NIEM COI

Transition Outreach

Cait Ryan

• Additional transition efforts include:
  • Attending business and technical architect meetings
  • Reaching out to government POCs identified as a possible fit to determine their level of interest in continuing the work and dialogue from an FHA perspective
  • Holding one-off conversations with select COI participant organizations
  • Email communications in addition to the Fact Sheet sent with the meeting invitation

Lesson Learned

Cait Ryan and Brian Handspicker

• Additional transition efforts include:
  • More than 300 “health-related” elements already modeled within NIEM and various NIEM Domains
    • They do not align with HIE standards
    • Without a true repository with provenance and IEPD element indexing it is nearly impossible to decipher provenance and intent of elements
    • There appears to be no coordination among the domains to have a cohesive definition of what those NIEM “health elements” look like and how they are defined
  • Only a subset of clinical health elements is required
    • NIEM is not expected to be used for the exchange of significant clinical information
    • NIEM Health can be used for the exchange of specific healthcare information such as:
      • Community of Care Document
    • Edge-case Scenarios
      • The Team is exploring edge-case scenarios that are not the typical exchange provider-to-provider they, along with Health Information Exchange and HL7, tend to look at and remain driven by
      • The edge-case scenarios create a funding opportunity for multiple organizations
    • NIEM Health overlaps with, touches, and affects different Stakeholders and multiple domains reflecting a true COI with multiple layers
      • FHA had a difficult time identifying only one organization to take charge because NIEM affects so many people

NIEM Health Crosses Multiple Domains

Brian Handspicker

• Brian shares that he joined the NIEM initiative as a trained NIEM Architect who spent time developing HL7 standards
  • He was perplexed that they chose 72.5 0.1 for meaningful use:
    • If a prisoner is released into the community and their medical records need to be sent to a local doctor, why not use HL7 to do that from the infirmary to the doctor’s office?
    • There is real use of health-related information being exchanged by NIEM
      • It is often being done in environments in which organizations don’t have an Electronic Health Records or Healthcare Information Exchange system, but they do have NIEM systems which is why it is mandated by their agencies
    • How do we coordinate the healthcare information being exchanged?
    • How do we rationalize it with clinical healthcare standards?
    • How do we make sure this information can be reasonably exchanged between HL7 FHIR-based environments and NIEM environments?
      • Example: For the Justice Department, healthcare information is not the core of their domain
        • It is the same for MilOps, emergency management, and Human Services
    • It is not the center of what Human Services organizations do, but they still must collect foster children medical records
• NIEM Health Information has been at the periphery of each of the NIEM domains
  • From a clinical healthcare and HL7 FHIR perspective, exchanging information for natural disasters is important; however, it is not at the center of supporting clinical information exchange for oncology patients, an average pediatrician, or general practitioner, etc.
  • It is at the edge of both the clinical health domain and all NIEM domains
  • There are many domains that need to use some bit of healthcare-related information in order to do their job

Recommended Scenarios

Brian Handspicker

• Edge-case scenarios discovered thus far include scenarios actively using NIEM for support as well as envisioned scenarios:
  • Disaster Response
    • Earthquake and tsunami
    • Tsunami, Drought, and wildfire
  • Emergency Response
    • Multi-vehicle accident with trauma and burns
    • Building collapse requiring search and rescue
  • Public Health Reporting
    • Ebola-infected flight arriving
    • Vaccine causing wide-spread allergic reactions
    • Pharmaceutical recall
  • Medical Report Exchange
    • Foster/juvenile records collection
    • Wounded warriors on the battlefield
    • Reentry into the community after incarceration
  • Substance monitoring including
    • Substance abuse rehabilitation with effective supervision
    • Tracking opiate abuse and illegal distribution
    • Law enforcement poisoned by drugs during mission

COI Lead Responsibilities

Cait Ryan

• What the NIEM Team and FHA led for the past few years is a COI
  • No modeling was done to be a true domain
  • To satisfy FHA’s role, this is a call to action for someone to stand up and lead the NIEM COI
  • Leadership requires a minimal level of effort
  • A solid foundation is in place with a repeatable process being published on the COI page
• Minimal effort leadership from a meeting perspective:
  • The Team currently attends monthly NIEM Business Architects Council meetings (invite only, one hour)
  • Weekly NIEM Technical Architects Council meetings (one hour)
  • A four-to-five-day annual Face2Face meeting at the Rosslyn office
    • If participating in NIEM Business Architects Counsel calls, the requirement is to attend the first two days which focus on end-back discussions
  • Monthly NIEM COI meetings introducing those who have use cases or scenarios that have proven successful in the past, or those looking for collaboration
    • Monthly as opposed to quarterly meetings generate the most participation and interest
    • New Steward/s will determine what works best for them and their resources
• Minimal effort leadership from an administrative perspective:
  • Periodic questionnaires from the NIEM MO
  • Updating the NIEM Health Community of Interest page currently on GitHub
  • Updating meeting materials and webinar logistics for upcoming meetings
  • Updating announcements, relevant documentation referenced during calls, or deliverables being produced
• If there are multiple agencies excited about NIEM MO, work can be done mapping a healthcare data requirements document called US CDI from HL7 standards into NIEM
  • Coordination across multiple domains ensures new healthcare-related elements defined are done in collaboration with what has already been done, as well as other projects that could be developed to further extend NIEM Health

Transition Next Steps

Cait Ryan

• Interested agencies are instructed to send a letter of intent to the FHA at www.federal.healthathhs.gov (or to Cait Ryan or Brian Handspicker)
• After approval the FHA will introduce to the NIEM MO for onboarding
  • The Team will set up GitHub account/access/permissions to COI page
  • The Team will populate the new Steward’s calendar with necessary meetings
  • The Team will identify a point of contact
• Before the FHA sunsets, the Team will make sure everything on the NIEM COI page is up to date including:
  • Documents already produced will be archived, including:
  • Lessons learned
  • Recommendations for NIEM Health
  • Meeting minutes
• A joint, formal announcement will me made by NIEM, FHA, and
  • Ryan Schultz commits NIEM MO resources to help with transition and set up
    • NIEM MO has worked with many domains
    • NIEM MO knows what works effectively

Q&A Plus Closing Comments

All participants

• Ryan Schultz asks if anyone wants to meet with him and Nikolay Lipskiy to confer on what a collaborative effort between the NIEM MO, CDC, and another organization/s would look like
  • No attribution
  • No commitment
• Chris from ACF shares the challenge may be that FHA has been playing multiple roles best suited to be addressed at different levels
  • In terms of the use case approach:
    • There will be specific domains, communities, or agencies that have a role to play in defining exchanges based on the fact they are implicated in that exchange
    • From the standpoint of Human Services as part of the discussion on foster care health records, ACF expresses a desire to be involved and help support the implementation of that exchange
    • At the Domain or COI level, Chris shares that it is an aggregation of agencies that are part of the different conversations and all interact with health
      • They have a role to play in defining the data set that becomes part of the NIEM framework supporting various exchanges
      • It is a multi-dimensional, multi-agency type of challenge
    • At the highest level, there is a role to play in terms of “thought leadership” to ensure appropriate health IT experts and implementers are part of the conversation
      • That is critical
      • That will enable potential leaders to have important conversations
      • That role is hard for people outside the health space to initiate
    • If ONC is not able to support the work financially or put resources behind it, it is essential someone step forward with the “health bonafide” to speak as a representative of the Community and bring the right people to the table
• Ryan Schultz shares what Chris described is a “healthy functioning, fully operable Health Community of Interest”
• Nikolai states, based on the model of NIEM that is the core part in the domains, there is a clear picture of how this core needs to be connected to healthcare and other domains
• Ryan reiterates that he wants to address the “clever thoughts” being shared in a discussion, devising a plan to put them in motion
  • Everything need not fit perfectly into place just yet
  • Recognize it is a process of transition
  • Discussion must focus on a “leadership way forward”
  • Ideas and comments are encouraged
  • Ideas and comments can be shared via email, phone call, or in-person
  • Ryan emphasizes non attribution, no commitment discussions
• Ryan shares his contact number, (757) 203-8605
  • Cait Ryan agrees to share Ryan’s email address with all participants

Upcoming Events

• August 15, 2019: NIEM Health Symposium hosted by NIEM MO

Action Items

• Cait will distribute slides from presentation to the NIEM COI
• Cait will share necessary contact information with the NIEM COI
• Cait will email a meeting transcription to the NIEM COI

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