Health Infomration Technology Advisory Commission (HITAC)
Technical Infrastructure Committee
Thursday, April 22, 2010
10:00AM to 12:00PM
200 Ednam Drive, Tack Conference Room, Charlottesville, VA 22903
Fred Norman – NoVA Consulting (General Public)
Justin Samson – Castle Technologies (General Public)
Benson Chang, CGI Project Manager
Jaime Woltz, CGI Project Support
Nadine Hoffman, TIC Staff Support
Introduction and Committee Logistics
Cindy Perry moved to have the meeting minutes from April 8th approved with no changes. Terri
Ripley seconded. There was unanimous approval of the minutes.
Chairman Ruffin reported there was a HITAC Meeting on April 15, 2010. Ms. Ripley
represented the Finance Committee and Chairman Ruffin represented Technical Infrastructure
HITAC reviewed the decision brief to buy or build and resolved to buy. . The Virginia
Department of Health (VDH) received an unsolicited proposal on April 14, 2010 to build the
statewide HIE. A recommendation on whether to accept this unsolicited proposal or not will be
provided to Secretary Hazel’s office by the Office of Health IT by April 23. 2010. The next part
in the process will occur at the HITAC Commission meeting on May 20, 2010 at which the
Commission will decide if the Public-Private Education and Infrastructure Act (PPEA) process
will be the vehicle for procuring the vendor(s) that will support the Commonwealth’s Health
Information Exchange (HIE). At the time of this decision the unsolicited bid will need to be
posted for 45 days publically before any movement can be made. It is the hope that all bids
whether they are solicited or not will not be evaluated until after strategic and operational plans
are complete on or before August 1, 2010 as to not divide the HITAC Commission focus on the
The Technical Infrastructure Committee (TIC) should have the draft of Technical Infrastructure
sections of the Strategic and Operational Plans available by May 20th HITAC meeting for other
committees to comment on. Benson Chang will coordinate gathering feedback.
At Chairman Ruffin’s request, Mr. Chang described how the other committees would be asked to
evaluate the services matrix created by TIC.
1. Does the matrix identify all the services the Commonwealth HIE intends to provide?
2. Are there any services in the matrix that the Commonwealth does not wish to provide?
3. Is the proposed implementation prioritization of services acceptable?
State Summary Reviews
TIC members presented their state HIE summaries.
1. New Mexico – Ms. Ripley reported that New Mexico is currently sharing data as part of
National Health Information Network (NHIN) in 2007. The state has a federated model
with centralized MPI. (Initiate), a physician portal, (MedPlus Centergy), Record Locator
service. New Mexico plans to do Social Security Administration (SSA) Disability use
cases with NHIN.
2. New York – Paul McGowan reported that New York’s planning phase started in August
2008 and plans to run until August 2010. New York does not have a defined architecture
but rather has several tiers from state backbone up to consumers. The state has a
consumer centric view of services it plans to provide. New York is not currently moving
data. New York’s plan has two service categories; core and functional. Core services are
those mandated by Office of National Coordinator (ONC).
3. Vermont- Bill Perko reported that Vermont’s HIE has been active for several years and
an independent organization with its own board runs the program. Currently Vermont is
taxing all claims to financially sustain the HIE but this will be phased out in 2015. The
state is moving some data and planning to add hospitals to the network one at a time
through the creation of point to point interfaces with each hospital. This appears to be
something that will only work well in smaller states. Mr. Perko reviewed that there is no
operational plan that could be found. The patient must “opt-in” to participate in the HIE
and the Continuity of Care Document (CCD) format will be implemented. Vermont is
centralizing data as each source sends data into a state repository which stores the data
temporarily. John Quinn made a comment that future document types will be able to be
added besides CCD.
4. Colorado- Mr. Perko reported that they are less far along. The state went with a Request
for Proposal (RFP) that was issued December 2009. Results have not been published
and the RFP did not appear to be very impressive. Colorado created a state organization
in 2007, CO-RHIO, whose purpose is to be state HIE coordinator. The state has been
divided into referral regions. The state is currently not moving data.
5. California- Chairman Ruffin reported there appears to be no architecture and no moving
of data. There are 20 existing HIEs that need to be brought together in this state and they
are mired in disputes at the moment.
6. West Virginia- Chairman Ruffin reported that in 2006 the state passed a law that health
data needs to be moved electronically in 10 years. West Virginia Health Information
Network (WVHIN) was formed, but an RFP was just issued several months ago to buy a
vendor solution. The technical architecture is vaguely defined in the strategic plan and
there is no moving of data.
7. North Carolina- Mark Clemmons reported that the state is 9 to 12 months ahead of
Virginia. Most of the group meetings halted in September 2009 and their HIE application
was submitted to ONC in October 2009 but there has yet to be an announcement of
award. The plan takes note of all the ONC and HL7 and SNOMED standards. North
Carolina has set aside money for an NHIN gateway project. As of yet there is no
indication of data being moved. The North Carolina Health Information and
Communications Alliance (NCHICA) appears to be the responsible entity but Mr. Quinn
said will try to find out if there are other organizations involved. Mr. Chang will try to
ask for drafts of their plans as August 1 approaches.
8. Tennessee- Jerry Kevorkian reported that it appears Tennessee’s plan is to use their
existing eHealth Network and leverage CareSpark as opposed to developing their own
HIE. Chairman Ruffin reported that he believes that the Governor of Tennessee is going
to create another network that federates SharedHealth, a network in Western Tennessee
and CareSpark. The state is not moving data yet but does have several mature HIEs that
have been mentioned above.
9. Maryland- David Mix reported that the state is about 1.5 years ahead of Virginia as they
finalized their draft plans in 2009 which were then approved by their state in February
2009. The state will be using a hybrid approach with the data at a provider site and a
centralized document registry. It has not been confirmed if Maryland is moving data or
not. The state does recognize that the physician is the key to success and is looking at
medically underserved areas using clinical use cases. The plan is to start small and build
incrementally. Not much is known about the architecture of their plan. There is a plan to
connect with Personal Health Records for consumers.
10. Indiana- Chris Riha reported the Indiana Health Information Exchange (IHIE) formed in
2004 and is very mature. This program came from the Regenstrief Institute and the two
have been exchanging data for years. All the data is collected there and analyzed. This
service for analytics can be purchased by physicians. IHIE has not been able to become
self sustaining and still requires funding from Regenstrief. Indiana markets out to urban
cities geographically close to the state, specifically Chicago. Mr. Quinn added IHIE also
markets to Cincinnati. It has a pay per click model. The architecture appears to be very
home grown and is more proprietary as opposed to based on open-source technical
solutions. Their infrastructure is based on old versions of HL7. Mr. Quinn noted that
IHIE will have technically difficulty in aligning to ONC’s standards.
11. Nebraska- Steve Browning reported that the statewide implementation was announced
July 2009 and is fully operational. The state is leveraging an existing network to run its
HIE. Nebraska implemented a hybrid model using centralized MPI and record locator
service (RLS). The state has proposed phased implementation, network infrastructure and
clinical messaging in its plan. Axolotl runs the infrastructure. Mr. Quinn recommends
that the committee follow Nebraska in the area of analytics. Ms. Ripley has a contact in
Nebraska and will send information to Mr. Chang for sharing.
Chairman Ruffin summarized the reports by stating New Mexico, Vermont, and Nebraska should
be the states Virginia follows as they are the most advanced - moving data and aligning to ONC
standards). It was discussed that the Finance Committee will be most interested in Indiana
because of their quality marketing to providers and the variety of their revenue models. The
Governance Committee might want to learn more about how Tennessee plans to govern the
connections between their existing HIEs. In response to Justin Samson’s question, Chairman
Ruffin responded that the data exchange TIC members were referring to during their state
summaries was primarily clinical data. Mr. Samson participated in the meeting as a member of
the general public.
Ms. Perry researched the NHIN architecture standards and incorporated the research into the
services matrix. Mr. Mix added MITA requirements to the service matrix. Mr. Quinn referenced
the National Cancer Institute’s (NCI) Enterprise Architecture Strategy presentation which
includes a periodic chart of services. Mr. Quinn provided the following update on activities at the
federal level. There appears to be a lot of change happening. Around the time of the Healthcare
Information Management System Society (HIMSS) conference in February 2010, ONC came out
with a number of RFPs. One of these RFP’s is for extending the National Information Exchange
Model (NEIM) to include health IT. NIEM is being promoted by the Office of Management and
Budget (OMB). Another RFP was issued for defining a NHIN architecture. The Federal Health
Architecture (FHA) put together some documentation but no formal NHIN architecture has been
defined. The deadline for bids has come and gone and there have not been any announcements.
Mr. Quinn reported that there was much confusion at the ONC HIT Advisory Committee
meeting last month around the NHIN Direct approach to push clinical information between
physicians. This project appears to contradict the need for state HIEs. ONC claims to know how
NHIN Direct and NHIN Connect can coexist. Mr. Quinn and others encourage Dr. Blumenthal
and Dr. Frisdma to offer those outside the federal government some explanation. Dr.
Blumenthal advised the HIT Advisory Committee that documentation will be updated to reflect
ONC’s vision. As of today, no new documentation has been provided. Mr. Quinn believes this
will come up at their HIT Advisory Committee meeting next week.
Discussion of Service Matrix
Ms. Ripley inquired as to the difference between checks and Xs in the “High Priority” column
and Nadine Hoffman explained that it was originally intended to show what would be included
in the pilot implementation ( included , x not included,) . Mr. Chang suggested that the
columns in the operational plan section cover this and the “High Priority” column is redundant
and should be removed.
It was decided that the column name “Standard Technology” would be changed to “Technology
Comments” so vendors will not interpret the comments as standards they must follow.
Mr. Mix asked for clarification on the defining of the Connection Services and the answer was
that it is a package of service. There was agreement to remove rows 2.1,2.2, and 2.3 and to
move 2.1.1, 2.1.2., and 2.1.3 to Integration Services.
Chairman Ruffin questioned the group where to declare centralized or federated architecture and
it was decided to add a location column to define where each service will be located from a
technical architecture perspective.
Assignments for May 6 Meeting
Mr. Mix will create the first draft of a Topology Diagram and will distribute. Eventually the
diagram will need to link up with the Services Matrix.
The Services Aware Enterprise Architecture Framework (SAEAF) and how services will operate
over NHIN was discussed. Mr. Quinn suggested Virginia include references to SAEAF so that
vendors will align their proposal with the framework. It was not resolved whether SAEAF needs
to be a column in the Services Matrix.
Mr. Quinn offered to come to Richmond on Tuesday, April 27th to work with Mr. Mix and Ms.
Perry on the draft plan and services matrix as he will be attending meetings in Washington, D.C.
The services matrix was broken into sections and TIC members were assigned to write up those
services from both a strategic and operational perspective.
Section 1 – Integration Services – Chris Riha (example out by Friday using the working papers
for strategic and operational plans)
Section 2 – deleted
Section 3 – Core Services - Cindy Perry and Bill Perko
Section 4 – Functional Services – Mark Clemmons and Terri Ripley
Section 5 – Reporting Services – Paul McGowan and John Underhill
Section 6 – Decision Support Services – Marshall Ruffin and Yevonne Childers
Section 7 – Infrastructure/Utility – Jerry Kevorkian and Steve Browning
The members will send their respective sections to Mr. Chang by May 4th and will present them
at the May 6th TIC meeting. Mr. Chang will email the latest templates out for the working papers
for the strategic and operational plans. It was suggested and agreed that the May 6th electronic
meeting will be an interactive session (Web-X).
Chairman Ruffin called for other business and there was none.
Chairman Ruffin called for public comment and there was one question.
In response to Justin Samson’s inquiry as to which version of HL7 will be required, Mr. Quinn
responded HL7 version 3.0 is current national standard for CCD. Upon further inquiry for
laboratory data, Mr. Quinn clarified that HL7 version 2.5.1 was the current standard..
Chairman Ruffin s adjourned the meeting at 12:05PM