Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

September 25-26, 2007

Crowne Plaza Silver Spring Hotel
Silver Spring , Maryland

Meeting Minutes

The National Committee on Vital and Health Statistics was convened on September 25-26, 2007, in Silver Spring, Maryland. The meeting was open to the public. Present:

Committee members

  • Simon P. Cohn, M.D., M.P.H., Chair
  • Jeffrey Blair, M.B.A.
  • Justine M.Carr, M.D.
  • Leslie Pickering Francis, J.D., Ph.D.
  • Larry Green, M.D.
  • John P. Houston, J.D.
  • Garland Land , M.P.H.
  • Carol J. McCall, F.S.A., M.A.A.A.
  • J. Marc Overhage, M.D., Ph.D.
  • Harry Reynolds
  • Mark A. Rothstein, J.D.
  • William J. Scanlon, Ph.D.
  • Donald M. Steinwachs, Ph.D.
  • C. Eugene Steuerle, Ph.D.
  • Paul Tang, M.D.
  • Kevin C. Vigilante, M.D., M.P.H.
  • Judith Warren, Ph.D., R.N.

Staff and liaisons

  • Marjorie Greenberg, NCHS/CDC, Executive Secretary
  • James Scanlon, ASPE, Executive Staff Director
  • J. Michael Fitzmaurice, Ph.D., AHRQ liaison
  • Karen Trudel, CMS liaison
  • Steve Steindel, Ph.D., CDC liaison
  • Edward J. Sondik, Ph.D., NCHS liaison
  • Debbie Jackson, NCHS

Others

  • Debbie Jackson, NCHS
  • Katherine Jones, NCHS
  • Susan Kanaan, consultant
  • Frank Kyle, American Dental Assn.
  • Maria Friedman, Rx Hub
  • Carol Bickford, American Nurses Assn.
  • Mary Moien, NCHS
  • Virginia Cain, NCHS
  • Allison Viola, AHIMA
  • Jeanette Thornton, AHIP
  • Chantal Worzala, Alazro Consulting
  • MaryBeth Farquhar, AHRQ
  • Sheilah Dwyer, AOA
  • Paul Gammill, HHS
  • Bob Kambic, CMS
  • Michael DeCarlo, BlueCross BlueShield Assn.

EXECUTIVE SUMMARY

Much of this meeting was spent discussing a draft report on the “secondary uses” of health information, being developed by an ad hoc NCVHS workgroup at the request of the Office of the National Coordinator. The Committee also approved three letters/reports and was briefed by representatives of the Data Council and the Office of the National Coordinator.

ACTIONS

  1. The Committee approved a letter on the HIPAA transaction standards.
  2. The Committee approved a report on data sources for quality measurement. It is expected that the report will be part of a letter to the Secretary developed jointly by NCVHS and the AHIC Quality Workgroup.
  3. The Committee approved the 2005-2006 NCVHS report.

Update from the Department

  • Data Council—Mr. Scanlon

Mr. Scanlon briefed the Committee on the Secretary’s current priority areas, the new HHS strategic plan, legislative developments, budgetary developments, and several new Data Council projects.

  • Office of the National Coordinator—Ms. Cronin and Ms. Daniels

Ms. Cronin reported on the transition of AHIC to an independent public-private partnership (called “AHIC 2.0”) and on the status of the trial NHIN implementations. NCVHS members had questions and comments on privacy protections, involvement of consumers on the “AHIC 2.0” board, and the balance between cooperation and market-stimulating competition and innovation.

Ms. Daniels described ONC’s state-level work in the areas of privacy and security as well as other policy and legal issues. ONC has extended the Health Information Privacy and Security Collaboration contract until the end of 2007 to continue the learning and collaboration and bring more states into the fold. (By the end of the first stage, forty- -four states and territories were participating.)

Asked how the Committee could best help these efforts, Ms. Daniels said a pivotal question is what issues the Federal government can legitimately take on. She encouraged the Committee to make concrete, actionable recommendations on “the hard questions,” including those related to secondary uses, to guide Federal policy-setting.

Letter on Revisions to HIPAA Transaction Standards—Mr. Reynolds

The group reviewed a draft letter prepared by the Subcommittee on Standards and Security on new versions of the HIPAA transaction standards, which Mr. Reynolds called “the first major change to existing HIPAA transaction standards.” He read the letter, pausing periodically for discussion. Timing and sequencing issues were one focus, especially in terms of the implications for ICD-10 code set implementation. A revised version of the letter was presented to the Committee on day two of this meeting, discussed, modified further, and approved.

Enhanced Protections for Uses of Health Data—Dr. Carr and Mr. Reynolds

ONC asked NCVHS to develop a policy framework to provide guiding principles and clarify terminology and a taxonomy on secondary uses of data, with particular attention to the quality use case. The ad hoc Workgroup on Secondary Uses held three hearings with 58 testifiers, plus multiple meetings and conference calls. Its work draws on previous work by NCVHS, AHIC, AHRQ, AMIA and HISPC. The Workgroup favors talking about uses of health data, not secondary uses.

The purpose of the discussion during this meeting was to familiarize NCVHS members with the report’s context and content, to clarify areas of agreement and disagreement among members, and to identify ways it can be improved. The report offers observations and recommendations in the following areas (using 9/07 wording):

  • privacy legislation
  • cross-cutting data stewardship principles
  • HIPAA covered entities and the chain of trust
  • covered entities and data stewardship
  • business associates
  • health data uses for quality measurement, reporting and improvement
  • health data uses for research
  • exercising choice within the NHIN

The Committee engaged in several hours of discussion of the draft report over two days. The Workgroup will use members’ suggestions in creating a revised document, after which there will be further opportunities for input by both NCVHS members and the public. The report is planned as an action item for the November NCVHS meeting.

Quality Workgroup: Upcoming Report on Quality Measurement—Dr. Carr

Dr. Carr presented a draft report summarizing the findings from a June Quality Workgroup hearing. Dr. Clancy has asked that this status report be combined with forthcoming AHIC recommendations about future states into a single letter to the Secretary. (The exact form of that letter has not yet been determined.) Dr. Carr reviewed the themes of the report, which focuses on the emerging use of hybrid data (electronic, administrative, and other) to measure and report quality. It offers ten recommendations. The group discussed the report and offered a few editorial suggestions to strengthen it. On day two, the Quality Workgroup presented a revised draft, which was discussed, further revised, and approved.

NCVHS 2005-2006 Report: Action

After brief discussion, the Committee approved the 2005-2006 report. Members encouraged the broad dissemination of this report because it provides an overview of what NCVHS is and does.

Committee Operations and Process

Members reviewed a draft document on Committee operations and process. After a wide-ranging and candid discussion, several members commented on the value of the document and the discussion it prompted. The Executive Subcommittee will revise it based on members’ inputs and bring it back to the November meeting.

Subcommittee and Workgroup Status Reports

(See the brief summaries at the end of the detailed summary.)

DETAILED SUMMARY

—DAY ONE—

CALL TO ORDER, WELCOME, INTRODUCTIONS, REVIEW OF AGENDA

Dr. Cohn called the meeting to order and, following introductions, commented briefly on the exceptionally rapid pace of the Committee’s work in recent months. He noted the growing importance the Department is attaching to the potential contributions to health care quality of health information technology, and the Department’s use of the NCVHS recommendations on privacy and NHIN functional requirements.

Much of the present meeting will be spent discussing a draft report proposing a conceptual and policy framework for the “secondary uses” of health information, which is being developed by an ad hoc NCVHS workgroup at the request of the Office of the National Coordinator. The group is chaired by Dr. Cohn and co-chaired by Dr. Carr and Mr. Reynolds. The purpose of the discussion during this meeting is to familiarize all members with the document’s context and content, to clarify areas of agreement and disagreement, and to identify ways it can be improved. It is planned as an action item for the November NCVHS meeting.

UPDATE FROM THE DEPARTMENT: Data Council—Mr. Scanlon

Mr. Scanlon began by reviewing the Secretary’s nine priority areas, which were recently revised. The Secretary is providing leadership in these areas, which he regards as potentially transformational activities. They include universal health insurance access, insurance for children in need, value-driven health care, and information technology. The Department also recently revised its strategic plan; health IT and data continue to be important common themes. (The priority areas and strategic plan are posted on the HHS Website.)

On the legislative front, there are several HIT bills in Congress. The Wired for Healthcare Act, a Senate bill, would codify ONC and AHIC and fund studies on privacy, among other things. Regarding the budget, Mr. Scanlon predicted a continuing resolution to continue funding in the next fiscal year. One concern for the FY08 budget is that Congress is considering reduced funding for ONC compared to the President’s budget. The core statistical systems are to be funded at current levels.

Mr. Scanlon then described recent and new Data Council projects:

  • A recent study on the utility of EHR data for health care provider surveys and health statistics concluded that the data are not yet sufficient to support representative sampling, though they may support various kinds of research. The National Library of Medicine has offered grantees as potential pilot sites of studies to identify what kind of research might be appropriate.
  • ASPE is supporting an NCHS survey of hospital emergency preparedness for pandemics, to update data gathered in 2004. It will begin in January.
  • ASPE is supporting a CMS assessment of PHRs in fee-for-service Medicare programs.
  • ASPE is assessing HIT and health information exchange (HIE) in community health centers and safety net programs.

Members talked with Mr. Scanlon about a recent FDA bill to strengthen the capacity for post-market surveillance; the prospects for expediting e-prescribing; and the Department’s work on PHRs. They asked for a briefing on the CMS study of PHRs at the next meeting.

Letter on Revisions to HIPAA Transaction Standards—Mr. Reynolds

The group reviewed a draft letter prepared by the Subcommittee on Standards and Security on what Mr. Reynolds called “the first major change to existing HIPAA transaction standards.” He read the letter, pausing periodically for discussion.

Members talked about the “business case/cases” and the “return on investment” for revising the transaction standards, and in particular how the two concepts may be different in this context. There was agreement that there is a clear business case for adopting the HIPAA 5010, the new standard—i.e., to support patient care—even if the ROI is not demonstrable. Mr. Reynolds stated that implementing the 5010 is “a glidepath for future things”—including, Ms. Greenberg pointed out, implementation of ICD-10 code sets.

The group discussed timing and sequencing issues at some length, especially in terms of the implications for ICD-10 code set implementation. Mr. Reynolds stressed the need for realism in accommodating the time it takes for the industry to implement regulations. The draft letter establishes a process for doing so. Ms. Greenberg expressed strong concern about having to continue with the “broken” ICD-9-CM for as long as another six years. Dr. Cohn suggested that the Subcommittee on Standards and Security in the next phase ask the industry about these issues. Dr. Green pointed out that there is more than one “industry,” and some industries need the new structure as soon as possible. The idea, he said, is to establish a structure that minimizes further delays.

A revised version of the letter will be presented to the Committee on day two of this meeting.

Update from the Office of the National Coordinator—Ms. Cronin and Ms. Daniels

The presenters reported on the transition of AHIC to an independent public-private partnership (“AHIC 2.0”) and on the status of the trial implementations. ONC has been working to conceptualize the new entity, and engaged three contractors to look at issues such as structure and business model in an evolving market. Ms. Cronin stressed that this is not an effort to “privatize governance,” but to facilitate the public-private partnership for decision-making; she distinguished this from an advisory role.

In August, ONC released a white paper on key attributes and functions of the AHIC 2.0 organization, and received 53 comments. It also held two public meetings. It will move toward the transition between November 2007 and April 2008, with a grantee serving as a neutral convenor and working on organizational design and business plan. After that, a new legal entity will be set up, so it can be operational by Spring 2008 and start taking on work that is now being done by AHIC. HHS is expected to provide up to $13 million over two years for this work; they hope for private sector contributions as well. The relationships between AHIC 2.0, HITSP, and CCHIT have yet to be worked out by the planning board, along with the funding allocations to the three bodies.

In response to member questions, Ms. Cronin commented on privacy protections, involvement of consumers on the board, and the balance between cooperation and market-stimulating competition and innovation. She also pointed out that ONC is “very restricted by our budget process,” limiting the trial implementations that are possible. She added that ONC is striving to coordinate this process with the NHIN trial implementations, e.g., on surveillance.

Ms. Daniels continued the briefing. She described the state-level work in the areas of privacy and security as well as other policy and legal issues. The Health Information Security and Privacy Collaboration (HISPC) involved 34 states and territories in an effort to look at and compare state-level privacy and security policies and practices. A final report by the contractor, RTI, summarized the variations, solutions and implementation plans. A major finding was that the stakeholders—consumers, providers, et al.—lack enough knowledge about HIT and information exchange to understand the implications of the privacy and security practices. This points to the need for education and outreach.

The variations among state laws, both within a single state and between them, present challenges. Another consistent theme was the challenges in obtaining and managing patient consent; the result will be an effort to standardize patient consent. Variations in methods for implementing authentication authorization, access controls and audits were another challenge, along with privacy and security oversight.

ONC extended this contract until the end of 2007 to continue the learning and collaboration and bring more states into the fold. The focus is on individual state implementation plans, and also to foster multi-state collaborative workgroups. All the non-participating states and one territory took part in a recent meeting, after which the project grew to 44 states. ONC will encourage more collaborative efforts across the states in the coming months.

ONC collaborated with the National Governors Association on the State Alliance for e-Health, formed to support consensus development on state issues and to increase the efficiency of state efforts through shared learning. The Alliance is composed of high-level state officials.

In response to questions, Ms. Daniels said the participating state entities in HISPC are either a state agency (e.g., a health department) or a private organization endorsed by the Governor’s office — one entity per state. In the State Alliance, all members are government representatives.

Asked how the Committee could best help this effort, she said a pivotal question is what issues the Federal government can legitimately take on. She encouraged the Committee to make concrete, actionable recommendations on “the hard questions,” including those related to secondary uses, to guide Federal policy-setting. She added that even when the Committee is not unanimous, it is more helpful for it to take a decisive position on tough issues than to articulate all sides. It would also be helpful to identify where the consensus is lacking within NCVHS and to articulate the dissenting opinion(s). She noted that the NHIN trial implementations can serve as test beds for the various recommendations and dissenting opinions.

Enhanced Protections for Uses of Health Data—Dr. Carr and Mr. Reynolds

Leaders of the Ad Hoc Workgroup on Secondary Uses then presented and led a discussion of the Workgroup’s draft report. The discussion took place over both days of the meeting.

In her introduction, Dr. Carr said the project began with a request from ONC that the Committee develop a policy framework to provide guiding principles and clarify terminology and a taxonomy on secondary uses of data, with particular attention to the quality use case. People have been concerned that HIT is driving the uses of health data; the idea is to clarify how HIT can be a tool in the service of quality health care, used with privacy protections and transparency. Another premise of the NCVHS project is that HIT can help optimize the use of health information to improve health care and health. The Workgroup held three hearings with 58 testifiers, plus multiple meetings and conference calls. Its work draws on previous work by NCVHS, AHIC, AHRQ, AMIA and HISPC. The Workgroup favors talking about uses of health data, not secondary uses, for many reasons.

These issues are being addressed now for multiple reasons. In brief, the vision of HIE has expanded beyond what HIPAA envisioned; health information is available for an expanding range of uses, with more granular detail; the sources are expanding; and the linkage of large databases creates a need for stewardship.

Dr. Carr reviewed the HIPAA privacy rule and the security rule, noting key aspects of the coverage they afford and the gaps in coverage. She outlined the challenges in and beyond HIPAA related to the de-identification of data. Regarding data stewardship, she referred to the AMIA definition of the concept and added that a major question that emerged in the course of the ad hoc Workgroup’s study was, “Is there a need for more attention in relation to data aggregation and analysis when personal health data are used for quality analysis?” The major reason for concern is the potential for re-identification in such cases.

In the hearings, the Workgroup heard testimony on the following themes:

  • It is important to understand both the benefits and the potential harms in the enhanced use of HIT
  • The uses of health data for quality measurement reporting and improvement that are enabled by HIT and HIE yield new benefits and potential challenges.
  • Linkage of information must assure privacy, and vendors who link data must not violate trust.
  • Data for performance improvement may evolve into research without the protections of the Common Rule, raising questions about the boundary between performance improvement and research.
  • Data quality issues are crucial in regard to data aggregation.

This concluded Dr. Carr’s introduction, which Dr. Tang praised as “a beautiful rendition of the issues and statement of where we are.” He added that patients’ expectations are the crux of the issue and “a great operational test”; trust erodes and privacy concerns may increase when people’s health data are used for purposes other than the ones they expected.

Mr. Reynolds then presented the ad hoc Workgroup’s observations and proposed recommendations in the following areas:

  • privacy legislation
  • cross-cutting data stewardship principles
  • HIPAA covered entities and the chain of trust
  • covered entities and data stewardship
  • business associates
  • health data uses for quality measurement, reporting and improvement
  • health data uses for research
  • exercising choice within the NHIN

As is the practice, he read these sections aloud, pausing periodically for discussion. (This summary notes some, though not all, of the major themes of the discussion.)

The first recommendation concerns attributes for new privacy legislation. Much of the discussion in that context concerned the complexities of aggregation, so-called de-identification, and the risks of re-identification. To protect legitimate uses of aggregate data such as vital statistics, Mr. Scanlon urged the Committee to approach these issues in terms of “the likely threat” and “reasonable risks” rather than worst cases. Mr. Rothstein noted that “a higher level of permission” may be called for in these instances.

Raising a more general point, Dr. Francis proposed that all the recommendations be forceful, urging specific actions by HHS, rather than being “minimalist.”

Further on the first group of recommendations, the group discussed whether the Committee should recommend comprehensive health information privacy legislation in response to new HIT developments; more narrowly conceived legislation to augment HIPAA, based on a gap analysis; or some combination of the two.

Dr. Steuerle urged that the report make clear the tradeoffs between the potential risks and the potential benefits of HIE and the fact that certain health improvements will not occur if the entire focus is on minimizing the risk of privacy violations. He was asked to suggest language to this effect. Dr. Tang suggested that the heart of the matter is to find ways to protect privacy without interfering with potential health benefits. He asserted that the major loophole to be closed is the uses of data for commercial gain that do not contribute to society’s health.

Mr. Reynolds said that the general spirit of the recommendations is that “we are entering a new world that is moving quickly . . . and it’s all about stewardship.” The recommendations build a framework for stewardship to strengthen the chain of trust.

Ms. McCall proposed adding the principle of data quality to the concept of data stewardship. While there was agreement on the principle, Dr. Scanlon pointed out that there is a limit to the government’s responsibility for ensuring data quality.

The group discussed the potential impact of privacy protections on research, such as on hospitals’ willingness to provide aggregate data to medical researchers.

The third set of recommendations are about constructing a chain of trust and responsibility to protect information as it is passed from entity to entity. Dr. Tang commented that a core problem is that at present, business associate agreements are “completely ineffective” because accountability is diffuse and the agreements are difficult to enforce; and Mr. Houston agreed that the business associate concept is “very difficult to manage.” The group discussed possible solutions. There was considerable discussion of this topic. As part of the solution, the group appeared to agree on the merits of building clear standards into contracts that obligate the covered entities to enforce them.

The next topic of discussion was the recommended measures—such as transparency, enforcement and education—to support data stewardship.

The Committee then moved on to other agenda items, to return to this one on day two of the meeting.

Quality Workgroup: Upcoming Report on Quality Measurement—Dr. Carr

Dr. Carr presented a draft report summarizing the findings from a June Quality Workgroup hearing. Dr. Clancy has asked that this status report be combined with forthcoming AHIC recommendations about future states into a single letter to the Secretary. (The exact form of that letter has not yet been determined.) She reviewed the themes of the report, which focuses on the emerging use of hybrid data (electronic, administrative, and other) to measure and report quality. The report offers ten recommendations.

The group discussed the report and offered a few editorial suggestions to strengthen it. Dr. Green observed that although the hearing focused on hospital quality measurement, the findings of the report are applicable well beyond the hospital. He urged that the report be treated as a starting point in a conversation about public reporting and the continuum of care.

The Workgroup was asked to present a revised version based on this discussion on day two.

—DAY TWO—

NCVHS 2005-2006 Report: Action

After brief discussion, the Committee approved the 2005-2006 report. Noting that the report provides an overview of what the Committee is and does, several members encouraged that it be widely disseminated, and they asked for multiple copies for their own use. Ms. Jackson said a graphic designed and printed version would be ready in January or February. Until then, a desktop-published version can be available. One suggestion was to disseminate the report to AHIC members, to familiarize them with what NCVHS does.

HIPAA Transactions Letter: Action

Mr. Reynolds took the group through the revisions to the draft letter on the HIPAA 5010 and NCPDP transactions discussed the previous day. Members revisited the question of how to encourage rapid forward movement. Mr. Reynolds noted that the Subcommittee would hold a hearing on ICD-10 code sets in January, leading to a letter on that subject. The Committee approved the draft as revised.

Quality Workgroup Report: Action

Dr. Carr described the changes to the original draft and discussed the new draft with fellow members. A major focus of the discussion was how to express the potential contributions of EHRs to quality measurement without exaggerating their anticipated role. After making several refinements, the members approved the revised document, allowing for further wordsmithing by the Executive Subcommittee as needed.

Committee Operations and Process

Members reviewed a draft document on Committee operations and process. Several themes arose in the discussion. The first was the importance of transparency and full participation in the document development process in subcommittees and workgroups. When they are unable to reach agreement on controversial issues, the groups were encouraged to advise the Committee of this fact and to invite input from the full Committee early in the development process.

Another cluster of topics concerned the importance for members to come to full Committee meetings well prepared, having read the documents included on the agenda, and the concomitant need for those producing documents to be timely in distributing them in advance. Members supported having a closing date for advance distribution and, when that is not possible, providing redlined revisions to highlight changes. It was noted that full Committee members should respect the work and judgment of the group producing the document, and/or give their input as early as possible in the process, rather than second-guessing the version brought to the full Committee. On a related subject, Dr. Cohn and Ms. Greenberg explained the reasons for reading aloud key portions of documents in full Committee meetings, to convey essential messages to Internet listeners and others unable to view the documents.

Finally, Dr. Steuerle suggested that the Committee could be more effective in its writing and editing, and avoid spending time on refinements that are nice but not necessary, if it made a regular practice at the outset of stating (to itself) the target audience(s) and key objectives of each document.

Several members commented on the value of this document on Committee process, and of the discussion it prompted. Dr. Cohn said the Executive Subcommittee would revise it based on members’ inputs and bring it back to the November meeting.

Enhanced Protections for Uses of Health Data (cont’d)

The Committee resumed their discussion of the draft report on “secondary uses.” They examined the first topic, the status of clearinghouses, in terms of a variety of functions and both current and future incarnations. The possible need for another term than “clearinghouse” was noted.

The next category was health data uses for quality measurement, reporting and improvement. The challenges include distinguishing between quality-related operations and research and having appropriate rules to ensure that the data uses in each are protected by data stewardship principles. Members pointed out other issues and nuances in this area, as well.

The next sets of recommendations concerned research and the exercise of choice over uses of health data within an NHIN. Dr. Green pointed out that the Committee’s recommendations must be viewed as transitional because of the evolving nature of the field. He also proposed that data stewardship be used as the frame for all the observations and recommendations, with the goal of protecting persons and their information. Dr. Deering noted that in the future, it is likely that individuals themselves will be aggregators of data and actors in the secondary use of data; how this evolves is one of the unknowns about the future.

As a general suggestion, a member recommended making a clearer distinction in the next iteration of the report between “real recommendations” and other kinds of comments.

Mr. Reynolds expressed appreciation for the foregoing discussion, saying “This is what we do best as a group.” The Workgroup will use members’ suggestions in creating a revised document.

Dr. Cohn thanked Mr. Reynolds and Dr. Carr for their leadership in the discussion. He reviewed the next steps for the ad hoc Workgroup in continuing to develop the report and recommendations. There will be further opportunities for input by both NCVHS members and the public.

Subcommittee and Workgroup Status Reports

  • Subcommittee on Privacy and Confidentiality—Dr. Francis

The Subcommittee is working on a letter on additional privacy protections for interoperable EHRs, which it hopes to present at the November meeting.

  • Subcommittee on Populations—Dr. Steinwachs

The Subcommittee is working on surge capacity and preparedness and will develop a letter on the topic. In addition, it has talked with Dr. Michael O’Grady, a new member of the NCHS Board of Scientific Counselors, who attended the Subcommittee’s break-out session, about possible areas of collaboration between NCVHS and the BSC. The Subcommittee is also considering next steps regarding data linkages, and deciding on future projects such as updating the Vision for 21st Century health statistics. They are considering ideas about system transformation around the medical home concept. (Dr. Steinwachs noted that the term “health home” is more appropriate from a public health standpoint.)

  • Subcommittee on Standards and Security—Mr. Reynolds

The Subcommittee will focus on ICD-10 code sets in a January hearing; it may also hear ROI comments on claims attachments and e-prescribing; and it continues to monitor the progress of the NPI.

  • Quality Workgroup—Dr. Carr

The Workgroup is interested in holding hearings on the difference between quality operations and research, to help develop one of the issues in the report on the uses of health data.

Final Comments—Dr. Cohn

After briefly reviewing plans for the November meeting, Dr. Cohn adjourned the meeting.

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

/s/ November 18, 2007

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Chair Date