Sunday, June 14, 2015

CODA: the back story, Part 2

A second email went out a little over a week later, with an updated "logic model."

Email 2: sent March 21, 2015
Subject: Update on the Emerging Interoperability Alliance

Colleagues & allies:

It has been an incredible week. Dozens and dozens of you have stepped forward to say you'd like to be part of this effort. Even without a formal name or structure, many of you are volunteering to form a community of people who recognize the mission-critical need for agnostic coordination of interoperability.  Three quick updates and short requests:

1.  Dinner this Sunday night (3/22/15), for those coming into Baltimore for the HIT Connect Conference, will be at 6:30 at La Scala Restaurant( We have a private room reserved for up to 20. We'll meet, greet, talk about opportunities for collaboration, and have a delicious Italian meal together (again: Dutch treat).  La Scala is at 1012 Eastern Ave. -- less than 10 minutes (.3 miles) from the conference hotel: the Baltimore Marriott Waterfront. Our place mats will be printed 11x17 copies of:

2. the Attached, an updated logic model.

3. Below, a synopsis of activity and updates from the week since my original email:

The phrase "mission control for HIT" has been replaced by "mission-critical coordination for HIT" to underscore the point that not one of us, no person or institution, public or private, can or should control the dynamic ultra-large-scale system-of-systems that form the networks-of-networks of interoperability.

Yes, it's a mouthful.  But that's the point: coordination and collaboration of systems this complex don't just happen. All of the nodes of those networks must be represented in its governance.  We can and must do much, much more to coordinate, orchestrate, and leverage our collective efforts to serve the common good. This alliance of willing, generous partners can help the National Coordinator do just that. Our goalsbroadly stated, are:
  • first, convene a kind of "Bretton Woods gathering to agree upon 'the gold standard' for interoperability governance," and 
  • second, make a set of coordinated recommendations for the "coordinated governance venue and single trust framework" the Roadmap calls to be established in 2016.
Many groups and organizations are stepping forward, offering to do that convening, and likely more will emerge in the coming weeks as responses to the Roadmap go public. We should applaud, embrace and welcome those efforts, because this work -- and its layers of complexity and interdependency -- requires maximum collaboration to bring the Learning Health System's information supply chain to life, at scale

Ours a vision of data abundance, not scarcity, and a tent large enough for all partners across many domains. However, like the distributed network of health data itself, there is no center, so the convening and the recommendations must be from a group that spans a broad spectrum of shared interests. By focusing on the ~80% of common vision and values, we can dramatically leverage to accelerate our shared work.  

There are seven leadership domains emerging from the group's response:
  1. State and local government, who bring an on-the-ground, implementation perspective, adding government to governance at a level to which "we the people" can relate, working together with national state-facing partners
  2. Health Information Exchanges and other data infrastructure services organizations and providers;
  3. the Research and Pure & Applied Science, community;
  4. the champions of Transparency, Value, and Quality of healthcare systems and financing;
  5. the HIT Vendors' community, which includes both EHR vendors and larger IT systems and solutions companies; and most importantly;
  6. the data generators & end Users: Providers & Customers, themselves including multiple subsets:
    • Patients and Families;
    • Providers: individuals, institutions, and organizations across the care, services, health & wellness continuum;
    • Federal providers of healthcare services and federal senders/receivers of data (DoD, VHA, IHS, CDC, CMS... the members of the Federal Health Architecture) 
  7. cross-cutting individuals and organizations that weave across two or more of these domains.
There is news to report from each: 
  • States responded unanimously when asked if they wanted to schedule a call to discuss how they can collaborate together in response to the Roadmap's Call to Action.  NESCSO (the NE States Consortium Systems Organization), the folks who bring us the annual Medicaid Enterprise Systems Conference, is hosting a call for State leaders on Friday, March 27th at 2:30 pm EDT. (Write if you don't have but want the invitation and registration for the call.) The NGA, APHSA, and others who support states and localities will join as well. 
While all still at the "consideration" stage in terms of what it means for them as organizations, domains 2, 3, 4 and 7 have leadership champions engaged in conversation about their potential role helping to raise this "big tent": 
  • The Strategic Health Information Exchange Collaborative (SHIEC) is expanding its own membership and reaching out to other HIE organizations (;
  • The Learning Health Community's leadership has expressed a desire to partner (;
  • The Network for Regional Healthcare Improvement is exploring a number of ways in which they could support a national collaboration of collaborative organizations and leaders (;
  • The Stewards of Change, celebrating their tenth year of advancing interoperability in the human services domain, and increasingly, the boundaries between health and wellness, healthcare, and human services  (;
  • The CURE Project, led by individuals who believe HIT requirements definition efforts should be under the direct coordination of the larger healthcare community (
Members of domain 5 are in active discussions among themselves and elsewhere. We can look to HIMSS or earlier to hear more specific plans, proposals or responses to the Roadmap. There's enough in the trades about them, no need to cover them here, but if they are able to form a kind of "Wi-Fi Alliance," that could certainly be beneficial to the broad effort of equitable interoperability. Domain 6 has growing representation on this list and remain the point, the "why" of interoperability, and it's been an honor to reconnect with and to meet others with a shared vision who live as cross-boundary actors in domain 7. 

I will post a weekly or less frequent synopsis of feedback, as we move forward, to keep this growing community informed. 

  • Please let me know if you wish to be removed from this list. 
  • This alliance is continuing to grow. Please continue to forward the communications to other allies. 
  • Let me know of groups or individuals to add to my list.

Welcome, and thank you, all. 

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