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John Williams

Great topic. My input is to encourage broad participation. You never know which organizations will end up making important contributions, so inclusive participation is a must.

Case in point is my organization Health-ISP, a service of Garden State Health Systems Inc. The Direct project was not on our radar until until it was well under way. We came in late but are contributing with a pilot project (Catawba County, NC, see Potential Implementation Geographies) and connectathon participation (HISP interconnectivity)

When this topic was first identified, I assumed the discussion would be "membership" going forward. For direct messaging to have the market impact we hope it will, there is need for coordination akin to the CONNECT project coordinating committee. Thoughts on future membership:

- Does the Direct Project plan to provide this industry coordination going forward?

- Self regulation by a HISP association or Direct Project leadership is reasonable approach.

- Planning for future industry coordination should begin as early as possible.


John Williams

Fred Trotter

I think the Direct Project has been an perfect example of how a small focused group of participants, following the general principles of Openness and Open Source, can collaborate at a much higher level. It has been wonderful to see Cerner, Microsoft and Epic at the last meeting, operating like Open Source pros!

This true open-ness comes at a cost. There are deep differences between the priorities and agenda of the different participants. It is a hard balance to know when a debate (open source vs proprietary or protocol A vs protocol B or CCR vs CCD) is productive and useful or counter-productive. These arguments are traumatic and difficult for a project, but if those issues are not brought out into the open, then long term a project will self-implode. The secret, which Arien and Brian have done a fine job of, is to know just how much tension is productive.

Moving forward, it will be critical to continue to reward participation with special consideration regarding decisions. Its not just being on the phone calls that matters, its actually doing stuff. Writing code, testing code, writing documents and the like. The Direct project has done a fine job of this so far, but this ultimately needs to be formally embedded into the governance of the project.

Just my two cents.


Keith W. Boone

Thanks for bringing up this point David. My comments can be found here:


John Moehrke

Thanks for bringing up this point... When reinventing the wheel: hint it is circular in shape...

For more details on what I mean by this, see my blog expansion on your original question:

Karen Witting

The Direct Project Governance process is vague and confusing. There is very little content to it and leaves a lot to the imagination. As a participant I have found the lack of clear governance the most distressing and frustrating part of this project.

In fact the process has been continually evolving based, seemingly, on the desires of the leadership. Only very recently, in particular AFTER this blog was released, has the leadership actually documented the process. An undocumented, unexplained process is the exact opposite of open and transparent. Anything the leadership documents now cannot be considered the Direct Project process since only the leadership was aware of their beliefs about how things worked. Little was explained to the participants and almost nothing was documented.

Much better to consider starting with a governance model that actually works, has been in practice for many years, is well documented and is less prone to undue influence of the leadership. I recommend the IHE process which is documented in the IHE Governance document http://www.ihe.net/governance/index.cfm.

In particular I recommend IHE's model for membership. Any organization can join but to have the right to vote the organization must acquire and maintain voting privileges by attending meetings on a regular basis - never missing more than three consecutive meetings. It is natural that those who contribute the most have the most impact on the direction of the work. There is no need to legislate this. But sometimes the best idea comes from a minor contributor who just has that needed insight to help the project make good progress. Allow broad participating and do not legislate contributions. The most recent Direct approach gives membership to those who "contribute significantly" but this is much too vague a term to be applied without the possibility of leadership favoritism.

Arien Malec

Just a quick reply to Karen's comments here.

We are trying to get things written down, and Karen has raised, both in private and in public, valid comments on how consistent we've been on issues such as base time that a deliverable is posted for consensus, and how an organization that believes it should be part of the Implementation Group can challenge a judgement of the "contribute significantly" test.

However, the basic rule for the Direct Project is, and has been from the beginning, that any organization in the Implementation Group had the right to object to a deliverable, on any grounds, so long as they propose the fix. That right has been used to object both to substance and to process, and provides a very strong redress mechanism for organizations who have concerns about process.

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