Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

November 16-17, 2011

Holiday Inn Rosslyn at Key Bridge

Meeting Minutes


The National Committee on Vital and Health Statistics was convened on November 16-17, 2011, at the Holiday Inn Rosslyn, Key Bridge. The meeting was open to the public.

Present:

Committee members:

  • Justine M. Carr, M.D., Chair
  • John J. Burke, MBA, MSPharm.
  • Raj Chanderraj, MD, FACC
  • Bruce Cohen, Ph.D.
  • Leslie Pickering Francis, J.D., Ph.D.
  • Larry A. Green, M.D.
  • Mark Hornbrook, Ph.D.
  • Linda Kloss, RHIA, FAHIMA
  • Vickie Mays, Ph.D., MSPH
  • Blackford Middleton, M.D., MPH, MSc
  • Sallie Milam, J.D., CIPP/G
  • Len Nichols, Ph.D.
  • William J. Scanlon, Ph.D.
  • Walter Suarez, M.D.
  • Paul Tang, M.D. (by phone)
  • Judith Warren, Ph.D., R.N.

Absent:

  • W. Ob Soonthornsima
  • James Walker, MD, FACP

Lead Staff and Liaisons

  • Marjorie Greenberg, NCHS, Exec. Secretary James Scanlon, ASPE, Exec. Staff Director
  • J. Michael Fitzmaurice, AHRQ liaison
  • Seth Foldy, M.D., M.P.H., CDC Liaison (by phone)

Others

  • Debbie Jackson, NCHS
  • Katherine Jones, NCHS
  • Marietta Squire, NCHS
  • Susan Baird Kanaan
  • Michael DeCarlo, BCBSA
  • Margaret Weiker, HP
  • Erin Richter, CAQH
  • Steve Lazarus, B.I.G.
  • Jon White, MD, AHRQ
  • Bill Alfano, BCBSA
  • Peter Barto, PWC
  • Lynne Gilbertson, NCPDP
  • Dane Rode, AHIMA
  • Devin Zatorski, BCBSA
  • Rachel Foerster, Rachel Foerster & Assoc., Ltd.

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

This meeting was primarily dedicated to discussion, revision, and approval of the three documents referenced immediately below. Final versions are posted on the NCVHS website. Members and staff discussed dissemination plans at some length, and agreed to keep dissemination as a continuing focus. The Committee also was briefed by Mr. Scanlon, Ms. Doo, and Dr. Foldy on HHS activities in their respective domains; and all four NCVHS subcommittees held breakout sessions to plan future activities.

ACTIONS

  1. The Committee unanimously approved a letter on EFT/ERA operating rules.
  2. The Committee unanimously approved the 10th NCVHS report to Congress on HIPAA implementation, with final wordsmithing to be completed by the Executive Subcommittee.
  3. The Committee unanimously approved the report, “The Community as a Learning System for Health: Using Local Data to Improve Local Health,” with final approval delegated to the Executive Subcommittee.

HHS Update–Mr. Scanlon (ASPE) and Ms. Doo (CMS)

Mr. Scanlon briefed the Committee on the data policy activities under way at HHS. The Department is making small revisions to its strategic plan, which will be shared with NCVHS. To monitor the implementation and impact of the ACA, HHS has set up a dashboard with 10 domains in which the Act is expected to have an impact. The dashboard will be public-facing within two months. NCVHS will be fully briefed on this effort in the near future.   HHS leadership has asked the Data Council to look at the portfolio of surveys and other data systems including new ones created by the ACA, in terms of the extent to which data and standards are adequate for policy research, monitoring, and evaluation. The idea is to plan ahead, with attention to standardization and design principles.

Mr. Scanlon noted that Dr. Foldy would report later in the meeting on an HHS research agenda project, regarding how the public health arena could benefit from EHRs. The Health Data Initiative is focusing on how to move existing data out to communities and states. HHS will probably want to get NCVHS involved in bridge-creation efforts by helping determine what would be useful to communities.

In the discussion period, members talked with Mr. Scanlon about privacy and confidentiality, the need for standardization across data sources (an issue NAHDO has raised), the need for public education about data uses, and the transition to ICD-10 code sets.  NCVHS members asked for regular updates on the 10 ACA domains being monitored and on meaningful use developments.

Ms. Doo suggested that NCVHS be briefed by the CMS people coordinating the preparations for ICD-10 code sets. She then discussed the expanded scope of CMS activities and briefly reviewed recent CMS work on HIPAA and Meaningful Use.

In further discussion, Dr. Cohen expressed hope that HHS would offer guidance and assistance to nonprofit hospitals for the community health assessments now required by the ACA. He also suggested that the Department determine what short- and long-term population health improvements are anticipated as a result of the ACA, and then monitor them. He stressed the importance of training data collectors to maximize the quality of demographic data collection, and encouraged the Department to work with CDC and BRFSS on small area estimation, a huge issue for local health.

Community Health Information Project Report–Ms. Milam, Dr. Green, Dr. Francis

The Subcommittee co-chairs presented the report “The Community as a Learning System for Health: Using Local Data to Improve Local Health” for discussion and approval. Mr. Scanlon said the report is “perfectly aligned” as “a vision document that offers the best thinking from the Committee and others about needs, priorities, and future directions,…with some directional kinds of recommendations.”

The Committee discussed next steps, with these suggestions:

  • A follow-up letter to the Secretary highlighting a few key themes and ideas regarding local data use for community health, including NCVHS priorities that align with NAHDO recommendations;
  • Further development of the thinking about and agenda for a supportive infrastructure for community-oriented learning systems;
  • A full Committee retreat to explore next steps in this area as well as those following from the 10th HIPAA report to Congress (see discussion, below);
  • Inventory of similar work in other locations and by other groups that will hit the national scene in 2011, to “connect the dots”; and
  • A dissemination plan for the NCVHS community health information report.

On day two, the Committee approved the report (with final approval delegated to the Executive Subcommittee); expressed appreciation to the writer, Ms. Kanaan; and continued the discussion of dissemination plans.

Letter on EFT/ERA–Dr. Suarez

Dr. Suarez presented a letter drafted by the Subcommittee on Standards containing recommendations on adopting a series of operating rules for the electronic fund transfer and electronic remittance advice transactions.  The letter, as revised, was approved on day two.

10th Report to Congress on HIPAA–Dr. Suarez and Dr. Warren

After a far-reaching discussion of the 10th HIPAA report’s key messages, members embraced a suggestion that NCVHS hold a new set of hearings and invite testimony on the questions articulated in that discussion. Dr. Carr summarized the key themes as vision, metrics, incentives, enforcement, synchronization, timelines, and unintended consequences. The group then discussed how to use the points raised in the foregoing discussion in the report itself. Several members offered to draft a framing preamble, and Dr. Tang sent written suggestions. Dr. Carr applauded the incredible work on this report by Drs. Suarez and Warren; in turn, they acknowledged lead writer Margaret Amatayakul and lead Subcommittee staffer Lorraine Doo. Dr. Suarez stressed the importance of strategically disseminating the report and its key messages.

The draft report was referred to the Subcommittee on Standards for revision, for final action on day two of this meeting. It was approved the following day, as revised, with final wordsmithing to be completed by the Executive Subcommittee.

Meaningful Use and Population Health–Seth Foldy, MD, CDC (slides)

Dr. Foldy, the CDC liaison to NCVHS, briefed NCVHS on how the Meaningful Use objectives and program interact with population health. In this context, the EHR is envisioned as a systematic collection of patient information that is organized to assist the care of patients and practice populations and digitally formatted to be used, reused, and shared over secure networks for purposes such as triggering warnings and measuring clinical quality.

An anticipated impact of Meaningful Use related to population health is that large numbers of eligible professionals and hospitals will seek to report to public health; and reporting is expected to be more complete and timely. Dr. Foldy showed a schematic of the pathways of information flow over time, and said it is CDC’s responsibility to facilitate the flow. There has been a “fairly high level of success” in the first year, with 38 public health jurisdictions successfully testing; and public health is a full participant.

In the discussion period, NCVHS members asked about the vision for vital statistics and commented on the limited government support so far for the standards and interoperability framework for public health reporting initiative, causing it to lag behind other initiatives. Dr. Suarez noted that NCVHS will be working on public health data standards, which are also a concern of NAHDO. Asked about the worst-case scenario regarding public health in the next two stages, Dr. Foldy forecast that even in that case, we will be better off at the end of Meaningful Use than we were at the beginning, although not necessarily universally across public health departments. Asked where the CDC vision interfaces with CMS, NIH, and other agencies and where the vision can be discussed, Dr. Foldy said he had been looking for those connections.

Finally, Dr. Suarez showed his fellow members the Leadership in Technology Award, given to NCVHS by the Workgroup for Electronic Data Interchange in October 2011 in recognition of the Committee’s “vision and leadership contributing to the advancement of EDI and eCommerce in health care.”

Subcommittee Report-outs and Next Steps

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


DETAILED SUMMARY

– Day One –

Welcome, Introductions, Review of Agenda

Following the call to order and introductions around the room, Dr. Carr welcomed Mr. Scanlon.

HHS Update–Mr. Scanlon

Mr. Scanlon briefed the Committee on the data policy activities under way at HHS. The Department is making small revisions to its strategic plan, which will then be shared with NCVHS. Every initiative (e.g., tobacco control, HIV, reducing disparities) has an action plan or its own strategic plan; and each includes a data focus with a dashboard to indicate whether things are getting better or worse.

The Secretary has adopted and promulgated the data collection standards required by the ACA. These minimum data standards, which were subject to public comment, apply to self-reported personal attributes (e.g., race and ethnicity, language, disability) and will be implemented in new surveys and at the next update or revision of existing ones. HHS is working on additional standards on SES measures, and has asked for NCVHS assistance to look at the state of the art in this area. The Department is also looking at data on vulnerable populations more generally, including the LGBT population, transgender health issues, and disabled and rural populations.

To monitor the implementation and impact of the ACA, HHS has set up a dashboard with 10 domains in which the Act is expected to have an impact: access to care, cost and affordability, insurance coverage, quality of care, vulnerable populations, workforce issues, innovation, population health, prevention, and health information technology. Each domain has five indicators. The dashboard will be public-facing within two months. NCVHS will be fully briefed on this effort in the near future.

Finally, HHS leadership asked the Data Council to look at the portfolio of surveys and other data systems including new ones created by the ACA, in terms of the extent to which data and standards are adequate for policy research, monitoring, and evaluation. The idea is to plan ahead, with attention to standardization and design principles. The Data Council formed several interlocking work groups that are beginning to produce results. NCVHS will be briefed on this, as well. The foci include desirable content; how to speed up data access from federal surveys and administrative data collection; moving ahead with the learning health system; and creation of a framework for aligning, standardizing, and supporting the various arenas of data collection and storage.

Work in the last area is focused initially on demonstrating a proof of concept and defining projects in a research agenda–for example, regarding how the public health arena could benefit from EHRs. A couple of projects have already begun in that area, as Dr. Foldy will report later in this meeting. Mr. Scanlon stressed that in every area and activity, close attention is given to protecting privacy. He added that another Data Council working group with broad representation is coordinating and planning the data needed to monitor and evaluate the impact of health reform, not just in the short run but down the road. Examples are in surveys and administrative data. The Data Council is also working on further survey integration, including emergency department and hospital care surveys.

The Health Data Initiative is focusing on how to move existing data out to communities and states (Todd Park’s data liberation initiative). This includes not just researchers and public health people but the Web, search engines, innovators, and developers that take the data and make it more broadly available. This initiative is currently in Stage 1. It primarily has a geographic focus, like many common apps. Survey data are not organized in this way. HHS will probably want to get NCVHS involved in bridge creation efforts by helping to determine what would be useful to communities.

Discussion

Asked about the planning for the transition to ICD-10 code sets, Mr. Scanlon said there is an informal workgroup that Ms. Doo would report on.

Dr. Middleton asked about how privacy, security and confidentiality will be assured with data liberation. He noted concerns about cell size that were expressed in a recent NCVHS meeting with NAHDO. This dimension of privacy will be central to dealing with geospatial data. Mr. Scanlon agreed, and said it is becoming increasingly difficult for HHS to even issue public use files because of the potential for re-identifying individuals. HHS would like the Committee’s advice on this. Genomic data have similar issues. Dr. Carr and Dr. Francis affirmed that NCVHS is well positioned to deal with these questions, and expressed interest in working together as soon and effectively as possible.

Ms. Milam raised another issue that NAHDO identified–the need for standardization across different data sources.  She asked how NCVHS could help the Department take the next step on that. Mr. Scanlon noted that standards for demographic data in surveys are under way and expressed doubt about standardizing administrative data; EHRs could be a good focus, he added, starting with a demographic minimum dataset for EHRs. HHS prefers to be able to adopt an industry standard. Ms. Greenberg noted the relevance of HIT Standards Committee recommendations on demographic data for clinical quality of care measures.

Dr. Mays noted that one purpose of ensuring privacy and confidentiality is to enable people to participate, and this also requires an aggressive PR campaign so that people understand why their data are being collected. She encouraged HHS to conduct such a campaign. She also discussed several questions with Mr. Scanlon, including the need for work on small group statistics. Mr. Scanlon said HHS has a couple of projects under way in this area.

Dr. Hornbrook expressed concern about the likelihood that many health care providers will rely on crosswalks instead of learning to code correctly using ICD-10-CM and ICD-10-PCS. Dr. Carr asked for a report on the landscape of all the places where current administrative data interact with ICD-9-CM data; Ms. Greenberg will arrange a briefing in March. Dr. Carr suggested that the Subcommittee on Quality take on the issue of the transition to ICD-10 code sets. (The issue was briefly discussed again at the end of the day-one meeting, with members predicting that it will not be in providers’ interest just to use a crosswalk and that over time, behaviors will change. The intention is for them to use ICD-10-CM “natively” inside their coding systems.)

CMS Update–Ms. Doo

Ms. Doo suggested that NCVHS have a future briefing by the CMS people coordinating the preparations for ICD-10 code set implementation. She then noted that CMS’s scope has expanded from “just Medicare and Medicaid” to include the Center for Consumer Information and Insurance Oversight, a Center for Innovation, the Center for Program Integrity, plus considerable work on health care transformation and information exchange in the Office of eHealth Standards and Services (OESS).

Turning to Meaningful Use, she said the numbers of registrants are continuing to rise, though they are lower than expected. Payments to date have gone to 3700 eligible professionals and 8 hospitals. The CMS website shows the outreach and educational efforts to help promote adoption and identify certified systems. Ms. Doo suggested a future briefing on the details of what professionals are registering, attesting, and reporting on.

Regarding HIPAA, regulations are in clearance for the proposed rule for health plan identifier and an interim final rule for a standard for electronic funds transfer, getting ready for the 2013 deadline. Other rules will come out over the next 6-7 months.

Discussion

Dr. Suarez said the Committee is thinking about the need for a common data and information reference model for public health. Many large organizations are going down that path; a tsunami of information is coming soon; and the public health arena needs information models that allow their internal systems to talk to each other. This is an area to focus on in the future.

NCVHS members agreed that it would be useful in the future for NCVHS to have regular updates on the 10 domains mentioned by Mr. Scanlon and on meaningful use developments.

Dr. Cohen asked if HHS would offer guidance and assistance to nonprofit hospitals for the community health assessments they are now required to conduct every 3 years (ACA section 9007). He also suggested that the Department focus on determining what short- and long-term population health improvements are anticipated as a result of the ACA, and then monitor them. Regarding demographic data collection, he stressed the importance of training data collectors to maximize the quality of the data. Finally, he noted that small area estimation is a huge issue for local health, and he encouraged the Department to work with CDC and BRFSS in this domain. Ms. Greenberg added that it is important to combat the conventional wisdom that it is not possible to improve race and ethnicity data.

Community Health Information Project Report–Ms. Milam, Dr. Green, Dr. Francis

The Subcommittee co-chairs presented the report “The Community as a Learning System for Health: Using Local Data to Improve Local Health” for discussion and approval. Dr. Green noted that the project and report had stimulated a robust conversation among nearly all NCVHS members over a period of months. Several minor additions and refinements were suggested during this meeting. Some members pointed out the potential educational function of the report, and its alignment with several major HHS priorities and initiatives.

Asked for his perspective, Mr. Scanlon said the report is “perfectly aligned” as “a vision document that offers the best thinking from the Committee and others about needs, priorities, and future directions,…with some directional kinds of recommendations.” He added that vision documents are “what the Committee does very well.”
The Committee discussed next steps, with these suggestions:

  • A follow-up letter to the Secretary highlighting a few key themes and ideas regarding local data use for community health, including NCVHS priorities that align with NAHDO recommendations
  • Further development of the thinking about and agenda for a supportive infrastructure for community-oriented learning systems
  • A full Committee retreat to explore next steps in this area as well as those following from the 10th HIPAA report to Congress (see discussion, below)
  • Inventory of similar work in other locations and by other groups that will hit the national scene in 2011, to “connect the dots”

There was also considerable discussion of a dissemination plan of the NCVHS community health information report, with these ideas:

  • Data Council agenda
  • Webinar for National eHealth Collaborative
  • Presentation for the APHA Spirit of 1848 group

The population health and privacy subcommittees will discuss the suggested revisions to the report at their joint breakout session, and bring the revisions to the following day’s meeting.

Letter on EFT/ERA–Dr. Suarez

This letter drafted by the Subcommittee on Standards contains recommendations on adopting a series of operating rules for the electronic fund transfer and electronic remittance advice transactions. Dr. Suarez reminded NCVHS members that NCVHS has already issued a series of letters and recommendations on electronic transfer and an EFT standard for transactions. He called attention to several items in the letter. NCVHS looked primarily at whether the development process for the standards met the criteria for inclusiveness and completeness. He reviewed the main recommendations.

He also briefed the Committee on letters received from financial institutions, particularly the credit card industry, expressing concerns about an ambiguity in a previous NCVHS recommendation regarding electronic funds transfer. The Subcommittee will clarify the recommendations to eliminate any ambiguity and allay concerns. Beyond that issue, no substantive concerns were raised about the letter, which will be revised as needed and presented for action on day two.

10th Report to Congress on HIPAA–Dr. Suarez and Dr. Warren

Dr. Carr initiated a round-table of statements of what each participant regards as the HIPAA report’s key message to Congress, stimulating a rich discussion. Major themes and points included (see transcript page 95ff for details):

  • An overview of what HIPAA is designed to accomplish, and the potential benefits thereof–of “the whole”–is still missing.
  • There is a lot more work to be done.
  • We have failed to deliver on the original vision for HIPAA by being too permissive on the ASC X12 transactional set and missing the ball on clinical information exchange; as a result, health IT is behind every other industry, compromising the ability to deliver safe and effective health care. The fundamentals of HIPAA are essential to health care reform. The patient is waiting.
  • Creating this infrastructure is more complicated than the crafters of the legislation understood.
  • HIPAA’s scope is actually quite narrow.
  • Despite considerable progress, the vision remains unfulfilled.
  • HIPAA focused the national information agenda on standardization, but it has not yet achieved its objectives.
  • The Department has so far failed to evaluate the impact of the privacy and administrative simplification provisions, despite NCVHS exhortations.
  • Meaningful metrics for evaluating impact are lacking, along with true enforcement; the true benefits lie ahead.
  • This is a journey, not a destination; HIPAA was step one.
  • The glass is half-full.
  • HIPAA made privacy a national reference point and stimulated nationwide change. It will take HIPAA 2.0 to realize the potential and evaluate the impact.
  • HIPAA has yet to achieve true administrative simplification.
  • Optionality is a major barrier; it is the opposite of simplification. Another issue is the lack of compliance monitoring.
  • Both incentives and enforcement are needed.
  • Industry has delivered what the rule requires, but little of what it permits in terms of collaborative information-sharing.
  • Complexity and the lack of aligned incentives have both impeded adoption.
  • Moving the largest industry in the U.S. toward a common goal is complicated and takes time. HIPAA has started the process. We lack metrics that would make it possible to demonstrate its value and significance.
  • Data are safer than they used to be. It feels worse, but it is probably much better.
  • HIPAA laid the groundwork for moving to the next version of international standards, but also erected obstacles through a cumbersome rulemaking process that needs to be streamlined.
  • HIPAA helped move us from paper to electronic.
  • Burden is a concern for the provider community, with all that is required of them.

Members embraced Dr. Warren’s suggestion that NCVHS hold a new set of hearings and invite testimony on the questions articulated in the foregoing exercise. Dr. Carr summarized the themes as vision, metrics, incentives, enforcement, synchronization, timelines, and unintended consequences.

Dr. Scanlon lamented the industry’s attitude with respect to its customers and said it will take aggression on the demand side–the public, the public sector, and payers–to bring about change. He urged that the HIPAA report begin with a one-page summary with the major “punch- lines.”

Dr. Mays called for a heightened sense of “where the patient is” and of the potential benefits of HIPAA for the public and communities, to encourage greater cooperation and inform consumers and patients about their rights. Dr. Cohen called for thinking about how HIPAA could be expanded for wider use.

Dr. Green noted that the pace of HIPAA-induced change in the health care system is far too slow to keep up with other changes. Ms. Kloss cited the transition to ICD-10 code sets as an example of the importance of sequencing change.

The group then discussed how and where to use the points raised in the foregoing discussion. Several members offered to draft a framing preamble, and Dr. Tang sent written suggestions that will be used as a base.

Dr. Carr applauded the incredible work on this report by Drs. Suarez and Warren; they in turn acknowledged lead writer Margaret Amatayakul and lead Subcommittee staffer Lorraine Doo. Dr. Suarez stressed the importance of strategically disseminating the report and its key messages.

Meaningful Use and Population Health–Seth Foldy, MD, MPH, CDC (slides)

Dr. Foldy, the CDC liaison to NCVHS, was asked to brief NCVHS on how Meaningful Use objectives and program interact with population health. He began with comments on how the EHR is envisioned as more than an “electronic folder,” but rather as a systematic collection of patient information that is organized to assist the care of patients and practice populations and digitally formatted to be used, reused, and shared over secure networks for purposes such as triggering warnings and measuring clinical quality. Other software systems such as laboratory information management and admission discharge systems are being certified as part of the EHR. Most public health reporting is expected ultimately to take place through the EHR.

EHR interoperability rules for Meaningful Use are set by ONC and “enforced” by the Medicare and Medicaid incentive program. This is a voluntary program. To qualify, eligible professionals and hospitals have to implement a certified EHR capable of achieving objectives that include sending lab reports to public health agencies and sending immunization records to immunization registries. Population health is one of many objectives. Stage One will probably take effect in December 2013; stage 2 may begin in October 2013, and stage 3 may begin in October 2014. Incentives are front-loaded to favor early participation. Penalties will start in 2015.

An anticipated impact of Meaningful Use related to population health is that large numbers of eligible professionals and hospitals will seek to report to public health; and reporting is expected to be more complete and timely. The information is reusable by public health agencies, which thereby become a participant in the process with the larger business sector. After reviewing the types of standards–format, implementation guide, vocabulary, and transport–Dr. Foldy showed a schematic of the pathways of information flow over time. To facilitate the flow, it is CDC’s responsibility to make sure that standard vocabularies are in place, create implementation guides, train users, provide technical assistance, and more. A remaining question is the role of HIEs in mediating information exchange between health care and health departments.

After giving an example of how electronic laboratory reporting is playing out in stage 1, Dr. Foldy said there has been a “fairly high level of success” in the first year, with 38 public health jurisdictions successfully testing. Public health is a full participant. Only 8700 or 8 percent of registered hospitals and eligible providers (EPs) have attested to meeting objectives under meaningful use. He gave the data on the EPs that have claimed exclusions, for various reasons. New standards are being developed for syndromic surveillance, to be ready for stage 2, which will have two public health areas: all menu options will become core, and there will be a standard for immunization.

Things that are possibly or definitely on the horizon include the Standards and Interoperability Public Health Reporting Initiative, possibly in stage 3; a reportable condition knowledge base; secure transport, replacing the PHIN-messing system; the use of quality measures and HIEs for surveillance; using EHR connections to measure chronic and other health issues; and queries of EHRs for public health agencies.

Discussion

Asked about his vision for vital statistics, Dr. Foldy said he believes that uniform data collection by EHRs could help automate vital statistics, at least for birth. The big question will be the level of readiness for information exchange by stage 3 of Meaningful Use. A Wiki site is asking for submission of user stories to help inform development of industry-ready standards.

Dr. Suarez noted that there is as yet little government support so far for the standards and interoperability framework for public health reporting initiative, causing it to lag behind other initiatives. Dr. Foldy said CDC is providing some support to this community-supported initiative. ONC has limited funds, in general, but is “extremely interested” in this initiative. Dr. Suarez added that NCVHS will be working on public health data standards, which are also a concern of NAHDO. He expressed hope that CDC would get into the reporting of conditions in the disease reporting system.

Asked about the worst-case scenario regarding public health in the next two stages, Dr. Foldy forecast that even in that case, we will be better off at the end of Meaningful Use than we were at the beginning, although not necessarily universally across public health departments. He affirmed that it will be “hard to get to a better place” and a few things could even hurt public health–an outcome he will be working to prevent. He noted that ONC is being pressured by the industry to “keep it simple.”

Dr. Green asked whether CDC’s public health informatics vision envisions universal population coverage or a more limited sentinel system; Dr. Foldy acknowledged that for the foreseeable future, “having an EHR is the price of doing business” in health care, and a more universal system is a more distant goal. Asked where the CDC vision interfaces with CMS, NIH, and other agencies and where the vision can be discussed, Dr. Foldy said he had been looking for those connections and hopes to find them.

Dr. Suarez showed his fellow members “the very first award ever received by NCVHS,” the Leadership in Technology Award given by the Workgroup for Electronic Data Interchange in October 2011 in recognition of the Committee’s “vision and leadership contributing to the advancement of EDI and eCommerce in health care.”

The Committee then recessed for subcommittee breakout sessions, to reconvene the next day.

–Day Two–

Standards Letter–Action

Dr. Warren brought forward the revised letter on EFT/ERA and explained the revisions. After brief discussion, a motion was passed unanimously to approve the letter.

HIPAA Report–Action

Dr. Warren brought forward the revised HIPAA report and explained the revisions made by the Subcommittee on Standards. There was further discussion, and several revisions were made. The Committee then unanimously passed a motion approving the report, with final wordsmithing to be completed by the Executive Subcommittee.

Community Health Information Project (CHIP) Report–Action

Dr. Green presented the CHIP report for approval. A few further modifications were suggested and discussed. Dr. Green said that Susan Kanaan, the report writer, would complete the revisions within two weeks. A motion was passed unanimously to accept the report, with final approval referred to the Executive Subcommittee.

The Committee continued its discussion of a communication and dissemination plan for this and other reports (notably, the HIPAA report). The CHIP report will be sent to the Secretary and posted on the NCVHS website by mid-December. Mr. Scanlon said the Department would distribute the reports through government channels (including to the Surgeon General and Howard Koh, both of whom were suggested by an NCVHS member). Ms. Kloss offered to draft a template; members are asked to send suggestions of organizations or people who should be included. Dr. Green said the Subcommittee on Population Health would focus on dissemination of the CHIP report as an immediate next step. Other targets include NAHDO members and the NAHDO network. Dr. Carr said dissemination would be a standing topic of future NCVHS meetings, in conjunction with new work products.

Subcommittee Report-outs and Next Steps

Subcommittee on Quality–Dr. Middleton
During its breakout session, the Subcommittee reviewed the NAHDO presentation on quality activities over the past decade and used it as a springboard for talking about future work. Dr. Tang said next fall would be good time for output related to Meaningful Use policy development. The Subcommittee decided to hold hearings in late February on preference-based individualization of quality measurement. This builds on the work of the Subcommittee on Population Health, and has bearing on health disparities and functional status. Dr. Middleton added that the Subcommittee is also interested in working on ICD-10 code sets–how they will affect quality assessment, and how to take advantage of new opportunities. The full Committee will receive a briefing on this in March. The group discussed the multiple facets, nuances, and possible emphases within this context.

Subcommittee on Privacy, Confidentiality and Security–Dr. Francis
In its breakout session, following a joint meeting with the Subcommittee on Population Health, Ms. Bernstein presented a review of the Subcommittee’s activities over the last several years and where it might go next. The Subcommittee then made a list of issues that warrant attention, including HIPAA issues related to data, compliance, and enforcement; and privacy standards for aggregate data. The co-chairs and Ms. Bernstein will prioritize and circulate the list.

Subcommittee on Population Health–Ms. Milam
The Subcommittee met jointly with the Subcommittee on Privacy, Confidentiality and Security. It planned a hearing to be held early in the new year on socioeconomic status/position, to be organized by Dr. Mays.

The Subcommittee also discussed the CHIP report. Ms. Milam acknowledged Ms. Kanaan’s role in helping to plan the workshops and write the report on community health information. The Subcommittee proposes a full Committee retreat to prioritize and plan next steps, following from the report. Dr. Suarez said he hoped there would be opportunities at the retreat to discuss next steps following from several NCVHS projects, and notably the just-completed HIPAA report. Dr. Carr said the Executive Subcommittee would take up this idea.

Subcommittee on Standards–Dr. Suarez
The Subcommittee’s future activities relate to its implementation monitoring roles for ACA, 5010, ICD-10, and other standards; plus work on the health plan ID, operating rules for eligibility and claim status, authoring entities, and other matters. Standards maintenance is another big focal area; and in addition the Subcommittee will start work on the 11th report to Congress. Public health data standards is another major area of interest. Dr. Hornbrook added meta-tagging to the list, to identify where data come from. Dr. Mays asked about providing guidance for making data available to the community–for example, by providing incentives to software developers and guidance for large NIH grantees.
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/                                                                            March 1, 2012

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Chair                                                                           Date