Department of Health and Human Services

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

September 22-23, 2014

National Center for Health Statistics, Hyattsville, MD

MEETING MINUTES

The National Committee on Vital and Health Statistics was convened on September 22-23, 2014 at the National Center for Health Statistics, 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 (phone)
  • Vickie Mays, Ph.D., MSPH
  • Sallie Milam, J.D., CIPP/G
  • W. Ob Soonthornsima
  • William W. Stead, M.D.
  • Walter Suarez, M.D.
  • James Walker, MD, FACP (by phone)

Absent:

  • Lynn A. Blewett, Ph.D.
  • Len Nichols, Ph.D.

Lead Staff and Liaisons

  • Debbie Jackson, NCHS, Interim Exec. Secretary
  • James Scanlon, ASPE, Exec. Staff Director
  • Judy Murphy, R.N., ONC
  • Jon White, AHRQ
  • Terri Deutsch, CMS

Others (not including presenters)

  • Katherine Jones, NCHS
  • Marietta Squire, NCHS
  • Nicole Cooper, NCHS
  • Susan Queen, ASPE
  • Michelle Williamson, NCHS
  • Tammara Jean Paul, NCHS
  • Donna Pickett, NCHS
  • Hetty Khan, NCHS
  • Minh Wendt, OMH
  • Virginia Cain, NCHS
  • Ruth-Ann Phelps, VHA
  • Margaret Amatayukul
  • Dan Rode, Dan Rode & Assoc.
  • Victor Richardson, WV HealthCare Authority
  • Michael DeCarlo, BlueCross BlueShield
  • Bill Alfano, BC/BS Assn.
  • Melissa Scroggs, Noblis
  • Kathryn Wilber, American Benefits Council
  • Joshua Rising, Pew Charitable Trust
  • Wayne Myers, Karna
  • Marlena Wald, Karna
  • Thomas Bizzaro, FDB
  • Kelly Turek, AHIP
  • Matt Albright, CAQH CORE
  • Susan Kanaan, consultant writer
  • Maureen Henry, consultant writer (by phone)
  • Leah Vaughan, M.D. (Working Group)

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. Final versions of NCVHS documents discussed in the meeting are posted in “Reports and Recommendations.”


EXECUTIVE SUMMARY

ACTIONS

1. The Committee approved letters on the following subjects:

  1. ASC X12 XML Schemas
  2. Virtual credit cards and credit card use
  3. Incorporation of the Unique Device Identifier (UDI) in administrative transactions
  4. Health care claim attachments
  5. Coordination of benefits, Health Plan Identifier (HPID), and ICD-10 delay

The votes approving letters 1-4 were unanimous. For letter 5, after a motion to amend the letter was defeated, a motion to approve it passed with one vote opposed.

2. The Committee passed a separate motion authorizing NCVHS leadership to address any minor editing issues in the letters before they are finalized.

3. The Committee approved the charter of the new Review Committee on Data Standards.

Updates from the Department

  • ASPE – Jim Scanlon
  • CMS – Todd Lawson
  • ONC – Judy Murphy (slides)
  • ONC Privacy and Security Update – Julie Anne Chua (slides)
  • OCR Update and Outreach – Rachel Seeger (slides)

Mr. Scanlon reported on the new Secretary, activities related to the HHS strategic plan, monitoring of the impact of ACA, and efforts to increase the timeliness of HHS data.

Dr. White offered to report in December on AHRQ statistical briefs on the impact of ACA implementation, and Dr. Green asked him to do so.

Mr. Lawson described a range of CMS activities to prepare for and support ICD-10 implementation, and briefed the group on a few other CMS subjects.

Ms. Murphy reported on the latest EHR adoption statistics and the 2014 attestation, Meaningful Use CEHRT flexibility and Meaningful Use 2014 edition release 2, re-aligned FACA workgroups, and the 2014 FACA work plan. She welcomed Ms. Kloss’s offer for the Subcommittee on Privacy, Confidentiality and Security to look at the topic of e-measures. Ms. Murphy agreed to include in future updates information on efforts to align policy levers, funding, and HIT plans across multiple agencies.

Ms. Chua reported on an ONC data provenance S&I initiative, including the goals, intended outcomes, issues, challenges, and progress to date. Dr. Green stressed the Committee’s strong interest in coordinating and collaborating with ONC, and its appreciation to Dr. DeSalvo and others for their efforts to see that that happens.

Ms. Seeger announced that OCR’s new director is Jocelyn Samuels, who has a strong enforcement background in civil rights and provides continuity with the former director. She updated the group on the “three pillars” of the HIPAA privacy division enforcement, policy, and communication.

Five Letters on Standards – Dr. Suarez

Dr. Suarez presented for discussion, revision, and ultimate approval five letters covering seven topics:

  1. ASC X12 XML Schemas
  2. Virtual credit cards and credit card use
  3. Incorporation of the Unique Device Identifier (UDI) in administrative transactions
  4. Health care claim attachments
  5. Coordination of benefits, Health Plan Identifier (HPID), and ICD-10 delay

As he presented each letter, he described the focus, major findings from hearings, proposed recommendations, industry input on an earlier draft, and changes made in response to industry input. The Committee then discussed each one and suggested revisions.

On day two, revised versions of the five letters were presented. After brief discussion and a few small modifications, all five were approved. (See Actions above and Detailed Summary below for details on the vote.) Final versions of the letters are posted on the NCVHS website.

NCHS Update – Charlie Rothwell, Director

In addition to briefing the group on NCHS staffing and budget, Mr. Rothwell described the recent early release of the National Health Interview Survey (HIS), containing the first data on health insurance coverage since implementation of the Affordable Care Act (ACA). He commented on “what a federal statistical agency is about… and why they are important.” In mid-September, NCHS and the Census Bureau held a joint technical briefing and webcast for researchers and policymakers, to talk about why NCHS (HIS) and the Census Bureau (CPS) collect health insurance information. NCHS plans further such events with other federal statistical agencies, to talk about why we need a federal statistical system. In response to a member question, he suggested that the NCVHS Subcommittee on Population Health consider looking at how to get data on health care that occurs virtually.

Review Committee on Data Standards – Mr. Scanlon, Dr. Suarez

Section 1104 of the ACA requires the Secretary to establish a Review Committee to advise HHS and the industry on “how we are doing with administrative simplification” by assessing the impact of adopted standards and operating rules. In June, NCVHS indicated its willingness to serve in this capacity; and the Secretary has now designated NCVHS to serve as this Review Committee. Dr. Suarez presented the draft charter for discussion. The Review Committee’s work will be accomplished primarily by NCVHS members during regular NCVHS processes. Regular hearings will be convened at least biennially, in accordance with FACA policies and NCVHS practices. The hearings will lead to recommendations to the Secretary (after approval by NCVHS) on the need to update specific standards. This work will be coordinated with ONC.

Members discussed the charter and operational questions, and agreed to reserve time in the December full Committee agenda to consider how NCVHS will carry out the charter, set goals, and explore ties to the roadmap.

On day two, they approved the final charter. It will be posted on the NCVHS website, and an announcement of this action will be sent to the NCVHS email list. In future NCVHS meetings, all full Committee agendas will include a category for the Review Committee.

Toolkit on Community Data Stewardship – Dr. Francis, Ms. Kloss, Ms. Henry

After Dr. Francis described its development, Ms. Kloss took the group through the stewardship toolkit and invited suggestions and discussion. Following wide-ranging discussion, she said the Privacy Subcommittee would work further on it after the meeting. She asked the Committee to arrange a virtual meeting to approve it when ready. Members agreed to participate in a publicly announced conference call to take action, prior to the December meeting.

Subcommittee on Population Health – Drs. Cohen and Stead

This session focused on plans for the October NCVHS Roundtable on Supporting Community Data Engagement, discussion of the Overview and Status Report on the NCVHS Framework Project, and the relationship between the two. Members had suggestions for the Roundtable agenda, participants, and ways to consolidate and clarify the findings and use them in recommendations. They also discussed ways to use and build on the Framework Project report in the Roundtable and to create an ongoing dialogue that will develop the Framework. At Dr. Stead’s request, members shared ideas about how to develop and disseminate the Framework report. They agreed to talk further about converting it into a working document and getting more input into it.

There was support for Dr. Cohen’s idea of pulling together all the Committee’s reports on communities into a body of NCVHS work on communities as learning systems “our own rainbow series of documents.” The group agreed to consider this further at the December meeting.

Final sessions

(See detailed summary for further information on these brief sessions.)

At Dr. Green’s request, members shared their thoughts and suggestions on meeting process, based on this meeting.

At Ms. Kloss’s request, the group suggested ways to publicize and disseminate the new stewardship toolkit.

Dr. Mays briefed members on plans for the Working Group on Data Access and Use.


DETAILED SUMMARY

– Day One –

Welcome and Introductions

NCVHS Chair Dr. Larry Green called the meeting to order, and all those present introduced themselves.

Updates from the Department

  • ASPE – Jim Scanlon

Mr. Scanlon noted that the new Secretary of HHS is Sylvia Burwell Matthews. The Department continues its strategic plan, with four goals and 21 objectives. ASPE manages a system to monitor progress toward the objectives. It is also monitoring the impact of health care reform implementation through administrative data and surveys. In addition to looking at the general impact of the ACA, ASPE wants to increase the capacity to look at the status of vulnerable populations with respect to access and quality.

Another dimension of the Data Council data strategy is increasing the timeliness of data release notably, shorter turnaround from field data collection to getting the data to HHS. The third part of the strategy is data alignment and integration across administrative data, EHR data, and research survey and surveillance systems, to improve health and health care and human services. He described several strategies for that.

ASPE will be looking at ICD-10 implementation and provider surveys in terms of their impact on measurement. It is also looking at the impact of the ACA on the roles and functions of state and local public health institutions.

Discussion

NCVHS members had questions on studying short- and long-term health impacts of health care reform, improving the data on subpopulations, HHS research on access, and plans to use the new information on access required from insurance companies.

Dr. White offered to report in December on AHRQ statistical briefs on the impact of ACA implementation, and Dr. Green asked him to do so.

  • CMS – Todd Lawson, CMS

Mr. Lawson described a range of CMS activities to prepare for and support ICD-10 implementation. One is end-to-end testing of claims submissions and remittance advice, with 3 opportunities in 2015. Stakeholders can also conduct acknowledgement testing at any time with their MACs. CMS also has developed educational materials, events, and resources on ICD-10, and it has a national training collaborative with biweekly national planning calls as well as ongoing email updates. The CMS ICD-10 website has many resources; and the Center will pilot a direct mail flyer to small practices in four states, expanding it if it’s successful.

On other subjects, CMS has approved 776 of the 889 Health Plan Identification Number applications received. And it is seeing an increased use of electronic funds transfer for health transactions. CMS is evaluating the recommended approach to X12 schemas.

Discussion

Most of NCVHS members’ questions concerned the transition to ICD-10, including state Medicaid agencies’ preparedness, participation in testing, and contingency plans if the testing fails. Ms. Greene of CMS stressed the emphasis at CMS on helping providers prepare early.

ONC – Judy Murphy (slides)

Ms. Murphy reported on the latest EHR adoption statistics and the 2014 attestation, Meaningful Use CEHRT flexibility and Meaningful Use 2014 edition release 2, re-aligned FACA workgroups, and the 2014 FACA work plan. 92 percent of eligible hospitals and 76 percent of Medicare and Medicaid eligible professionals have received an EHR incentive payment, totaling $24.8 billion. The hospital numbers for 2014 attestations have been relatively low, and ONC has been looking into the sticking points such as a lack of trading partners for care transitions. However, the good news is that it is spreading to non-eligible providers. She described the flexibility with regard to Meaningful Use CEHRT attestation and showed several options for Stages 1 and 2.

A final rule for the 2014 edition of certification criteria was published on September 11. It is pared down from the original version proposed in February 2014. Ms. Murphy described the attempts to address the confusion around the naming convention. The idea is to “stick with the year it was to be enacted or used for the first time.” ONC will publish a proposed rule for the next edition of EHR certification criteria with the CMS EHR Incentive Program’s proposed rule by the end of 2014.

She turned to the realignment of HIT Policy Committee’s workgroups and chairs (slide 15). There are six workgroups, providing both continuity and change from the previous structure. She also presented the FACA work plan for 2015 (slides 16 and 17). A roadmap is to be released at a joint meeting on October 15. Dr. DeSalvo is chairing a group that has been working on an HHS-wide health IT strategic plan.

Discussion

Members had questions and comments on a national dialog on the roadmap, cross-fertilization between ONC FACAs and NCVHS, and the status of other ONC programs. Ms. Murphy welcomed Ms. Kloss’s offer for the Subcommittee on Privacy, Confidentiality and Security to look at the topic of e-measures. She agreed to include in future updates information on efforts to align policy levers, funding, and HIT plans across multiple agencies. Dr. Suarez asked about progress toward a merit-based payment system (MIPS), stressing its potential for transformative change in the quality measurement arena. Dr. Green underscored the Committee’s interest in convergence of all kinds, including this lever for consolidating three quality measurement systems.

  • ONC Privacy and Security Update – Julie Anne Chua (slides)

Ms. Chua reported on an ONC data provenance S&I initiative, including the goals, intended outcomes, issues, challenges, and progress to date. The agreed-upon definition is: “The term provenance refers to attributes about the origin/source of health information at the time it is first created and tracks the uses and alterations of the health information over its lifecycle.” Its development was preceded by a landscape analysis by the Office of the Chief Privacy Officer, which generated a white paper.

The goals of the Standards and Interoperability (S&I) initiative are to raise the visibility of the source of and alterations to health information; to improve stakeholders’ confidence in the reliability and authenticity of data by identifying the source and tracking any changes; and to facilitate interoperability and health information exchange by establishing a standardized way to capture, retain, and exchange the provenance of health information. At present, there is no authoritative specification, standard, or model for provenance within HIT; and HIEs, EHRs, and PHRs vary in the ways they capture, retain, and display provenance. Another challenge involves differences in system capacities .

The S&I initiative works with the community on specific challenges, and depends on volunteer participation. The community will create technical specifications, guidance for handling data provenance, and a minimum set of provenance data elements and vocabulary. Ms. Chua outlined the steps for phase 1 and the progress to date. The initiative launched in April 2014; consensus on the charter was achieved in June; and it worked on use cases and user stories until mid-September. It is also supporting an HL7 data provenance project and working with HL7 workgroups on vocabulary harmonization. Participation is encouraged.

Discussion

NCVHS members asked questions about data segmentation and granularity. Dr. Green stressed the Committee’s strong interest in coordinating and collaborating with ONC, and its appreciation to Dr. DeSalvo and others for their efforts to see that that happens.

  • OCR Health Information Privacy Update – Rachel Seeger (slides)

Ms. Seeger announced that OCR’s new director is Jocelyn Samuels, who has a strong enforcement background in civil rights and provides continuity with the former director, coming from the same division of the Department of Justice, with which OCR collaborates closely.

She then updated the group on the “three pillars” of the HIPAA privacy division enforcement, policy, and communication. OCR had an enforcement action against Parkview Health System that underscores the importance of proper disposal of patient information. Parkview has paid OCR $800,000 and undertaken a robust corrective action plan. On September 19, OCR issued new guidance on HIPAA and same-sex marriage. It will issue additional clarifications in this area in the coming months. Finally, she previewed the 7th annual OCR/NIST Conference on Safeguarding Health Information, which takes place September 23-24 in Washington, DC.

Discussion

Members commented on the value of OCR’s guidance and asked about privacy issues related to data on sexual orientation (OCR is working on an NPRM on Section 1557 of the ACA) and how NCVHS can be helpful to OCR.

Five Letters on Standards – Dr. Suarez

Introducing this portion of the meeting, Dr. Green remarked on the immense volume of work represented by the five letters the Committee is being asked to approve at this meeting. Dr. Suarez then began a presentation of the letters in a lengthy session that spanned the lunch-hour. They cover seven topics, which the Subcommittee on Standards chose to cover in separate letters because of their distinctness and importance. The developmental process included hearings and posting the draft letters for public feedback, which generated valuable feedback from industry. The subjects of the five letters are:

  1. ASC X12 XML Schemas
  2. Virtual credit cards and credit card use
  3. Incorporation of the Unique Device Identifier (UDI) in administrative transactions
  4. Health care claim attachments
  5. Coordination of benefits, Health Plan Identifier (HPID), and ICD-10 delay

As he presented each letter, Dr. Suarez described the focus, major findings from hearings, proposed recommendations, industry input on a draft, and changes made in response to industry input. The Committee then discussed each letter, and suggested revisions. (Details of the presentations and discussions are in the searchable transcript posted on the website.)

On letter 2, Ms. Goss suggested that a CI expert be invited to future NCVHS hearings on this topic.

On letter 3, Dr. Francis prompted discussion by asking about possible privacy issues with the UDI. Several members were of the opinion that there are indeed privacy implications. In response to comment from Dr. Chanderraj, Dr. Green noted that the clinical community is hungry for the UDI matter to be decided. From the audience, as public comment, Stanley Nachimson, who has been working with the Pew Foundation and others on the UDI, explained input already made in writing by the organization to the Committee, cautioning against imposing a greater burden on UDI adoption than what has been placed on other data elements.

Revised versions of the five letters were presented for approval on day two. (See below.)

NCHS Update – Charlie Rothwell, Director

Mr. Rothwell reported that Ms. Jackson would continue as Acting NCVHS Executive Secretary until the position is permanently filled, a process that is under way. There are also vacancies for NCHS Deputy Director and chief information officer. He announced that Jane Gentleman has retired from the Division of Health Interview Statistics, and expressed great appreciation for her contributions over many years. Marcie Cynamon has been appointed acting director of that division.

He then described the recent early release of the National Health Interview Survey (HIS), containing the first data on health insurance coverage since the ACA was in place and showing a significant impact. In that context, he commented on “what a federal statistical agency is about… and why they are important.” In mid-September, NCHS and the Census Bureau held a joint technical briefing and webcast for researchers and policymakers to talk about why NCHS (HIS) and the Census Bureau (CPS) collect health insurance information, as they have for decades. In an unusual move, Census released poverty data as well. The issues surrounding these actions included both politicization of data release decisions and the usual timeliness issues. Mr. Rothwell said he liked the pressure to release data more quickly. NCHS plans further such events with other federal statistical agencies, to talk about why we need a federal statistical system.

Regarding the budget, he said “things are looking good” compared to many other agencies, though there are concerns that reduced funding to CDC’s prevention fund could result in less money for NCHS in the next fiscal year. This is likely to result in smaller sample sizes and no state estimates. NCHS will be redesigning HIS in coming years, with fewer questions.

Discussion

In response to a member question, Mr. Rothwell suggested that the NCVHS Subcommittee on Population Health or the Board of Scientific Counselors look at how to get data on health care that occurs virtually. To another question, he predicted some of the consequences of reduced budget and said NCHS is “spread very, very thin,” notably in the methodological staff who will be looking at the HIS redesign.

Review Committee on Data Standards – Mr. Scanlon, Dr. Suarez

Mr. Scanlon reminded the group that Section 1104 of the ACA requires the Secretary to establish a Review Committee to advise HHS and the industry on “how we are doing with administrative simplification” by assessing the impact of adopted standards and operating rules. In June, NCVHS indicated its willingness to serve in this capacity and the Secretary has now designated NCVHS to serve as this Review Committee. He stressed that the idea is for the functions to be carried out in the Committee’s normal processes of review, reflection, and assessment. The next step is to finalize a charter and move forward on a work plan and approach.

On behalf of the Committee, Dr. Suarez expressed excitement at this opportunity. He and Mr. Soonthornsima have worked with HHS staff to draft a charter for the Review Committee. He read the draft charter and reiterated that the focus is on standards adopted already. The charter drafters attempted to be clear about the difference and boundaries between the role of the Review Committee and that of the Subcommittee on Standards, to which responsibility for the Review Committee is delegated. The Subcommittee works on three areas: 1) new health care administrative transactions not yet addressed by HIPAA regulations; 2) existing transactions named in HIPAA regulations; and 3) a range of other topics. The Review Committee will only be responsible for things in the second area. There is the possibility of forming time-limited, purpose-focused task groups within the Review Committee including non-NCVHS members. The Review Committee’s work will be accomplished primarily by NCVHS members, during regular NCVHS processes. Regular hearings will be convened at least biennially, in accordance with FACA policies and NCVHS practices. The hearings will lead to recommendations to the Secretary (after approval by NCVHS) on the need to update specific standards. This work will be coordinated with ONC.

Dr. Green asked members for comments on the draft charter. The comments and questions revolved around two themes: the possible need to look at topics beyond HIPAA and the possible need for information from sources other than hearings (e.g., ways to get data on what is and is not working, to guide and inform the hearings); and practical operating suggestions such as having a checklist of all the relevant standards and operating rules as an ancillary working document.

Members agreed to look further in the future at questions such as what information the Review Committee will need to be able to assess how well things are working. Also needed is a clear process for resolving “gray areas” of topics not clearly in one category or another. Broadly speaking, Ms. Kloss recommended that NCVHS take time to deliberate on how the Committee will carry out the charter and set goals, since all of the burden need not fall only on the Subcommittee on Standards . Ms. Goss suggested deliberation on what needs to be accomplished and how it ties to the roadmap. These subjects were agendized for the December 2014 meeting, which is envisioned as a planning-oriented meeting.

In response to a question, Mr. Scanlon stated that he will report that the Review Committee has been established and was launched as of this meeting. He cautioned that resources will not be available for any surveys or “big evaluation.” The final charter will be presented for action on day two, and will be posted on the NCVHS website.

Toolkit on Community Data Stewardship – Dr. Francis, Ms. Kloss, Ms. Henry

Dr. Francis described the development process for the new toolkit and acknowledged the hard work of Maureen Henry and the contributions of participants in an NCVHS webinar held to receive comments.

Public comment: Michael DeCarlo spoke on behalf of the Confidentiality Coalition, a broad group founded to advance effective patient confidentiality protections. The Coalition supports the toolkit and believes it provides a useful framework for community users and others. It hopes to work with the Committee to make minor revisions to the section on de-identification. At the Committee’s request, he participated in the later discussion of that topic. (See transcript for details.)

Ms. Kloss then moved through the toolkit, inviting comments and discussion of each section. The first topic to arise concerned the audience for the toolkit and the relative merits of broad versus narrow audience-targeting. Dr. Cohen observed that several audiences can benefit from the content, while Ms. Milam argued that the greatest value will come from tailoring it to a specific set of uses. Dr. Stead suggested inserting “hooks” in what is essentially a general primer, directing readers to experts as needed.

Members suggested several revisions to the toolkit. Ms. Milam expressed concern about the section on security, and Victor Richardson, public health law fellow at West Virginia Health Care Authority, offered suggestions. Dr. Walker proposed including simple heuristics and rules of thumb, developed by experts, that could be useful to this audience, targeted to what are known to be the greatest risks for the target audience.

Concluding this session, Ms. Kloss said that because the recommendations and comments are “beyond editorial,” the Subcommittee will work further on the toolkit after the meeting. She asked the Committee to arrange a virtual meeting to approve it when ready. Following discussion, the Committee agreed to participate in a publicly announced conference call to take action prior to the December meeting.

Working Group member Dr. Vaughn called attention to the growing volume of health-related data on individual patients and communities generated as “commerce” but being used for policy, with both beneficial and harmful effects. This includes both donated data and repurposed data that “fall through the cracks” as a “product.” She also pointed to the emerging community of vocal, non-geographic e-patients. Ms. Kloss said the Committee’s definition of community is broad enough to encompass non-geographic communities.

– Day Two –

Subcommittee on Population Health – Drs. Cohen and Stead

This session focused on plans for the October NCVHS Roundtable on Supporting Community Data Engagement, discussion of the Overview and Status Report on the NCVHS Framework Project, and the relationship between the two.

Dr. Cohen explained that the purpose of the Roundtable is to bring together community data users, data connectors (intermediaries), and data suppliers to discuss how best to share information, what each group needs and can provide, and how they can be more helpful to each other. The main emphasis at the meeting, which will be facilitated by Monte Roulier of Community Initiatives, will be on enabling generative dialog. An overarching goal is to identify actionable recommendations to the federal government on how it can reorient its work to be more useful and valuable at the community level. The Subcommittee developed an online feedback tool to gather input on local practices, disseminating it through NCVHS members’ networks. Dr. Cohen said he’d like to see the tool continually in the field, accumulating more feedback.

In addition to a few comments on the Roundtable agenda, members had these suggestions:

  • Ask about failures to access data because of a refusal to provide the data.
  • Talk to CTSIs.
  • Include health care provider organizations and look at their role as data suppliers, and/or ask communities about what data they have gotten from health care organizations.
  • Look at multi-payer database initiatives.
  • Aim for explicit findings from the three perspectives, to serve as the basis for developing recommendations; design a table to record and display this.

Dr. Cohen observed that there may be a need for one or more follow-up meeting to the Roundtable, to build on the momentum from this set of interactions.

Dr. Stead then commented on the report on the Framework Project, which is seen as “a snapshot of a generative process” that will continue the development of a set of classification resources. He observed that “it will continue to live in a word processor” as it continues to be developed and fleshed out. Ms. Goss described “creating an ongoing dialogue, since it is a living, breathing document.”

Mr. Scanlon suggested framing the project as generating recommendations for “the whole ecosystem of data producers,” not just the federal government. Others suggested minor revisions to the report. In response to the discussion, Dr. Stead observed, “You just relived the complexity that we discovered in the workshop. We learned that we have got to face up to this messiness and try and end up with an extensible taxonomy that is something we can point to and understand.”

Roundtable participants will be sent copies of the report (revised based on this discussion) prior to the meeting, to show them how NCVHS is thinking about the complexity of what needs to happen. At the Roundtable, Dr. Stead will modify the Framework with relevant community inputs on specific data needs and uses. He asked for members’ thoughts about developing and disseminating the report. (There was discussion of providing Roundtable participants the stewardship toolkit, as well, and eliciting feedback on both documents and their dissemination either during or after that meeting.)

Ms. Kloss suggested revising the Framework report after the Roundtable to be a standalone concept paper, without a narrative on the June workshop that helped to develop it. The report/paper could then be used to engage groups in dialogue for example, at the AMIA meeting in November. She suggested pairing it with the 2002 NCVHS report on a Health Statistics Vision for the 21st Century, which lays out a foundational vision that is fleshed out in the Framework. She suggested brainstorming about how to make the Framework report into a working document and getting more input into it.

There was support for Dr. Cohen’s related idea of pulling together all the Committee’s reports on communities into a body of NCVHS work on communities as learning systems “our own rainbow series of documents.” The group agreed to consider this further at the December planning and visioning meeting.

Action on Standards Letters – Dr. Suarez

Dr. Suarez presented the five letters that were discussed the previous day and subsequently revised by the Subcommittee on Standards:

  1. Re: ASC X12 XML Schemas
  2. Virtual credit cards and credit card use
  3. Incorporation of the Unique Device Identifier (UDI) in administrative transactions
  4. Health care claim attachments
  5. Coordination of benefits, Health Plan Identifier (HPID), and ICD-10 delay

For each letter, he described the changes made and entertained comments and suggestions. There were a few or no edits to each one. For each letter in turn, a motion to approve it was passed. The votes were unanimous in all cases except for letter 5 (see below).

In the discussion of the letter on the ICD-10 delay, Dr. Chanderraj commented on the cost of ICD-10 implementation for health care providers and the additional cost if implementation is delayed further. He moved to amend the letter to add this point, and the motion was seconded. Mr. Scanlon said there was a full and transparent benefit/cost analysis, with opportunities for industry comment. After discussion, a vote on the amendment did not pass. Following that vote, a motion to approve the letter passed with one vote opposed.

The Committee also passed a motion authorizing NCVHS leadership to address any minor editing issues in the letters before they are finalized.

Final versions of the letters are posted on the NCVHS website.

Action on Review Committee Charter – Dr. Suarez

Dr. Suarez reported that because of the strong support for the charter, the Subcommittee on Standards made no changes to it except to add comments and side notes on the matters suggested on day one concerning process, worksheets, and the larger NCVHS discussion. The Committee then passed a motion approving the Review Committee charter.

Next, members explored ideas for spreading the word that the Review Committee has been established. The charter will be posted on the NCVHS website, and the Committee’s mailing list will be notified about its posting. Beyond that, Mr. Scanlon said HHS would handle any further announcements, possibly a press release. Ms. Kloss suggested extracting a short statement of the purpose and structure of the Review Committee from the charter for use in the publicity.

Dr. Green stated that the new standard operating procedure would be for NCVHS full Committee agendas to include a category for the Review Committee. Any recommendations or actions generated in that context will be processed through the full Committee, which will continue to function largely as a Committee of the whole. He thanked Mr. Scanlon and the Department for the opportunity for NCVHS to serve in this manner.

Comments on Meeting Process

At Dr. Green’s request, members offered comments on recent NCVHS process, which has included some innovations. The large majority of comments were very positive, especially about working as a Committee of the whole and encouraging convergence. However, members also noted the challenges of the heavy workload between meetings. Some suggestions:

  • Establish a routine cycle of virtual meetings between face-to-face meetings, and schedule them well in advance.
  • Create a master calendar.
  • Keep working on how to regulate and manage the workload.
  • Try using SharePoint to keep up with the latest drafts of documents.
  • Provide timely feedback on documents that are in development.
  • Keep doing the dinners on day one, and encourage everyone to attend.
  • Keep an eye on staying at the right level of detail to be able to handle a broad agenda.
  • Publishing draft letters early to get industry input is a useful process.

Mr. Scanlon thanked NCVHS members for their service and encouraged them to take advantage of ways to make the work easier, including virtual meetings. He said the Department was working on filling the current member vacancies and the ones that will occur in 2015.

Ms. Jackson announced that there would be a dinner social on December 2.

Finally, Dr. Green praised the extraordinary spirit of voluntarism and high standards that animate the Committee.

Subcommittee on Privacy, Confidentiality and Security

Ms. Kloss thanked the group for their valuable input on the toolkit. She asked for suggestions about dissemination of this online resource. These dissemination channels were suggested:

  • Campus-Community Partnerships for Health (next meeting May 2015)
  • APHA community health group (next meeting 11/15-19)
  • American Public Data Users Association
  • Public Health Institutes
  • State Departments of Health, via ASTHO or CSTE
  • Health care delivery system privacy officers
  • RWJF
  • Community Commons
  • FQHCs
  • Institute of Medicine office responsible for learning system work
  • Word of mouth by NCVHS members
  • American Society for Bioethics and Humanities
  • Hastings Center
  • Public Health Law Network
  • Public health schools
  • Association of Community Organizers and Social Administrators
  • NCVHS mailing list
  • HHS Office of Civil Rights
  • HIT Policy Committee

Dr. Green underscored that there should be an active approach to disseminating the report, because of its excellence. He also confirmed that there would be a virtual meeting in November to approve the toolkit.

Briefing on the Working Group on Data Access and Use – Dr. Mays

Dr. Mays reported that since becoming Working Group Chair, she has talked with members individually to get a better sense of their skills and interests. Future meetings will have two phases: first, hearing from Damon Davis and other HHS staff working on data programs (e.g., NHIS) about what HHS is doing, and offering suggestions on getting the information out; and second, working together on a project. The first project will be to develop guiding principles for preparing data for release in ways that optimize access and usability. A final portion of the meeting will be reserved for announcements from Working Group members about forthcoming events and activities of interest to others.

Final Committee Business

Finally, Mr. Scanlon asked all NCVHS members to be prepared to attend the June 2015 meeting. After Ms. Jackson acknowledged the NCVHS staff team of Katherine Jones, Marietta Squire, Nicole Cooper, Tammara Jean Paul, and Jeannine Christiani, Dr. Green adjourned the meeting.