[This Transcript is Unedited]

National Committee on Vital and Health Statistics

National Health Information Infrastructure (NHII) Workgroup

January 29, 2004

Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington , DC 20201

Proceedings by:
CASET Associates, Ltd.
10201 Lee Highway, suite 160
Fairfax, Virginia 22030
(703) 352-0091

TABLE OF CONTENTS

P R O C E E D I N G S [8:10 a.m.]

Agenda Item: Introductions – Dr. Lumpkin

DR. LUMPKIN: I’d like to encourage our new members to join us at the table,
take an empty slot.

MS. GREENBERG: — if the old time members aren’t here then take their
spots.

DR. LUMPKIN: Basically what I thought we would do today are three things,
the first is to just recap what we did at our retreat, when was the retreat,
last year, our last meeting, an update on some developments in Connecting for
Health, then finally an overview discussion and status of where we’re moving in
the conference in early summer, late spring, or whenever.

DR. YASNOFF: It won’t be late spring, early summer would be the earliest.

DR. LUMPKIN: Okay, because spring is June 22.

DR. STEINDEL: Yeah, that means it’s after June 22.

DR. LUMPKIN: In summer. Any other items that we want to —

MS. GREENBERG: Maybe what your plans are for the February 18th
meeting.

DR. LUMPKIN: And then our plans for the February 18th meeting
which would be like number four. Okay, 3.5.

DR. YASNOFF: Are we live on the internet?

MS. GREENBERG: We’re being taped, we’ll have a transcript, but we’re not on
the internet.

DR. LUMPKIN: So we’re going to start off going around the room for
introductions so everyone gets to know each other. My name is John Lumpkin and
I’m senior vice president of Robert Wood Johnson and chairing the workgroup.
And why don’t we go this way.

DR. DEERING: Mary Jo Deering, Office of Disease Prevention and Health
Promotion and lead staff to the workgroup.

MS. WILLIAMSON: Michelle Williamson, CDC, NCHS, and staff to the workgroup.

DR. WARREN: Judy Warren, University of Kansas.

DR. STEINDEL: Steve Steindel, Centers for Disease Control and Prevention,
staff to the workgroup and liaison to the full committee.

MR. HOUSTON: John Houston, University of Pittsburgh Medical Center, member
of the full committee and member of the subcommittee, NHII Subcommittee.

DR. LUMPKIN: Well, we’re a workgroup.

MR. HOUSTON: Workgroup.

MR. HUNGATE: Bob Hungate, Physician Patient Partnerships for Health, member
of the workgroup.

DR. VIGILANTE: Kevin Vigilante, new member, Brown University.

DR. YASNOFF: Bill Yasnoff, senior advisor NHII, and Office of the
Secretary, and liaison to the workgroup.

DR. ORTIZ: Eduardo Ortiz, Agency for Healthcare Research and Quality and
staff to the working group.

DR. CARR: Justine Carr, new member, Beth Israel Deaconess Medical Center in
Boston.

DR. HARDING: Richard Harding, Department of Neuropsychiatry, University of
South Carolina.

DR. FERRER: Jorge Ferrer, staff to the workgroup, CMS.

DR. LUMPKIN: Why don’t you have a seat at the table?

DR. FERRER: I didn’t see my name —

DR. HUFF: Stan Huff, Intermountain Health Care, Salt Lake City.

MS. GREENBERG: Marjorie Greenberg —

DR. LUMPKIN: Actually I’m going to suggest we go around the room quickly
one more time. John Lumpkin.

DR. DEERING: Mary Jo Deering.

MS. WILLIAMSON: Michelle Williamson.

MR. HOUSTON: John Houston.

DR. WARREN: Judy Warren.

DR. STEINDEL: Steve Steindel.

MR. BLAIR: Jeff Blair.

DR. COHN: Simon Cohn.

MR. HUNGATE: Bob Hungate.

DR. VIGILANTE: Kevin Vigilante.

DR. YASNOFF: Bill Yasnoff.

DR. ORTIZ: Eduardo Ortiz.

DR. CARR: Justine Carr.

DR. FERRER: Jorge Ferrer.

DR. HARDING: Richard Harding.

DR. HUFF: Stan Huff.

MS. GREENBERG: And since I never got a chance to officially introduce
myself, Marjorie Greenberg, National Center for Health Statistics, CDC, and
executive secretary to the committee.

DR. LUMPKIN: As I mentioned before as we’re getting started we’re going to
try to cover in a very quick order four items. The first item is a quick
overview of our last meeting, second item is a quick update on Connecting for
Health and how that fits in with our strategy. Third item is the upcoming
meeting in summer, and then the fourth item is our meeting on the
18th of February.

Agenda Item: Overview of Last Meeting – Dr. Lumpkin

We had at our last meeting just to sort of recap, we looked at what we
would want to do over the next year or two what we, we’re looking to do is
develop a seven to ten year vision and approach to what the NHII should look
like as a long term vision. That we would look at developing metrics for
progress towards the vision, look at some of the financial models and
incentives and how we can align those models and incentives with the vision.
Look at fleshing out perhaps as we, and just to remind, those of us who were
there when we developed the report remember but we struggled with what we
should call those things that we ended up calling dimensions, one of them were
views, and it really is how does the NHII look to certain groups of people and
we felt that it needed to look for patient, providers, and for the population
health dimension, it needed to work there if it was going to be successful. One
of the thoughts was to flesh out other dimensions, such as the payer/purchaser,
research and public policy. We also thought we needed to as part of our report
to look at the business case in NHII and go through the pieces, the legal, the
policy, the standards, and architecture as part of developing a seven to ten
year roadmap.

That’s kind of the vision, as we worked through that we thought that it
would, as our work plan move forward, the upcoming conference that the NHII
Office in ASPE was planning might be a very good vehicle to sort of kick off
and focus on discussion and help us accelerate the process of developing this
vision.

MR. BLAIR: When we had our NHII report November 2001 I think in the report
we put forth what I think of as a vision, so at least in my mind I was thinking
that what Bill is developing and what we would be sharing with the industry is
more a series of models going a little bit past the vision. I was just thinking
of it to distinguish it from what was in the report, it’s not quite to the
level of an architecture but it’s at least a series of models. Do you, am I
going too far, am I not in sync?

DR. LUMPKIN: I think that’s consistent with our discussion. Bill?

DR. YASNOFF: I believe the word roadmap was used and I think that’s exactly
consistent with the discussion. Certainly I didn’t hear anything at that
meeting indicating a desire to go back over what the report that was already
done but rather fill in more detail in terms of how it’s going to look and how
we’re going to get there.

DR. LUMPKIN: Any other comments? Is that how we remember our work plan and
thoughts from our full day meeting?

DR. YASNOFF: I think I was asked, or I volunteered, or both, to provide
discussion documents on as many of these areas as possible and I intend to do
that for the February 18th meeting so that we don’t have to start, I
mean you can accept them or not but at least you have something to discuss.

DR. DEERING: I had a couple notes that certainly as you said the conference
is sort of the middle piece chronologically in this year and a good kick off
point and to, my notes say to assist in the planning and see what it can and
what the gaps are when it’s over and map out hearings in the second half of the
year to fill the gaps, and then have those concluded either by the end of the
calendar year or by January of ’05 and write the report in ’05, and then
possibly present a draft of the report at the ’05 NHII Conference.

You may have mentioned it amongst the discussions that came out and again,
pardon me if you did mention it, it was this notion of focusing more on the
interfaces among them, did you —

DR. LUMPKIN: Yes, my eyes went over that line but the words did not come
out of my mouth. But I did say flesh out, because we wanted to look at the
overlap areas.

Agenda Item: Connecting for Health – Dr.
Lumpkin

Okay, that review over, the next item on the agenda is Connecting for
Health and some potential for work for us as a workgroup, I assume most of the
people here are familiar with Connecting for Health, which is an initiative
that started out with the Markle Foundation, a public/ private partnership
looking at intercedes or what can be done to accelerate the process of
improving health informatics connectivity and it has a fairly broad steering
committee representing many areas and I’ve been the co-chair. And one of the
concerns that we’ve had is how does this fit with everything else that’s going
on and with what we’re doing. Simon has worked with the standards workgroup a
little bit.

After we had our meeting the leadership of Connecting for Health sort of
looked at the NCVHS, our activity as being the long range perspective and what
they’re tending to do over the next nine months is to develop a short term
roadmap for what are the tasks that need to be done within the short timeframe
of a couple years in order to assure that the vision moves forward.

The leadership of Connecting for Health in the sense of full disclosure, my
organization is now a grantee to the Connecting for Health process.

MS. GREENBERG: You’re getting a grant from them or they’re getting a grant
from you?

DR. LUMPKIN: We’re giving them a grant. We don’t get grants. They are our
grantees, from the Robert Wood Johnson Foundation in order to assist in this
particular process. The intent and I think the interest would be is that to the
extent that they develop a short term roadmap, which would be defined as
anywhere from four to six things that ought to be done in the near term, that
that would then come to our workgroup as a presentation and should we decide to
make any recommendations to the department along the lines of this
public/private partnership recommendation then that would be brought through
the department through the auspices of the NCVHS as a recommendation, which is
we agree with it, we disagree with it, well, obviously if we disagree with it
we probably just wouldn’t say anything, but if we agreed with it
recommendations for modification along the lines of some of the work that we’ve
done for CHI.

The department is a participant as amongst any other parties in the
Connecting for Health Initiative and there is no easy way for them to look at
these recommendations without going through a back up committee.

DR. COHN: Cause for hearings in other words.

DR. LUMPKIN: Right. I think it would be a hearing where we would use the
hearing basically as saying do these things that make sense as the short term
roadmap and then do they sort of fit in with where we’re going in our long
term.

DR. COHN: What is the timeframe of their recommendations, is something
spring where that information would feed into a longer term roadmap?

DR. LUMPKIN: I think they’re actually looking for a shorter timeframe,
maybe the fall.

DR. COHN: A longer timeframe.

R. LUMPKIN: Fall of ’04.

DR. COHN: Okay, okay.

MR. BLAIR: So then they would have the benefit of what Bill is able to
develop as the longer term set of models first so that they could be heading
towards the seven to ten year, they could be within that longer term goal.

DR. LUMPKIN: I think the level of detail and perspective are different, I
think our perspective is going to be the 30,000 view. I think they’re looking
to say, I don’t know what would be a good example of something that needs to be
done in the short term, maybe there needs to be some consensus on the
architecture like we had as a discussion at our table last night for those who
weren’t at our table, saying somehow we have to decide is this vision going to
be a peer to peer or is it going to be a spoken hub, some of those decisions
need to be made in a relatively short period of time. That I don’t think is
going to be something in a seven to ten year vision the horse will already be
out of the barn, but that may be something and I’m not saying that that will be
but that would be an example of the kinds of things that may come out.
Something looking in two to three years time that the industry and providers,
the government and the public/ private partnership should say these are things
we should do.

MR. BLAIR: May be the point I was trying to make was that it is going to be
very helpful to have somebody who’s going to say what should we do for the next
two to three years, and I think that if they’re going to wind up presenting
that to us in the fall that would be very helpful because that means that in
June we would wind up at least having some flesh on the bones for where we’re
trying to head seven to ten years from now and they could be on the same path,
working in the same context and that’s what I was trying to say.

DR. STEINDEL: I’m having a little bit of confusion on dates. We’re having a
meeting this, NHII is having a meeting this June, right Bill?

DR. YASNOFF: July.

DR. STEINDEL: Summer. And so Jeff are you talking about using the results
from this meeting to fulfill the short term Connecting for Health?

DR. LUMPKIN: No, actually I think what Jeff is saying, you’ve got the June
meeting, I’m sorry, the summer meeting, after June 22nd meeting, the
presentation in the fall by Connecting for Health, and then the following year
we do our vision so there’s synergy and alignment that can occur as part of
that interface, by the time we will have had enough time to process the summer
meeting in the fall to be able to evaluate the recommendations that will be
coming to us.

DR. STEINDEL: Now for putting my Mary Jo staff timeframe hat, if we want to
send a letter to the Secretary concerning the Connecting for Health roadmap
that means we have to put it before the full committee, which means that we
have to have our committee meeting either, for this hearing, either before the
September meeting or before the November meeting.

DR. LUMPKIN: Or, I don’t think, let’s suppose they get done in
September/October because I just don’t remember the timeframe, but we would
probably want to do a hearing and my guess would be that we would then be
talking about our winter meeting rather then our late fall meeting.

DR. STEINDEL: That fits in with their timeframe then, okay, that’s what I
was trying to get on the schedule.

DR. COHN: And doing a letter in the middle of elections is not going to be
a very productive activity.

DR. STEINDEL: That’s fine, I just wanted to get the timeframe down.

MR. HUNGATE: There’s a window —

DR. LUMPKIN: Then they’ll be a whole transition period and making
recommendation in that period of time and I think we need to, first of all we
need to as the process goes through is make sure that that’s something we still
want to do —

DR. DEERING: Speaking of details of deliverables, I’m hearing a couple of
different things that are not necessarily mutually exclusive but I just wanted
to get them both on the table. We know that we will hold one or more hearings
sometime in the fall that would encompass not only Connecting for Health I
would assume but perhaps some other things that we’ve determined based on the
work that we already know they’re doing, in advance of hearing from them and
Bill’s conference and the HHS conference, so we’ll see some things already
knowing that we’re going to have at least one set of hearings and at least more
then one set of speakers. And then we immediately jump to talking about making
recommendations to the Secretary, on the other hand we also talked about not
writing our report, a full report, until into the calendar year of ’05. So I
just want to be sure that what we have on the table is perhaps a preliminary
letter with recommendations that are more specific to one or two short term
action items that would be followed by a lengthier report.

DR. LUMPKIN: And I think we need to look at what they are because to the
extent that there are those processes outside and there have been a number of
independent efforts to try to look at what are the short term steps and how to
move forward. My impression is within the federal government, which is beyond
HHS, there is an initiative by the White House to kind of pull that all
together so that there is more convergence and not moving in different
directions. It appears that the partnerships that are involved in trying to
also move forward this agenda are looking to say that that can be the role of
the NCVHS to also pull together the public/private so it all goes through one
channel and therefore is more likely to be aligned. So that the work product,
the two products would be some recommendations for short term actions and then
the second work product would be the long term vision and the refinement.

DR. DEERING: It occurs to me that another set of inputs that we need to put
in is the HL7 EHR effort that would have been balloted and completed, and
regardless of the outcome it’s certainly engaging an awful lot of energy in the
industry and so simply to sort of take, get a briefing on exactly what
happened, what’s the impact, what does it mean for all of these activities,
because I think one way or the other to ignore it would be —

DR. COHN: I actually think it’s an important effort, obviously now in its
second version, but that may be actually something that we want to get a
briefing on at the next full committee. The timing would be good only because
it’s coming up on the ballot at that time.

MS. GREENBERG: — March 4th, 5th, could be a little
premature on that. When is the voting —

DR. DEERING: The go to ballot on the 15th of March —

DR. YASNOFF: There will not be a decision whether they’re going to go
forward on the ballot until March 10th, so although by the
4th or 5th probably it’ll be clear which way it’s going
to go but there won’t be an actual decision.

DR. LUMPKIN: And I think that part of this, and we’ll have to make the
decision as we look at how things are developing, we may look at the sort term
roadmap and say it’s all standards and security stuff, in which case we may
want to punt.

DR. COHN: Do you think that the short term roadmap results, I mean I think
there’s some architecture pieces that, now of course that could be standards
but let’s begin to bound the role of standards —

DR. LUMPKIN: My only point is that we’re going to have to, to the extent
that there are folks in the outside world who want us to play that role we need
to figure out internally how we’re going to do that. And while we have a strong
representation in standards and security on this workgroup there may be pieces
that may seem more appropriate to be handled by our committee that certainly is
much stronger on standards issues.

DR. YASNOFF: I think along the same lines Mary Jo was talking about, there
are, as these various road mapping, planning, thinking, recommendation
processes move along, as you might imagine there are activities that actually
have to occur immediately, so the activities are not all by any means put on
hold while those things are going on and so I think that the HL7 process is
just one example of a number of short term things that I hope the workgroup
would be willing to take a look at. And I think depending on how events move
along, I can’t necessarily predict exactly what things are.

DR. LUMPKIN: Right. So it really describes a long term vision activity,
which is a roughly two year initiative to produce a document, some short term
activities by the committee to address some of the pieces that are beginning to
fall into place. Are we in agreement with that sort of our plan? Okay. That
takes care of the first two items.

Agenda Item: Summer Meeting Planning – Dr.
Lumpkin

DR. LUMPKIN: The third item is the upcoming meeting in the summer.

DR. YASNOFF: In the summer, yes. The upcoming meeting, we are currently
soliciting for a contractor to help with that meeting and it looks like it,
best guess it will be in July. We have internally had some considerations about
postponing it but I think that would be a mistake and I’d be interested in
other people’s thoughts. I hope to have a relatively detailed proposal for you
on February 18th, I do not have that today, but I can tell you that
there are two major objectives from the department’s perspective we’d like to
accomplish at the meeting.

One is we would like to update, we want to present the summary of the
recommendations from the last meeting and engage the attendees at this meeting
in some kind of process to comment on, expand on, clarify, review, update those
recommendations. So we want to take advantage bringing together all the
stakeholders to further refine the recommendations that came from the last
meeting. Essentially the consensus building agenda setting part of the meeting.

The second objective is to present activities that are occurring in
building the NHII, so as to begin the process of sharing lessons learned,
people can see what other people are doing, providing people with an outlet for
NHII specific activities.

There’s some question as to whether both those objectives can be met in
what amounts to a 48 hour meeting, and we’re pondering that and we’ll be
interested in your additional input.

MS. GREENBERG: I can just mention, if you’re looking at July, the NCHS Data
Users Conference, which generally attracts like over 1500 people is the week of
July 12th, so I would encourage you not to have it that week.

DR. YASNOFF: Thank you. We are wanting not to overlap any related meetings.

MR. BLAIR: Could I ask a question? In the July session will Bill, will you
be presenting some straw models, your initials ideas of what the NHII would be
looking like seven to ten years from now to begin to get feedback and critique?

DR. YASNOFF: Well, I think that’s a good idea but I’m not, I think that
information should be presented and I would think that the workgroup would want
that kind of information presented. I don’t think I will be presenting anything
personally. One of the things I’ve learned from doing these meetings is that
when you organize the meeting it is a mistake to put yourself on the agenda in
any form. But I think that those are the kinds of things that do need to be
presented and could logically be part of this refining the vision, refining the
consensus agenda. For example there were specific, there were architecture
recommendations that came out of the last meeting that actually were not very
specific and so logically one could present those recommendations and a straw
man architecture and then have some kind of breakout group to get comments,
that’s one strategy.

DR. COHN: I know that you’re putting a lot of energy into planning the
session and I would obviously defer to you on what you think are the pertinent
items. I guess having been reflecting over the work we’ve been doing and our
discussion of models and roadmaps and all of this other stuff, I guess I was
reflecting back to our last discussion where we were I think observing that the
payers may or may not be engaged and that they’re still sort of looking on at
the business case around all of this, and I don’t mean to be sort of obvious
about this but you’re not going to get much of an NHII if the payers aren’t
convinced that this is a good idea because they’re going to be likely paying
for most of this. So this is I think something we talked about in terms of
model development but it probably is something that has a little greater
urgency then some of the high level models that you may create and it really
may need to be something that’s frankly discussed around the business case
engaging the payers and other pieces like that. And once again, this may have a
little more urgency, I see you’re nodding your head, you’re agreeing also.

DR. VIGILANTE: Yeah, we’ve been talked about this as well, I mean the payer
issue is really, incentives in line is a key part of this.

DR. YASNOFF: Yes, and I agree, and that is urgent and in fact we’ve been
holding stakeholder specific meetings as you know, and we did have a payer
stakeholder meeting. We have since had an employer stakeholder meeting which
was quite interesting. I think if anything the employers are more enthusiastic
about this then the payers because ultimately it’s the employers who are really
paying. Of course it’s the consumers that are ultimately paying but at the
moment they’re not well organized and it’s difficult to, they don’t really
control the process at the moment, I’m not commenting as to whether that’s good
or bad, but that’s a fact. And in fact at the employer stakeholder meeting
several of the employer groups not only were supportive but were imploring us
to move faster, emphasizing the urgency of the problems, of the need for
solutions of the problems that an NHII addresses. So I think that we certainly
are going to make serious efforts, and I think we will be much more successful
this year engaging that community and bringing them to this meeting and
actually my expectation is that the meeting will be quite a bit larger because
we will have better representation from more stakeholder groups.

DR. LUMPKIN: If I could sort of give a little feedback conceptually how
this might fit into what we’re looking at. I think that when you think about a
meeting like that you think about the plenary sessions and then the breakouts.
One of the areas for discussion could be trying to flesh out alternative models
for financial incentives. My guess is is that we don’t want to come out of this
conference with one model, that’s going to be a political disaster. But if
there are multiple models for incentives that then allows researchers,
foundations, AHRQ, to commission research to do some financial modeling and
determine what would be the cost, what would be the expected outcomes of these
models in preparation for really short to medium term decision making.

The second would be on architecture models, and again with the goal not to
develop a single model and reach “consensus” but rather flesh out a
few alternative models which then could be also evaluated as to how this would
move forward, what were the barriers and obstacles.

The third is to perhaps look at breakouts that may focus in on the new
dimensions that we want to describe, a payer/purchaser breakout of what does
NHII need to, what down the stream should it look like in seven to ten years.
One for research, which has two aspects of it that we may or may not want to
address, one being health care clinical research, that sort of thing, and the
second is health services research, which are two components but two separate
components. And then the third being the public policy implications, which
would be a separate thing. So I think that kind of may be one of the frameworks
that’s consistent with what we have put in our agenda but that would I think
present some very interesting and useful work product.

MR. BLAIR: The only thing I guess maybe I was reacting to because I wasn’t
able to exactly tell, we have a situation here where we’re forming one seventh
of our economy, it’s huge and it’s complex, and it’s going to take time. And
maybe part of what I was trying to put forth before, it’s swimming upstream,
it’s a struggle, how do you put a sense of urgency into where we’re going when
it’s going to take some time to identify where we’re going. But maybe the point
of what I’m trying to get to here is I would like the series of models to be as
high a priority as we can because we’re going to have a lot of folks like
Connecting for Health coming to us and saying we’ve got an interim plan, we got
a two to three year plan, and they’re going to say is it good. And how are we
going to say whether it’s right or not if we don’t have at least if not a solid
vision of where we’re going seven to ten years from now, at least the
beginnings of a converging vision of what the architecture, the finances, the
standards, the legal issues, the ethical issues, so I was trying to see if
there’s something we could do to try to get that series of models in place as
soon as possible to help us make decisions for the next two to three years. If
it’s going to take two years to get to it maybe we have to accept that, it just
can’t realistically be done before then, but if there’s any way for us to
accelerate and put that as a real high priority I think we should.

DR. YASNOFF: I share your concern and I think that the way we need to
approach this is in an incremental fashion where we don’t attempt to put
together an architectural document that specifies every aspect of this down to
the last connector, that’s just not realistic and I think we need to start at
the top and move gradually to a more and more detailed level. Your point I
think demonstrates why it’s so important at this meeting to have reports from
if you will the explorers in the new territory, the people who are building
these systems in their communities, we need to hear about that and I can tell
you that there’s a tremendous amount of interest in building community health
information exchanges around the country and I don’t know that we’re going to
have results form those efforts by the summer, in fact I suspect not, the new
efforts are not going to have a chance to get very far by then, but I think we
will be able to for example compare and contrast a number of approaches the
different communities are taking in terms of how they assemble the
stakeholders, how they’re doing the governance, how they’re planning to pay for
the systems and distribute the financial benefits, I mean these are all going
to be plans but I think that the different communities will give us a range of
ideas as to how people are really doing this. Because people —

MR. BLAIR: Know what the problems are that we might not have anticipated
when we start looking long term.

DR. YASNOFF: Correct, and I think the people in communities are not waiting
for this recommendation document.

DR. LUMPKIN: I’m going to have to put a bookmark here. The fourth item on
our agenda is what we’re going to do on the 18th.

MS. GREENBERG: I would like my opportunity just to say one thing. Since I
had my hand raised and Jeff started talking.

Well, I know it’s not at the top of everybody’s agenda, it may relate to
the health services research, it certainly I think relates to community health
information exchange, but I just want us not to forget that as you mentioned in
the beginning, one of the dimensions of the NHII was the population dimensions.
It wasn’t a major focus at last year’s meeting, part of that dimension was the
21st Century Vision for Health Statistics, the NCHS Board of
Scientific Counselors is very interested in kind of staying on top of that and
coordinating with the NCVHS on that, and I’ve told them about the session we’re
having in March. But I’d like us to think about how the June/July summer
whatever meeting, and our overall process, still keeps that as a piece of it
because I think the population part tends to kind of fall off our agenda.

DR. LUMPKIN: Let me put my bookmark in right here.

Agenda Item: February 18th Meeting Planning –
Dr. Lumpkin

DR. LUMPKIN: We will be meeting in three weeks and I think we have pretty
much framed the discussion we will be having in three weeks.

DR. YASNOFF: Can I ask one very quick question? Is there a desire on the
part of the workgroup to schedule formal hearings as part of this conference?
If there’s no quick answer then I’ll ask that question again on the
18th.

DR. LUMPKIN: To tell you the truth the thought hadn’t even crossed my mind
and so we would, it may be good to explore what would be the value of actually
having formal meetings, formal hearings, because that’s intriguing.

DR. DEERING: And we could rephrase that also to say the way I would like to
interpret that is an invitation to the workgroup to think about what we need to
get out of it, I mean hearings is just one mechanism for getting something out
of the conference.

DR. YASNOFF: And actually that’s a good point and could I ask in order to
help expedite the process if people have ideas about what they would like to
get out of the meeting, if those could be fed to me in the next three weeks so
that I can at least try to incorporate those into this draft plan that would be
very much appreciated.

DR. STEINDEL: I would not like to hold hearings at the meeting but I would
like to hold hearings around the meeting.

DR. LUMPKIN: Well, let me just toss this out because Bill raised it and it
just sort of clicked something in my brain. What if the last session, which was
the report back from the workgroup, was a hearing of the subcommittee? An open
hearing —

MS. GREENBERG: People would have to be able to come whether they paid the
registration for the meeting or not.

DR. COHN: 1500 attendees, that could be interesting.

DR. LUMPKIN: My point being is we look at our timeframe, that then makes
the work product of this meeting a work product of the workgroup, which means
it can be almost immediately published.

MR. HUNGATE: Much more direct input.

DR. YASNOFF: I think that’s something that needs to be considered and
again, I’m not committing either way to what needs to be done but obviously
would like to hear from the workgroup as to what the desires are. Clearly, I
suspect most of the people that the workgroup would want to hear from are going
to be attending this meeting.

DR. DEERING: It also enables us to identify what we want to go into the
hearing, I’m sorry, into the meeting, so that by the time we report out we know
who’s going to be there. And just to pick up on a couple of points that you all
have talked about, fleshing out the models, to get to even the point where you
have draft models for discussion at the conference I’m sure you would be using
the process that you set up before, which was a very robust preparatory process
where you got that kind of input. And picking up on Jeff’s sense of urgency,
there would be a lot that needed to be done before that meeting ever occurred
so that you could be sort of doing the polishing and the refining even if it
weren’t final —

DR. YASNOFF: That hasn’t escaped my attention.

DR. DEERING: So I’m just observing that if indeed that was something that
we were quite strong on hoping to see come out of that meeting then we have an
opportunity to work with Bill in making sure that those things are drafted —

DR. LUMPKIN: Solicitation of papers, those kind of things that could be
then as the workgroups within the conference met those would be part of the
preparatory –. I think that there’s a lot of potential there.

What we had hoped to do today was to get our thought juices flowing about
the meeting on the 18th. I think we’ve kind of outlined pretty much
the broad areas that we want to talk about, we want to talk about what models
we want to see, how we may produce those models as part of the conference, we
also need to give some thought to once we’ve produced the models, or have some
fleshing out of those at the conference what do we do with them after that as
part of our work plan in developing the final document.

I think that we would want to kind of review the timelines for getting that
work done, and to look at other aspects of the working on the three new
dimensions and to flesh out the overlaps between the three old dimensions. And
to make sure that some dimensions that may not have been fleshed out as well as
we would have liked since our report, such as the population dimensions, gets
some attention.

DR. COHN: I agree absolutely with all things that you’re saying. I think
the one other thing that I think I had heard from our last meeting, and I
apologize, it’s early in the morning and it’s really early California time —

DR. LUMPKIN: But you’ve been here all week.

DR. COHN: But I’ve been here, I can’t use that as an excuse. I had thought
that there was also an opportunity on the list to hear from, I wouldn’t say
you’re quite the holder of the vision or the actuator of the vision at this
point. My sense is that you’ve taken really that NHII vision and moved it in
different directions and have a number of sort of world views about it, and
these aren’t roadmaps, these aren’t models, these aren’t frameworks, these are
sort of fundamental beliefs around all of this that, I mean I personally need
to understand it, I think maybe the rest of the workgroup needs to talk about
it to make sure that we’re all in agreement with them, just because I think it
would be useful to help us understand sort of the, I mean it helps us
understand the strategy and the actions of HHS —

DR. LUMPKIN: So we probably would want to start the meeting off with that.
Yes? I think we have a plan, we’ve worked through our agenda, we’re running
about five minutes late so we need to have a ten minute interlude before we,
after we end this meeting to get the equipment upstairs.

Okay, we’re going to —

DR. YASNOFF: Can I just add one more point, I would like in as we develop
the formal agenda for the 18th I want to be sure we don’t spend, the
thing from my perspective that has to get done on the 18th is
whatever input into the conference planning the workgroup wants to have has to
be completed on the 18th. So I would like to suggest that while
obviously the workgroup is very anxious to get into specifics of various
issues, that if we get distracted in those then the conference is going to have
to be planned regardless of whether the workgroup has any input or not. So I
just want to make that —

DR. LUMPKIN: So we want to talk about what models we want, we don’t want to
get into the models themselves.

DR. STEINDEL: May I request that whatever planning documents Bill was
planning to give out at that session reach us in an expeditious fashion between
now and the meeting?

DR. YASNOFF: I will do my best to get them to you a week in advance, that’s
probably the best I can do.

MS. GREENBERG: I’m a little concerned and that’s why I just want to kind of
check with people about the fact that I realize that this was the only time the
meeting could be scheduled, the 18th, but the Subcommittee on
Privacy and Confidentiality is hold a meeting on the 18th and the
19th and they’re working on a number of panels, going to have a lot
of testifiers, right now that subcommittee with two retiring members is made up
of Mark Rothstein, Simon Cohn, Richard Harding, and John Houston. So everyone
but Mark is also on this NHII Workgroup and I don’t want to be bringing in lots
of outside testifiers and have Mark sitting there by himself. So we have to
think through, I don’t know and I don’t see staff, they must be upstairs,
whether both meetings are going to be in the Humphrey Building, which would
certainly be helpful if that’s the case, but I just alert you to that as, with
our new rules —

DR. COHN: Don’t look at me, look at Richard. Richard, what do you think? If
Mark were here we’d ask him.

DR. HARDING: I think that if we do have the quality and caliber and number
of testifiers that we had in the last hearings that it is very important that
members be there.

MS. GREENBERG: We don’t have the same quorum, we don’t have quorum
requirements explicitly for subcommittees but you hear me.

DR. LUMPKIN: Right, we need to have a division of labor.

MS. GREENBERG: Need to be some decisions among you.

MR. HOUSTON: I intend to go to privacy, I think it’s important if you’re
having people come in that clearly we show our support and attendance of that,
so I am concerned about how we try and share time.

MS. GREENBERG: The other thing is that the Subcommittee on Privacy and
Security hopes to have a letter based on that hearing and the previous hearing,
and obviously, by March 4th, there’s not going to be time to wait
and get the transcript and all that. So some people are going to have to have
been there to contribute, to have heard what the testimony was and contribute.
So I know that you probably don’t want to hear this but I think it’s important
that we think that through so we have a division of labor. Of course the new
members are encouraged to go to one or the other.

MR. HOUSTON: Or both.

MS. GREENBERG: Or both as the case may be.

DR. LUMPKIN: Both is going to be hard but we do want to point out that we
need to make sure we have an adequate division of labor.

DR. YASNOFF: Is it too late to move one of them one day?

MS. GREENBERG: We can’t move the Privacy.

DR. YASNOFF: But the NHII Workgroup, we’re not having any testifiers, so
would it be possible to have that the day before?

DR. LUMPKIN: No.

DR. YASNOFF: Or the day after.

DR. LUMPKIN: We’ve been looking for, we’ve been through about five
different things and trying to pull schedules together it’s just —

DR. DEERING: Is it possible to at least plan the agendas and the lunch
breaks, squeeze out any little bit of —

DR. LUMPKIN: I think we’re going to have to pretty much have, I’m not sure
that all the members, the current members of Privacy will be there but we want
to have the vast majority of the members of Privacy at the Privacy hearing.

MS. GREENBERG: Now maybe like the Privacy starting at 9:00, we could even
start at 8:00, vary our lunch hours, let’s try to be creative here so that
people can, hopefully both will be in the same —

DR. COHN: Sounds like cloning may be an option.

MS. GREENBERG: But I preferred to bring this up here then upstairs.

DR. DEERING: If we’re starting out with a discussion of the conference and
Bill has been able to share any documents in advance, and if we have given him
feedback in advance, then members who have to miss the morning will have
already in some senses both gotten a little bit of input and given a little bit
of input themselves, so that might be also what we have to do.

MS. GREENBERG: We’ll work it out but I just wanted to make you all
sensitive to that.

DR. LUMPKIN: Okay, back upstairs.

[Whereupon at 9:03 a.m. the meeting was adjourned.]