Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

February 9-10, 2011

Meeting Minutes


The National Committee on Vital and Health Statistics was convened on February 9-10, 2011, at the St. Regis Hotel in Washington, D.C. The meeting was open to the public.

Present:

Committee members:

  • Justine M. Carr, M.D., Chair
  • Leslie Pickering Francis, J.D., Ph.D.
  • Larry A. Green, M.D.
  • Mark Hornbrook, Ph.D.
  • Garland Land, M.P.H.
  • Blackford Middleton, M.D.
  • Sallie Milam, J.D.
  • J. Marc Overhage, M.D., Ph.D.
  • 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
  • Charles Friedman, Ph.D., ONC liaison
  • Brenda Edwards, NIH liaison
  • Jorge Ferrer, M.D., VHA liaison
  • Edward Sondik, Ph.D., NCHS liaison
  • Karen Trudel, CMS liaison

Others

  • Raj Chanderraj, M.D., incoming member
  • Vickie Mays, Ph.D., incoming member
  • Debbie Jackson, NCHS
  • Katherine Jones, NCHS
  • Marietta Squire, NCHS
  • Susan Baird Kanaan
  • Emily Graham, Hart Health Strategies
  • Frank Kyle, American Dental Assn.
  • Matthew Albright, CMS
  • Gwendolyn Lohse, CAQH
  • Robin Thomashauer, CAQH
  • Dan Rode, AHIMA
  • Marla Friedman, Brookside Consulting
  • Michael Herd, NACHA
  • Priscilla Holland, NACHA
  • Catherine Hanson, AMA
  • Steven Lazarus, BIG
  • Angela Jeansonne, AOX
  • Michael DeCarlo, BCBSA
  • Janet Estep, NACHA
  • Carol Bickford, ANA
  • Lisa Aceto, JP Morgan
  • Bill Alvano, BCBSA
  • Allison Viola, AHIMA
  • Jeannette Thornton Barrett, AHIP

Note:  The transcript of this meeting and speakers’ slides are posted on the NCVHS Web site, http://ncvhs.roseliassociates.com. Use the meeting date to locate them. For final versions of NCVHS documents discussed in the meeting, see “Reports and Recommendations.”


EXECUTIVE SUMMARY

Action Items:

  1. A motion was passed, with one abstention and the rest in favor, to approve a letter on the quality measurement roadmap, as revised.
  2. A motion was passed unanimously to approve a letter on a standard for health care electronic funds transfers (EFT) and operating rules for EFT and health care payment and remittance advice, as revised, with final edits to be made by the Executive Subcommittee.

Update from the Department

  • HHS/ASPE: Jim Scanlon

  • CMS: Lorraine Doo

Mr. Scanlon reported on the HHS strategic plan and other planning documents; the budget situation for three years; and other HHS initiatives.

NCVHS members talked with Mr. Scanlon about the potential for HHS to assist local communities in their health efforts in the ways identified at the February 8 NCVHS workshop on the subject (see below).

Ms. Doo briefed the Committee on the interim final rules for the health plan identifier and for the operating rules for eligibility and claims status; the transition to 5010 and ICD-10; and CMS’s outreach to industry to help them meet all the current requirements.

ONC Update-Chuck Friedman, PhD, Chief Scientific Officer (slides)

Dr. Friedman talked with the Committee about a general ONC update; two recent workshops; and the PCAST report and workgroup. Ms. Greenberg asked about training and technical assistance for community health project staff, citing the findings from the previous day’s workshop on community health in which the local representatives stressed the need for technical assistance to health departments, and especially for short-term on-the-job training.

Privacy and Security Activities-Joy Pritts, JD, Chief Privacy Officer

Ms. Pritts reported on HIT Policy Committee’s (HITPC) provider authentication recommendations; a December 2010 hearing on patient information matching; the recommendations of the HITPC’s Privacy and Security Tiger Team; work related to the Affordable Care Act (ACA) and to PHRs; federal privacy initiatives; and the regulatory agenda.

PCAST Report Review

Dr. Carr led the Committee in a discussion of the PCAST report on HIT and its resonance with NCVHS goals. The group agreed to develop a letter on the subject, and discussed the contents. Mr. Quinn offered to be the point person on writing the letter, which the Executive Subcommittee will draft and the full Committee will review and approve by mid-April.

Standards Letter on Standard for Health Care Electronic Funds Transfers (EFT) and 0perating Rules for EFT and Health Care Payment and Remittance Advice

Drs. Warren and Suarez presented a draft letter developed by the Subcommittee on Standards. The Committee discussed the draft and suggested revisions; the Subcommittee used these suggestions to revise the letter during a break-out session; and the following day the revised letter was approved, with one abstention.

Quality Letter on a Quality Measurement Roadmap

Drs. Middleton and Tang presented the Quality Subcommittee’s draft letter on a quality measurement roadmap, which full Committee members discussed. The Subcommittee used these suggestions to revise the letter during a break-out session; and the following day the revised letter was approved.

Community Health Information Project Workshop

On February 8, the Subcommittees on Population Health and Privacy, Confidentiality and Security hosted a workshop on The Community as a Learning System for Health, featuring representatives of 11 exemplar communities around the U.S. A summary of the workshop, with descriptions of each of the communities, observations, and preliminary findings, is posted on the NCVHS website. Ms. Milam and Ms. Kanaan gave an overview of the workshop, and the group discussed the meeting’s significance and how NCVHS might follow up.

IOM Report on Learning Health System

Dr. Carr led the Committee in a brief discussion of NCVHS priorities for the next 18 to 24 months in the light of the NCVHS charter and vision documents, national priorities, legislative mandates, and emerging issues, such as the Learning Health System.

Subcommittee Reports

Each of the subcommittees reported on its break-out session and plans for the near future. See the brief summaries, below.

Bridging SNOMED CT and International Classifications-Betsy Humphreys, NLM

NLM roles include distributing HIPAA classifications and code sets and terminologies required for EHR certification within UMLS; serving as the HHS coordinating body for clinical terminologies; being a principal funder of LOINC; developing RxNorm; and paying for the US membership in IHTSDO, which enables US use of SNOMED CT. Ms. Humphreys described the activities and status in these areas, particularly regarding the ongoing mapping between SNOMED CT and various iterations of ICD.


DETAILED SUMMARY

-Day One –

Update from the Department

  • HHS/ASPE: Jim Scanlon

Mr. Scanlon reported on the HHS strategic plan and other planning documents, the budget situation for three years, and other initiatives. First, he reviewed the newest HHS Strategic Plan through 2015, which has five major goals, each with a set of objectives: transforming health care; advancing scientific knowledge and information and their translation into health care; advancing the health, safety, and wellbeing of the American people; increasing the efficiency, transparency, and accountability of HHS programs; and strengthening the nation’s health and human service infrastructure and workforce.

The Strategic Plan provides the framework for all HHS activities, which include more specific strategic plans and initiatives including Healthy People 2020 and several open government initiatives including data.gov. HHS has been a leader in the work on open government. Under the direction of Chief Technology Officer Todd Park, it has pushed a large volume of data onto data.gov in a way that protects privacy. Complementary projects include the CMS Dashboard and the Community Health Data Initiative.

The Department is working simultaneously on three budget years: waiting for approval of the FY2011 budget, getting ready for the President’s 2012 budget, and starting work on the 2013 budget. For the 2012 budget, which will freeze overall spending, HHS has tried to protect basic health statistics programs.

Dr. Carr noted that the Committee held an excellent workshop on community health data projects on February 8, featuring 11 exemplary communities. (See more on this topic below.) At that meeting, the community representatives talked about the variability in their infrastructures, their need for more data, and their challenges in analyzing data, and they discussed the merits of having a uniform set of community health indicators. Another request was for alerts when new resources are available, via a newsletter or clearinghouse. Mr. Scanlon agreed that at present, the data resources the Department is releasing are more usable by data “aficionados” and developers than by communities, and HHS needs to work on that. It is receptive to suggestions on other ways to present the data and useful tools, and it might consider providing a Help desk to assist communities.

  • CMS: Lorraine Doo

The interim final rules for the health plan identifier and for the operating rules for eligibility and claims status will go into the clearance process on February 11 and are targeted for publication in June and July. Both are on target. Three entities have applied to be authoring entities for operating rules for electronic funds transfer and electronic remittance advice; work on that is under way.

Medicare has started its 5010 testing, and testing of the errata program will begin in April. There is talk of doing an industry-wide testing day. From a CMS perspective, 5010 is well under way. The industry is “reeling” with the many new requirements. To help them get on track with ICD-10 code sets, CMS is launching an ICD-10 campaign through professional journals, listservs, and other forms of outreach. There will be survey work to identify problems and reasons for delays in order to target additional outreach efforts.

On the EHR incentive program, a new listserv with information for this program has just been launched. Partner associations will roll it out to their constituents. Of the Medicare-eligible providers, 18,000 have registered to participate (including 23 hospitals), another 2,000 are in process; and 777 Medicaid providers (including one hospital) are registered. Data on registrations will be generated and posted regularly.

Ms. Greenberg reported that the Public Health Data Standards Consortium’s Executive Committee agreed on a similar plan to work with public health agencies on the transition to ICD-10-CM and ICD-10-PCS.

Ms. Doo said she would supply the Committee with a graphic showing all the things that touch ICD-9-CM, along with information from the weekly discussions of findings from the 5010 implementation testing.

ONC Update-Chuck Friedman, PhD, Chief Scientific Officer (slides)

Dr. Friedman talked with the Committee about a general ONC update, two recent workshops, and the PCAST report and workgroup. In the first area, he reported the latest statistics on EHR adoption by primary care physicians, the expressed intent by providers to reach meaningful use; certified EHR products, enrollment in Regional Extension Center assistance programs, and enrollment in six-month community college and university health IT workforce programs.

He then answered questions and engaged in discussion with Committee members and staff. Ms. Greenberg said that at the previous day’s workshop on community health projects, the local representatives had stressed the need for technical assistance to health departments, and especially for short-term on-the-job training. She asked whether the extension centers and training programs were available to people in local health departments. Dr. Friedman said that 25 percent of the training slots are designated for people working in public health. Most courses are offered through distance-learning modes. Some educational materials will be available to the public via the Web starting in June.

The group discussed questions and indicators of “success” in the government’s HIT initiatives, something Dr. Friedman said ONC intends to address more fully than the current annual survey can do. It was noted that survey data typically trail the actual state of affairs.

He then described two workshops that took place in January-“Images, EHRs, and Meaningful Use,” cosponsored with the National Institute of Biomedical Imaging and Bioengineering; and “Next Generation Interoperability for Health.” Reports on both are forthcoming.

Privacy and Security Activities-Joy Pritts, JD, Chief Privacy Officer

Ms. Pritts reported on HIT Policy Committee’s (HITPC) provider authentication recommendations, a December 2010 hearing on patient information matching, the recommendations of the HITPC’s Privacy and Security Tiger Team, work related to the Affordable Care Act (ACA) and to PHRs, federal privacy initiatives, and the regulatory agenda.

At the organization level, the recommendations on authentication deal with digital certificates. ONC has been advised to establish a new accreditation program for reviewing and authorizing certificate issuers. The Tiger Team held a hearing in December on patient information matching; a video of the hearing is on the ONC website. The major finding concerned the need for “a lot of research and work” in this area, especially on metrics for establishing an acceptable level of matching data. The next step in provider authentication concerns human users. In other activities, ONC is acting on HITPC recommendations on data segmentation. It is doing a lot of work concerning the ACA, including on enrollment issues such as patient identity management and the privacy issues with accountable care organizations. ONC has a study under way on PHRs, following its December workshop on the issue; and it is working with other agencies and departments on privacy and security issues, notably the Department of Commerce.

Finally, ONC will conduct town hall meetings in six areas of the U.S. starting this summer, as part of its consumer outreach campaign on the uses of people’s health information and consumer rights. The meetings will gather information on what citizens what to know.

PCAST Report Review

Dr. Carr led the Committee in a discussion of the PCAST report on HIT and its resonance with NCVHS goals, with the idea of possibly developing a letter on the subject. She asked subcommittee co-chairs to comment. Dr. Overhage noted that many aspects of the report are well aligned with NCVHS thinking; and he identified a number of issues that it raises. For example, a recent NCVHS letter on tagging categories of information raises issues that are also relevant to the PCAST report; and the latter report does not address the need for data sharing agreements between organizations.

Dr. Middleton said the Subcommittee on Quality thought the report did not adequately address how data are generated in source systems, nor “the real world of where clinical data are.” He stressed that what is needed is an evolutionary process that starts from existing data. It is important, he said, for PCAST thinking to be aligned with other emerging efforts around data standardization and normalization, such as by HL7. These points became major themes of the ensuing NCVHS discussion.

Dr. Suarez noted that while the report paints a vision of the future, it fails to define the prerequisites for achieving the goals it outlines. It also puts forward a very aggressive time frame. He stressed the need for policy to take precedence over technology (another theme of the NCVHS discussion), adding that the report does not take into account the work over the last five years to develop interoperable standards. Dr. Green said he and Ms. Milam noted the parallels between the PCAST report and the IOM digital infrastructure report, including the considerable “ambition” of both reports. He wondered aloud whether, “while we are designing the new world to exchange everything,” there might be a way to “make it possible to exchange something.” Ms. Milam noted the merits of the PCAST report from a privacy perspective; and Dr. Francis reiterated the concern about whether policy or technology is driving the vision. Dr. Overhage suggested that NCVHS take the long view and the population health view.

Dr. Friedman asserted that the report offers “a liberating vision” that provides a flexible way to think about things. He described ONC’s PCAST workgroup, which will hold public hearings and issue a report to the HITPC in mid-April.

Dr. Fitzmaurice noted the need for a proof-of-concept study followed by a pilot study.

The discussion turned to an NCVHS letter to the Secretary with comments on the PCAST report. The group discussed the key points of the letter in the broad areas of potential benefits and challenges of the PCAST vision and the areas of alignment with the NCVHS vision. Mr. Quinn offered to be the point person on writing the letter, which the Executive Subcommittee will draft and the full Committee will review and approve by mid-April.

Standards Letter on Standard for Health Care Electronic Funds Transfers (EFT) and Operating Rules for EFT and Health Care Payment and Remittance Advice -Drs. Warren and Suarez

The co-chairs presented a draft letter developed by the Subcommittee on Standards. Dr. Warren described the extensive review process the letter has already undergone. It offers three overarching observations and makes several recommendations. Dr. Suarez then read the key parts of the letter, which Committee members discussed. Jan Estep of NACHA offered clarifying comments at one point. (The transcript on the website contains the full discussion; the final letter is posted on the NCVHS website.)

The Subcommittee on Standards will revise the draft letter during its afternoon session, based on the foregoing discussion and suggestions, and present the revised version for discussion/approval on day two of this meeting.

Quality Letter on a Quality Measurement Roadmap-Drs. Middleton and Tang

Work began on the letter on a quality measurement roadmap in the Fall of 2010. The Subcommittee on Quality wanted to address the future of quality measurement, given the dramatic changes resulting from HIT adoption and the acquisition of data from a growing range of sources. The Subcommittee wanted to examine the activities needed to support stakeholders in quality assessment. It had four stakeholder groups in mind: consumers; providers; professional organizations and accreditation organizations; and regulators, payers, and group purchasers. It held a hearing in October 2010 to hear testimony from these groups. Based on the testimony, it developed recommendations outlined in the letter. The letter’s four sections, with a recommendation in each area, cover the consumer’s perspective; the value perspective; accountability and care coordination; and a systems perspective on efficient acquisition and use of health care data for quality. The thrust of the draft letter is a recommendation to move toward quality measures with greater relevance and utility to consumers and patients, drawing on broader sources of information.

The group discussed the draft letter at length. (See the transcript for details and the final letter on the NCVHS website.) The Subcommittee on Quality will revise the draft letter during its afternoon session, based on the foregoing discussion and suggestions, and present the revised version for discussion/approval on day two of this meeting.

Community Health Information Project Workshop

On February 8, the Subcommittees on Population Health and Privacy, Confidentiality and Security hosted a workshop on The Community as a Learning System for Health, featuring representatives of 11 exemplar communities from around the U.S. A summary of the workshop, with descriptions of each of the communities and the Committee’s preliminary findings, is posted on the NCVHS website. Ms. Milam said the workshop was very well received by its participants. Common themes included the need for a supportive infrastructure.

At her request, Ms. Kanaan reviewed the highlights of the meeting. These communities are forming broad-based coalitions and leveraging multiple data sources to address local health concerns. Some are conducting their own local research, with community participation. Generally, they define health broadly and include the determinants of health in their focus; thus they also need data on the environment and economic and other factors as well as small-area health data. The community presenters stressed their need for more complete and more granular local data, and for stronger analytic capacities. Local public health departments need training and technical assistance to make full use of health information technology.

Dr. Francis said that the Subcommittee on Privacy, Confidentiality and Security will take the lead in planning a follow-up workshop in May to look at best practices in protecting privacy in the context of local data use. She and Dr. Overhage noted the inherent tension between more actionable, localized data and the risks of identifiability. Dr. Francis said the Committee learned at the February 8 workshop that some communities are building trust by involving community members in designing research questions and deciding how to use the findings. Ms. Greenberg noted the importance of careful decisions about where resources are most needed, including identifying good models and promoting replication around the U.S.  In that vein, Mr. Quinn said that AHRQ is publishing a report and literature review, “Community Collaboration: Lessons Learned for Health Information Exchange,” which he offered to make available to NCVHS.

Dr. Steinwachs said the health orientation of the exemplar communities was especially striking to him, in contrast with the usual talk about “diseases and disorders.” He and others stressed the important role the federal government could play in making data available and providing other forms of support to community efforts such as the ones showcased in the workshop.

Noting that communities “see health as a fundamental capacity,” Dr. Green stressed that the workshop exposed the missing translational infrastructure that is needed to connect communities and necessary knowledge. He also noted the potential they represent for healing the schism between public health and personal health systems. He suggested that NCVHS focus on this area and find ways to contribute. Dr. Carr noted that this would be consistent with the recommendations of the former NCVHS chairs, cited at the end of the 60th anniversary report.

Finally, the group discussed how NCVHS would contribute to the June 9 community Health Data Initiative forum hosted by HHS and IOM. They also discussed the need to revisit the question of how the Committee’s effectiveness is evaluated, and the need to appoint a new liaison to the NCHS Board of Scientific Counselors-a task delegated to the Subcommittee on Population Health. Members then dispersed into Subcommittee sessions.

-Day Two –

Action Items:

  • Quality letter

  • Standards Letter

The co-chairs of the relevant subcommittees presented the revised versions of their Subcommittees’ letters that had been reviewed and revised the previous day. In each case, they explained the thinking behind the revisions, and there was further discussion.

A motion was passed, with one abstention and the rest in favor, to approve the letter on the quality measurement roadmap, as revised.

A motion was passed unanimously to approve the letter on a standard for health care Electronic Funds Transfers (EFT) and Operating Rules for EFT and Health Care Payment and Remittance Advice, with the final edits to be made by the Executive Subcommittee.

IOM Report on Learning Health System

Dr. Carr led the Committee in a brief discussion of NCVHS priorities for the next 18 to 24 months in the light of the NCVHS charter and vision documents, national priorities, legislative mandates, and emerging issues, such as the Learning Health System. Using slides, she proposed a construct for clarifying NCVHS activities and priorities in relation to HHS strategic initiatives and emerging data sources. She urged that every Subcommittee come out of this meeting with a work plan for the next 18-24 months.

Subcommittee Reports

  • Subcommittee on Quality-Dr. Middleton

In addition to working on its letter, the Subcommittee discussed the PCAST report. NCVHS members need to inform themselves and perhaps develop recommendations on where the work with USHIK fits in the country’s standardization process. Dr. Middleton proposed joint NCVHS hearings to look at standardization issues related to metadata. Given the privacy issues, as well, others suggested that the full Committee host such a hearing.

Mr. Quinn noted that many of the PCAST recommendations have to do with metadata, and he predicted that the NCVHS response to PCAST will be influenced by the quality letter just approved.

Dr. Carr asked how the Committee can add value and not duplicate others’ efforts; Dr. Warren responded that NCVHS will look 5-10 years into the future and include the Semantic Web in its view. Dr. Suarez noted the need to understand how other groups define their roles before it can clarify its own role. Dr. Overhage suggested that NCVHS look at how to manage the overall momentum to keep the whole country moving. Several spoke to the importance of keeping the NCVHS focus on the long term. Dr. Middleton suggested that the Subcommittee on Quality also look at issues around identity management.

  • Subcommittee on Population Health-Ms. Milam

The Subcommittee is interested in pursuing the community health information project, to help promote effective policies and interventions. The next steps are the privacy-focused hearing in May, participation in the June 9 community data forum, and a report or series of reports on these topics, possibly including a primer of best practices. The two Subcommittees involved in this project will decide what should be communicated with the Secretary.

Regarding privacy issues, Dr. Vickie Mays (who is returning to NCVHS as a member) suggested that trust may not be the best frame for the privacy concerns of local communities; instead, she proposed framing the topic as ensuring the right use of data.

  • Subcommittee on Privacy, Confidentiality and Security-Dr. Francis

Beyond the May workshop, the Subcommittee is considering developing a primer on best practices as a longer-term goal. Ms. Milam added that the Subcommittee wants to “demystify privacy” so data can flow more fully and efficiently.

On a new subject, Dr. Middleton suggested that the Committee consider looking at knowledge management and representation in relation to decision support.

  • Subcommittee on Standards -Dr. Suarez

The Subcommittee is working in two areas: its responsibilities assigned by the ACA, and other standards activities. In the latter area, a particular interest is standards for the next generation of elements such as metadata, public health data exchanges (including distributed queries), and personal health records. These are not in the purview of other advisory groups.

Dr. Friedman agreed that standards for public and population health are very important, especially given that meaningful use is not sufficient for a learning health system. Dr. Warren added that standards from the research community warrant a look with respect to data sharing between clinicians and researchers. Asked what else in his view aligns with NCVHS, Dr. Friedman pointed to policy and governance. He said the ONC governance committee is not likely to address the elements needed to support a learning health system. Dr. Warren added the implications of the ultra-large-scale engineering approach as another topic of interest. Dr. Friedman suggested that NCVHS look at a forthcoming report on next-generation interoperability, which will address that, and then discuss all of these topics.

Dr. Carr reviewed the Committee’s near-term work plan and told Dr. Friedman that after June, 2011, when its new members will join, NCVHS would be open to suggestions for new work in the learning health system domain. Dr. Suarez asked Dr. Friedman for a set of priority areas coming out of the learning health system project.

The group discussed plans for orienting new members prior to the June full Committee meeting. One co-chair from each Subcommittee is encouraged to attend the orientation. Ms. Greenberg suggested that the full Committee hold a retreat sometime in the next year. The group then briefly discussed plans for the June full Committee meeting and new liaisons. Ms. Jackson said bio sketches on all members, new and current, will be distributed.

Bridging SNOMED CT and International Classifications-Betsy Humphreys, NLM (slides)

As background, Ms. Greenberg noted that the implementation of more granular terminologies in EHRs raises questions about the transition to ICD-10 code sets and how the two will work together, and how terminologies and classifications will be mapped. This is being done collaboratively by the World Health Organization (WHO) and the International Health Terminology Standards Development Organization (IHTSDO). The U.S. is focusing primarily on the ICD10-to-SNOMED CT map.

Ms. Humphreys said NLM roles include distributing HIPAA classifications and code sets and terminologies required for EHR certification within UMLS; serving as the HHS coordinating body for clinical terminologies; being a principal funder of LOINC; developing RxNorm; and paying for the US membership in IHTSDO, which enables US use of SNOMED CT. (See her slides and the transcript for the details of this technical presentation and the discussion with NCVHS members.) There are three different efforts in bridging between SNOMED CT and ICD, related to the three different versions: ICD-9 CM, ICD-10, and ICD-10-CM. She described the crosswalks in each case. The first of the three is “relatively complete.” In general, she said, people are asking for one-for-one mapping.

Dr. Suarez postulated that people are increasingly realizing that there will never be a simple one-to-one crosswalk between the concepts for any of the coding systems and classifications. Instead, people are looking for the intelligence to discriminate between the maps and matches in particular circumstances.

 

Continuing, Ms. Humphreys said IHTSDO is doing most of the work to map ICD-10 to SNOMED CT. Others are invited to participate in completing the map, which is targeted for completion by summer 2011.

The NLM analyzes terminologies to detect synonymy between “the new thing” and existing UMLS Metathesaurus contents. Ms. Humphreys cited the findings for the classifications in question, and said other relationships besides synonymy are also represented in the Metathesaurus. Dr. Warren noted that she and Dr. Middleton are advising NCVHS to work on knowledge representation because of the complexity and questions raised in this area. Concluding on the mapping theme, Ms. Humphreys said NLM wants to finish the mapping to ICD-10-CM and has a plan for doing so, and people from Kaiser Permanente and others are helping; but they will not be able to finish the work until they get funding. Very little has been mapped to date.

She also briefed the group on NLM’s recent work on access to UMLS; a forthcoming US extension to SNOMED; the development of international collaborative editing via a workbench; a CORE problem list; a nursing problem list; the status of RxNorm’s National Drug Code; a new Beta version of the RxNav-RxNorm browser; and newborn screening work, which is “coming along nicely.” She noted that SNOMED CT is increasingly being used in problem lists.

Dr. Fitzmaurice asked about the likelihood that WHO and IHTSDO will cooperate and link together, to reduce the need for continuous mapping. Ms. Humphreys affirmed that this is the desirable direction for things to move. Ms. Greenberg said that this is part of a collaborative agreement between the two organizations; however, accomplishing it requires a research budget.

She predicted that we will be in a transitional phase, with a need for mapping, for at least another decade. She pointed out, and Ms. Humphreys agreed, that this transitional period provides an opportunity for testing and making improvements.

Dr. Carr then adjourned the meeting.


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

/s/                                                                   June 15, 2011

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Chair                                                                           Date