Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

November 13-14, 2013

National Center for Health Statistics, Hyattsville, MD

Meeting Minutes

The National Committee on Vital and Health Statistics was convened on November 13-14, 2013, at the National Center for Health Statistics in Hyattsville, MD. The meeting was open to the public.

Present:

Committee members

  • Larry A. Green, M.D., Chair
  • John J. Burke, MBA, MSPharm.
  • Raj Chanderraj, MD, FACC
  • Bruce Cohen, Ph.D.
  • Llewellyn Cornelius, Ph.D.
  • Leslie Pickering Francis, J.D., Ph.D.
  • Alexandra Goss
  • Linda Kloss, RHIA, CAE, FAHIMA
  • Vickie Mays, Ph.D., MSPH
  • Sallie Milam, J.D., CIPP/G
  • William J. Scanlon, Ph.D.
  • W. Ob Soonthornsima
  • William W. Stead, M.D.
  • Walter Suarez, M.D. (by phone)
  • Paul Tang, M.D., MPH

Absent:

  • Lynn A. Blewett, Ph.D.
  • Len Nichols, Ph.D.
  • James Walker, MD, FACP

Lead Staff and Liaisons

  • Marjorie Greenberg, NCHS, Exec. Secretary
  • James Scanlon, ASPE, Exec. Staff Director
  • Michael Fitzmaurice, AHRQ liaison
  • Justine M. Carr, M.D.,  Working Group Chair

Others

  • Debbie Jackson, NCHS
  • Katherine Jones, NCHS
  • Marietta Squire, NCHS
  • Suzie Burke-Bebee, ASPE
  • Kamahanahokulani Farrar, CMS
  • Virginia Cain, NCHS
  • Dan Rode, Dan Rode & Assoc.
  • Michael DeCarlo, BCBS Assoc.
  • Margret Amatayakul, Margret A Consulting
  • Susan Baird Kanaan

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

EXECUTIVE SUMMARY

Updates from the Department

  • ASPE – Mr. Scanlon

Mr. Scanlon talked about the HHS strategic plan and several policy and program initiatives. HHS has a system for keeping track of measures of progress toward goals and objectives, and it works to align all the objectives. Data alignment is a major theme of the HHS data strategy with respect to its surveys, surveillance, administrative data systems, pilot projects, evaluation, and potentially also EHRs, so that all these systems reinforce each other.

  • CMS – Ms. Buenning

Ms. Buenning briefed Committee members on the Meaningful Use EHR incentive payment program, administrative simplification, ICD-10, and the Health Plan Identifier (HPID). Regarding ICD-10, she emphasized that CMS is holding firm on the implementation deadline. It has just launched the ICD-10 Industry Support Center, a private-public partnership, to offer pre- and post-implementation support. She also described other available support.

In the discussion period, Dr. Scanlon and Dr. Tang expressed concern about the plan to allow the HPID to be an aggregate identifier.

  • Laura Rosas, JD, MPH, ONC (slides)

Ms. Rosas briefed the group on ONC policies (notably accounting for disclosures) and projects. The projects include the Meaningful Use Consent website; an eConsent toolkit and video series, and models of notice of privacy practices. The Tiger Team has had several discussions of accounting for disclosures, a subject on which ONC recently held a hearing. The big issues are the importance of transparency and the patient’s right to have understandable and actionable information. ONC was busy with projects in September and October, with a focus on meaningful consent, geared to health information exchange organizations and other HIT implementers. A new website on that topic is now available through HealthIT.gov. Providers are struggling to understand risk assessment with respect to cybersecurity and why they need to do it.

In the discussion, Dr. Cohen asked that NCVHS agendize the issue of re-disclosure of HIE data.

  • HHS Office for Civil Rights (OCR) – Rachel Seeger (slides)

Ms. Seeger gave updates on model notices of privacy practices, CLIA, HIPAA and NICS NPRM, HIPAA and mental health disclosures, and the new HIPAA privacy rule blue card for law enforcement. OCR is clarifying its guidance for health care providers on disclosing mental health information, stressing the “duty to warn” when deemed appropriate. A forthcoming guidance will address permitted disclosures to friends and family. Finally, there is a new pocket-sized blue card for law enforcement outlining disclosure permissions for law enforcement. This is part of a broader effort “to clear up preconceived barriers to the sharing of information.”

Dr. Francis offered the Committee’s help in identifying barriers and ways to overcome them regarding providers’ understanding of risk analysis and management. Ms. Rosas asked for help in getting these issues on the agendas of state and county medical societies, and in finding ways to get to small providers.

Laying the Groundwork: Status of NCVHS Activities, Direction, and Leadership

This meeting featured a series of presentations and discussions about subcommittee and Working Group plans. The goals were to consolidate understanding of what is going on and to make progress toward interpreting this shared understanding in terms of the four NCVHS topical domains. (See the Detailed Summary for more content.)

  • Subcommittee on Privacy, Confidentiality and Security (slides)

Ms. Kloss described the Subcommittee’s evolving 2014 plans with respect to the community data stewardship framework, HIPAA and related HITECH privacy issues, and possible “future-focused” projects. She and Dr. Francis commented on what lies ahead with accounting for disclosures. NCVHS members agreed that for the time being, things seem to be headed in the right direction regarding accounting for disclosures. Interest was expressed in seeing the process opened up to further deliberation and participation on this topic in the future. Ms. Greenberg pointed out that while at present, NCVHS is represented in both the ONC Policy Committee and the Tiger Team, the Committee might think about a more formal mechanism to assure representation on these ONC bodies in the future.

  • Subcommittee on Population Health (slides)

Dr. Cohen and other Subcommittee members reported on the NCVHS session at the November American Public Health Association (APHA) meeting, the emerging Framework Project, and the Subcommittee’s work plan for the next two years. In his overview of the proposed data continuum and methods framework, Dr. Stead noted that it could help frame the work of the entire Committee. The idea is to develop a systems approach to measurement and analysis and a holistic way to think about data stewardship. Several participants expressed excitement and support for the project.

  • Subcommittee on Standards (slides)

Mr. Soonthornsima noted that “convergence is alive and well” and accelerating. After several acknowledgements, he reported on the 11/12/13 hearing on public health data standards, the 2013 HIPAA report to Congress, the 9/18/13 Roundtable on eHealth Vision and Roadmap, and the proposed Subcommittee workplan for 2014.

  • Working Group on HHS Data Access and Use

Dr. Carr reported that the Working Group has a special interest in how social media data might augment HHS data. Its early work has generated a proposal to conduct an environmental scan of current activities and best practices related to using HHS and new data. It may hold a hearing to pursue key concepts and questions with invited guests.

NCHS Update – Charlie Rothwell, Acting Director

Mr. Rothwell began by saying Ms. Greenberg would be greatly missed, and announcing who would continue her responsibilities until the positions are permanently filled. (See below.) The Center will move from its present location sometime in 2014. He commented on emerging new approaches to using NCHS survey and registry data for public health surveillance. Data linkages are one of the most important things NCHS is doing now. He predicted that it would increasingly be analyzing its data in conjunction with other data sets from various other agencies. This results in the need “to collaborate a lot better” as well as the need for “an analytic strategy between us” to guide planning, to ensure the utility and use of the data. What is needed, he said, is a core data set that can be used for various health care and public health purposes.

Ms. Greenberg reviewed the appointments of her successors:

  • NCVHS Acting Executive Secretary – Debbie Jackson
  • NCVHS team leader – Katherine Jones
  • Head of Classifications and Public Health and Public Health Data Standards staff – Donna Pickett
  • Team leader for informatics – Michelle Williamson

Strategic Discussion, Continued

The final half-day of the meeting was dedicated to presentation of preliminary Subcommittee work plans for 2014 (which had been further developed during break-out sessions) and an extended discussion designed to create coherence among them. The group discussed the need for new thinking about audiences (always including the Secretary as the primary audience); the need to bring the right people to the table, including those with direct community experience; and how NCVHS products and dissemination need to change to reach and serve target audiences. They also talked about the need for a nuanced understanding of what they mean when they talk about “the community.” Another theme concerned how to maximize congruence among NCVHS work streams while giving subcommittees the freedom to follow their respective paths.

The meeting ended with a roundtable of brief final comments. This was Ms. Greenberg’s final meeting prior to retirement (she was honored with a special dinner the previous evening), and there many expressions of affection and appreciation for her. Members also expressed gratitude to Dr. Scanlon and Dr. Tang, whose terms are ending, for their contributions over many years of service.

DETAILED SUMMARY

-Day One-

Opening Remarks

Dr. Green said the goal of this meeting is to reach a good understanding and sense of common ground and how the Committee’s domains of work converge, and in that context, the work plans for 2014.

Updates from the Department

  • ASPE – Mr. Scanlon

Mr. Scanlon talked about the HHS strategic plan and several policy and program initiatives. Health care reform is a major focus at present, with enrollment as the major task. HHS is revising its strategic plan; he reviewed the present goals and objectives and noted that the plan is associated with plans for some two dozen topic areas, such as tobacco control and health disparities. HHS has a system for keeping track of measures of progress toward goals and objectives, and it works to align all the objectives.

Data alignment is a major theme of the HHS data strategy with respect to its surveys, surveillance, administrative data systems, pilot projects, evaluation, and potentially also EHRs, so that all these systems reinforce each other. A framework has been created for this, and ASPE is planning several proof of concept projects and pilot studies. NCHS has projects to look at the potential of using EHRs for provider surveys. Another pilot is looking at using EHR networks to study hard-to-reach populations; and there is work on integrating administrative data and the standardization needed to do so, among other projects. HHS has developed a survey module on sexual orientation and is funding 14 states to test it in 2014. In other activities, a contract has been let for the study of the mosaic effect, and ASPE is looking at the impact of the ACA on specific public health programs.

In response to questions and comments from NCVHS members, Mr. Scanlon affirmed that the NCVHS presentation to the Data Council would be rescheduled soon; and he noted that HHS has just published the final parity rule for mental health and behavioral health treatment.

  • CMS – Ms. Buenning

Ms. Buenning briefed Committee members on the Meaningful Use EHR incentive payment program, administrative simplification, and ICD-10. The Center is continuing to monitor progress on Meaningful Use, for which she reported the latest statistics. The certification of compliance regulation proposed rule will be out by the end of 2013, timed to align with the Health Plan Identifier (HPID). CMS’s enumeration system for the HPID is open. Large health plans have until November 2014 to enumerate, and CMS is learning that some are having trouble figuring out their enumeration policies. CMS will do outreach and education to assist them. It is also getting feedback that industry providers are not ready to meet the 1/1/14 compliance date on the EFT and ERA Operating Rule Set. CMS has instituted a communication strategy for that and will report on progress at the next NCVHS meeting.

As for ICD-10, she emphasized that CMS is holding firm on the implementation deadline, and it continues to work closely with industry stakeholders and to offer technical assistance to small, rural, home health, and safety net providers. CMS has just launched the ICD-10 Industry Support Center, a private-public partnership, to offer pre- and post-implementation support. She also described other available support.

In the discussion period, NCVHS members had questions and comments about the readiness of Medicaid state agencies for ICD-10, the blue button, and the optimal way to enumerate large plans from the standpoint of providers and others. Dr. Scanlon and Dr. Tang expressed concern about the plan to allow the HPID to be an aggregate identifier when a more micro identifier could supply more information from a policy standpoint. Dr. Tang pointed to the purpose of measurement as the appropriate context, and Ms. Buenning said the ACA Review Committee would look at this. Finally, Dr. Green talked with Ms. Buenning about prospects for primary care providers to use the International Classification of Primary Care (ICPC) to file claims, and she promised to explore the possibility.

  • Laura Rosas, JD, MPH, ONC (slides)

Ms. Rosas briefed the group on ONC policies (notably, accounting for disclosures) and projects. The projects include the Meaningful Use Consent website; an eConsent toolkit and video series, and models of notice of privacy practices.

The Tiger Team has had several discussions of accounting for disclosures, a subject on which ONC recently held a hearing. The big issues are the importance of transparency and the patient’s right to have understandable and actionable information. Regarding transparency, she noted that the auto-report approach in the NPRM would result in a “deluge of information” that is not useful to patients. Those with disabilities or limited English proficiency particularly need/want to know what information about them is in an EHR.

Regarding rights, patients are not asking for reports on disclosures, and it is not known why that’s the case. It also is not clear what patients want in this area. There is agreement that patients have a right to a full investigation if there has been inappropriate access. Ms. Rosas reviewed a number of concerns about creating a workable process and system.

ONC was busy with projects in September and October, with a focus on meaningful consent, geared to health information exchange organizations and other HIT implementers. A new website on that topic is now available through HealthIT.gov. ONC also released several videos and customizable tools about eConsent, which are posted on ONC’s website. ONC and OCR also released new model Notice of Privacy Practices for covered entities to use; and ONC launched its second video game on contingency planning (also on the website). She said providers are struggling to understand risk assessment with respect to cybersecurity and why they need to do it. A big message is that “it is not just about natural disasters.”

In the discussion, Dr. Cohen asked that NCVHS agendize the issue of re-disclosure of HIE data.

On disclosure accounting, Dr. Francis said the Tiger Team is looking for middle ground between “dumps of access information” and only having investigations done after the fact. A national group that works on domestic abuse has flagged the issue of stalking. NCVHS participants discussed the tight scheduling of forthcoming discussions and recommendations in this area.

  • HHS Office for Civil Rights (OCR) – Rachel Seeger (slides)

Ms. Seeger gave updates on model notices of privacy practices, CLIA, HIPAA and NICS NPRM, HIPAA and mental health disclosures, and the new HIPAA privacy rule blue card for law enforcement. The model notices of privacy practices, one each for providers and health plans, are posted on OCR’s website and are being translated into Spanish. Because CLIA rules regarding changes in what is required of CLIA and CLIA-exempt laboratories with respect to giving individuals copies of their information are in a holding period, OCR and ONC have delayed the deadline for these covered entities to update their notice of privacy practices. OCR is clarifying its guidance for health care providers on disclosing mental health information, stressing the “duty to warn” when deemed appropriate. A forthcoming guidance will address permitted disclosures to friends and family.

Finally, there is a new pocket-sized blue card for law enforcement outlining disclosure permissions for law enforcement. This is part of a broader effort “to clear up preconceived barriers to the sharing of information,” targeting elder law and other vulnerable areas of industry. OCR is trying to work with and educate designated chief privacy officers and to educate small health care providers, and there is a training module on risk management on its website, for CME and CE credit. Ms. Seeger noted that entities of all sizes lack a security risk analysis, and this is “very much on our mind right now.”

NCVHS members raised several detailed questions (see transcript). Ms. Kloss talked with Ms. Seeger about plans for a report on the audit findings that provides a short list of the major lessons learned. Dr. Francis offered the Committee’s help in identifying barriers and ways to overcome them regarding providers’ understanding of risk analysis and management. Ms. Rosas asked for help in getting these issues on the agendas of state and county medical societies, and in finding ways to get to the small providers who do not tend to join such associations and otherwise getting beyond preaching to the choir. Dr. Tang stressed making sure that this valuable information is visible where it needs to be. He also urged follow up on providing data on audits of people who collected Meaningful Use dollars.

Concluding these briefing sessions, Dr. Green called participants’ attention to Section 5204 of the ACA, concerning the Public Health Workforce. The comments in the preceding sessions, he said, reveal the absence of a mechanism to drive federal resources and programs “to the local level, to the small practice, to actually help people.” He stressed what a difference the activities and programs outlined in Section 5204 could make if they received appropriations.

Laying the Groundwork: Status of NCVHS Activities, Direction, and Leadership

(The following series of presentations and discussions about subcommittee and Working Group plans took place over several segments and both days of the meeting, but is summarized together here for continuity.)

  • Subcommittee on Privacy, Confidentiality and Security (slides)

Ms. Kloss described the Subcommittee’s evolving 2014 plans with respect to the community data stewardship framework, HIPAA and related HITECH privacy issues, and possible “future-focused” projects. Three priorities emerged from the joint roundtable held in mid-2013: expanding the 2012 stewardship framework, examining legal barriers to data sharing, and identifying useful stewardship examples and resources for communities. The Subcommittee has developed a five-step research outline to address these priorities. The three priorities that emerged in the HIPAA/HITECH area are accounting for disclosures, minimum necessary, and a group of issues “mushrooming” at the edges of HIPAA. The Subcommittee plans hearings and actions in each area. As a future-focused topic, it is likely to pursue either genomics or patient-generated data.

Dr. Francis and Ms. Kloss commented on what lies ahead with accounting for disclosures. Ms. Kloss noted that “this is a classic roadmappable issue” and suggested that NCVHS craft recommendations in this area. Members agreed that for the time being, things seem to be headed in the right direction regarding accounting for disclosures. As to future NCVHS inputs, it was noted that a process map that would indicate how NCVHS might participate properly would be useful. Interest was expressed in seeing the process around this topic opened up to further deliberation and participation in the future. Ms. Greenberg pointed out that while at present, NCVHS is represented in both the ONC Policy Committee and the Tiger Team, the Committee might think about proposing a more formal mechanism to assure representation on these ONC bodies in the future.

Dr. Mays appealed (as she has in the past) for a mechanism for getting regular input from people with a community-based perspective and experience, perhaps via the participation of community agencies based in DC and/or federal agency people working on community-level projects.

  • Subcommittee on Population Health (slides)

Dr. Cohen and other Subcommittee members reported on the NCVHS session at the November American Public Health Association (APHA) meeting, the emerging Framework Project, and the Subcommittee’s work plan for the next two years.

Dr. Mays, who organized the APHA session with Dr. Breen, described the session, “Supporting Health Data Needs for Community-Driven Change.” Its diverse speakers included Claudia Grossman of IOM on learning health systems, Marc Rodman of Tufts on access to public data, Clara Savage with a community agency perspective, and Pat Remington of County Health Rankings. Dr. Mays noted that the County Health Rankings found a way to present data in a way that gets attention in the community, and NCVHS should think about the format of its reports if it wants to engage communities. Dr. Cohen was a discussant in the session, and described NCVHS priorities, activities, and resources. The NCVHS space is about connecting the federal interest in liberating data with communities’ growing sophistication in using data; an emerging theme is figuring out how to reinvigorate the federal workforce to provide support.

Dr. Stead then gave an overview of the proposed data continuum and methods framework, noting that it could help frame the work of the entire Committee. The idea is to develop a systems approach to measurement and analysis, and a holistic way to think about data stewardship. The Framework will link a multi-level data continuum to a methods framework, and both to community-focused case studies that generate case-based problem/solution descriptions as well as highlighting where the gaps are in methods and data sources. He proposed that the framework could enable the Committee to help the Secretary understand how to tackle problems at scale using actionable data, and periodically to assess the overall status. An early step for NCVHS is to find out if anyone else is already attempting such an effort or has made the case that such an effort is needed. Finally, he noted that this represents a multi-year effort, and needs to be seen as important across NCVHS domains to be worthy of taking on.

Several participants expressed excitement and support for the endeavor. Members commented on the embedded assumptions about data quality (including recognizing who isnot represented by the data) and the need to clarify the underlying concept of community, in both cases to assure that the model can be used to promote equity and benefit communities. Dr. Carr remarked on the convergence between the framework project and the planning of the Data Access Working Group; Ms. Greenberg noted the broad relevance of the project to the Committee’s population health mission and work and its consonance with the Committee’s seminal 2001 and 2002 reports (Information for Health and the vision for 21st Century Health Statistics, respectively). Ms. Jackson pointed to the importance of staffing this “ambitious endeavor,” and thus the need to bring the staff along as the Committee’s thinking evolves. Dr. Mays suggested informing the Data Council about it, as well.

  • Subcommittee on Standards (slides)

Mr. Soonthornsima noted that “convergence is alive and well” and accelerating; noted the need for a roadmap; thanked the Subcommittee’s staff and members; and introduced Terry Deutsch of CMS, who will help draft the HIPAA report. After acknowledging Dr. Suarez for his leadership, he reported on the 11/12/13 hearing on public health data standards, plans for the 2013 HIPAA report to Congress, the 9/18/13 Roundtable on eHealth Vision and Roadmap, and the proposed Subcommittee workplan for 2014.

He focused particularly on the eHealth Vision and Roadmap, noting that it dovetails with the new work on public health data standards. He reviewed the common themes and pain-points that arose in the roundtable related to patients, government, provider/payer/ industry actors, and standards and rules. The consolidated view that emerged was of a “consumer-centric, information-driven ecosystem that supports anytime, anyplace, anywhere access to the right information about the right person through a seamless, interoperable, secure, efficient, sustainable system of technology infrastructure, application tools and devices.” Several guiding principles and visions were identified. They include the need to distinguish between transformative and evolutionary change (including “what will be abandoned”) as a result of eHealth policies such as 5010 and ICD-10. Other principles include designing changes for the greater good and recognizing that not all changes will be embraced by all entities.

Ms. Kloss said the roundtable showed the need for a roadmap (“a graphical depiction of standards-based and policy initiatives into the future”) to help people “see where all this is heading and the interrelationships.” There was also interest in an evaluation piece a balanced scorecard or similar technique to ensure that objectives, measures, and desired results are available for each initiative on the roadmap. She showed slides of illustrative roadmaps and a possible evaluation scorecard format.

Mr. Soonthornsima called attention to the “population/public health” dimension of the roadmap and stressed the interest in seeing it fleshed out. He asked for feedback from fellow members. Dr. Cohen noted the significance of a “universal belief,” revealed at the previous day’s meeting on public health data standards, that public health is far behind the curve in adopting standards compared to other players and sectors. Ms. Greenberg pointed to the theme of workforce needs that arose in the same meeting.

Asked about the audience for the ehealth roadmap and guiding principles, Mr. Soonthornsima named the Department as well as NCVHS, industry, and others with “implementation fatigue.” Dr. Carr urged a clarification of both authorship and audience for this deliverable. Ms. Goss suggested addressing “the right governance” and integrating the ehealth roadmap effort and the NCVHS Framework Project.  Finally, Mr. Soonthornsima reviewed the Subcommittee’s plans for 2014, which include meetings and letters/reports on three clusters of topics.

  • Working Group on HHS Data Access and Use (slides)

Dr. Carr reviewed the Working Group’s charge. She said that after looking at what data exist and how useful they are, the Working Group looked at what data do not exist and would be useful. It also is looking at what existing data might be repurposed and what data are needed to make community-level assessments. The Working Group has a special interest in how social media data might augment HHS data. Its early work generated a proposal to conduct an environmental scan of current activities and best practices related to using HHS and new data, guided by a framework (mental model) developed by Dr. Josh Rosenthal. It may hold a hearing to pursue key concepts and questions with invited guests. Dr. Carr noted that social media offer an opportunity to measure and encourage the kind of engagement that is considered key to community data use.

Dr. Tang commented on the changeability of social media use, and the group discussed the implications for NCVHS work in this area. He also pointed to the mosaic issues created by social media data. Dr. Cohen noted the proliferation of frameworks, which the Executive Subcommittee may need to coordinate. Dr. Carr called the Working Group’s project an “application” of the Framework Project described by Dr. Stead.

Concluding this set of briefings and discussions, Dr. Green expressed satisfaction that they had consolidated the Committee’s understanding of what is going on and made progress toward interpreting this shared understanding in terms of the four NCVHS topical domains.

NCHS Update – Charlie Rothwell, Acting Director

Mr. Rothwell began by saying Ms. Greenberg would be greatly missed, and announcing who would continue her responsibilities until the positions are permanently filled. (See below.) The Center will move from its present location sometime in 2014. A slate of NCHS reports was delayed by the government closing and is now scheduled for release in December. Work for the states on cause of death coding was also set back by the furloughs. Regarding staffing, Mr. Rothwell said he has learned while serving as Acting Director that “the Office of Center Director is very thin”; more than one person is needed in the office to be responsive and provide leadership. Positions for deputy director and head of the office of planning and evaluations are now slated to be filled.

He then commented on emerging new approaches to using NCHS survey and registry data for public health surveillance, with implications for more timely release. Data linkages are one of the most important things NCHS is doing now, he said. There is a push by OMB to make administrative data systems and data sets more accessible to statistical agencies like NCHS, so the Center will look at how to use these data appropriately. He predicted that NCHS would increasingly be analyzing its data in conjunction with other data sets from various other agencies. He noted the resulting need “to collaborate a lot better” as well as the need for “an analytic strategy between us” to guide planning regarding ensuring the utility and use of the data. He predicted that the National Committee will be consulted on issues of data linkage and how linked data can be analyzed, including the standards issues and others that this raises. He noted the need for standards processes that do not act as a deterrent to standards development. A related concern is whether EHR data can be collected and combined in meaningful ways, rather than simply producing “a cacophony of different data sets.” What is needed, he said, is a core data set that can be used for various health care and public health purposes. (Dr. Green noted the resonance of these comments with the thinking about the new NCVHS Framework Project.)

Finally, Mr. Rothwell shared his thinking about government service as a calling and the accountability the tax-paying public is entitled to expect.

Ms. Greenberg then reviewed the appointments of her successors: NCVHS Acting Executive Secretary Debbie Jackson; NCVHS team leader Katherine Jones; Head of Classifications and Public Health and Public Health Data Standards staff Donna Pickett; team leader for informatics Michelle Williamson. She expressed her confidence in all the appointees and predicted a smooth transition. She also acknowledged Mr. Rothwell’s leadership and support for NCVHS. The group discussed the possible ramifications of the NCHS move for the Committee in terms of meeting venues.

They then recessed into break-out sessions.

-Day Two-

Strategic Discussion, Continued

The final half-day of the meeting was dedicated to presentation of preliminary Subcommittee work plans for 2014 and an extended discussion designed to create coherence among them. (There was also attention to logistics issues such as staffing needs, possible hearings/workshops, and timetables.) Dr. Green began and ended the session by encouraging members to think of themselves as members of a Committee of the whole. This summary first lists the major activities of each subgroup and then summarizes the major threads of the overarching discussion. (For the full texture of the discussion, see the transcript.)

Major areas of Subcommittee Workplans for 2014

Subcommittee on Privacy, Confidentiality and Security:

  • Contribution to HIPAA report to Congress
  • Report on stewardship best practices for community health data use
  • Follow up as needed on accounting for disclosures; continued collaboration with Privacy Tiger Team
  • Study of an emerging issue (to be determined)

Subcommittee on Population Health:

  • Operationalize the Framework Project
  • Brief the Data Council on NCVHS activities related to community learning systems
  • Carry forward work generated by the 2013 Roundtable regarding community readiness (meeting communities where they are) and technical assistance/support

Subcommittee on Standards:

  • Ongoing administrative simplification activities (operating rules, ICD-10, HPID, claims attachments, etc.)
  • Monitor ACA health insurance exchange standards implications
  • HIPAA report to Congress
  • eHealth vision and roadmap
  • Participate in Framework development
  • Population health data standards

Discussion

The presentations stimulated wide-ranging discussion among members and staff, spurred in part by the sense of rapid change in the policy environment and information technology. This combines with internal changes as a result of the Committee’s convergence around a body of work to help communities become learning systems for health.

The group discussed the need for new thinking about audiences (always including the Secretary as the primary audience); the most effective forms of interaction and learning with content experts and the need to bring the right people to the table, including those with direct community experience; and how NCVHS products and dissemination need to change to reach and serve target audiences. They also talked about the need for a nuanced understanding of what they mean when they talk about “the community.”

Another theme concerned how to maximize congruence among NCVHS work streams while giving subcommittees the freedom to follow their respective paths. Ms. Greenberg observed that “life is not linear,” and NCVHS faces the challenge of developing an organic process within a federal advisory committee structure. (She expressed the conviction that if anyone can do this, NCVHS can.) Dr. Green proposed as the modus operandi as a committee of the whole “for the next stretch” that subgroups move ahead on their respective paths and keep checking with each other, and that everyone tolerate the inevitable uncertainties and messiness and watch for opportunities to bring it all together. (One aspect of “messiness” that was noted was the recent proliferation of frameworks, roadmaps, visions, and overviews.) Several members affirmed that the Committee’s work is, indeed, becoming more congruent and synergized, although different subgroups orient to somewhat different audiences. Ms. Jackson emphasized the critical importance of communication, moving forward.

The meeting ended with a roundtable of brief final comments. Many members expressed their gratitude to Dr. Scanlon and Dr. Tang, whose terms are ending, for their great contributions over many years of service as NCVHS members. This also marked Ms. Greenberg’s final meeting prior to retirement (she was honored with a special dinner the previous evening); and Ms. Kloss predicted that future meetings would resonate with the question, “What would Marjorie have said?” Dr. Tang urged members to consider “How can NCVHS make a difference in a unique way?” Dr. Scanlon spoke of NCVHS membership as “an incredible journey.” And Ms. Greenberg had the last words: “This is a connection that lasts a lifetime.”

Dr. Green then adjourned the meeting.

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

/s/

Chair Date