Department of Health and Human Services

 NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

 May 21-22, 2008

Renaissance Washington Hotel

Washington, D.C.

 

Meeting Minutes

 

The National Committee on Vital and Health Statistics was convened on May 21-22, 2008, at the Renaissance Washington Hotel in Washington, D.C. The meeting was open to the public. Present:

 

Committee members

Simon P. Cohn, M.D., M.P.H., Chair (retiring)

Harry Reynolds (incoming Chair)

Jeffrey Blair, M.B.A.

Justine M.Carr, M.D.

Leslie Pickering Francis, J.D., Ph.D.

Larry A. Green, M.D.

John P. Houston, J.D.

Carol J. McCall, F.S.A., M.A.A.A.

Blackford Middleton, M.D.

Sallie Milam, J.D. (new member)

J. Marc Overhage, M.D., Ph.D.

Mark A. Rothstein, J.D. (retiring)

Donald M. Steinwachs, Ph.D.

C. Eugene Steuerle, Ph.D. (retiring)

Paul Tang, M.D.

Judith Warren, Ph.D., R.N.

Absent:

William J. Scanlon, Ph.D.

Kevin C. Vigilante, M.D., M.P.H. (retiring)

New members (June 1, 2008)

Blackford Middleton, M.D.

Sallie Milam, J.D.

Walter Suarez, M.D.

Lead Staff and liaisons

Marjorie Greenberg, NCHS/CDC, Executive Secretary

James Scanlon, ASPE, Executive Staff Director

Debbie Jackson, NCHS

Jorge Ferrer, M.D., VA liaison

J. Michael Fitzmaurice, Ph.D., AHRQ liaison

Steve Steindel, Ph.D., CDC liaison

 

 

Others

Katherine Jones, NCHS

Allison Viola, AHIMA

Michael DeCarlo, BlueCross BlueShield Assn.

Frank Kyle, American Dental Assn.

Sandra Fuller, AHIMA

Nancy Ferris, Government Health IT

Angela Franklin, ACEP

Douglas Boenning, ASPE

Marybeth Farquhar, AHRQ

Adam Birnbaum, BlueCross BlueShield Assn.

Kathryn Serkes, Assn. of Amer. Physicians & Surgeons

Dan Rode, AHIMA

Henry Heffernan, NIH

Jonah Houts, Express Scripts

Winston Wilkinson, HHS/OCR

Odies Williams, HHS/OCR

Jeffrey Cooper, CooperSoft

Susan Kanaan

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 approved at the meeting, see “Reports and Recommendations.”

EXECUTIVE SUMMARY

 

ACTIONS

  1. The Committee passed a motion approving a letter on e-prescribing standards for long-term care.
  2. The Committee approved the production of a compilation, background and brief summary of the 2006-2008 NCVHS letters on privacy and confidentiality, in a format similar to the one used for the report on enhanced protections for the uses of health information.
  3. Members passed a motion that after all members had a chance to offer modifications, a status report on the 2004 candidate recommendations of the Quality Workgroup (“23 Building Blocks for Quality: The View from 2008”) would be revised and brought to the Executive Subcommittee for final review.

 

This was the final meeting for retiring members Cohn, Rothstein, Steuerle and Vigilante. Members Carr, Reynolds and Warren have been reappointed, and Mr. Reynolds has been appointed the new Chair, starting in June. The following new members are joining NCVHS:

 

  • Mark Hornbrook, Ph.D., Senior Investigator and Senior Healthcare Economist of the Center for Health Research, Kaiser Permanente Northwest Region  (Portland, OR);
  • Sallie Milam, J.D., Executive Director, West Virginia Health Information Network (Charleston, WV);
  • Blackford Middleton, M.D.,  Corporate Director, Clinical Informatics
    Research and Development, and Chairman, Center for Information Technology for Partners Healthcare (Wellesley, MA); and
  • Walter Suarez, M.D., President & CEO, Institute for HIPAA/HIT Education and Research (Alexandria, VA).

CMS Update—Stewart Streimer, CMS

 

Mr. Streimer, who coordinates NPI implementation for CMS, reported that the agency is ready internally for full implementation. Compliance rates are showing progress in anticipation of the May 23 deadline. He expressed cautious optimism about NPI implementation. CMS has established NPI coordination teams to help contractor sites address problems. Mr. Reynolds and other NCVHS members praised CMS for its effective handling of the NPI transition and for standing by the May 23 deadline.

 

Department Update: Data Council—Mr. Scanlon

 

Mr. Scanlon presented Mr. Rothstein, Dr. Cohn, and Dr. Steuerle with certificates and letters of appreciation from the Secretary. (Dr. Vigilante was absent.) He then briefly reported on the nine HHS policy priority areas, recognition for the Department’s progress in strategic planning, a cooperative agreement to create the AHIC successor organization, the 2009 and 2010 budgets, and the Medicare EHR Ambulatory Care Demonstration Project. He said ASPE would soon brief the Committee on the EHR and PHR demos, and it welcomes suggestions.

ONC Update: Strategic Plan, AHIC Successor, and NHIN—Dr. Kolodner

 

ONC will release its Strategic Plan within a few weeks. It has two goals, patient-focused health care and population health, each with a structure with objectives around the themes of privacy/security, interoperability, adoption, and collaborative governance and decision-making. Dr. Kolodner described plans for the AHIC successor (informally called “A-2”). A grant has been let to LMI and Brookings for management. Planning groups in four areas will present recommendations for the next phase at a June 4 meeting. There are 10 initial contractors and 6 new NHIEs in the NHIN Cooperative. ONC will test specific data and terms and the envelope holding the data to be sure that communication is working. Finally, he outlined the timetable for the trial implementations. The goal is to have several entities ready to exchange information on day-to-day operations in 2009.

 

NCVHS members offered comments on the structure and governance for Network privacy and security, the lags in privacy protections for the NHIN, the prospects for interoperability, the need for attention to incentives, the importance of engaging politicians and business leaders to further IT adoption, and shared hopes for continued collaboration among NCVHS, ONC, and A-2.

Letter on e-Prescribing Standards in Long-term Care—Mr. Reynolds

 

After Mr. Reynolds read aloud a letter on e-prescribing standards and long-term care,

the Committee passed a motion approving the letter, as written.

 

Update: Clinical Terminology and Classifications—Betsy Humphreys, NLM

 

The National Library of Medicine (NLM) is the central coordinating body for clinical terminology standards, appointed as such by the HHS Secretary. Ms. Humphreys reviewed NLM’s major roles in that arena, which consist of supporting, licensing, developing, coordinating and distributing standard clinical vocabularies through various formats, including the Unified Medical Language System Metathesaurus.  She discussed recent NLM priorities related to health IT standards.  First on the list has been helping the recently established International Health Terminology Standards Development Organisation (IHTSDO), which now owns the SNOMED-CT, with a variety of start-up activities, including establishing a framework for collaboration and clear division of labor between SNOMED and LOINC. Ms. Humphreys summarized the IHTSDO priorities related to international classifications, which are mapping from SNOMED CT to ICD-10, mapping SNOMED-CT to ICF, and collaboration on the development of ICD-11 – in that order. On the U.S. front, NLM has been working to advance several mapping projects, which include SNOMED CT to CPT, LOINC to CPT and SNOMED CT to ICD-9-CM. Ms. Humphreys also commented on several other priorities being pursued by NLM, including expansion of standards to accommodate genetic testing and newborn screening.

 

NCVHS members had questions and comments on the stability of funding for these activities, the practical uses and benefits of SNOMED, the past and future role of AHIC, the need to speed up the mapping work without sacrificing rigor, the impact of PHRs on these activities, and the prospects for terminology to capture people’s reasons for seeking health care.

Committee Structure and Work Alignment Considerations—Mr. Reynolds

 

As preparation for breakout sessions, Mr. Reynolds reviewed the NCVHS mission, outlined a subcommittee structure modified by the Executive Subcommittee, and discussed several process considerations relevant to future operations. He and fellow NCVHS members discussed a variety of operating principles that they felt should guide the Committee’s future activities.

Privacy Monograph—Mr. Rothstein

 

For the Subcommittee on Privacy and Security, Mr. Rothstein requested approval for publishing a compilation, background and brief summary of the 2006-2008 letters on privacy and confidentiality, in a format similar to the one used for the report on enhanced protections for the uses of health information. The Committee passed a motion approving the production of the proposed monograph. Dr. Francis offered to be the Subcommittee’s contact person for the project.

 

Subcommittee Work Alignment; Workplans; Other Committee Business

 

(Please see the brief summaries, below.)

 

DETAILED SUMMARY

—Day One—

Introductory Remarks—Dr. Cohn

 

This meeting marked a transition in membership, with four members, including the Chair, retiring (Dr. Cohn, Mr. Rothstein, Dr. Steuerle, and Dr. Vigilante) and four new members joining NCVHS. After introductions around the room, Dr. Cohn commented on the Committee’s recent achievements and the challenges and changes that lie ahead, both internally and for the country. He celebrated the contributions of his three fellow “departing members,” and welcomed these new members (see details in Executive Summary): Mark Hornbrook, Ph.D.; Sallie Milam, J.D.; Blackford Middleton, M.D.; and Walter Suarez, M.D.  Dr. Cohn announced that Drs. Carr and Warren and Mr. Reynolds have been appointed for a second term and Mr. Reynolds has been named the new NCVHS Chair. He also thanked the members of the Executive Subcommittee and the Committee’s staff and liaisons.

CMS Update—Stewart Streimer, CMS (by phone)

 

Mr. Streimer, who coordinates NPI implementation for CMS, reported that the agency is ready internally for full NPI implementation, including Medicare fee-for-service. CMS is closely monitoring compliance rates, which are showing considerable progress, and it is “aggressively” reaching out to the health care industry, especially Medicare contractors, to ensure that they understand expectations for the May 23 deadline. Remittance licenses were issued with NPI only, starting on April 7, and there has been full compliance and no reported concerns. Mr. Streimer described NPI-related activities and results in further detail, including CMS’s use of an NPI Crosswalk for Medicare fee-for-service. He reported that 8 million claims with only NPI came into the Medicare program in the second week in May. He expressed cautious optimism about NPI implementation. CMS has established NPI coordination teams to help contractor sites address problems. It is also involved with other payors across the U.S. that handle supplemental insurance.

 

In the discussion period, Mr. Reynolds praised CMS for its effective handling of the NPI transition and for standing by the May 23 deadline. Dr. Suarez, who chaired WEDI’s National implementation Workgroup, added his praise and commented on complexities in the transition to the NPI, predicting where problems may arise. Members asked questions about the status of State Medicaid agencies, the secondary identifier, low NPI-only compliance, customized enumeration, consequences of reimbursement problems for patients, and other matters.

Department Update: Data Council—Mr. Scanlon

 

Mr. Scanlon added his welcome to new members and his thanks to those who are retiring. After reflecting on the Committee’s stature and contributions, he presented Mr. Rothstein, Dr. Cohn, and Dr. Steuerle with certificates and letters of appreciation from the Secretary. (Dr. Vigilante was absent.)

He then briefly reviewed the nine HHS policy priority areas, noting that most rely on health IT. Much attention is being given to food and drug safety. HHS been recognized for its progress in strategic planning. Mr. Scanlon also described the prospects for legislation related to health IT, in which there is considerable interest on the Hill.

 

HHS has awarded a cooperative agreement to create an AHIC successor organization, which Mr. Scanlon discussed. It is to be a public-private partnership, a membership organization, and no longer a FACA Committee. After brief comments on the 2009 and 2010 budgets, he concluded by describing the 5-year Medicare EHR Ambulatory Care Demonstration Project, which is moving along. The Office of Planning and Evaluation has received 33 applications from would-be community partners. Demonstrations of EHRs and PHRs are also under way, with an evaluation component. ASPE is also analyzing health IT workforce needs.

 

In the discussion period, Mr. Scanlon said ASPE would brief the Committee on the EHR and PHR demos, and it welcomes suggestions. Dr. Middleton pointed out the distinction between structural adoption and effective use, and the importance of evaluating the latter. Dr. Carr, referring to the recent NCVHS hearing on the medical home, noted the need to extract data on population health from EHRs via the creation of registries, as identified in the hearing. Dr. Middleton said the National Quality Forum will put forward two possible measures on registries. Members had further comments and questions about the EHR and PHR demonstrations, and Dr. Cohn suggested a session on this topic in September, including the related privacy and confidentiality issues.

ONC Update: Strategic Plan, AHIC Successor, and NHIN—Dr. Kolodner

 

ONC works in five areas: governance, policies, interoperability standards and products, adoption, and networking. It will release its Strategic Plan within a few weeks. It has two goals, patient-focused health care and population health, each with a structure with objectives around the themes of privacy/security, interoperability, adoption, and collaborative governance and decision-making. Dr. Kolodner described the structure of the Plan, which outlines how the Federal government expects to play its role in a public-private endeavor.

 

He then described plans for the AHIC successor (now called “A2”), depicting the next stage as a push toward national momentum that has been envisioned since the early 1990s and that started to gain momentum in 2004, with strong support from Secretary Leavitt. The idea now is to move AHIC’s function outside the fluctuations inherent in government, although government (which pays for 40 percent of health care) will remain a major player. Among other things, government will be a major advocate for population health activities. A grant has been let to LMI and Brookings for management. Planning groups in four areas have been active, and they plan to present recommendations for the next phase at a June 4 meeting.

 

After acknowledging the multiple contributions of NCVHS to the work on the NHIN, Dr. Kolodner showed lists of 10 initial contractors and 6 new NHIEs in the NHIN Cooperative for activities planned for the Fall. Four “core functions” of the Network for which a “dial tone” is needed have been identified: patient look-up and information retrieval, information routing and delivery, the exchange of consumer preferences, and support for population data uses. ONC will test specific data and terms and the envelope holding the data to be sure that communication is working. He showed and commented on a schematic of the NHIN, as envisioned, and stressed that the solutions deployed must support information exchange among a diverse community of entities.  He also noted the need for standards, specifications and agreements for secure connections to enable use of Internet for communication, and the fact that government cannot make this happen though it can create the opportunity.

 

Finally, he outlined the timetable for the trial implementations, which will end in December 2008 with demonstration of core and use cases and a production-level data use agreement. The goal is to have several entities ready to exchange information on day-to-day operations in 2009.

 

Discussion

 

Mr. Houston asked about the structure and governance for Network privacy and security, and commented on the issue of scalability. Mr. Rothstein urged that the AHIC successor not be entrusted with much responsibility for privacy, given the continuing urgent need for central organizing principles to govern the NHIN and the fact that it will take AHIC-2 some time to get organized. He expressed the Committee’s concern that privacy is falling further and further behind technical developments. Dr. Kolodner stressed that ONC would not “let the technology make the decisions.” Dr. Francis expressed hope that the Committee’s privacy expertise will have an impact on decision-making, moving forward.

 

Dr. Green called attention to the barriers to interoperability that result from the drive to make a profit, and he asked how that tension is being considered and might be managed. Dr. Kolodner agreed that this tension is a recurring theme and that generally there is no business case for the public good. Government is struggling with these issues.

 

Dr. Steuerle, an economist, urged attention to incentives and disincentives. He asked Mr. Scanlon and Dr. Kolodner to what extent changing incentives is part of the discussion in their arenas. Dr. Kolodner described several such activities, including one to try and get malpractice insurers to offer reduced premiums for practices using EHRs. The Medicare demo is another example. Dr. Steuerle pointed out the varied consumer attitudes about the tradeoffs between privacy protection and the health benefits of access to their information. Dr. Kolodner commented on this tension, stressing the importance of creating a climate to encourage growth in trust and participation.

 

Mr. Reynolds pointed out the different dimensions in which NCVHS works—near term; keeping an eye on things; and visioning, which is often cross-cutting. He said the Committee hopes to continue to work with ONC and AHIC-2 in all three, and Dr. Kolodner agreed.

 

Dr. Middleton expressed concern about the need for a business case for a technology infrastructure and exchange, which calls for engaging the interest of more MBAs, CEOs and politicians. Besides both “carrot and stick” incentives, this involves figuring out how to monetize information assets so information exchange can be properly rewarded.

 

Ms. Milam commented on West Virginia’s experience as an NHIN-2 participant, particularly regarding the complexities of privacy, and suggested getting into granular-level discussions on this topic.

 

Letter on e-Prescribing Standards in Long-term Care—Mr. Reynolds

 

Before beginning his presentation, Mr. Reynolds, who will succeed Dr. Cohn as NCVHS Chair, praised him as “a leader, a mentor, a sounding board, a collaborator, a debater, a subject matter expert, and more importantly, a friend.” On behalf of NCVHS members, he thanked Dr. Cohn for his leadership. In particular, he noted Dr. Cohn’s contributions to the unusually rapid progress being made on e-prescribing standards. (The Committee and staff also honored outgoing members at a dinner that evening.)

 

Mr. Reynolds then gave background comments on the letter before the Committee, and read the letter aloud. It recommends that the current exemption from the requirement to use NCPDP SCRIPT standard for non-prescribing providers in long-term care be lifted.  The letter also recommends that once NCPDP SCRIPT 10.5 is balloted and approved, it be considered for voluntary adoption under the streamlined process for backward compatible standards.

 

The Committee passed a motion approving the letter, as written.

 

Update: Clinical Terminology and Classifications—Betsy Humphreys, NLM

 

Dr. Cohn hailed the “phenomenal” progress on health care terminologies under Ms. Humphreys’ leadership. In turn, she acknowledged the “tremendous difference” he has made, thanks to his tenacity regarding knotty issues.

 

The National Library of Medicine is the central coordinating body for clinical terminology standards, appointed as such by the HHS Secretary. Ms. Humphreys reviewed its five major roles in that arena, the paramount one of which, she said, is supporting, licensing, developing, coordinating and distributing standard clinical vocabularies through various formats. The others are distributing FDA-approved structured product labels via “Daily Med”; directing efforts to map clinical terminologies to HIPAA administrative code sets; directing the contract to align HL7 with standard vocabularies and support other HL7 work to promote interoperability; and working with NIH to promote the use of standards in clinical research.

 

She then discussed four recent NLM priorities, starting with assisting the International Health Terminology Standards Development Organisation (IHTSDO) with start-up. (Dr. Warren and Dr. Steindel are members of elected IHTSDO committees.)  There is a lot of international participation in the several open working groups. New openings for members will be announced soon. There are four committees.

 

NLM has been focusing on establishing a framework for collaboration and clear division of labor between LOINC and SNOMED. That process is going well. There also has been productive work to set up harmonization activity between the IHTSDO and WHO, with contributions from Ms. Greenberg.

 

IHTSDO priorities on classifications include mapping from SNOMED CT to ICD-10 and to ICF, and development of ICD-11 (with integration of the clinical terminology as WHO proposes). These activities will be accomplished in the order listed, because parallel work is not regarded as feasible.

 

In response to a question, Ms. Humphreys agreed that there are many issues and problems with mapping. She expressed her belief that getting a robust mapping from the current version of SNOMED to ICD-10, is a prerequisite to figuring out how to do aggregation from terminologies to classifications. Many agree on the need for pilot testing of the proposed methodology for ICD-11.

 

NLM also has been trying to advance the U.S. mapping projects, which include SNOMED CT to CPT and LOINC to CPT. A draft of the first is currently scheduled to be available for testing in Summer 2008; on the second, the 2nd edition of the high frequency usage map should be available for use and testing in Summer 2008, and a radiology map, in September 2008. The AMA is involved in all of these reviews, and the schedule depends on AMA staff completing some review tasks. Ms. Humphreys predicted that “we may come up with a reasonable way to keep this thing up to date and going.” She added that NLM’s aim is to make CMS comfortable with helping to test and evaluate the maps and their impact on billing data, etc. Another mapping project is SNOMED CT to ICD-9-CM. Because of a lack of concurrence to date, a decision has been made to focus on a heavily used subset, which AHIMA is now reviewing for NCHS. A draft may be available for testing by October 2008.

 

Ms. Humphreys commented on other priorities being pushed by NLM, including expanding coverage of genetic testing and newborn screening tests in health data standards and ensuring that actual test results are reported in addition to text strings providing the clinical interpretation of the results. The AHIC personalized health care workgroup has helped to move these two priorities forward.

 

Discussion

 

Dr. Cohn asked how vulnerable these activities are to this year’s transitions in government, and Ms. Humphreys described the efforts to stabilize and protect their support. However, she noted that NLM lacks the level of funding needed to ensure development on the scale desired. Asked if NCVHS could do anything to increase support, she stressed the goal of adoption the feedback on needed changes to standards that implementation in real systems will generate, and the additional level of support that will be required to ensure that needed improvements to standards are made in a timely manner.  Ms. Greenberg referred to Dr. Chute’s presentation to the Committee on ICD-11 in February 2008, which is summarized in the minutes. Other members commented on the practical uses and benefits of SNOMED, the past and future role of AHIC, the need to speed up the mapping work without sacrificing rigor, the impact of PHRs on these activities, and the prospects for terminology to capture people’s reasons for seeking health care.

 

Committee Structure and Work Alignment Considerations—Mr. Reynolds

 

As preparation for breakout sessions, Mr. Reynolds reviewed the NCVHS mission, outlined a subcommittee structure developed by the Executive Subcommittee, and discussed several process considerations relevant to future operations.

 

The new NCVHS subcommittees are on Standards, Privacy and Security, Population Health, and Quality, plus an Executive Subcommittee. All except the last have co-chairs. (The NHII Workgroup has been phased out, and the Quality Workgroup was elevated to full subcommittee status.) In addition, an unchartered ad hoc workgroup will be mobilized in the event that projects and assignments arise that cut across the domains of the existing subcommittees, with Mr. Reynolds as Chair and Ms. Jackson providing administrative support. Subjects that span the expertise of more than one Subcommittee can be approached by supplementing with selected members, creating an ad hoc Workgroup, and dividing the work among more than one subgroup. Mr. Reynolds stressed the importance of horizontal thinking among and across the various subcommittee specialties. Historically, taking the broad view and integration have been distinctive NCVHS contributions.

 

To maximize effectiveness, he encouraged subcommittees to take the following into consideration for all new projects: the audience/customer; the intended impact (especially for visionary projects); how best to tailor the work product; and how to ensure its readability and (when appropriate) that it reaches the intended audience. He noted that increasingly, NCVHS work products need to “play in all audiences.”

 

Mr. Reynolds also encouraged balanced thinking that can help protect the Committee from what he called “undertow.” The subcommittees’ agendas should include some future (vision) items and some near term initiatives, plus any necessary follow-up to previous assignments. He offered suggestions for scaling the work and planning hearings, and then showed a diagram that can be a tool for guiding a balanced and comprehensive Subcommittee portfolio (see slides 9 and 10). After reviewing a list of topics and questions that emerged in the Executive Subcommittee for subcommittees to consider as they develop their work plans, he asked subcommittees to keep the foregoing analysis in mind as they develop their work plans.

 

Discussion

 

Mr. Houston made a “plea” that if non-Subcommittee members expect to offer opinions on documents, they engage in the development process in an “early and substantive” way and make timely comments. Mr. Reynolds and others commented on the merits of having subcommittees present their thinking about new projects to the full Committee at early stage, and then bring forward preliminary drafts for early input.

 

Ms. McCall asked whether any organizing themes were being considered for cross-cutting work, and Ms. Greenberg pointed out that medical home and related topics had emerged as one possibility. Mr. Reynolds (who suggested “care coordination” as a paraphrase) said the Subcommittee on Populations might propose this as a cross-cutting theme.

 

To clarify the focus of each subcommittee, Dr. Francis proposed a few summary descriptions. Other members hailed the idea of creating concise descriptions, but wanted to refine the proposed content. Dr. Cohn noted that the subcommittee charges also need to be revised. There was further discussion of various formulations of what NCVHS is all about. Ms. Greenberg commented that another full Committee retreat might be in order in June 2009.

 

On pacing, Mr. Rothstein urged the group to “keep in mind the political calendar,” and Mr. Reynolds advised that the Committee move forward slowly in view of the loss of several long-time members and the fact that this is a time of transition. After a few concluding comments, the Committee recessed into Subcommittee sessions, followed by a dinner to honor outgoing members.

—Day Two—

Privacy Monograph—Mr. Rothstein

 

Mr. Rothstein reported that the Subcommittee on Privacy and Confidentiality requests approval for publishing a compilation, background and brief summary of the 2006-2008 letters on privacy and confidentiality, in a format similar to the one used for the report on enhanced protections for the uses of health information.

 

Dr. Warren and Mr. Blair predicted that colleagues in their states and others would find value in an accessible compilation such as this, because they are interested in the Committee’s privacy recommendations and the original letter format is challenging.

 

The Committee passed a motion approving the production of the proposed monograph. Dr. Francis offered to be the Subcommittee’s contact person for the project.

 

Subcommittee Strategic Work Alignment and Workplan Ideas

§         Quality Subcommittee report— Dr. Carr

 

Dr. Carr discussed a draft report that gives status reports on the 23 candidate recommendations in a 2004 internal document from the NCVHS Quality Workgroup. She explained that although only one of the candidate recommendations (for present on admission diagnosis indicator) moved on to the Secretary as written, the Subcommittee thought it worthwhile to revisit the entire set of recommendations at this point. After briefly describing the updates prepared by NCHS staff, herself, and others, she asked the group what should happen to the document.

 

After discussion, members agreed that the final version would be posted on the NCVHS Website as an historical background document plus a status report. Because of its breadth, members noted its possible utility for planning. Its possible value for other stakeholders was also noted. Members passed a motion that after all members had a chance to offer modifications, the report would be revised and brought to the Executive Subcommittee for final review.

 

§         Standards—Mr. Blair, Dr. Warren

 

The Subcommittee plans three major focus areas: ways to improve implementation of HIT standards in medical practice, especially small ones; moving ahead with the 5010 and ICD-10 code sets; and reviewing the overall strategy for health care information standards.

It also will be following the roll-out of the NPI and harvesting the lessons learned. Mr. Blair proposed this as a descriptive phrase: “The Subcommittee on Standards is an enabler of health care information policies and processes.”

 

§         Subcommittee on Privacy and Security—Mr. Houston, Dr. Francis

 

The Subcommittee has a list of topics that it will prioritize in a conference call. Some follow on prior recommendations and some (e.g., the medical home) crosscut the work of other subcommittees. The topics include privacy issues related to voluntary web-based data aggregators, uses of PHI for disease surveillance, disclosure for non-health care uses, defining the categories of sensitive information, considering best practices for business associate agreements, and privacy and security governance issues in the NHIN.

 

 

§         Subcommittee on Population Health—Dr. Steinwachs

 

Dr. Steinwachs’ co-chair is Dr. Scanlon. The Subcommittee has just co-hosted a hearing on the patient-centered medical home, with the Subcommittee on Quality. The first draft of a thematic summary will be ready for review in a few weeks; it may be useful for the Executive Subcommittee as it considers how to build on that hearing. The fundamental idea behind the medical home is to redesign the health care system to reinvigorate primary care and deliver chronic disease care. Members have identified the need for a data model that supports all these activities.

 

Other areas of interest to the Subcommittee are vital statistics, data linkages, and updating the vision for 21st century health statistics. On the first, it is considering helping to advise NCHS on how to respond to ongoing budget constraints in its approaches to data collection on population health. On data linkages, it is considering a hearing to get a status report on its previous recommendations and to keep the issue visible. On the third topic, he noted the connection to recent discussions about the need for an HHS data strategy, and the need to think beyond data silos. Dr. Cohn noted that data linkages, too, can be seen as linked to the HHS data strategy topic. Ms. Greenberg suggested using the 21st century health statistics vision as the frame of reference for these NCVHS endeavors. The Subcommittee on Population Health is also interested in pursuing the topic of information needs for the medical home with the Subcommittee on Quality. Dr. Green added that it remains to be seen whether the subcommittees will want to do any further data gathering on that topic.

 

§         Subcommittee on Quality —Dr. Tang

 

Dr. Tang (co-Chair with Dr. Carr) reviewed the Subcommittee’s reflections on the medical home concept following its hearing. One idea is to look at the concept in the light of the three dimensions inInformation for Health, partly to evaluate whether the medical home model is too “medical” in nature. The Subcommittee plans a number of conference calls, possibly to plan a workshop to delve more deeply into these questions. He added that it is considering as a new name “Subcommittee on Quality, Information and Data,” or SQUID.

 

Dr. Francis noted the privacy issues at stake in Web-based health applications such as Google Health. Ms. McCall commented on the interconnections among several of the topics mentioned in the foregoing briefings, including the 21st century vision, the medical home, and new visions of health care in a wired world. They might be addressed through one or more NCVHS reports.

 

Members responded to the proposed Quality name change, with Dr. Warren wondering whether having “data” in the name would lead to confusion with the Subcommittee on Standards. Dr. Cohn urged that all the groups take a fresh look at their charters. Ms. Greenberg encouraged the groups to keep their charters broad and to put the specifics in their workplans.

 

In view of the cross-cutting nature of many of the topics under consideration, plus the fact that there are no action items for September, Ms. Greenberg suggested scheduling full Committee meeting time then to talk about cross-cutting hearings. Dr. Green noted Mr. Reynolds’ comment at the end of the medical home hearing about the Committee’s historic role of pulling things together and advancing “the whole,” which he contrasted with other actors’ narrower functions. Mr. Reynolds added that the Executive Subcommittee would continue this line of exploration in its forthcoming retreat. He predicted that in the future, NCVHS would look and act “a little different.”

As parting comments, Mr. Rothstein urged the Committee to “choose wisely where you’re going to invest your human capital” until a new administration comes in with a new agenda. Dr. Steuerle agreed that NCVHS should “keep some slack in its system” and be prepared for the “tremendous data demand” that will accompany any effort at health care reform. Dr. Cohn commended the Committee for the exciting issues it is considering. He noted that health statistics are a critical issue that deserves the Committee’s attention.

 

Communication and Report Dissemination—Ms. Jackson

 

Ms. Jackson noted the publication and distribution of the two recently published reports– Enhanced Protections for Uses of Health Data and the NCVHS 2005-2006 report.  She also reported that Ms. Jones is leading a team of staff members working on updating the Website, with Dr. Deering, Dr. Carr and Ms. Kanaan available for consultations.

 

NCVHS 60th Anniversary Celebration—Ms. Greenberg

 

The current thinking about observing the Committee’s 60th anniversary is to hold a culminating event at the National Academy of Sciences in June 2010. In addition, leading up to the final celebration, Ms. Greenberg envisions a series of prior events over several months, probably related to themes discussed in this meeting. If the vision for 21st century health statistics and/or Information for Health have been updated, those documents would be featured as well. She noted that these activities and related documents can help acquaint the new administration with NCVHS and its potential contributions to achieving the administration’s objectives. Ms. Kanaan will write a ten-year history on NCVHS, covering the first decade of the 21st century and building on the 50-year history. Also under consideration is a document based on interviews with or conversation among the six living NCVHS chairs and past chairs. Ms. Greenberg noted that past Chair Kerr White, M.D., prizes the work he did with the Committee and still follows its activities. She expressed hope that he can participate in the 60th anniversary events.

 

Mr. Blair observed that the Committee’s reputation as a respected thought leader stems from its steadfast support for NCHS, its deliberative process, and the stature of NCVHS members throughout its history. Telling what the Committee has produced, its impact, and the reasons for its influence would, he asserted, make for a compelling story. Dr. Middleton said he thought it was time for “NCVHS: The Movie.” Ms. Greenberg reflected further on the contributions of Dr. White, who was responsible for getting NCVHS into legislation in 1974, linked to NCHS reauthorization. She added that “the whole ecosystem of the Federal Advisory Committee is something we can celebrate, as well.” The Executive Subcommittee will pursue these ideas further, and all members are invited to submit their suggestions to Ms. Greenberg and Mr. Reynolds.

 

After a few concluding comments and expressions of thanks, 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/                                                     September 16, 2008

_____________________________________________________________________

Chair                                                                                                    Date