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General Questions

How do I get started?
If you have decided you would like to participate in the S&I Framework and its initiatives, your immediate first step will be to read the overview on getting started as a participant. You can do this at the following wiki page: Getting Started as a Participant

Where is the S&I Framework Wiki site located?
The wiki site is made available to all interested participants who wish to participate in the S&I Framework. The wiki is located at From there, a participant can sign up for specific initiatives, learn more about the S&I Framework process and S&I Framework initiatives, and join active discussions on current S&I Framework initiatives.

Where can I learn more about the S&I Framework?
The S&I Framework team has developed an Introduction and Overview wiki page where you can get an introduction to what the S&I Framework is and how it works. This page is located at: Introduction and Overview for the S&I Framework

What are the goals of the S&I Framework?
The objective of the S&I framework is to create a robust, repeatable process based on federal best practices that will enable ONC to execute on initiatives that will help improve interoperability and adoption of standards and health information technology. The S&I Framework include processes and tools that will streamline and coordinate the execution of the initiatives to support the goals of the ONC and the HITECH Act.

More specifically the S&I framework will enable:
  • Linkage of objectives, challenges, use cases, requirements, and standards across the solution development lifecycle; e.g., pre-discovery, discovery, implementation, pilot, and evaluation
  • Repeatable mechanisms for harmonization and integration of existing standards as well as identification of new standards
  • Development of tools that enable consistent, robust, and testable solutions; e.g., test suite to validate an implementation against a specification
  • Integration of multiple Standard Development Organizations (SDOs) with different expertise across the solution development lifecycle
  • Leveraging of federal guidance and best practices

What is an S&I Framework Initiative?
An S&I Framework initiative is designed to focus on a specific interoperability challenge identified through a formal prioritization process.

How does an S&I Framework Initiative get started?
An S&I Framework Initiative is defined in an Initiative Charter. Initiatives are also prioritized by ONC and other advisory bodies, who will decide which initiatives will move forward through the S&I Framework.

So what is an Initiative Charter?
The Initiative Charter defines:
  • The problem statement, which should be a statement of how a standards and interoperability obstacle currently limits the achievement of a national health goal
  • The Initiative Goal and scope, which should be 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

How can I participate in an initiative?
The first and most basic step is to participate. This can be done at the link directly above and gets you connected into the S&I Framework process and your specific initiatives of interest. Then we would ask you to sign a statement of commitment.

What are the success metrics for the S&I Framework?
The S&I Framework will have measurable and planned results. In the beginning, metrics will be baselined and focused on the initial phases. Metrics will be measured on improvement over the baseline. The key to measuring the success of the framework is to measure the throughput of the framework, and the impact that it has on the Health Information Technology community.

Initial success metrics are shown below:

Outcome Metrics
  1. Ability to fulfill Meaningful Use criteria and drive real business value
  2. Cumulative cost reduction from using Initiative outputs
  3. Cumulative time reduction in producing, developing or implementing Initiative outputs compared to currently available standards
  4. Number of artifact/output downloads from S&I Framework
  5. Number of use cases implemented by S&I Framework
Process Metrics
  1. Number of participants engaged in the S&I Framework
  2. Number of visitors to the S&I Framework Wiki
    • Visitor volume/day
    • Time spent/page
    • Number of pages visited/visitor/day
  3. Participant contribution level of output development in S&I Framework
    • Lines of code count
    • Documentation contribution
    • Number of comments
    • Number of participants in consensus review
    • Number of specifications developed

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Technical Questions

What role do Standards Development Organizations (SDO’s) play in the S&I Framework?
SDO’s are envisioned to play an important role in the S&I Framework process. They possess the expertise and intellectual property needed to solve complex health interoperability challenges. It is expected that SDO’s will form a core piece of the membership in each Initiative Group.

How does the S&I Framework deal with SDO Intellectual Property (IP)?
By contributing to the S&I Framework Initiatives, contributors agree to license their contribution under the Creative Commons Attribution 3.0 License for documentation and other content, and under the Simplified BSD License for software code and to disclose all known Intellectual Property Rights (IPR).
It is the preference of the S&I Framework to work with material that is freely distributable with wide usage rights. In some cases, where a Standard Development Organization (SDO) provides source material under restricted licenses (for instance, those that require paid membership to access), the S&I Framework will need to deal with content that is not compatible with the preferred content license framework. In those cases, one of the following must be true:
  1. By preference, the SDO is a member of the Initiative and makes the source material available under the S&I Initiative open content license
  2. Alternatively, the SDO agrees to provide Initiative Members and S&I Staff access to the source material, agrees that reasonable portions of the source material may be quoted in public discussion, and agrees that the resulting implementation guide or derivative work of the source material may be published under the S&I Initiative open content license.
  3. At the consent of the S&I Steering Team, the SDO agrees to an alternative licensing approach which allows the Initiative to appropriately reach its Initiative Goal

Is this HITSP 2.0?
This question will commonly come up as new participants who previously may have participated in the Health Information Technology Standards Panel (HITSP) for the new S&I Framework initiatives.

The answer is NO; the S&I Framework is not envisioned to be the “sequel” to HITSP, but a new evolution in standards harmonization. There will be a commitment to reuse HITSP’s work products and processes where they are deemed useful and applicable, but this new level of standards harmonization is intended to have a broader focus than HITSP and is an attempt to build on some of the lessons learned from the HITSP process.

How much will HITSP’s work be reused?
A core principle of the S&I Framework will be to focus on reusing and refining existing standards harmonization and development work wherever applicable and possible. The S&I Framework initiatives will review and consider previous work already completed by HITSP and other SDO’s and will strive to reuse this work as we seek to work collaboratively on interoperability challenges.

What is a Computational Independent Model?
The Computational Independent Model (CIM), is intended to illustrate exactly what the system is expected to do, by representing it in the environment in which it will operate. However, it does not include details of the system structure. The CIM consists of a vision document, use cases, functional requirements and domain models. A CIM is useful in understanding the problem and also provides a source of shared vocabularies for use in other models. The CIM should be traceable to the subsequent PIM and PSM constructs.

What is a Platform Independent Model (PIM)?
A Platform Independent Model (PIM) describes the system, but does not include details of the platform. It exhibits a specified degree of platform independence so as to be suitable for use with a number of different platforms of similar type. Moreover, it shows the parts of specifications which do not vary from one platform to another. A PIM consists of an interface diagram, class diagrams, a components diagram demonstrating traceability between the Computational Independent Model (CIM) and PIM, behavior diagrams and business rules. A PIM is transformed into a Platform Specific Model (PSM).

What is a Platform Specific Model (PSM)?
A Platform Specific Model (PSM) is a "platform specific" view of the system. It combines the specifications in the PIM with the details that specify how that system uses a particular platform. Therefore, a PSM is produced through the transformation of the PIM into a PSM. It consists of web services, schema, WSDL, and a components diagram showing traceability between the PIM and PSM. It will be an implementation if it provides all the information needed to construct a system into operation (e.g. Java code, SOAP over HTTP, implementation guidance, etc). A PSM may also be used as a PIM that is used for further refinement to a PSM that can be directly implemented (e.g. converting from Java to .NET).

What is an Information Exchange Package Documentation (IEPD)?
An IEPD is a specification for a data exchange and defines a particular data exchange. It is a set of artifacts consisting of normative exchange specifications, examples, metadata, and documentation encapsulated by a catalog that describes each artifact. The entire package is archived as a single compressed file. When uncompressed, the catalog is a hyperlinked index into the IEPD and can be opened in a standard browser. The user may use the catalog to overview the IEPD contents or to open each individual artifact (provided the appropriate software required to open a given artifact is installed).

The S&I Framework will leverage the National Information Exchange Model (NIEM) process and package specifications into a NIEM Health IEPD. This will build upon the specifications visions for the NHIN, adhering to applicable governing body decisions and prioritizations to support use cases, business scenarios and implementations. The NIEM Health IEPD will be developed using the model driven architecture (MDA) approach in which each artifacts will be categorized into a Computational Independent Model (CIM), a Platform Independent Model (PIM), and Platform Specific Model (PSM). Each category will be used as an input into another category. Together, the CIM, PIM and PSM will be compiled to generate the NIEM Health IEPD (refer to figure below).

What role will S&I Framework outputs play in certification activities?
It is envisioned that S&I Framework specifications would, in the future, be used to inform certification requirements that may be developed in support of Meaningful Use Requirements.

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Process Questions

What are the core principles of the S&I Framework?
The S&I framework is based on the core principles of Transparency, Prioritization, Consensus, Engagement, Rapid Results. These principles are further elaborated below.
  • Transparency - The S&I Framework activities need to be transparent and open to stakeholders. These objectives are achieved by making all the artifacts available publicly to everyone, following an open process that creates consensus. The S&I Framework process is based on the W3C consensus process.
  • Prioritization - Each of the Initiatives executed within the S&I Framework are prioritized to ensure that each Initiative meets the larger goals of healthcare reform and healthcare system improvement. Specifically, the Framework strives to remain aligned with national health priorities, and with the overall goals and expected outcomes of all the various stakeholders involved in the activities of the framework.
  • Engagement - It is imperative that in each phase of the S&I Framework, stakeholders affected by the Initiative are engaged. This ensures that each of the Initiatives within the framework will be executed with full participation from affected stakeholders, and ensures the involvement of qualified and knowledgeable resources within the phases of each Initiative. This is especially important in working with healthcare standards, which in most cases have been developed by collaborative processes external to this framework and have a cumulative body of knowledge to draw from.
  • Consensus - Consensus is a core value of S&I framework. To promote consensus, the S&I framework process will consider all legitimate views and objections, and endeavor to resolve them, whether these views and objections are expressed by the active participants of the group or by others (e.g., the general public).
  • Rapid Results - Every Initiative and it’s phases are designed to achieve rapid, quality results, through the articulation of the expected outputs from each phase and by documenting a smooth flow and transition among the phases of the framework. This will ensure that expected results can be achieved, ensure that bottlenecks and risks that are interfering with the success of the Initiative are identified and resolved, and the outcomes measured and published to the healthcare community.

What is an Initiative Coordinator?
The Initiative Coordinator is assigned by the S&I Steering Team to coordinate activities in the Initiative to ensure that the Initiative meets the Initiative Goal.

What is an Initiative Committed Member?
An Initiative Committed Member is an organization or individual who has a particular interest in solving the problem statement and reaching the Initiative Goal and commits to actively achieve the Initiative Deliverables.

Can an initiative member resign from an initiative?
Of course, an Initiative Member may resign from a group.

How does the S&I Framework deal with perceived or real conflicts of interest?
Individuals participating materially in S&I Initiative work MUST disclose significant relationships when those relationships might reasonably be perceived as creating a conflict of interest with the individual's role in the S&I initiative. Each S&I participant MUST disclose their affiliating and sponsoring organization.

What type of consensus policy is used by the S&I Framework Initiative Groups?
Consensus is a core value of the S&I Framework. To promote consensus, the S&I framework process requires Initiative Coordinators to ensure that groups consider all legitimate views and objections, and endeavor to resolve them, whether these views and objections are expressed by the active participants of the group or by others (e.g., the general public). Decisions MAY be made during meetings (face-to-face or distributed) as well as through email.
The following terms are used in this document to describe the level of support for a decision among a set of eligible individuals:

  1. Consensus: A substantial number of individuals in the set support the decision and nobody in the set registers a Formal Objection. Individuals in the set may abstain. Abstention is either an explicit expression of no opinion or silence by an individual in the set. Unanimity is the particular case of consensus where all individuals in the set support the decision (i.e., no individual in the set abstains).
  2. Dissent: At least one individual in the set registers a Formal Objection.

By default, the set of individuals eligible to participate in a decision is the set of Initiative Committed Members in Good Standing. The Process Document does not require a quorum for decisions (i.e., the minimal number of eligible participants required to be present before the Initiative Coordinator can call a question). A charter MAY include a quorum requirement for consensus decisions.

The goal is unanimous consent, which is obtained by carefully considering and addressing significant input from the Community of Interest. Where unanimity is not possible, a group SHOULD strive to make consensus decisions where there is significant support and few abstentions. Any significant deliverable of the Initiative Charter will be approved through a formal Consensus process.

How do I specifically dissent on an Initiative Group decision?
In the S&I Consensus process, an individual may register a Formal Objection to a decision. A Formal Objection to a group decision is one that the reviewer requests that the Initiative Coordinator consider as part of evaluating the related decision. Note: In this document, the term "Formal Objection" is used to emphasize this process implication: Formal Objections receive Initiative Coordinator consideration. The word "objection" used alone has ordinary English connotations.

An individual who registers a Formal Objection SHOULD cite technical arguments and propose changes that would remove the Formal Objection; these proposals MAY be vague or incomplete. Formal Objections that do not provide substantive arguments or rationale are unlikely to receive serious consideration by the Initiative Coordinator.

A record of each Formal Objection MUST be publicly available. A Call for Consensus (of a document) to the participants MUST identify any Formal Objections.

Can I appeal a decision made by an Initiative Group?
When group participants believe that their concerns are not being duly considered by the group, they MAY ask the Initiative Coordinator to confirm or deny the decision. The participants SHOULD also make their requests known to the Team participants. The Team participants MUST inform the Initiative Coordinator when a group participant has raised concerns about due process.

Any requests to the Initiative Coordinator to confirm a decision MUST include a summary of the issue (whether technical or procedural), decision, and rationale for the objection. All counter-arguments, rationales, and decisions MUST be recorded.

How will Initiative Groups deal with deadlocked decisions?
In some rare cases, even after careful consideration of all points of view, a group might find itself unable to reach consensus. The Initiative Coordinator MAY record a decision where there is dissent (i.e., there is at least one Formal Objection) so that the group may make progress (for example, to produce a deliverable in a timely manner). Dissenters cannot stop a group's work simply by saying that they cannot live with a decision. When the Initiative Coordinator believes that the Group has duly considered the legitimate concerns of dissenters as far as is possible and reasonable, the group SHOULD move on.

Groups SHOULD favor proposals that create the weakest objections. This is preferred over proposals that are supported by a large majority but that cause strong objections from a few people. As part of making a decision where there is dissent, the Initiative Coordinator is expected to be aware of which participants work for the same (or related) Member organizations and weigh their input accordingly

Can I still participate in the S&I Framework if I don't sign up as a committed member?
The general public is invited to participate in discussions and can provide comments and feedback by joining the wiki. However, non-committed members do not have voting rights in the consensus process.

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Logistical Questions

What if I have a problem getting on the wiki?
We will provide a support link for all participants to help guide you through the process of setting up your wiki access and navigating through the S&I Framework wiki site. If further detailed support is required, such as issues with logging in or actually getting the site to display, the S&I Framework team will provide support as possible to help ensure participants are able to participate.

What if I have a problem dialing into an Initiative meeting call?
The S&I Framework teams will provide technical support to participants to ensure that they are able to dial-in to meetings. This technical support will include a link on the S&I Framework wiki to allow participants to specifically log any complaints or issues so that they can be resolved.

What if I have a suggestion or comment?
The S&I Framework is an open and transparent process, that will undergo multiple levels of improvement and refinement as it evolves. As such, we would welcome your suggestions or comments related to the S&I Framework process, ONC interoperability initiatives, or any other suggested improvements.

What if I don’t understand something about the S&I Framework or ONC interoperability initiatives?
ASK. We encourage participants and general public members to ask questions on the S&I Framework Discussion Board. We also would encourage you to ask any and all questions you may have on the discussion board, or if needed, directly to S&I Framework team members.

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CET Questions

Where do I go for help with the wiki?
We have compiled a guide to the wiki called Wiki 101 Training. The answers to many common questions can be found in that guide. Should you have other questions, feel free to contact

What if I have a question for ONC?
You may direct your question to or the S&I Framework Coordinator.

What is an appropriate timeline for my Initiative?
There is no pre-determined time frame that is necessary to adhere to for each Initiative. It is up to the workgroup members to determine target outcomes which in turn will help dictate the Initiative timeline. For example, if your group would like to conduct an analysis to provide recommendations to the policy committee for Meaningful Use, it would be important to finish the analysis in a timeframe that would allow you to achieve this goal.

What is the rationale behind the Open process?
The S&I Framework is an “open government” initiative. The success of the S&I Framework relies on the participation of a wide range of stakeholders including (but not limited to), Health IT vendors, health systems, standards development organizations, and the general public. As all of these organizations have varied interests and the outcomes of the S&I Framework will impact our entire nation, it is crucial that all of our work is done in a public setting. This is why we use a wiki site which allows for any member to edit a page and also see the history of that page. Use of the discussion tabs on the wiki pages is encouraged, as e-mail does not allow for all members of the community to comment on the many discussions that are occurring at any given time.

What is the email account used for?
This account is used for our all-purpose administrative support. Questions about the S&I Framework, including technical support/administrative support issues, can be sent to this email address, and they will be answered or forwarded to the appropriate point of contact.

What if my workgroup members need to access protected content related to the Initiative?
Your Initiative may be doing work that requires access to copyrighted materials. In the past the S&I Framework was faced with this challenge regarding the use of HL7 documentation. In that scenario, the S&I Framework established a no-fee license granting Committed Members access to this information. For more information, visit the following URL:

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