Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

November 19-20, 2009

National Center for Health Statistics, CDC
Hyattsville, MD

Meeting Minutes

The National Committee on Vital and Health Statistics was convened on November 19-20, 2009, at the National Center for Health Statistics in Hyattsville, MD. The meeting was open to the public. Present:

Committee members:

  • Harry Reynolds, Chair
  • Jeffrey Blair, M.B.A.
  • Justine M. Carr, M.D.
  • Leslie Pickering Francis, J.D., Ph.D.
  • Larry A. Green, M.D.
  • Mark Hornbrook, Ph.D.
  • John P. Houston, J.D.
  • Garland Land, M.P.H.
  • Sallie Milam, J.D.
  • Blackford Middleton, M.D.
  • J. Marc Overhage, M.D., Ph.D.
  • Anthony Rodgers, M.S.P.H.
  • William J. Scanlon, Ph.D.
  • Donald M. Steinwachs, Ph.D.
  • Walter Suarez, M.D.
  • Paul Tang, M.D.
  • Judith Warren, Ph.D., R.N.

Lead Staff and Liaisons

  • Marjorie Greenberg, NCHS, Exec. Secretary
  • James Scanlon, ASPE, Exec. Staff Director
  • J. Michael Fitzmaurice, Ph.D., AHRQ liaison
  • Ed Sondik, Ph.D., NCHS liaison
  • Charles Friedman, Ph.D., ONC liaison
  • Michael O’Grady, Ph.D., BSC liaison

Others

  • Debbie Jackson, NCHS
  • Katherine Jones, NCHS
  • Marietta Squire, NCHS
  • Don Asmonga, AHIMA
  • John Burke, Col. of Amer. Pathol.
  • Henry Heffernan, NIH
  • Chantal Worzala, Alazro Consulting
  • Michael DeCarlo, BlueCross BlueShield
  • Adam Birnbaum, BC/BS
  • Thomas Bizzaro, First DataBank
  • April Falcon, Academy Health
  • Karen Lipkind, NCHS
  • Virginia Cain, NCHS
  • Amanda Cash, HRSA
  • Rashida Dorsey, ASPE
  • Adam Birnbaum, BlueCross BlueShield
  • Allison Viola, AHIMA

EXECUTIVE SUMMARY

ACTION

The Committee passed a motion approving a letter to the Secretary on meaningful measurement of health care quality using electronic health records (EHRs). Final approval is subject to wordsmithing based on the discussion held on day two of this meeting. A slightly revised version will be circulated to the full Committee, with 24 hours to respond, and then finalized by the Executive Subcommittee.

HHS Update—Jim Scanlon, ASPE

Mr. Scanlon briefed the Committee on HHS leadership positions, the budget, the Recovery Act, HHS projects, and health care reform. Todd Park is the new HHS Chief Technology Officer; the new Surgeon General is Regina Benjamin. HHS has been working on the regulations for implementing HITECH, which is part of the Recovery Act (ARRA). All the health care reform bills include more work for NCVHS related to standards and other advising.

CMS Update—Tony Trenkle, CMS

Mr. Trenkle said HITECH, other health care reform activities, and administrative simplification are the major issues for CMS now. CMS is working closely with ONC and OMB on the HITECH regulation. CMS also has been active in the HIPAA arena, getting feedback on transaction code set enforcement and moving forward on 5010 and ICD-10 code sets.  Its impact analysis on ICD-10 code sets has been completed and is on the CMS website. CMS is establishing a Program Management Office and has established a multi-component ICD-10 Steering Committee. Externally, it is engaging with industry leaders; and it is looking forward to the NCVHS hearings in December. If a health care reform bill passes, there will be many changes in HIPAA. Mr. Trenkle stressed his commitment and that of Dr. Blumenthal to making sure that the advisory committees in this arena can successfully work together and use their respective capabilities.

Quality Letter on Meaningful Measures Dr. Carr

Dr. Carr presented a letter drafted by the Subcommittee on Quality that focuses on meaningful measurement of quality health care using electronic health records (EHRs).  It is based on an NCVHS hearing held on October 13-14 (see summary on NCVHS website), and conveys three sets of observations and recommendations. After an extensive discussion of the letter, the Subcommittee revised the letter and presented the revised version on day two of this meeting. After further discussion and suggestions, the letter was provisionally approved, pending wordsmithing and finalization by the Executive Subcommittee.

Briefing: Department’s Work on Comparative Effectiveness Research – Patrick Conway, M.D., M.Sc., ASPE

Dr. Conway is the Executive Director of the Federal Coordinating Council for Comparative Effectiveness Research (FCC). The Recovery Act allocated $1.1 billion for comparative effectiveness research (CER), administered by several agencies, and established a new Federal Coordinating Council that on June 30 released a report defining CER. A complementary IOM report named 100 specific core research topics, prioritized into four quartiles. CER is defined as “the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in ‘real world’ settings.” The purpose of the research is to develop and disseminate information to patients, clinicians and other decision makers about which interventions are most effective for which patients under specific circumstances. The five prioritization criteria are potential impact; potential to evaluate in diverse populations and sub-groups; uncertainty within clinical and public health communities; addressing a need or gap unlikely to be addressed by others; and potential for multiplicative effect. There will be AHRQ and NIH funding mechanisms, complemented by investments from the Office of the Secretary for example, investments in Medicare and Medicaid data. HHS has a senior group meeting weekly to review solicitations and make sure everything is coordinated.

Enhancing Health Information Capacity for the 21st Century – Dr. Scanlon

NCVHS commissioned Dr. Dan Friedman and Dr. Gib Parrish to revisit the 2002 vision for 21st century health statistics to see how it could or should be updated. In the course of the review process and associated NCVHS discussions, the Committee’s focus broadened from health statistics to a vision for health information as a whole. A goal emerged to devise a set of NCVHS recommendations to the Secretary on developing a strategy to meet health information needs for health and health care. The idea is to present a preliminary document at the June 17, 2010, Symposium celebrating the Committee’s 60th anniversary. Dr. Scanlon explained that the Subcommittee on Population Health, which is spearheading this project, has been looking at how to simultaneously have a short-term impact keyed to current policy opportunities and set up a work agenda for the longer term.

As the new vision is intended to encompass all NCVHS domains, a Chair of each of the NCVHS Subcommittees suggested topics for possible inclusion. The meeting participants then engaged in a wide-ranging discussion of how to shape and carry out the project and what topics it should cover.

ONC Update – Dr. Charles Friedman

Dr. Friedman presented an analysis of the national health IT agenda showing progression toward adoption of health IT systems and establishment of a trusted national pathway to health information exchange as the first two elements (or tracks). The third element is creation of a learning system combining “gridware” (smart assembly), “cool applications” (delivering value to end users), and “learningware” (for discovering new knowledge).

Most of this session was dedicated to NCVHS members’ questions and comments about the Extension Centers and the IT Workforce grants.OCR Update Ms. McAndrew

Ms. McAndrew noted that there had been many changes at OCR recently, including the appointment of Georgina Verdugo as the new Director and new OCR authority to enforce the HIPAA Security Rule. She described how HITECH provisions will affect what OCR is doing in HIPAA, and other impacts of HITECH including a statutory increase in the penalty scheme. OCR is working on an NPRM on several of the HITECH changes, which she enumerated. Mr. Reynolds asked the co-Chairs of the Subcommittee on Privacy, Confidentiality and Security to meet with Ms. McAndrews to discuss how NCVHS can help in this changing and complex landscape.

Subcommittee and NCHS BSC Reports; 60 Anniversary Events and Plans

(Please see the final sections of the detailed summary, below, for these brief status reports.)

DETAILED SUMMARY

—Day One—

Introductory Remarks

Mr. Reynolds welcomed new NCVHS member Anthony Rodgers, reviewed the agenda, and asked everyone present to introduce themselves. To set the tone for the meeting, he likened the Committee’s field of endeavor to a journey with many stages.

HHS Update – Jim Scanlon, ASPE

Mr. Scanlon briefed the Committee on HHS leadership positions, the budget, the Recovery Act, HHS projects, and health care reform. Todd Park is the new HHS Chief Technology Officer; the new Surgeon General is Regina Benjamin; and several other people are slated for Senate hearings.  Probably until mid-December, HHS is funded by a continuing resolution, which does not allow any new activities to begin. If it materializes, the President’s 2010 budget has good news for surveys and NCHS.

Mr. Scanlon reviewed the several health IT activities supported by the Recovery Act (ARRA), a major arm of which is the HITECH Act. These programs are intended also to create an economic stimulus and create or retain jobs, with a local multiplier effect. HHS has been working on the regulations for implementing HITECH, as Dr. Friedman will explain further later in the meeting. The Prevention and Wellness Fund is being called “a down-payment on health reform” because it will support necessary improvements in the health care system. The biggest part is an initiative called Communities Putting Prevention to Work, which has a large evaluation component. The grant announcement has gone out, and communities are developing their submissions. Dr. Conway will report on the comparative effectiveness initiative. All of the health care reform bills include more work for NCVHS related to standards and other advising. NCVHS would provide a mechanism for public participation and make recommendations to the Secretary.

Dr. Tang raised the issue of matching patients with their medical records, stimulating considerable discussion among NCVHS members. The approaches suggested included devising a phased process for looking at standards, creating test-bed environments, strengthening legal protections against abuses, involving the states in state-level approaches and in that context using health information exchanges, and being attentive to the ecosystem with respect to this matter.

CMS Update – Tony Trenkle, CMS

Mr. Trenkle said the major issues for CMS now are HITECH, other health care reform activities, and administrative simplification. With HITECH, CMS is working closely with ONC and OMB on the regulation. He invited comments from NCVHS on this complex regulation, which cuts across several big programs. It is on target for publication by the end of the calendar year. He thanked NCVHS for the providing a “key early marker” on Meaningful Use in its April 2009 hearings. There are also many operational issues related to implementation and getting ready for 2011. CMS has been spending time with industry groups, which have various concerns over the regulation, which he enumerated.

CMS also has been active in the HIPAA arena, getting feedback on transaction code set enforcement and moving forward on 5010 and ICD-10 code sets.  Its impact analysis on ICD-10 code sets has been completed and is on the CMS website. CMS is establishing a Program Management Office and has established a multi-component ICD-10 Steering Committee. Externally, it is engaging with industry leaders; and it is looking forward to the NCVHS hearings in December. A contractor has been engaged to help develop an outreach strategy for 5010 and ICD-10 code sets, and another is conducting an environmental scan of readiness that will be used as a baseline in conjunction with the outreach strategy. CMS is working with several Congressional committees on the administrative simplification provisions.  If a bill passes, there will be many changes in HIPAA.

CMS is continuing its PHR pilots, and has completed one initial evaluation and is starting two others. In e-prescribing, it is continuing its pilot to test codified sig and rxNorm. The DEA controlled substances regulation and NCPDP 10.6 are in clearance. Finally, an effort is under way to make CMS data more readily available, while protecting privacy and security.

In the discussion period, Mr. Reynolds commended CMS for the leadership it is showing and for its support of NCVHS. Mr. Trenkle stressed his commitment and that of Dr. Blumenthal to making sure that the advisory committees in this arena can successfully work together and use their respective capabilities. He said he would like to sit down with the co-chairs of the Subcommittee on Privacy, Confidentiality and Security to discuss how the Committee can be helpful in this domain. In response to other questions, he said the issue of dual-eligibles is a high priority for CMS and that it is interested in easing the way and building synergy for the entities having to implement so many major changes at once.

Quality Letter on Meaningful Measures – Dr. Carr

Dr. Carr presented a letter drafted by the Subcommittee on Quality that focuses on meaningful measurement of quality health care using electronic health records (EHRs).  It is based on an NCVHS hearing held on October 13-14 (see summary on NCVHS website), and conveys three sets of observations and recommendations. The Committee expressed thanks to Dr. Matt Quinn for his work setting up and staffing the hearing and the follow-up.

After the hearing, the Subcommittee decided to focus on data capture in the EHR, in order to contribute to the comment period on Meaningful Use. Dr. Tang pointed out that the meaningful use initiative is “laying an infrastructure for reforming the health system,” and also that the nation’s thinking about health reform is limited by what it chooses to measure. Mr. Reynolds and others stressed that this letter is intended to start a process, and that data gathering and usage will change over time.

Dr. Carr began by outlining the components of quality measurement development and the supply chain, to distinguish and clarify the issues at different stages and in different domains. She said that while the Subcommittee had expected the hearing to generate “great examples,” and it did see some excellent initiatives, it was particularly struck by the lack of “an anchor holding them together” in the form of an overarching framework and oversight. It decided to focus on these concerns in a letter to the Secretary. One goal is to increase efficiency and minimize burden on providers. Dr. Carr pointed out that quality measurement has two purposes public reporting and performance improvement, which are associated with different issues.

NCVHS members talked at some length about the issues raised in the letter. As Dr. Carr read the draft letter aloud, they asked questions, offered comments, and suggested edits. The Subcommittee took all of the comments and suggestions into consideration in the revision process during its subsequent breakout session. The revised version will be presented in day two of this meeting.

Briefing: Department’s Work on Comparative Effectiveness Research – Patrick Conway, M.D., M.Sc., ASPE

Dr. Conway is the Executive Director of the Federal Coordinating Council for Comparative Effectiveness Research (FCC). The Recovery Act allocated $1.1 billion for comparative effectiveness research (CER), administered by several agencies, and established a new Federal Coordinating Council that on June 30 released a report defining CER. A complementary IOM report named 100 specific core research topics, prioritized into four quartiles. CER is defined as “the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in ‘real world’ settings.” The purpose of the research is to develop and disseminate information to patients, clinicians and other decision makers about which interventions are most effective for which patients under specific circumstances. There are five prioritization criteria: potential impact; potential to evaluate in diverse populations and sub-groups; uncertainty within clinical and public health communities; addressing a need or gap unlikely to be addressed by others; and potential for multiplicative effect.

The strategic framework for the research combines cross-cutting priority themes (research, human and scientific capital for CER, CER data infrastructure, and dissemination and translation of CER) on one axis; and priority populations, priority conditions, and types of interventions on the other. Specific investments can be within a single category and/or cross-cutting in one of the priority themes.  The Coordinating Council named several priorities in these broad areas. There will be AHRQ and NIH funding mechanisms, complemented by investments from the Office of the Secretary for example, investments in Medicare and Medicaid data. The Department’s spending plan has been approved by OMB and gone to the Hill. The Department is thinking about how to link Medicare and Medicaid data to other sources, and also about how to make the data accessible to researchers.

Investments in the dissemination of CER will be operationalized out of AHRQ, leveraging its networks. There also will be an effort to leverage delivery systems through ASPE. Complementing the NIH and AHRQ investments, HHS has a senior group meeting weekly to review solicitations and make sure everything is coordinated. Dr. Conway stressed the importance attached to coordination. In addition, there will be an inventory of CER and ongoing evaluation and impact assessment to determine what was effective.

In the discussion period, NCVHS members raised questions and talked with Dr. Conway about behavioral health and social impacts and determinants; systems of care; the need for “a science around HIT”; the merits of leveraging evidence from social networks such as “Patients Like Me”; costs as a factor; the use of qualitative data; and the federal coordination strategy.

Enhancing Health Information Capacity for the 21st Century – Dr. Scanlon

NCVHS commissioned Dr. Dan Friedman and Dr. Gib Parrish to revisit the 2002 vision for 21st century health statistics to see how it could or should be updated. In consultation with NCVHS members, they identified eight priority recommendations from the original set, which they then discussed in interviews with stakeholders. They developed a written report, streamlining the priority recommendations to three and suggesting additional priorities, which they presented in September; they also were present at this November meeting for the follow-up discussion by the NCVHS.

In the course of the review process and associated NCVHS discussions, the Committee’s focus broadened from health statistics to a vision for health information as a whole. A goal emerged to devise a set of NCVHS recommendations to the Secretary on developing a strategy to meet health information needs for health and health care. The idea is to present a preliminary document at the June 17, 2010, Symposium celebrating the Committee’s 60th anniversary.

Dr. Scanlon explained that the Subcommittee on Population Health, which is spearheading this project, has been looking at how to simultaneously have a short-term impact keyed to current policy opportunities and set up a work agenda for the longer term. Information is needed to guide policies and actions to protect and improve public health and the health care system, and to provide the private and public sectors with relevant data. Current data sources are limited in that individual sources have limited content, data sources are infrequently linked, and it is expensive to collect supplementary data.

Because of the ARRA investment of some $35 billion combined with the HHS statutory authority to define meaningful use, the Subcommittee on Population Health proposes that the focal question for the initial project be how EHRs can contribute. Thus, the guiding question proposed for the June 2010 report is, “How do we better meet the information needs of the 21st century by making more effective use of EHRs?”  NCVHS recommendations are relevant, Dr. Scanlon said, because of its general advisory role with HHS and its statutory role related to HIPAA, to which there are potential links. This project will build on NCVHS hearings and reports over the last several years.

At Dr. Scanlon’s request, the chairs of each of the subcommittees outlined the perspectives and issues in their domains that might be included in such a report. Dr. Tang noted the relevance of the content of the letter on quality measurement presented earlier in this meeting. For the Subcommittee on Population Health, Dr. Steinwachs noted that one of the issues for extending the relevance of EHRs for population health is the construction of denominators; and the methodologies for dealing with survey non-respondents may be useful. He mentioned a number of current data gaps and possible ways to use linked data to fill them. For the Subcommittee on Standards, Dr. Warren suggested using hearings to get the research, administrative, and clinical communities on the same page with respect to standards. For the Subcommittee on Privacy, Confidentiality and Security, Dr. Francis noted the tough questions about privacy, confidentiality, and informed consent raised by the interest in aggregating and linking data.

Drs. Friedman and  Parrish were asked for their perspectives. Dr. Friedman noted the differences between a “health care and sickness” frame and a “health and the influences on health” frame. He added that many data sources are relevant to population health besides administrative and survey data. Questions for consideration should include whether EHRs can replace any current information sources on population health or supplement them, and what they will not be able to contribute. He suggested looking at England’s National Spine project, a summary case record for population health purposes built on EHRs. He advised approaching EHRs with “some sense of skepticism” as to the utility of their data for population health, as distinct from their utility for improving clinical care. Dr. Parrish agreed, and pointed out that “true, population-based local and state data” remain a critical need for many programs. He cited the American Communities Survey as a good source of local data and recommended also looking for new data sources available through the Internet.

The Committee moved into a lively discussion of the issues and perspectives involved. Some of the key points and themes were: the value of timely, actionable, and bi-directional information; a caveat about data integrity; the potential uses of the small-population data available in data warehouses;  the most appropriate time-frame for the new NCVHS visioning project; whether the focus should be EHRs or sources more broadly; the need to frame the project in terms of the underlying questions and decisions for which information is needed; state health information exchanges as a pivotal activity; and the ongoing challenge of connecting individual and population health assessments. Members also brainstormed about new “populations” that warrant attention, such as baby-boomers, people with co-morbidities, people with access or affordability issues, and people in transition.

Dr. Scanlon acknowledged that the Committee encompasses multiple objectives and priorities. He asserted that at present, NCVHS can make the maximum contribution by seizing on the opportunities related to health care reform funding. The question in that context is, “How do we maximize data for health reform?”

Dr. Francis stressed the ongoing need for denominator-based data, given the possibility of reforming health care without improving the overall population’s health. Others commented that EHRs may help open up data at local and state levels and provide new ways to monitor and improve population health.

Dr. Green noted the traction achieved by the new project throughout the Committee, the important emphasis on helping decision-makers make good decisions, and the significance and long-term implications of the project. He urged that NCVHS be attentive to what is happening outside the US, where the leadership exists for addressing this set of problems. In this regard, Ms. Greenberg cited a previous report by Dr. Friedman on the use of EHRs for population health. On the challenge before the Committee of linking the micro and immediate to the macro and long-term, she reiterated that the June 2010 milestone is only the beginning of a longer journey; and she recommended that NCVHS devise both short- and long-term agendas. She added that at the Charlottesville convocation, it was clear that all former NCVHS Chairs agree about the importance of NCVHS keeping its eyes on population health and ensuring that information can serve the public as a whole, as well as clinicians and health planners.  She noted the continuing relevance of the “camera” metaphor developed in the 1990s by NCVHS members Dr. Lisa Iezzoni and Kathy Coltin, emphasizing the questions to be answered by information.

Dr. Carr commented that the Subcommittee on Quality learned in October 2009 about a potential interface between NCVHS and the Healthy People 2020 advisory committee, which is pursuing a broad, non-medical approach to population health.

– Day Two –

ONC Update – Dr. Charles Friedman

Dr. Friedman began by presenting what he called an “element view” of the national health IT agenda, with progression toward adoption of health IT systems and establishment of a trusted national pathway to health information exchange as the first two elements (or tracks). Different policy initiatives target one or both elements; meaningful use is enabled by combining them. The third element is creation of a learning system combining “gridware” (smart assembly), “cool applications” (delivering value to end users), and “learningware” (for discovering new knowledge).

Most of this session was dedicated to NCVHS members’ questions and comments about the Extension Centers and the IT Workforce grants. Topics included the merits of connecting the Workforce to NCHS to link the NHIN and national health statistics; identifying people with the skills to teach the curriculum, and the question of who should be trained; sustainability; and state-level strategic planning for health information exchange.

Quality Letter: Action – Dr. Carr

Dr. Carr read aloud the revised version of the letter presented on Day One, and members offered further comments and edits intended to clarify the content. It was reiterated that this is likely to be the first of a series of letters on quality measurement; it is meant to focus on foundational factors that must underlie measure development as it evolves. Like the project discussed above, this one is linked to current funding and policy priorities.

The Committee passed a motion approving the letter, subject to final wordsmithing based on the latest discussion. A slightly revised version will be circulated to the full Committee, with 24 hours to respond, and then finalized by the Executive Subcommittee.

OCR Update – Ms. McAndrew

Ms. McAndrew noted that there had been many changes at OCR recently, including the appointment of Georgina Verdugo as the new Director and new authority to enforce the HIPAA Security Rule. An apparatus of regional office investigators will facilitate more onsite activity for Security Rule cases. OCR continues to work with AHRQ on patient safety issues, with authority that began in January 2009. There are new prohibitions against health plans using genetic information in underwriting, complementing the nondiscrimination provisions under GINA. A new HIPAA NPRM has comments due in early December. She described how HITECH provisions will affect what OCR is doing in HIPAA, and other impacts of HITECH including a statutory increase in the penalty scheme. OCR is working on an NPRM on several of the HITECH changes, which she enumerated. There is also a range of non-regulatory requirements under HITECH. OCR hopes to hold public forums on de-identifying information in early 2010.

Mr. Reynolds asked the co-Chairs of the Subcommittee on Privacy, Confidentiality and Security to meet with Ms. McAndrew to discuss how NCVHS can help in this changing and complex landscape.

Subcommittee and NCHS BSC Reports

Mr. Houston said the Subcommittee on Privacy, Confidentiality and Security had a good breakout session the previous day, focusing on how best to coordinate activities with the other ONC advisory groups. One area of Subcommittee interest is developing better categories for sensitive information; another is the issues associated with interstate exchange of information.

For the Subcommittee on Standards, Dr. Warren described the December hearings it plans on implementation of the 5010 and ICD-10 code sets. It will be developing a strategy for mapping the intersections among ICD-9-CM, SNOMED-CD, RX-NORM, LOINC, the 5010, and ICD-10-CM and ICD-10-PCS. The Subcommittee is also coordinating with the Subcommittee on Population Health on the forthcoming work on a new vision for information for health. It also has completed an outline and rough draft of the report to Congress on HIPAA implementation in 2008-09, which Dr. Warren described. Among other things, the report will acknowledge the Department’s increased efforts around outreach, per suggestions by NCVHS.

Dr. Scanlon reported that that the Subcommittee on Population Health had a lively discussion of its visioning work in its breakout session. It will decide in the next few weeks whether to hold a half-day workshop on February 9, and will be reaching out to other subcommittee co-Chairs about this project.

Regarding the NCHS Board of Scientific Counselors, Dr. Scanlon described a recent BSC meeting at which he was part of a panel on long-term care data systems. In this as in other areas, there is interest in combining administrative and survey data. At Dr. Sondik’s request, he reiterated some of the major points from the discussion of the project on enhancing information on health. Dr. Sondik expressed hope that the lens would be wider than EHRs and would include how to incorporate new information sources.

For the Subcommittee on Quality, Dr. Carr thanked everyone for their work and input over recent weeks on the letter to the Secretary, which she described as a wonderful process. Mr. Reynolds commended the Subcommittee for producing a significant set of recommendations under considerable time pressure.

60 Anniversary Events and Plans – Ms. Greenberg and Ms. Jackson

Ms. Greenberg and Ms. Jackson described the Convocation of six NCVHS Chairs (serving from 1986 to the present) that took place in Charlottesville, VA in September. The main activities were individual oral history interviews with each Chair and Ms. Greenberg and a roundtable colloquium, both filmed, plus a celebratory dinner. Ms. Jackson is working with the videographer on a video record to be aired at the 60th Anniversary celebration in June 2010 and posted on the Website; Ms. Kanaan is using the content in the 60-year history. Ms. Greenberg thanked Dr. Green and Dr. Bob Phillips of the American Academy of Family Physicians and the leaders of the Family Practice Group of the University of Virginia School of Medicine for their support and participation in the event.

Those at this meeting who participated in the Charlottesville event shared their impressions of the exciting creative energy generated by the interactions among NCVHS Chairs and staff members. Ms. Greenberg noted that it was evident how meaningful their service on NCVHS was to them; Mr. Reynolds reported that they are still engaged. She then briefly described the plans for the 60-year history report, the June 17 celebration and symposium at the National Academy of Sciences, and related events planned by individual NCVHS members with their organizations.

Mr. Reynolds then adjourned the meeting.

I hereby certify that, to the best of my knowledge, the foregoing summary of minutes is accurate and complete.

/s/ Feb. 1, 2010

Chair Date