S&I+Initiative+Overview,+Phases+and+Outputs

1. S&I Initiative
A Standards and Interoperability (S&I) Initiative is a project aimed to solve a particular challenge that hinders interoperability in the healthcare industry. The Initiative organizes work necessary for the development or evolution of S&I Framework deliverables. The Initiative has no formal status outside of that purpose. There are two types of Initiatives within the S&I Framework : Staff Assigned Initiatives and Community Assigned Initiatives.

1.1 Staff Assigned Initiatives
Staff Assigned Initiatives are Initiatives that have formal staff allocations by the S&I Steering Team. The purpose of a Staff Assigned Initiative is to provide additional input and guidance to an area that the Office of the National Coordinator (ONC) and S&I Framework has determined to be an interoperability challenge.

1.2 Community Assigned Initiatives
Community Assigned Initiatives are Initiatives that do not have formal staff allocations by the S&I Steering Team.

2.1 Initiative Charters
An Initiative is defined in an Initiative Charter. The Initiative Charter includes:
 * The Challenge Statement: a statement of how a standards and interoperability challenge currently limits the achievement of a national health goal
 * The Initiative Goal and Scope: a statement of the value the Initiative will create, in specific, measurable, attainable, relevant, and time-bound terms
 * The overall staff resource allocation for the Initiative (for Staff Assigned Initiatives)
 * The key Initiative Deliverables
 * Key timelines, including the timeline for the Call for Participation
 * Key risks for the Initiative
 * Key stakeholders for the Initiative
 * Alignment with Meaningful Use

The Initiative Charters should be updated based on lessons learned during Initiative execution. All updates to the Initiative Charter will be reviewed and accepted by the S&I Steering Team or, for Community Assigned Initiatives, by the Initiative Community of Interest.

2.2 Initiative Coordinator
The Initiative Coordinator is assigned by the S&I Steering Team to coordinate activities following the S&I Steering and Consensus process to meet the Initiative goals.

2.3 Initiative Members and the Community of Interest
Formal Initiative Members are Initiative Committed Members, Invited Experts and the Initiative Coordinator. The broader Community of Interest consists of the Initiative Members and Other Interested Parties.

The Initiative Community of Interest develops deliverables corresponding to the Initiative Charter following the S&I Consensus Process. Generally, the consensus deliverables will be made available for the HITSC to review and, as appropriate, recommend to the ONC, following the process defined by the HITECH Act. The consensus-approved output of the S&I Initiative has no legal or regulatory weight, or implied formal recognition by the National Coordinator or the Secretary of HHS, or by any other Federal agency or function.

** 2.3.1 Initiative Committed Member **
An Initiative Committed Member is an organization or individual who has a particular interest in solving the Challenge Statement and reaching the Initiative Goal and commits to actively achieve the Initiative Deliverables. The nature of the commitment will vary depending on the Initiative Deliverables, but must be meaningful and relevant.

A meaningful commitment will not be fulfilled by merely attending required meetings but instead will require significant contributions outside of meetings; examples of meaningful commitment include, but are not limited to:
 * Testing implementation specifications in the real-world
 * Supporting providers in real-world pilot implementations
 * Writing code for production or test implementations
 * Writing and editing implementation specifications and/or other deliverable documentation

The commitment will be documented in a public Statement of Commitment within the timeline of the Call for Participation. The Initiative Coordinator will be responsible for verifying that the Statement of Commitment is meaningful and relevant to the Initiative Deliverables. Should the Initiative Coordinator believe the Statement of Commitment is not meaningful or relevant; the Initiative Coordinator will inform the prospective member of the issue with the Statement of Commitment to provide an opportunity to address the issue. Should the prospective member feel the Statement of Commitment does meet the tests of relevance and meaningfulness; the member will have the right to a single written appeal to the S&I Steering Team. After the Call for Participation timeline, Statements of Commitment from prospective members may only be approved by the S&I Steering Team.

Organizational Initiative Members may assign multiple employees to participate in Initiative workgroups or other activities, but will only have one vote in Consensus decisions. Organizations that provide S&I Staff may not be Initiative Members. When an individual represents an organization, the individual’s vote represents the organization’s vote. Lastly, organizations and individuals should not create “pseudo-organizations” to gain multiple votes in the S&I Consensus Process.

** 2.3.2 Initiative Invited Experts **
Invited Experts are individuals who do not individually meet the requirements of the Initiative membership and whose organization is not an Initiative Committed Member. These Experts are invited by the Initiative Coordinator to participate in discussions but do not have voting rights in the S&I Consensus Process.

**2.3.3 Other Interested Parties**
Any interested party is invited to participate in discussions and can provide comments and feedback by joining the Wiki. However, only Committed Members have voting rights in the S&I Consensus Process.

3. S&I Initiative Phases
Each of the S&I Initiatives will follow a phased approach to achieve the key outcomes outlined for the Initiative. The phasing approach provides the ability to fail-fast, re-prioritize initiatives, and better understand the interoperability challenge. The Initiative execution plan will be modified periodically based on lessons learned and the adjustment of goals and objectives due to new or better information. This is called **"phase-wise" re-forecasting**. The phases are not a **"Waterfall"** approach but rather an "**Agile"** approach executed by an integrated team with well defined outcomes for each phase. The figure below shows the different phases for an S&I Initiative.

Note: Not all Initiatives need to advance through all the phases, This is the essence of fail-fast, re-prioritization of Initiatives and execution using an open and transparent process.

An Initiative can potentially execute 5 phases namely Pre-Discovery, Discovery, Implementation, Pilot, and Evaluation as shown in the diagram below. The following is a description of each of the phases:
 * S&I Initiative Phases and Activities**
 * **Pre-Discovery:**The purpose of the Pre-discovery phase is to create the Initiative Charter for review and approval by the S&I Steering Team. The Pre-Discovery phase is executed before the Call for Participation is provided to the broader Community of Interest.
 * **Discovery:**The purpose of the Discovery phase is to identify the use cases and user stories for the Initiative. Interoperability gaps, costs and barriers are identified and defined to further refine the Initiative. Feasibility tests and prototypes are done using relevant models and standards to determine potential approaches to solve the challenges outlined. The information accumulated and the lessons learned through the Discovery phase will jump-start the next phase and also provide the necessary details to determine if the Initiative needs to continue.
 * **Implementation:**The purpose of the Implementation phase is to define the set of Harmonized Specifications and documentation required to solve the challenge, create the necessary reference implementation using the specifications and plan for operational pilot testing if goals and objectives are still justified.
 * **Pilot:**The purpose of the Pilot phase is to implement the technology in real-world situations and aid in learning the policies that will be required for an operational system, identify barriers for implementation, and revise reference implementations and harmonized specifications based on real-world lessons learned. Finally the implementations will be transitioned to open source communities for long term sustainment.
 * **Evaluation:** The purpose of the Evaluation phase is to measure the Initiative against the Key Outcomes outlined in the Initiative Charter, and determine if there is benefit in wide scale deployment and adoption. The Initiative will provide a recommendation of the various policy tools that the ONC can use to facilitate wide-scale deployment and adoption of the solutions.

4. Summary of S&I Initiative Outputs by Phases
The following table provides guidance on the //typical outputs// of each phase for each of the Initiatives at a very high level and their suggested formats. Each output is a consensus-generated artifacts through the identified S&I consensus process. The artifacts listed in the table are high level artifacts from the process and each Initiative might package many different lower level artifacts to create these high level artifacts. Further, each Initiative may have only a sub-set of the artifacts listed in the table as outputs or could define additional outputs as needed.


 * **Phases** |||| **Outputs** ||
 * || **Artifacts** || **Format** ||
 * **Pre-Discovery** || Initiative Charter || PowerPoint Deck ||
 * || Informational Interview Summaries || Document ||
 * || "White paper" with Pre-Discovery summary, outcomes and relevant issues || Document ||
 * **Discovery** || Use Case Inventory || Excel Spreadsheet ||
 * || Use Case Documentation Package:
 * Use Case and Requirements Document
 * Diagrams: Use Case, Context, Activity, Sequence
 * Functional Requirements (includes information interchange, data and system requirements) || Word Document, XML, Visio, JPEG, Excel Spreadsheet ||
 * || Use Case Simplification Core Matrix || Excel Spreadsheet ||
 * || Data Elements Set spreadsheet || Excel Spreadsheet ||
 * || Inventory of Candidate (relevant) Standards || Excel Spreadsheet, Word Document, PDF ||
 * || Content Module Mappings - Standards Analysis || Excel Spreadsheet, PDF ||
 * || CEDD || Excel Spreadsheet, PDF ||
 * || Standards Recommendations || Word Document ||
 * || Standards Support and Coordination Plan || Word Document ||
 * || Identification of Pilot Participants || Word Document ||
 * || Target Success Metrics || Excel Spreadsheet, Word Document, PowerPoint ||
 * **Implementation** || Implementation Guide || Word Document, PDF ||
 * || CDA Companion Guide ||  ||
 * || Exchange Profiles ||  ||
 * || Implementation Specifications || Word Document, PDF ||
 * || Code Packages/RI
 * Code
 * Documentation and Data Flows
 * User Release Notes
 * Unit/Component Test Scripts & Results || [] ||
 * || IEPD ||  ||
 * || Pilot/Demonstration Process and Plan || Word Document, PDF ||
 * **Pilot** || Pilot Feedback (using Success Metrics) || Word Document, PDF ||
 * || Transition Plan to Open Source Communities || Word Document, PDF ||
 * **Evaluation** || Lessons Learned || PDF, Word Document, PowerPoint Deck ||
 * **Common Documents**
 * (Documents related to multiple phases and Initiatives)** || CM Plan || Wiki document, Word/PDF documents ||
 * || S&I Framework Tools ||Wiki document, Word/PDF documents ||