Arien and I have discussed the topic that was presented at the HIT Standards Committee on October 27th: NHIN Direct: Current State and Lessons Learned (1). Dr. Doug Fridsma said in his Standards and Interoperability Framework presentation that the Direct Project is an example for how other ONC-sponsored interoperability projects may be run. Lots of people are watching and learning from the Direct Project!
One of the points in Arien's presentation was: "Implementation group grew too large, too fast. In future, set the commitment bar even higher and have firm limits on number of participants". This blog post is to express some initial thoughts, and urge others to weigh in, on a question stimulated by the presentation:
How should The Direct Project (and future ones like it) establish their group of participants?
In reflecting, you could ask yourself other questions. What is "right-sized" for such a project? Should there be a public call for participation open to everyone? If not, how should participants be selected or qualified? How should the tradeoff between "broad/open/large" vs. "committed/fast/efficient" be made?
There's a tradeoff between an open, broad, and formalized, but slow process (e.g., SDOs), vs. a selective, smaller, less formal, but quicker/agile process such as The Direct Project has used. In any group, the number of "committed and contributing" members may be fewer than the full number of participants, so I understand the reasons that the presentation recommended a high commitment bar.
On the other hand, if an arbitrary limit is set (e.g., no more than 20 organizations) then a project might face credibility problems down the road due to lack of openness, and lower probability of people "buying into" and adopting specifications in which they could not participate.
In the Direct Project, we have over 20 EHR vendors represented individually or through the Clinical Groupware Collaborative, covering a significant share of the EHR market; about 10 state or regional HIEs; several medical and professional associations; several HIE/infrastructure vendors; government agencies, and more. IMHO this has brought sufficient critical mass so adoption can spread "virally" in a good way. However, if the group were restricted, cutting those numbers by 50% or more, then the critical mass and buy-in necessary for broad/quick adoption might not be there. What would "consensus" really mean among too small a group? I think the industry would not put too much credence in something that was supported, say, by only 3-5 vendors and 3-5 HISPs/HIEs through a closed process, even if it were developed quickly and worked well in pilots.
IMHO, our group is reasonably sized. Deloitte and the leaders have done yeomen's work in moving the project forward. Still there's room for improvement. We have technology (LiveMeeting, wiki, google groups, blog) to facilitate collaboration, even with a fairly large group. Some streamlining of administrative processes (e.g., shortening and partially automating capture of attendance, eliminating exhaustive "roll-call rounds" while still giving everyone the opportunity to speak) could help use our time more efficiently.
My thoughts: I totally agree with continually improving the process for the Direct Project and for other S&I Framework projects modeled after it. But I think that great care must be given to avoid sacrificing the openness and critical mass necessary to adopt, while trying to making things easier, rapid, and efficient.
But that's just my opinion, and I think Arien and the Direct Project leadership would welcome feedback from all of you, who are "living" this project. What do you think about How The Direct Project (and future ones like it) should establish their group of participants? It would be helpful if you could reply to this post, so that the discussion will be transparent and all views can be seen together.