Minutes of the January 29, 2004 NCVHS Full Committee Meeting

Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

January 29, 2004

Hubert H. Humphrey Building
Washington , D.C.

Meeting Minutes

The National Committee on Vital and Health Statistics was convened on January 29, 2004 at the Hubert H. Humphrey Building in Washington, D.C. The meeting was open to the public. Present:

Committee members

John R. Lumpkin, M.D., M.P.H., Chair
Jeffrey Blair, M.B.A.
Justine M. Carr, M.D. (new member)
Simon P. Cohn, M.D., M.P.H., FACP
Richard K. Harding, M.D.
John P. Houston, Esq.
Stanley M. Huff, M.D.
Robert W. Hungate
Eugene Lengerich, V.M.D.
Vickie Mays, Ph.D.
Harry Reynolds (new member)
C. Eugene Steuerle, Ph.D. (new member)
Kevin C. Vigilante, M.D., M.P.H. (new member)
Judith Warren, Ph.D, RN (new member)
Kepa Zubeldia, M.D. (retiring)

Absent:

John Danaher, M.D. (retiring)
Peggy B. Handrich
A. Russell Localio, Esq., M.A., M.P.H., M.S.
Clement Joseph McDonald, M.D. (retiring)
Mark A. Rothstein, J.D.
Donald M. Steinwachs, Ph.D.

Staff and liaisons

Marjorie S. Greenberg, NCHS/CDC, Executive Secretary
James Scanlon, ASPE, Executive Staff Director
J. Michael Fitzmaurice, Ph.D., AHRQ liaison
Maria Friedman for Judith Berek, CMS liaison
Virginia Cain, NIH liaison
Ed Sondik, Ph.D., NCHS liaison
Steve Steindel, Ph.D., CDC liaison

Others

Katherine Jones, NCHS
Debbie Jackson, NCHS
Jackie Adler, NCHS
Gracie White, NCHS
Cynthia Wark, CMS, CHI
Bill Alfano, Blue Cross Blue Shield Assn.
Elizabeth Skillen, HHS intern
Dan Rode, AHIMA
Marilyn Zigmund Luke, AAHP-HIAA
Jorge Ferrer, CMS
Dan Price, Capitol Associates
Dan Landrigan, Atlantic Information Services
Carolyn Bloch
Meryl Bloomrosen, eHealth Initiative
Nancy Trenti, American Psychiatric Assn.
Stan Edinger, AHRQ

EXECUTIVE SUMMARY

ACTIONS

With minor modifications, the Committee approved a letter to the Secretary endorsing and commenting on CHI recommendations for 14 clinical data standards.
The Committee approved a letter to the director of the National Institute of Child Health and Human Development regarding the National Child Health Longitudinal Study.

(Both documents are posted on the NCVHS Web site, ncvhs.hhs.gov)

PURPOSE OF MEETING

The National Committee held a special one-day meeting for the purpose of taking action on CHI clinical data standards recommendations. The group also took the opportunity to say farewell to three retiring members and welcome five new ones.

UPDATE FROM THE DEPARTMENT

HIPAA Data Standards: Ms. Trudel
HIPAA Privacy Rule Compliance Update: Ms. McAndrew
Data Council: Mr. Scanlon

Ms. Trudel reported on the increasing compliance with HIPAA in claims submission, now up to about 66 percent of claims. She noted that t he National Provider Identifier was published on January 23, applying across the health care industry. The regulation takes effect in May 2005, after which there is a two-year implementation process. The National Provider System is being developed under a contract with HHS to process the applications, assign NPIs and store information.

Ms. McAndrew reported that as of the end of December 2003, OCR had received 3,745 complaints stemming from the privacy rule, averaging about 100 per week. Impermissible uses and disclosures of information and inadequate safeguards make up the bulk of the complaints, and access to information is the third most frequent complaint. No regulatory changes are planned in the immediate future.

Mr. Scanlon reported that the 2004 federal budget is expected to be signed by the President in the near future. Although it is not a “big growth budget,” there are positive elements for issues in the Committee’s domain, notably the NHII and standards. The Department has established a Council on the Application of Health Information Technology, to provide a focal point for realizing the potential of information technology and coordinating the work of HHS component parts in this area. Finally, the Data Council has awarded a contract to look at the geographic-level detail being collected and ways to standardize it, as part of a government-wide standardization effort, the Geospatial Geocoding Initiative.

In the discussion period, Committee members repeated their request to OCR for information on breakdowns for the types of complaints and the percentage of entity types that have been the subject of Privacy Rule complaints. Dr. Mays asked about the administration’s response to the Committee’s letter about targeted surveys for race and ethnicity data, and Mr. Scanlon said there is hope that the 2005 budget will include positive steps in that area; and the Disparities Report was briefly discussed.

NCHS BOARD OF SCIENTIFIC COUNSELORS (BSC)

Vickie Mays, NCVHS liaison to BSC
Dr. Aldonna Robbins, BSC liaison to NCVHS

Dr. Mays spoke of the evolving relationship between NCVHS and the BSC and noted the diverse composition of the Board.

Dr. Robbins said the purpose of the BSC is to advise the Secretary and the directors of CDC and NCHS on the scientific and technical program goals, objectives, strategies and priorities of NCHS. One of the topics the group has gravitated to initially is data dissemination

CONSOLIDATED HEALTH INFORMATICS INITIATIVE AND RECOMMENDATIONS

Dr. Cohn, Ms. Trudel, Cynthia Wark

Dr. Cohn noted that the 14 recommendations coming forward at this meeting mark the end of phase one of the CHI process to identify and recommend clinical data standards.

Ms. Trudel, the CHI Program Manager, said the aim of CHI has been to get all federal health care on a single platform with respect to clinical vocabularies, as a precondition to doing consolidated applications. CHI has used NCVHS both to get a reality check on the proposed standards and as a forum to communicate with industry about what the government proposes to do. She thanked the Committee for holding this special meeting to enable CHI to complete the 24 initial standards recommendations, and she described its decision-making process.

Ms. Wark, CHI Deputy Program Manager, worked her way through the lengthy letter and attachments, describing each domain addressed, the alternatives considered, and the recommended terminology. For each domain, Dr. Cohn indicated the NCVHS recommendation, which in each case concurs with CHI, sometimes with additional commentary or suggestions. NCVHS members were given an opportunity to comment and raise questions.

Regarding population health data, on which no standard is currently recommended, Dr. Cohn said that the Populations Subcommittee and/or the full Committee will need to pursue this subject in the future, possibly in conjunction with the NCHS Board of Scientific Counselors and the National Library of Medicine. The question, he said, is how to make clinical data and terminologies work for population health. The goal is for clinical data that flow through the population health dimension to be consistent with standards for clinical data. The topic stimulated considerable discussion among members and staff.

The Committee unanimously passed a motion approving the letter, with a few modifications. The final letter and summary CHI reports are posted on the NCVHS Web site.

Dr. Lumpkin commented that the completion of the first phase of CHI “is nothing short of historic” and it, together with the work on the NHII, will be viewed as the tipping point in the transformation of health and health care through the use of information technology.

UPDATE: SUBCOMMITTEE ON PRIVACY AND CONFIDENTIALITY

Dr. Harding

On behalf of Mr. Rothstein, Dr. Harding reported on the Subcommittee’s recent and planned activities related to monitoring implementation of the privacy rule. He outlined some of the specific issues raised, noting that in general the anxiety level among covered entities seems to have diminished.

Dr. Steuerle raised the general issue of the public health costs of the privacy rule, and he asked if the Subcommittee is gathering information on this. Ms. Greenberg noted that the Committee sent a letter to the Department last year recommending a systematic evaluation of the impact of the privacy rule.

Issues related to the interactions between state and federal law with respect to the flow of clinical data were raised and briefly discussed.

APPRECIATION OF RETIRING MEMBERS

Mr. Scanlon spoke on behalf of the Secretary in appreciation for the service of the three retiring members, Drs. Zubeldia, Danaher, and McDonald and Dr. Shortliffe, who retired previously.

HIPAA 6^TH REPORT TO CONGRESS, 2002-2003: Dr. Cohn

LETTER ON NATIONAL CHILD HEALTH LONGITUDINAL STUDY: Dr. Mays

Dr. Mays recalled the November presentation to NCVHS by study director Dr. Peter Scheidt. Based on his presentation and work by the Subcommittee on Populations in its hearings, they have drafted a letter to go to the director of the National Institute of Child Health and Human Development, which has responsibility for the National Children’s Study. She read the letter and invited comments, and the letter was approved as read.

SUBCOMMITTEE AND WORKGROUP UPDATES; FUTURE MEETINGS

The Committee heard brief updates on the Subcommittee on Populations, the Executive Subcommittee, and the NHII Workgroup, and discussed future meetings. Please see the minutes below for the summaries of these brief agenda items.

DETAILED SUMMARY

CALL TO ORDER, WELCOME, INTRODUCTIONS, REVIEW OF AGENDA

Dr. Lumpkin noted that this is a transition meeting, saying farewell to retiring members and welcoming new ones. The members whose terms have ended or who have recently resigned are Drs. John Danaher, Clem MacDonald, Ted Shortliffe, and Kepa Zubeldia. The new members are:

Dr. Justine Carr, a hematologist at Beth Israel Deaconess Medical Center
Harry Reynolds, Vice President of BlueCross/Blue Shield North Carolina
Dr. Eugene Steuerle, Senior Fellow at the Urban Institute
Dr. Kevin Vigilante, Brown University, a physician
Dr. Judith Warren, University of Kansas School of Nursing

Dr. Lumpkin also welcomed Dr. Aldonna Robbins, liaison from the NCHS Board of Scientific Counselors.

UPDATE FROM THE DEPARTMENT

HIPAA Data Standards: Ms. Trudel

Ms. Trudel reported that 65.35 percent of the electronic claims received by Medicare are in HIPAA-compliant format, a significant advance over three months ago. They have received a total of 46 complaints, of which 35 were valid and in CMS’s scope of authority. The large majority are from small providers filing against health plans. The process for addressing complaints is working well.

The National Provider Identifier was published on January 23 and applies across the health care industry. The regulation takes effect in May 2005, after which there is a two-year implementation process. The identifier will replace the use of legacy provider identifiers in transactions. The possession of an NPI, however, will not guarantee reimbursement to a provider, nor enroll providers in a health plan, nor make a provider a covered entity under HIPAA. The identifier consists of 10 positions, all numeric, none of which conveys any information about the provider. It is compatible with worldwide health insurance card issuer standards. Subparts of a legal entity are allowed to obtain an NPI if needed. To obtain an NPI, there is an application form that collects the minimum information necessary for unique identification and communication. There is no linkage between the NPI and the Social Security number.

The National Provider System is being developed under a contract with HHS to process the applications, assign NPIs and store information. A limited set of information will be available to the public. Information on the regulation is available at www.cms.hhs.gov/hipaa/hipaa2.

HIPAA Privacy Rule Compliance Update: Ms. McAndrew

As of the end of December 2003, OCR had received 3,745 complaints stemming from the privacy rule. Of these, 40 percent have been closed, mostly for jurisdictional reasons. The rate of complaints continues to be about 100 per week. Wherever possible (e.g., when covered entities are being overly conservative in their interpretation of the rule), OCR works with the complainant and the entity and provides technical assistance and clarification of the rule. Ms. McAndrew noted that there have been many stories in the press about people not being able to get information from covered entities about family members in the hospital, despite the fact that giving this information is “permitted but not required.” OCR also works to achieve voluntary compliance, which sometimes results in improved employee training by covered entities. No fiscal sanctions have been used to date.

Impermissible uses and disclosures of information and inadequate safeguards make up the bulk of the complaints. Access to information is the third most frequent complaint. Complaints are commonly lodged against places that frequently interact with the public.

OCR is also working aggressively on providing technical assistance, including developing the FAQs on its Web site and speaking at meetings. Ms. McAndrew said they are looking forward to the forthcoming hearing hosted by the NCVHS Subcommittee on Privacy and Confidentiality.

She stressed that the rule is designed to allow information to flow as freely as possible to achieve health care and facilitate payment flow. No regulatory changes are planned in the immediate future.

Data Council: Mr. Scanlon

The Secretary has renewed the Committee’s charter for two more years. The Department has done a solicitation for staff to support NCVHS and its Subcommittees. Staffing should be finalized by March. Mr. Scanlon welcomed the new members, noting that “graduating” members would be recognized later in the meeting.

The 2004 federal budget is expected to be signed by the President in the near future. Although it is not a “big growth budget,” there are positive elements for issues in the Committee’s domain. One example is a $3 million initiative for leadership on the NHII, such as promoting and accelerating the development and use of electronic health records and interoperable standards. The Department will host the second annual conference on the NHII in July 2004 in Washington, DC. The NCVHS NHII Workgroup is taking part in the planning. There is also new support for standards-related work, included in the AHRQ budget. The largest increase is $50 million to AHRQ for demonstration grants and research relating to health information technology in health care settings. The RFAs have already been released for these grants, with a set-aside for partnerships in rural areas.

The Department has established a Council on the Applications of Health Information Technology, to provide a focal point for realizing the potential of information technology and coordinating the work of HHS component parts in this area. Dr. Lumpkin is an invited participant and represents the thinking of NCVHS.

Following up on recommendations on geocoding in the report on the Vision for 21^st Century Health Statistics published by NCVHS, NCHS and CDC in 2001, the Data Council has awarded a contract to look at the geographic-level detail being collected and ways to standardize it. They will report to the full Committee and the Subcommittee on Populations. This is part of a government-wide standardization effort, the Geospatial Geocoding Initiative. The Data Council also is continuing its efforts to improve user-friendly access to de-identified, aggregated HHS data resources, through the HHS Gateway.

Regarding the 2005 budget, Mr. Scanlon said HHS expects support for the NHII to increase over 2004 levels. He noted that what began as a collaboration between NCVHS and the Data Council has become a “very broad and very high-level initiative.”

Discussion

In response to a question, Ms. McAndrew said OCR is helping put together a final enforcement rule.

Mr. Houston asked for information on breakdowns for the types of complaints and the percentage of entity types that have been the subject of complaints. He explained the Committee’s interest in comparing what it is hearing about problems with OCR’s experience with complaints. Dr. Lumpkin reinforced this request for detailed reporting on complaints.

Mr. Houston raised the issue of state laws that may be causing entities to take positions about information disclosure, or that at least may be causing confusion and frustration.

Dr. Harding mentioned the positive comments the Subcommittee has heard about OCR’s availability in response to complaints, and about the helpfulness of the FAQs. He asked about possible audits and compliance reviews, and Ms. McAndrew said that while OCR is empowered to do these, there are no plans to do so at present.

Asked whether OCR has looked at states’ exemption analyses and the impact of the privacy rule on state law, she said that they have had only one request for an exemption determination and no states have shared their state law preemption analyses nor been asked to.

Dr. Mays asked about the administration’s response to the Committee’s letter about targeted surveys for race and ethnicity data, and Mr. Scanlon said there is hope that the 2005 budget will include positive steps in that area. In response to her query about the status of the Disparities Report, Dr. Fitzmaurice said that AHRQ looks forward to pulling together and presenting the facts and drawing attention to the issues in this area on an annual basis.

NCHS BOARD OF SCIENTIFIC COUNSELORS (BSC)

Vickie Mays, NCVHS liaison

The BSC met in October 2003 and January 2004. It has diverse membership and shares particular interests with NCVHS, such as in having better data on measures of health. The liaison relationship between the two bodies will evolve; initially it consists of briefing each other at meetings, especially on areas of overlapping interest. Dr. Sondik hopes the BSC will get involved in intramural agenda setting.

Dr. Robbins, BSC

The purpose of the BSC is to advise the Secretary and the directors of CDC and NCHS on the scientific and technical program goals, objectives, strategies and priorities of NCHS. The disciplines represented on the Board include statistics, biostatistics, gerontology, epidemiology, public health, and economics. The Chair is June O’Neil, former director of the Congressional Budget Office. So far, it has been getting oriented about NCHS and its programs.

One of the topics the group has gravitated to initially is data dissemination, e.g., drawing public attention to the release of Health, U.S. and the data it contains. The Board expects to examine who uses the data, what data are used, how they are accessed, and for what purpose. Economics will be a prime area of interest, given current and anticipated budgetary pressures. Program performance and quality will be another focus.

Discussion

Ms. Greenberg noted the Committee’s interest in working collaboratively with the BSC, and referred to the discussions about holding a joint meeting in 2005.

Dr. Mays asked about how to represent the state vital statistics community at NCVHS meetings, now that Dr. Freidman is no longer a member. Dr. Lumpkin pointed out that he was the State Registrar of Illinois for 12 years.

Mr. Scanlon stressed the importance of close coordination between the work of the BSC and NCVHS.

CONSOLIDATED HEALTH INFORMATICS INITIATIVE AND RECOMMENDATIONS

Dr. Cohn, Ms. Trudel, Cynthia Wark

In introductory remarks, Dr. Cohn noted that the 14 recommendations coming forward at this meeting mark the end of phase one of the CHI process to identify and recommend clinical data standards.

Ms. Trudel, the CHI Program Manager, provided a broad overview of CHI, particularly for the benefit of new members. CHI is part of the President’s eGov portfolio, one of several initiatives overseen by OMB. HHS, VA and DoD are lead partners in CHI. The aim has been to get all federal health care on a single platform with respect to clinical vocabularies, as a precondition to doing consolidated applications. In other words, CHI is adopting existing clinical vocabulary and messaging standards to enable interoperability in the federal health care enterprise. The standards are to be built into individual IT architectures as agencies bring up new systems or do large system rewrites. As with HIPAA, the standards adopted don’t change how agencies do business.

CHI has used NCVHS both to get a reality check on the proposed standards and as a forum to communicate with industry about what the government proposes to do. She thanked the Committee for holding this special meeting to enable CHI to complete the 24 initial standards. Initially, teams of about 100 subject-matter experts identified the domains and candidate terminologies; this was followed by analysis, feedback and deliberation. Generally, they have recommended adopting existing standards, but when gaps were identified, these formed a list of action items that will be passed on to the SDOs as ways to improve the standards. In a few domains, there was no existing solution and CHI has identified next steps. The first five standards were adopted in March 2003.

Dr. Cohn commented that the process is the kind of synergy the Committee likes to have with HHS, and is an excellent example of private-public partnership. He also noted that NCVHS has done important work in laying the groundwork for administrative and clinical data standards throughout its history. Since HIPAA was enacted, it has had a major responsibility for HIPAA standards and for work on patient medical record information (PMRI) standards. The Committee has recommended that the government take the lead with implementing PMRI standards, and it is pleased that this is happening. Dr. Cohn then introduced Cynthia Wark, the Deputy Program Manager of CHI.

Ms. Wark began by praising the leadership of CDC liaison Steve Steindel, who led three of the teams. She then worked her way through the lengthy letter and attachments, describing each domain addressed, the alternatives considered, and the recommended terminology. She also described the kind of research required as alternatives were identified and considered, and the reasoning behind the recommendations. For each domain, Dr. Cohn indicated the NCVHS recommendation, which in each case concurs with CHI, sometimes with additional commentary or suggestions. The Subcommittee on Standards and Security will continue to track unfinished business identified in the recommendations.

NCVHS members were given an opportunity to comment and raise questions. (The final letter and CHI reports are posted on the NCVHS Web site. The details of this presentation and discussion can be found in the meeting transcript, also on the Web site.)

Regarding the recommendations in the nursing domain, Dr. Warren, a new member, expressed gratification that the hard work of the nursing community is finally coming to fruition and being recognized.

When the presentation turned to population health data, for which no recommendation is being made because no standard is ready for adoption, Dr. Cohn said that the Subcommittee expects that it and/or the full Committee will need to pursue this subject in the future. The question is how to make clinical data and terminologies work for population health. He added that the NCHS Board of Scientific Counselors and the National Library of Medicine may also need to be involved. Dr. Steindel said that the goal is for clinical data that flow through the population health dimension to be consistent with standards for clinical data. The topic stimulated considerable discussion among members and staff. Mr. Scanlon observed that strategy is involved as well as standards, given the complexity of the area. It was noted that with surveys, the OMB approval process is already designed to encourage standardization.

After making a few modifications, the Committee unanimously passed a motion approving the letter, as modified.

Dr. Cohn said that CHI will be looking for additional comments from the Committee on future directions and next steps. He added that terminologies for the personal health record have yet to be discussed. He congratulated Ms. Trudel, Ms. Wark, Dr. Steindel and the others responsible for the CHI accomplishments. Ms. Wark acknowledged the team leaders, NCVHS, and the Subcommittee on Standards and Security.

Dr. Lumpkin added congratulations to Dr. Cohn. Reflecting on the significance of this event, he recalled that the Committee had recognized the importance of CHI early on and offered to be the advisory committee to the CHI initiative. The Committee’s PMRI recommendations contributed to the process, as did the Department’s decision to influence industry through its own actions as a health care provider, rather than through federal mandates. The completion of the first phase of CHI “is nothing short of historic” and it, together with the work on the NHII, will be viewed as the tipping point in the transformation of health and health care through the use of information technology.

UPDATE: SUBCOMMITTEE ON PRIVACY AND CONFIDENTIALITY

Dr. Harding

On behalf of Mr. Rothstein, Dr. Harding reported on the Subcommittee’s recent and planned activities related to monitoring implementation of the privacy rule. The Subcommittee’s November 2003 hearings concerned public health and research; a February 2004 hearing will address law enforcement, school and minority issues, and banking. The Subcommittee will present a report in March summarizing the hearings and recommendations. Several areas of concern have emerged, but in general there appears to be less anxiety about the rule among covered entities than previously, and people are complimentary of OCR’s education efforts.

The issues raised include:

Misunderstandings or adverse effects in the public health area, e.g., around reporting of notifiable conditions. In general, the problem of erring on the side of caution has arisen frequently.
In research, there is concern about the divergence between the common rule and the privacy rule.
Concern about notice in non-traditional settings such as health fairs.
Concerns about business associate agreements

The group briefly discussed guidance documents, which sometimes alleviate or eliminate problems. Five guidances have been released, by several agencies.

Regarding the privacy of surveys on small racial and ethnic minority groups, Dr. Mays observed that Dr. Localio would be a useful resource.

Mr. Houston observed that the Committee should explore questions related to more stringent state laws and how to deal with information-sharing across states in relation to the privacy rule. Dr. Lumpkin said there is a large volume of state analysis comparing state laws to the federal privacy rule, and the Committee may wish to make a recommendation to the Department related to the general issue of state and federal law with respect to the flow of clinical data.

APPRECIATION OF RETIRING MEMBERS

Mr. Scanlon spoke on behalf of the Secretary in appreciation for the service of the four retiring members, Drs. Zubeldia, Shortliffe, Danaher, and McDonald. He then read and presented a letter and certificate of appreciation from the Secretary to Dr. Zubeldia (the one retiring member who remained); similar letters and certificates will be sent to the others.

Dr. Zubeldia spoke of the “honor and privilege” of serving on NCVHS and of his gratitude for “the opportunity to have an impact on something positive for the entire country.”

HIPAA 6^TH REPORT TO CONGRESS, 2002-2003: Dr. Cohn

Dr. Cohn explained that uncharacteristically, this report covers two years in order to provide perspective on the several rules that were implemented in 2003. He asked for comments on the document, which is still in development. He added that he hopes to include as much concrete information as possible on the status of implementation.

Mr. Houston pointed out that the report should include comments on recent testimony to the Committee on the privacy rule.

Dr. Fitzmaurice added that there should be a paragraph on the ASCA report, which was mandated by Congress.

Mr. Blair suggested including an explanation that the Committee’s work on what was initially called PMRI standards became part of what was subsequently called clinical data standards and adopted as CHI standards.

LETTER ON NATIONAL CHILD HEALTH LONGITUDINAL STUDY: Dr. Mays

UPDATE OF POPULATIONS SUBCOMMITTEE: Dr. Mays

The Subcommittee plans to submit its report on its first hearings on race and ethnicity in federal surveys at the March meeting. It is starting to look at the issue of mental health statistics. The Subcommittee is also taking up the challenge raised by Dr. Cohn at the November meeting, to move ahead on determining how best to capture race and ethnicity data. In addition, the group is working on developing a liaison with the Census Bureau and monitoring the Department’s response to its letter to health plans on capturing race and ethnicity data.

REPORT ON EXECUTIVE SUBCOMMITTEE RETREAT: Dr. Lumpkin

Letters of appreciation were sent at the end of 2003 to all NCVHS staff members, and letters were also sent to the heads of their operating units pointing out the Committee’s accomplishments and the agency benefits of being a part of this process.

Statistics compiled on NCVHS for a GSA report show that 71 percent of the Committee’s 77 recommendations (in 12 sets) have been at least partially implemented by the Department. Dr. Lumpkin observed that the Committee would not want to have 100 percent implementation, because that would mean it is not “pushing the edge enough.”

The Executive Subcommittee concluded that the Committee’s health information strategies and the Department’s strategic objectives are in better alignment than ever before. Dr. Lumpkin enumerated the HHS objectives and their links to NCVHS activities.

Other actions by the Subcommittee at its retreat:

Barbara Paul will be asked to brief the Committee on the CMS quality initiative.
Dr. Cohn was designated as the regular Data Council representative.
The work plan of the Quality Workgroup was discussed at some length.

NHII WORKGROUP UPDATE: Dr. Lumpkin

The Workgroup has concluded that it needs to develop a seven-to-ten year perspective on the NHII vision and to identify the gaps and priorities from that perspective, in order to help influence and complement the dynamic activity in this area. One focus will be the interactions between the three dimensions — population health, personal health, and provider health. The Workgroup will also explore adding three additional dimensions—purchaser/payers, health policy, and research—and will look at various models for the dimensions.

For these efforts, it hopes to partner with ASPE’s NHII Task Center, led by Dr. Yasnoff, and to work with that group to plan the summer conference on the NHII, to be convened by HHS. They will also look at fiscal and financial models and incentives related to NHII implementation, and at architecture issues.

Dr. Lumpkin noted that this represents a significant change in the Workgroup’s work plan. He also noted that Connecting for Health has entered its second phase.

UPCOMING MEETINGS

The group briefly reviewed the full agenda for the March meeting and made a few adjustments in breakout times. They also reviewed the plans for circulating the Quality Workgroup report in advance of the meeting.

Ms. Greenberg reported that she and Dr. Lumpkin will attend a meeting of the CDC Director’s Advisory Committee in early February. So far it has not been possible for Dr. Gerberding to fit a CDC briefing to NCVHS into her schedule, but an invitation has been issued for the June meeting.

Ms. Greenberg also noted that 2004 is the 55^th anniversary of NCVHS and she asked the group to consider marking it in some way at the June or September meeting, possibly with the participation of one or more former Chairs.

The Executive Subcommittee will hold a conference call or in-person meeting to plan the June meeting.

The dates of the September and November meetings will change from those initially announced, after new members have been polled as to availability. Ms. Greenberg said that henceforth, members will be provided with consolidated calendars of all NCVHS events. Dr. Zubeldia suggested that changes from earlier versions of the agenda be highlighted in bold face. Agendas are being posted at least a month before meetings, even if all speakers are not yet confirmed.

Dr. Lumpkin then adjourned the meeting.

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

/s/ John R. Lumpkin 5/17/2004

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Chair Date