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  1. Interoperability Showcase and Connectathon updates
    1. ECW, Epic, Medallies, Qvera  will participate in Showcase and Connectathon
    2. Netsmart and Nextgen are still considering the Showcase, will participate in Connectathon
    3. Allscripts won't be able to participate, but will continue following the progress, and eventually participate in project testing
  2. How would a 360X-enabled system communicate with a non-360X aware system
    1. On the initiator side, a 360X-enabled system could send a request package to recipient, without knowing whether the recipient is 360X-capable
      1. in many cases, an initiator is aware of the capabilities of all of their partners, in which case the initiator only sends a 360X request package to a 360X-capable recipient
      2. for the cases when the initiator is not aware of the capabilities of the recipient, the following is recommended:
        1. only non-urgent referrals should be sent using a 360X request package
        2. there should be a system configuration or a process that would alert the appropriate staff on the initiator's side when an accept or decline is not received within a given time frame.
      3. initially, the 360X project included the provision to send the C-CDA of the 360X request package as a stand-alone MIME part. This is now considered unnecessary, since the use of XDM has become more wide spread.
    2. On the recipient side, if a 360X-enabled system receives a Direct message that is not a 360X request package, but represents a referral request, the system should have a way to manually manage the request (for example, as if it was received via a telephone call). there is nothing else the 360X-enabled recipient system is expected to do in such a case.
    3. Communication infrastructure for Connectahon and Showcase
  3. There might be issues with using the existing SMTP setup over the Internet, instead of having all network communications locally. We should be prepared to handle this either way.
    4. Even with proper routing over the Internet, we'll need to account for message delays for the Showcase.
  4. update
    1. We have a scenario to work with
    2. Referral from PCP to cardiologist, first specialist is not available, second specialist accepts the referral. Outcome is that the patient needs a bypass (360X)
    3. Operation at an acute facility, device interoperability, discharge summary to PCP (not 360X)
    4. Post operation referrals to behavioral health and cardiac rehab - show multiple visits (360X)
  5. Dates for next testing session
    1. We decided on Monday, October 22 and Wednesday, October 24th
    2. We will make sure eClinical Works and Netsmart are aware of the testing dates
    3. Cerner would like to get sample 360X .zip packages shared with them
  6. Update on the Annual ONC meeting - there won't be any opportunities to do a demo or to present, the time is very limited, and the format is not conducive for that.
  7. Dr. Holly Miller and Vassil Peytchev will have a presentation at the HITAC Interoperability Prioritization Task Force on October 23rd. A link to the public meeting will be sent to the list.
  8. Updates to the Implementation Guide
    1. Add discussion on how 360X and eCQM can work together to automate reporting.
    2. Consider a use case of acute to post-acute referrals. where there are multiple possible destinations
      1. One approach is to create multiple referrals, and send them to each possible destination, the first who accepts, gets it, all others get a cancel. Not clear what to do if the one who originally accepts, later declines.
      2. Another approach is to send to one possible recipient as a date-sensitive request, and wait for a response. If there is a decline, send to the next one, etc. With 360X this is possible, because of the potential changes to current workflows that can be enabled. Instead of the post-cute facilities having nursing staff at the acute facilities looking for potential matches, they can staff their incoming referrals office to promptly respond to referral requests.
      3. Other things to consider: What is the appropriate closing of the loop; How is the PCP kept in the loop.
      4. We will get an initial written proposal