Public Hearing Standards & Interoperability Task Force Stan Huff, Co-Chair Arien Malec, Co-Chair February 27, 2015

S&I Taskforce Draft Work Plan 2 MeetingsTask Friday, January 23 rd 1:30pm – 3:30pm ET Kick off and overview of the S&I Framework Review charge Action steps Tuesday, January 27 th, 11:30 – 1:00 pm ET Briefed HISTC on focus and preliminary findings Friday, January 30 th 1:30pm – 3:30 pm ET Review and discuss action steps Explore “How” – starting with how “identified national priorities” should be made Tuesday, February 17 th 1:30pm – 3:30 pm ET Review and discuss action steps Prep for Virtual Hearing Friday, February 27 th 1:30pm - 3:30pm ET Virtual Hearing Thursday, March 5 th 12:00pm – 2:00pm ET Summarize Virtual Hearing Develop recommendations Friday, March 13 th 2:00pm – 4:00pm ET Finalize Phase I recommendations - update documents/plans Prep for March HITSC presentation Wednesday, March 18 th HITSC Meeting Phase I Recommendations

Progress to Date & Focus Ahead ApproachDiscussion / 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 HearingCase Studies: Cross-SDO Perspective; Stakeholder Perspective from Users of S&I Implementer / Industry Perspective; Non-S&I Standards Groups RecommendationsFinal recommendations to HITSC 3

Goal for Public Hearing 4 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 5

Jitin Asnaani athenaHealth 6

Larry Garber Reliant Medical Group 7

Margaret Donahue Veterans Health Administration 8

Brian Behlendorf Mithril Capital Management 9

Justin Richer MITRE Corporation 10

Lessons from the IETF and OIDF Justin Richer Bespoke Engineering February 27, 2015

Two Organizations Internet Engineering Task ForceOpenID Foundation

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 Sparkman American Clinical Laboratory Association 23

Walter Suarez Kaiser Permanente 24

Clem McDonald National Institute of Health 25

Committee Discussion and Next Steps 26