1. Automate Blue Button Initiative Push Workgroup Meeting November 26, 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 Announcements, Timeline3 minutes Patient Portal Flow10 minutes EMR Flow10 minutes Open Question: Payload15 minutes Open Challenge: Transmit to any Direct Address20 minutes Next Steps / Reminders2 minutes 3

4. Announcements and Reminders 4 Meeting Reminders – Push Workgroup Meetings are Mondays from 2:00 – 3:00 pm Eastern. – Direct Connect-a-Thon (December 6, 2012) – ABBI Face to Face (December 11, 2012 from 2:30-4 pm) – 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 Guides: http://wiki.siframework.org/Push+Implementation+Guidance+Comments+and+ Feedback – Comment period ends Wednesday, November 28 th.

5. Looking Forward ABBI Schedule November – October 22- November 19: Drafting and comment period on ABBI Implementation Guide (Part 1: Send via Direct + Content) – Nov 19 th : BEGIN Comment Period Round 2 on ABBI Implementation Guide (Part 1: Send via Direct, Content) – 26 th : Discuss Comments in workgroup calls – 28 th : END Comment Period on ABBI IG (Part 1) December – 3 rd : Review Implementation Guide Comments in Workgroup Calls and Finalize Guide – 6 th : ABBI Participates in Connect-a-thon – 10 th : “Public Release” of ABBI Implementation Guide (Part 1) – 11 th : ABBI Participates in Town Hall @ ONC Annual Meeting – 21 st : BEGIN Comment Period on ABBI Implementation Guide (Part 2: Send via Email, Payer Content, and Developer Toolkit) January – ~ 10 th : END Comment Period on ABBI Implementation Guide (Part 2) – ~ 15 th : Release ABBI Implementation Guide (Part 2) – All of January: Testing Period; Identify and Respond to Reference Implementations February – Testing Period; Identify and Respond to Reference Implementations March – Complete Testing Period – HIMSS: Showcase ABBI Implementations – Release Final Automate Blue Button v2 Implementation Guide (Part 1 and Part 2 listed above)

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

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

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

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

10. Flow 1: Patient Portal 5. Flow Complete

11. 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

12. Flow 2: Provider

16. Open Question: Payload 16 Push – Multi-part MIME – application/xml+ccda – Message Body: This message was sent by [Data Holder Name] at the request of [Patient Name] to [Direct Address]. (Optional) It includes: [List of Files]. – Structured Version? Data Holder Name Patient Name Direct Address Array of Files

17. Open Challenge: Sending securely to any address 17 Transmit will have two approaches When a transmission occurs, the HISP will pull down the organizational level certificate and self- signed certificate – Org: (Verisign  example.org) – Self: (Example.org  someone@example.org)someone@example.org (1) If the self-signed certificate matches a trust anchor that has already been loaded into the HISP, it will send the message that way. (2) If the self-signed cert is not in the system, it will use the organizational cert to encrypt the message. It will also include the destination address in the payload.

18. Open Challenge: Sending securely to any address 18 3 rd Party Applications / Locations – Need to exchange their anchors – Need to make their self-signed certificates discoverable via DNS and LDAP – Need to obtain a SSL certificate from CA – Need to make that org certificate discoverable via DNS and LDAP – Need to parse message to ensure it was delivered to right location

19. Next Steps / Reminders 19 Next Steps – Provide Feedback to revised Implementation Guide – Focus on Workflow Meeting Reminders – Next PUSH Workgroup Meeting is Monday, December 3 rd, 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

20. BACK-UP SLIDES ABBI Push

21. 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 21

22. 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 22  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

23. PUSH Current Deliverables Implementation Guide Push Workgroup 23 http://wiki.siframework.org/file/view/ABBI+ IG+- +Transmitting+Data+Using+the+Direct+Prot ocol+2012-11-15.docx http://wiki.siframework.org/file/view/ABBI+ IG+- +Receiving+Health+Data+Using+the+Direct+ Protocol+2012-11-15.docx