Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

November 29-30, 2016

National Center for Health Statistics, Hyattsville, MD

MEETING MINUTES

The National Committee on Vital and Health Statistics was convened on November 29-30, 2016 at the National Center for Health Statistics in Hyattsville, MD. The meeting was open to the public. Present (participating by phone or in person):

Committee members

William W. Stead, MD, Chair
Raj Chanderraj, MD, FACC 
Bruce Cohen, PhD
Nicholas Coussoule
Llewellyn Cornelius, PhD
Alexandra Goss
Linda Kloss, RHIA, CAE, FAHIMA
Richard Landen, MPH, MBA
Denise Love
Vickie Mays, PhD, MSPH
Bob Philips, MD
Helga Rippen, MD, PhD
David Ross, Sc.D.

Absent:
Barbara Evans, PhD, JD

Lead Staff and Liaisons

Rebecca Hines, MHS, NCHS, Exec. Secretary
Jim Scanlon, ASPE, outgoing Exec. Staff Dir.
Rashida Dorsey, PhD, ASPE
Terri Deutsch, CMS
Maya Bernstein, ASPE
Kate Brett, PhD, NCHS
Jim Sorace, MD, ASPE

Others

Debbie Jackson, NCHS
Katherine Jones, NCHS
Marietta Squire, NCHS
Mike Lincoln, VA
Mildred Hunter, HHS
Damon Davis, HHS Idea Lab
Delton Atkinson, NCHS
Cora Tracy, JD, CMS
Denesecia Green, CMS
Lucia Savage, ONC
Josh Rosenthal, PhD, Data Access & Use Work Group
Denise Buenning, CAQH CORE
Erin Richter Weber, CAQH CORE
Gail Kocher, BlueCross BlueShield Assn.
Michael DeCarlo, BlueCross BlueShield Assn.
Dan Rode, Dan Rode & Assoc/EHNAC

Planning and Visioning Work

This NCVHS full Committee meeting was the first one to be headed by Dr. Bill Stead, the new NCVHS Chair. He began by observing that while times of transition create great uncertainty, that is matched by the great opportunity for leadership. He pointed out that NCVHS has enjoyed bipartisan support throughout its 67 years of existence. 

This was primarily a planning meeting, covering three categories of Committee activity:

  • Projects already under way and slated for action in early 2017;
  • Legislative mandates and must-haves for 2017; and
  • Visioning for 2017 and beyond.

Over the course of two days, NCVHS members and staff developed a work plan through 2017 and into 2018, with attention to the following considerations and inputs:

  • The Committee’s charge, legislative mandates, and role
  • Status reports on current projects (including a discussion of themes for impending letters to the Secretary)
  • Scoping documents on new and proposed projects
  • Objectives and framing for each new project
  • Committee priorities
  • NCVHS band-width and resources
  • Associated information needs, including HHS briefings
  • Timing and sequencing within and across projects
  • The appropriate Subcommittee “home” for each project
  • Longer-term visioning
  • Relationships to NCVHS customers, stakeholders, and colleagues
  • Feedback and requests from HHS

The 2017-18 work plan, which will continue to evolve and be fine-tuned, encompasses the following projects (with the subcommittee with “ownership” of each project in parentheses):

  • 12th Report to Congress (Executive Subcommittee)
  • gov (Data Access and Use)
  • De-Identification hearing letter to the Secretary (Privacy, Confidentiality and Security)
  • APCD hearing follow-up (Population Health)
  • Follow-up on Measurement Framework and September workshop (Population Health)
  • Edits, audits and enforcement hearing/ACA 10109 (Standards)
  • Prior authorization end-to-End hearing/Review Committee (Standards)
  • Predictability Roadmap (Standards)
  • Next Generation Vital Statistics (Population Health)
  • Beyond HIPAA (Privacy―for 2018 and beyond)
  • Terminology and Vocabulary (TBD―for 2018 and beyond)

The Committee devoted time to drafting high-level work plans for projects and reports to be developed in the next 6 months, and tentatively scheduled hearings for several of these projects. After placing the large-scale projects on a timeline for 2017-18, members reviewed a “pick list” of possible smaller-scale activities and projects. They then voted on their top choices for the ones they would like to fit into the NCVHS work schedule as time permits.

Members selected the following priorities for the full Committee (listed in order of the number of votes received) should there be time:

  1. Preparation for removal of SSN from healthcare identifier
  2. Commission on Evidence-Based Policymaking (tied)
  3. Recommendations on improving the patient authorization process (tied)
  4. Chief Innovation Officer Forum (industry workshop idea)

Members also voted on their priorities among a pick list for the Work Group on HHS Data Access and Use, with the following results (listed in order of number of votes):

  1. Guidance on Best Practices for Access and Use (Data Stewardship, Workforce, Algorithms for Evaluation
  2. Data Use and Service Agreements for Wearables, M-health
  3. Impact of Changes in Privacy, Confidentiality and Security on Data Access
  4. Standards for webpages, use of infographics, data availability of HHS data sources that support health

Committee Meetings: Process, Structure and Format

Members endorsed the following proposed approaches to structuring and conducting NCVHS meetings in the coming year, to maximize efficiency:   

  • Departmental updates could be provided through webinars (which will be two-way conversations). They will be recorded for later listening if missed.
  • Departmental inputs during NCVHS meetings will be targeted to priority topics.
  • Periodic half-day sessions will be scheduled as full-Committee work sessions on long-term projects and topics.
  • An effort will be made to “mainstream” the Data Access and Use Work Group as an organic part of NCVHS.
  • Subcommittee break-outs will be scheduled concurrently when needed.
  • Meetings will end by 3:15 on Day 2 so members can travel home on Day 2.
  • When needed, telephonic meetings will be held for follow-up and to close out action on business not completed during face-to-face meetings.
  • Opportunities will be explored to establish ongoing relations with key agencies, akin to the liaisons NCVHS has had in the past. Members suggested agency and op-div candidates for this role, and discussed the attributes needed in both liaisons and staff.
  • NCVHS will emphasize continued coordination with the NCHS Board of Scientific Counselors, with attendance at each other’s meetings and reports on current activities.
  • Members expressed hope that the Committee will soon be at its full complement of members in light of the workload.

HHS Feedback

·         ASPE: Rashida Dorsey

Dr. Dorsey announced that upon the retirement of Jim Scanlon, she will become the NCVHS Executive Staff Director. She expressed appreciation for the Committee’s planning effort.

·         CMS: Cora Tracy and Denesecia Green

Ms. Tracy is Deputy Director of the Office of Enterprise Information and Acting Director for the National Standards Group (NSG). She echoed Dr. Dorsey’s words of appreciation, noting in particular that the plans for the predictability roadmap, the Review Committee, and ACA 10109 are areas in which NCVHS can support CMS in 2017.

Ms. Green, who is the NSG Deputy Director, agreed that CMS is “delighted with the discussions” and applauded the Committee’s interest in gathering metrics in key areas. She said CMS is responsive to looking at ICD-10, and the NSG is interested in the Beyond HIPAA topic.

·         ONC: Elise Anthony and Lucia Savage, Chief Privacy Officer

Speaking on behalf of herself and Jon White (who attended day one of the meeting), Ms. Anthony expressed ONC’s continued interest in working with NCVHS on several topics in its work plan. She noted in particular its interest in the forthcoming work on health terminologies and vocabularies, given ONC’s work on interoperability, and she asked that they be kept apprised and in the loop. She added that Ms. Savage (who joined via phone on day one) calls the Committee’s attention to the challenges of sharing data between health care and social service agencies and to the need for coordination around innovation related to genomics and precision medicine. Ms. Anthony agreed with Dr. Stead about the desirability of aligning the work of NCVHS and of ONC’s FACAs.

·         OCR: Rachel Seeger

Ms. Seeger applauded the Committee’s thoughtful planning work, and said OCR looks forward to working with NCVHS on de-identification and priority-setting for OCR’s policy enforcement and outreach efforts. OCR continues to support the Precision Medicine Initiative, one of its priorities. She then gave updates on recent and/or planned OCR work on patients’ right to access to information, enforcement efforts, cloud computing guidance, newsletters on cybersecurity and authentication, social media guidance, and audits.

Public Comment

On day one, Dan Rode (speaking in person) offered several comments. First, he urged the Committee to write Congress promptly, as it begins to consider changes to the ACA, to explain the significance and impact of the ACA sections on operating rules, which industry worked hard to get and which have been “a success story” thanks to collaborative work between NCVHS and industry. Second, he noted the burdensome amount of time it takes to make a change in HIPAA transaction standards (7 years on average), and he urged NCVHS in its future projects to look more broadly than just at how to change existing processes. Finally, he asked NCVHS to make its meetings and the materials under discussion at them more easily accessible for those in the public who want to follow the Committee’s work (e.g., through its Webcasts), based on the example of the ONC policy and standards committees. 

On day two, Steve Lazarus (via the Internet, writing as an individual) sent three suggestions for NCVHS related to terminology (adoption vs. implementation), its planned request for information, and prior authorization end-to-end. 

Farewell Conversation with Jim Scanlon

The Committee had celebrated Jim Scanlon, on the occasion of his retirement from federal service after a distinguished 48-year career at HHS, at a dinner with him the previous night. Mr. Scanlon spoke with the Committee again by phone on day two. Dr. Stead thanked him for his service and acknowledged that he was instrumental in the formation of the HHS Data Council; has been a strong advocate for NCVHS and its role in supporting the Department; provided “the perfect balance between healthy skepticism, restraint, and optimism”; and always helped the Committee choose the most helpful path.

Mr. Scanlon said it had been a pleasure working with NCVHS. He noted that it is “sometimes a victim of its own success” because its accomplishments tend to lead to being named in more bills. He credited NCVHS with significantly helping the Department with data standards and administration simplification, and said HHS could always rely on the Committee to find the consensus and the way forward. He noted its “wonderful record,” excellent thinking and recommendations, good advice, impartiality, and reputation as an honest broker. Finally, he announced that the names for filling three NCVHS vacancies are now being vetted at HHS.

Following a round of applause for Mr. Scanlon, Dr. Stead adjourned the meeting.

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

/s/

Chair

February 22, 2017