Public Hearing

Standards & Interoperability Task Force

Stan Huff, Co-ChairArien Malec, Co-ChairFebruary 27, 2015

S&I TaskforceDraft Work Plan

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Meetings Task

Friday, January 23rd 1:30pm – 3:30pm ET • Kick off and overview of the S&I Framework• Review charge• Action steps

Tuesday, January 27th, 11:30 – 1:00 pm ET • Briefed HISTC on focus and preliminary findings

Friday, January 30th 1:30pm – 3:30 pm ET • Review and discuss action steps• Explore “How” – starting with how “identified

national priorities” should be made Tuesday, February 17th 1:30pm – 3:30 pm ET • Review and discuss action steps

• Prep for Virtual Hearing

Friday, February 27th 1:30pm - 3:30pm ET • Virtual Hearing

Thursday, March 5th 12:00pm – 2:00pm ET • Summarize Virtual Hearing• Develop recommendations

Friday, March 13th 2:00pm – 4:00pm ET • Finalize Phase I recommendations - update documents/plans

• Prep for March HITSC presentationWednesday, March 18th HITSC Meeting • Phase I Recommendations

Progress to Date & Focus Ahead

Approach Discussion / Results

Is there a continued need for the S&I?

Yes, but there are opportunities for improvement

Evaluate the “what” Key Jobs to be Done• Support national priorities & production use• Facilitate Federal participation in SDOs• Recommend needs for infrastructure and non-traditional SDO artifacts

Evaluate the “how” Considerations to Improve Approach• Balanced representation• Measurable, meaningful real-world results• Reasonable implementation path• Interim and long term goals / outcomes• Rapid Cycle Implementation• ONC should facilitate not drive

How should S&I conduct business?

How are the jobs done?• What are the key business processes?• Which have worked well? • What are the successes and lessons learned?

Public Hearing Case Studies: Cross-SDO Perspective; Stakeholder Perspective from Users of S&I Implementer / Industry Perspective; Non-S&I Standards Groups

Recommendations Final recommendations to HITSC

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Goal for Public Hearing

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The goal of the virtual hearing is to better understand the role of the S&I Framework and its' jobs. We would like each panelist to address the following questions:

• The task force has proposed the following jobs to be done for S&I: – Support national priorities and production use– Facilitate Federal participation in SDOs

• Question for Panelists: Would you add or change any of those jobs? If so, which jobs and why?

• The task force has proposed criteria for defining “identified federal priorities”: – Balanced Representation– Measurable, meaningful real-world results– Reasonable implementation path– Interim and long term goals/outcomes– Rapid Cycle Implementation

• Question for Panelists: How would having these criteria in place have affected initiatives you participated in?

Bob Dieterle, CMS Electronic Submission of Medical Documentation

(esMD) Initiative Coordinator

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Jitin AsnaaniathenaHealth

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Larry GarberReliant Medical Group

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Margaret DonahueVeterans Health Administration

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Brian BehlendorfMithril Capital Management

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Justin RicherMITRE Corporation

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Lessons from the IETF and OIDF

Justin RicherBespoke Engineering http://bspk.io/

February 27, 2015

Two Organizations

Internet Engineering Task Force OpenID Foundation

http://ietf.org/ http://openid.net/

Many Standards

Similar Goals

• Produce open standards– Documents intended to drive technology

implementation and deployment– Can be used and implemented by anybody

without license• Broad participation– Big companies– Small groups– Individuals

Two Very Different Models

IETF Structure

• No formal membership or joining process– Join a mailing list, come to a meeting

• Lots of hierarchy– Working groups, editors, chairs– Areas, directors– Steering groups– Architecture review boards– RFC Editor– etc.

OIDF Structure

• Formal membership– Companies, groups, and individuals can join the

foundation for a membership fee– Anybody can join a working group for free • Note: you don’t have to join the foundation

• Formal IPR assignment– Explicitly sign a form to contribute to a group

IETF Process

• Working group mailing list is canonical– All decisions are made and documented there

• IPR handled by the “Note Well”– Nothing to sign, participation implies consent

• No voting– “Rough consensus and running code”

• Artifacts move through a well-established path along the hierarchy

OIDF Process

• Working groups define their own processes– Mailing lists– Phone conferences– In-person meetings

• Mixed consensus model– Rough consensus in the working groups– Formal membership voting on working group

products to produce final standards

IETF in Other Words

• Benevolent dictatorship by council– “The Elders of the Internet”– Very large membership base– Bad or ineffective leadership can ruin things

• Be prepared for heated arguments– Strong personalities tend to win– Good leadership can move things forward

• Susceptible to stalling– Can’t “vote around” a bad actor

OIDF in Other Words

• Small, focused, engaged membership– Slightly more friction for contribution

• Be prepared for heated arguments– Strong personalities tend to win– Good leadership can move things forward

• Susceptible to cliques– Smaller size means funny things can sometimes

sneak through (to a point)– Cases of “It might be a good idea if…”

Take Away

• Commitment to open standards• Different organizational structures have

strengths and weaknesses– No system is perfect

Thomas SparkmanAmerican Clinical Laboratory Association

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Walter SuarezKaiser Permanente

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Clem McDonaldNational Institute of Health

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Committee Discussion and Next Steps

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