Sunday, June 14, 2015

CODA: the back story, Part 3

As the deadline for public comments passed (on April 3), I began to focus more directly on what steps could be taken to actually take advantage of all of the positive feedback I'd been getting since launching on the process.  A third email went out, to an increasingly large list of prospective collaborators.

Email 3: April 8, 2015
Subject: Mission-critical collaboration campaign update, next steps

Update (or introduction if you're new to this list)
With the Roadmap comment period closed as of last Friday, this effort shifts to a new phase. For context, the first email sent out was just shy of 4 weeks ago, on Friday, March 13th, followed by an update on 3/21, with so much going on in the interim this has been my first chance to do an update. Your responses demonstrate that this is far from a “one man band,” as this "big tent" mission-critical collaboration for interoperability takes form, with organizations and individuals committing to participate in a joint effort to broaden the scope of the governance conversation.  
A couple of observations, based on your feedback. We have no illusions: this is not simple. The road to interoperability governance is littered with many noble, failed previous efforts. However, a common theme in your responses is that those previous failures make inaction now all the more unacceptable.  As a group, you’re quite clear: the chaos characterizing the status quo of interoperability must end, but without stifling innovation or imposing top-down control. Thus, this collaborative approach can capitalize upon and leverage the self-organizing impulses of affinity groups and entities acting on particular aspects of interoperability.
We have to think big, looking to the wisdom of General and President Dwight D. Eisenhower, who said “Whenever I run into a problem I can't solve, I always make it bigger. I can never solve it by trying to make it smaller, but if I make it big enough, I can begin to see the outlines of a solution.” 
Paradoxically, while thinking big in terms of a collaborative partnership, we may well also want to think small (as in "bite size chunks") when contemplating action steps and areas in which to focus joint efforts, with small "cycles" of activity. The key thing is moving from conversation to action, to get this learning health system kicked into gear by doing
Harold Morowitz observed this engineering principle: "the flow of energy through a systems acts to organize that system." We will only really know what we need to know about organizing governance structures based on what emerges from your collective, collaborative actions. Another way to say that: the structure for governance will emerge "in the rear view mirror" as we cycle through a set of loosely-coupled efforts. 
All the more reason to leverage the wisdom of your collective endeavors. You are a substantial, cross-domain, "big tent" group, representing individual patients and families, providers, policy wonks, states, federal and national partners, HIEs, the learning health community, organizations dedicated to delivery system reform, implementation, and transparency with health, healthcare, human services, and research perspectives. You all represent broad, diverse constituencies and you share many--at a minimum 51%, more likely closer to 80%--of the same core values, visions, and intentions
You’re all working on pieces of this puzzle. As a broad, agnostic coalition, we can test how it's possible to functionally implement a "coordinated governance process." You also know the technology of interoperability is not the hard part. The work is in the relationships that must be negotiated, the trust built among participants. That is where collaboration focused on common, shared needs, wants, and values becomes so important.
Capitalizing on what you share, one goal in the near-term is to begin to give specific shape to those core values, visions and intentions, through 3 to 5 sets of use cases we can work on together, that tell stories about the kinds of activities you want and need to see "HIT-enabled" by interoperability (remembering interoperability is just another word for cooperative communication). Those use cases can inform prioritization and sequencing of governance interdependencies, pinpointing tangible areas for specific cross-boundary collaboration, using the Roadmap as our framework.

Specific Actions & Next Steps with Big Tent Collaborators
1) What started as an exhortation has grown to something more substantial, a broad collaboration of diverse partners coming together to respond to the Roadmap's Calls to Actions. If you are willing,please share the Comments you submitted to ONC. I will synthesize the wisdom of the comments from this wonderful and growing community of thinkers and doers, and frame possible cross-domain connection points for this “big tent” alliance for mission-critical collaboration for interoperability.
2) Monday (4/6/15), the Learning Health Community’s Task Force for the Development of a Governance & Policy Framework for a Learning Health System met to to focus on its next steps, building on the Comments submitted last Friday. Their contribution will be focused on how the community can build on their Core Values (listed here: Those represent a kind of LHS “Declaration of Independence” that now need to be followed with a LHS “Constitution.” The value of that metaphor is that it underscores that the next step is not to create a governance structure (“Congress”) but to first build consensus on the scope, role, and purposes for such a governing process or body. That effort constitutes one of multiple threads that can weave together the fabric of a “big tent” collaboration and contribute to the broader conversation.
3) The Network for Regional Healthcare Improvement’s Collaborative Health Network (CHN), an RWJF-sponsored initiative, has offered to host an “electronic home” for the big tent alliance. Details on how to become involved in that effort will be forthcoming in the coming weeks. CHN will also enable us to create a repository of artifacts, including your Roadmap comments and our subsequent collaborative work on use cases.
4) The team at Michigan Health Information Network Services (MiHIN), who have created a wonderful Use Case Factory process, are eager to extend its inventory and its use. We will be working together to reach out to states, SDEs, other HIEs and others to do so and to weave those efforts into this broader effort.
5) The Stewards of Change Institute is holding its 10th Annual National Symposium at the Johns Hopkins University campus June 22-24. Invitations to participate in conversations there about defining cross-boundary use cases will also be forthcoming. While the SOC format of a small (100 person) meeting means only a subset of this list’s members can participate, we are working on invitations that include a broad cross-section of you to test ideas there, setting the state to expand the use case conversation further at subsequent gatherings.  Those could include the Medicaid Enterprise Systems Conference (MESC) in Iowa, August 17-20, the Strategic HIE Collaborative (SHIEC) First Annual Meeting, date/location tbd, this fall, and other appropriate convenings.
6) An increasing number of you are engaged in what could be described as an HIT-HIE “maker” movement, community-driven development of IT infrastructure solutions (much of it open source, all of it modern, SOA-oriented) to tackle the challenges of making interoperability implementation work. There is a high degree of overlap of that work with CMMI’s SIM grants and other delivery/payment system reform initiatives, focused on solving similar interoperability challenges. There are opportunities: 1) to convene an HIE “maker” group for an in-person meeting to compare strategies and approaches, and 2) to capitalize on your technical implementation strategies to inform governance policy development.
7) The NESCSO-sponsored call with state HIT and health reform leaders on 3/27/15 included over 50 participants from 30 states. Many state leaders spoke up to voice their interest in collaboration. That can proceed both in more formal, ongoing engagement with ONC and through this broader group and its efforts. Recognizing bandwidth challenges mean you cannot be spread too thin across multiple conversations, we need to find ways to weave these efforts into a coherent whole that will add value to, not distract from, your work at home.
8) Two opportunities for states coming up next week at HIMSS (and the following week many state leaders will be at either or both of the NGA and NGA/All SIM Grantee meetings) for continuing this conversation in person.
8.a) ONC will be hosting a meeting at HIMSS: States, Delivery System Reform & Interoperable Health IT, on Wednesday, April 15 from 9am -10am at in the Hyatt, Room W23BC.  As I noted on the NESCSO call, ONC wants to engage more formally with states to continue the Roadmap dialogue begun last summer, but it has taken some time to work out the details for how that can happen.  
8.b) I will be presenting at the HIMSS State Advisory Roundtable meeting on Monday, April 13, to explore how states and HIMMS might advance this work together.
The intent of all of these steps is to build a coalition and create tangible artifacts which illustrate the shared values and vision of the partners in mission-critical collaboration for HIT governance. We recognize that many entities will respond to the Roadmap’s Calls to Action, but our intent is to work with ONC to help ensure that the governance conversation includes the full context of health, healthcare, human services, and research perspectives.
Thanks for your interest. If you want to be taken off this list, just let me know. Likewise, if you think of others who would be interested, please pass on their email.
With respect and gratitude for your contributions to this important work,
Hunt Blair

Three final notes (plus an “elevator speech” for this effort):
1) Last week, the Strategic Health Information Exchange Collaborative (SHIEC) and the Mid-States Consortium of Health Information Organizations (Mid-States) joined forces to submit joint comments on the Roadmap, representing 38 HIEs and 24 states. Of particular note, the participation by both of Colorado’s HIEs in that effort, where they -- with CO State HIT Coordinator Kate Kiefert and multiple public and private partners -- are modeling precisely the kind of collaborative approach to governance they (and we all) are calling upon ONC to recognize as the national model for interoperability.  Kudos to Colorado’s HIT-HIE champions who are walking the talk of collaboration!
2) Last week, RWJF issued a report on its Data for Health Initiative and the sessions held around the country October, November & December last year. It’s excellent reading, and helps to underscore the point widely understood by those on this list: we must improve health, not from a disease or institution-centric focus, but from a person-centric, personal well-being focus.
3) For those of you who are part of the Twitter-verse, you will be interested in this Twitter chat (Thursday, 4/9 at 3pm EDT) about the Beacon Community program, hosted by Dr. Kavita Patel (@kavitapmd) with featured guest, Patrick Gordon (@RMHPCommunity) who served as executive director of the Colorado Beacon Consortium.  The 3 questions for the hour are:
 - How did the #BeaconCommunity Program accelerate improvement in your community?
 - What is an important #HIT problem that we still need to solve?
 - What would you have done differently in the #BeaconCommunity Program?
CHN uses #HealthDoers to promote broader engagement of individuals, organizations and initiatives who are interested in accelerating community health improvement, and also to promote awareness of the amazing groups (like the Beacon program!) and people who have wisdom to share. New to Twitter/can’t come but have something to contribute?  Email us at
Mission-critical collaboration for interoperability “elevator speech” (under construction...)
Interoperability must be governed with a commitment to open and unbiased exchange, organized and operated for the public good. Such exchange can and will be conducted by both private commercial, private non-profit, and public entities, united to serve the nation. We urge ONC to recognize the importance of diverse stakeholders’ roles in establishing a coordinated governance process, focused on taking action based on shared values and interests that will accelerate meaningful exchange and use of ecosystem data.

To advance that vision, a diverse group of states, organizations, and individuals committed to mission-critical collaboration for HIT, is working together for: 1) transparent, secure, and ubiquitous exchange and use of health, healthcare, research, and human services data; 2) creating an accountable, agnostic, interoperable information supply chain with public/private governance and coordination; and 3) supporting delivery & payment system transformation to build the digital infrastructure of a Learning Health System.   

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