1. Automate Blue Button Initiative Push Workgroup Meeting November 12, 2012

2. Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call o Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded o Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. o Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists 2

3. Agenda TopicTime Allotted Welcome and Announcements5 minutes Status, Deliverables, Dashboard5 minutes Draft Implementation Guide – Feedback, Workflow45 minutes Next Steps / Reminders5 minutes 3

4. Announcements and Reminders 4 Meeting Reminders – Push Workgroup Meetings are Mondays from 2:00 – 3:00 pm Eastern. – The next Community Meeting will be held as needed. – Meeting information is on the Automate Blue Button Wiki Page: http://wiki.siframework.org/Automate+Blue+Button+Initiative http://wiki.siframework.org/Automate+Blue+Button+Initiative Community Homework – Provide comments and feedback on the Push Implementation Guidance Documents: http://wiki.siframework.org/Push+Implementation+Guidance+Comments+and+ Feedback

5. Pre- Discovery Discovery Reference Implementations  Agreed and voted on charter, including  Scope  Timeline  Deliverables  Identified priority implementation options:  Transmit requirement of MU Stage 2 (from V/D/T requirement) + automation  Email + file encryption also discussed as option for PUSH  Wrote draft use case for two V/D/T + automation  Write draft use case for Email (and/or Payer) option  Identified issues related to V/D/T + automation  Write policy FAQ document to support PUSH options  Write draft implementation guide for V/D/T + automation  Write draft implementation guide for Email  Identify 1-2 V/D/T implementations that can serve as reference implementations for our group  Identify 1-2 vendors / data holders willing to work on Automated Push reference implementations Implementation Guidance Implementations  Refine use cases based on reference implementations  Refine implementation guide based on reference implementations  3-6 full implementations that reflect implementation guidance PUSH Current Status 5

6. PUSH Current Deliverables Implementation guideUse Case Issue List Push Workgroup 6 http://wiki.siframework.org/file/view/Implem entation+Guide_Direct_10-22-12v1.docx http://wiki.siframework.org/ file/view/ABBI+Push+Implem entation+Outlines+10121017.docx

7. WG Launch (09/17) Nov-12 Discovery S&I Framework Lifecycle Sep-12Mar-13 Pilot & Implementation Guidance Implementation Oct-12 Dec-12 Jan-13Feb-13 Finalize Implementation Guidance for Direct Use Case 1 Definition (DIRECT @ Physician’s Office) Use Case 2 Definition (DIRECT via Patient Portal) Use Case 3 Definition (Email) UC3 Implementation Guidance for Email Full implementations with providers / Payers Timeline Outstanding Issues Pilots Identified & On Track Next StepsStatus PUSH Dashboard Draft Implemen tation Guidance Reference Implementations using Direct Reference Implementations using Email Push Workgroup 7  Write policy FAQ document to support PUSH options  Write draft implementation guide for V/D/T + automation  Write draft implementation guide for Email  Identify V/D/T implementations that can serve as reference implementations for our group  Identify vendors / dataholders willing to work on Automated Push reference implementations

8. Community Feedback and Comments Thank you to all who have provided feedback and comments on the Push Using Direct Outlines and Implementation Guide We are in the process of responding to and incorporating edits into a new version of the document We still encourage more comments and feedback from the community

9. Push Implementation Outlines http://wiki.siframework.org/Push+Implement ation+Outline+Comments+and+Feedback http://wiki.siframework.org/Push+Implement ation+Outline+Comments+and+Feedback

10. Implementation Guide – For Example… 10

11. Outstanding Questions Summary + Encounters What gets sent when a patient asks for a transmit? What gets sent when the transmit is automated? Decision: Initial and Recurring Transmits = Entire patient history CCD within a particular date range + latest Encounter Summary per MU2

12. Outstanding Questions XDR / XDM How will the files be packaged? Multi-part MIME format (preferred) One packaged XDR/XDM zip file (non-preferred option)

13. Outstanding Questions Documenting Transmit as Patient Initiated How do we remove the implied referral/action/burden ? How do we indicate that this came from the patient and not the doctor? Discussions: Can the CCD header include this? Currently there is a statement in the message stating that this was sent on behalf of the patient

14. Outstanding Questions Publically Discovered Certificates - DEFER How can we ensure patients will be able to send to “any” address? How can we ensure a minimal level of trust?

15. Flow 1: Patient Portal 1. Patient logs into portal

16. Flow 1: Patient Portal 2. Patient clicks on “Share with Direct”

17. Flow 1: Patient Portal 3. Patient reads and accepts transmit terms

18. Flow 1: Patient Portal 4. Patient enters Direct address and selects transmit frequency

19. Flow 1: Patient Portal 5. Flow Complete

20. Flow 1: Patient Portal 1. Patient logs into portal2. Patient clicks on “Share with Direct” 3. Patient reads and accepts transmit terms 4. Patient enters Direct address and selects transmit frequency

21. Flow 2: Provider

25. Next Steps / Reminders 25 Next Steps – Provide Feedback to revised Implementation Guide – Focus on Workflow Meeting Reminders – Next PUSH Workgroup Meeting is Monday, November 19 th, 2012 @ 2:00 pm Eastern. – The next Community Meeting will be held as needed. – http://wiki.siframework.org/Automate+Blue+Button+Initiative http://wiki.siframework.org/Automate+Blue+Button+Initiative Upcoming Face-to-Face Opportunities: – Dec 6 th – Direct Connect-a-thon which will include an ABBI opportunity – Dec 11th – ONC Annual Meeting – ABBI Town Hall For questions, please contact your support leads – Initiative Coordinator: Pierce Graham-Jones (pierce.graham-jones@hhs.gov)pierce.graham-jones@hhs.gov – Presidential Innovation Fellow: Ryan Panchadsaram (ryan.panchadsaram@hhs.gov)ryan.panchadsaram@hhs.gov – Project Manager: Jennifer Brush (jennifer.brush@esacinc.com)jennifer.brush@esacinc.com – S&I Admin: Apurva Dharia (apurva.dharia@esacinc.com)apurva.dharia@esacinc.com