[This Transcript is Unedited]




Wednesday, June 16, 2004

Hubert H. Humphrey Building
Room 443E
200 Independence Avenue, NW
Washington, D.C.

Proceedings by:
CASET Associates, Ltd.
10201 Lee Highway, Suite 160
Fairfax, VA 22030


Call to Order and Introductions – Dr. Lumpkin

Update on Plans for NHII Conference – Dr. Rippen

Update on CAHIT – Ms. Cronin

Update on Connecting for Health – Dr. Lumpkin

P R O C E E D I N G S [4:13 p.m.]

Agenda Item: Call to Order and Introductions – Dr. Lumpkin

DR. LUMPKIN: — so we’re going to play around with our schedule and I guess
we need to do introductions. I’m John Lumpkin with the Robert Wood Johnson
Foundation and chair of the workgroup as well as the full committee. Why don’t
we go with Simon?

DR. COHN: I’m a member of the NHII Workgroup and the full committee.

MR. HUNGATE: Bob Hungate, member of the NHII Workgroup and the full

DR. HARDING: Richard Harding, University of South Carolina, member of the
subcommittee and the full committee.

MR. BLAIR: Jeff Blair, member of the workgroup on National Health
Information Infrastructure and member of the committee.

MS. BEBEE: Suzie Bebee, ASPE.

DR. RIPPEN: Helga Rippen, ASPE and ONCHIT, I didn’t want to do the

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

MS. POKER: Anna Poker from AHRQ and I’m going to be staff to the quality
subcommittee and a staff member here at NHII.

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

MR. HOUSTON: John Houston, University of Pittsburg Medical Center, and
member of the NHII Workgroup.

DR. DEERING: Mary Jo Deering, National Cancer Institute and lead staff to
the workgroup.

MS. SERTZ(?): I’m Katherine Sertz on behalf of the Association of American
Physicians and Surgeons.

MS. BOWER: Cynthia Bower from that other unknown office, Office of Disease
Prevention and Health Promotion.

MR. LARSON: Ed Larson, I’m a business strategy consultant.

MR. DAVIS: Lynell(?) Davis, Blue Cross/Blue Shield Association, also a
member of the Electronic Health Record Task Group of HL7.

MS. CARVELL(?): Jennie Carvell with ASPE on detail to David Brailor’s

DR. LUMPKIN: Which is called?


DR. LUMPKIN: Somebody’s got to pronounce it.

MS. CARR: Justine Carr from —

DR. BICKFORD: Carol Bickford, American Nurses Association.

MR. RODY: Dan Rody, American Health Information Management Association.

DR. WARREN: Judy Warren, University of Kansas and a member of the full

DR. LUMPKIN: So we’re going to postpone Kelly’s spot and then move on to —

DR. HUFF: John —

DR. LUMPKIN: Oh, there’s somebody on the phone.

DR. HUFF: The thing said there are a couple of us but this is Stan Huff
with Intermountain Health Care and University of Utah in Salt Lake City.

DR. LUMPKIN: Great, Stan, anybody else on the phone? There’s supposed to be
somebody else, Stan, could you introduce yourself again maybe as a different

DR. HUFF: I don’t have that much imagination.

DR. DEERING: Amy Patterson of NIH had intended to join, I know that she was
by phone on one of the previous calls.

DR. LUMPKIN: Okay, take it away.

Agenda Item: Update on Plans for NHII Conference
Ms. Cronin and Dr. Rippen

MS. CRONIN: Well all of you will be getting more paperwork of course that
you can actually help use if you would like to follow, well, you’re just going
to have to take it by faith. But I will be going through it in a verbal way. As
you know we are planning for that wonderful conference in July and we are
actually looking forward for all of you to participate so I hope that you have
registered and we have ways of following up on that as a first thing because we
really do need your input and we do need your support.

As you know Dr. Brailer did join recently and he will be giving I guess
some comments tomorrow at one of the larger, the entire meeting, and what we
have done is given him the first morning of the first day on Wednesday to
actually provide a kind of a status report on the strategic plan. And so I’m
not going to be going into detail on the specifics of the morning session but
let you know that it will be called the Secretarial Health Information
Technology Summit II, it’s a follow-on to the May 6th meeting that
occurred, and it will be very exciting and that’s part of the larger meeting.
So that was going to be happening then from 9:00 until 2:00 in the afternoon on

Does this make sense with regards to process check? Okay, just want to make

Then from 2:30 to 4:00 we had I guess previously had several discussions
with regards to the breakout groups and to whether or not topic focus versus
stakeholder focus and we are continuing with the topic focus and then a
reconfiguration with stakeholders to have some ability to do stakeholder
concerns. And so in that vein then the first breakout is going to be based on
the topic tracks, as you know there are eight topic tracks, we have four of the
eight papers already drafted by various co-chairs, and we are hoping to get the
next four by the end of this week, early next week. Once we review them and
make sure that they’re in a consistent format what we’re going to do is send
them out and post them so that everyone will have a chance to see where they
are. There is a standard format, the first part is really kind of an overview
of the scope of what the topic is and what’s going to be covered under the
topic. The second then is what the recommendations if any were made from the
NHII ’03 meeting but actually more importantly then is what have the, what were
the advances between that meeting and today so that we’re all up to speed and
we’re not reinventing the wheel.

And then the final section of that would be then what are the
recommendations. And that will be presented in the first breakout session by
the people that were co-chairs and co-leads and co-authors of that paper. And
then there will be a time for the group to discuss that in light of the morning
summit and the strategic framework.

And then based on deliberations for that they’re going to make
recommendations, then they’re going to have a little because we do believe in a
little coffee and tea, and then coming back then from 4:30 to 6:00 to really
define then an action agenda based on those recommendations of moving it

Then the evening from 6:00 to 8:30 we have a reception and the posters of
the endorsers, and that will be a very nice event. Then we’re going to start
then Thursday morning from 8:00 to 9:00 with a preliminary presentation of the
drafts recommendation and action items of the eight topic groups.

Following that then we’ll have our first plenary because now as you know our
meeting was cut in half, we’re going to have implementation, community buy-in
and business case, and that will be followed then by a stakeholder breakout
group where now the stakeholder groups are able to respond to each of the
recommendations in the topic areas and voice any concerns because again they
may have a different perspective based on stakeholder interest. And that will
continue through a working lunch and then we will have a plenary session that
talks about what are the private sector initiatives and that includes LeapFrog,
eHealth Initiative, NAHIT, WEDI, HIMSS, Connecting for Health. And then 2:30
people are going to reconvene in the topic groups to talk about how to
incorporate the stakeholder responses and advices to topic area action plans.
And then the final stakeholder or I should say not stakeholder but this topic
track, so there’s a correction there, from 4:30 to 6:00 is to then prepare for
the NCVHS meeting the following morning on Friday.

There will be a special interest group session on community of practice in
the evening on Thursday and on Friday we’re going to be doing the report outs
with then a closing by Dr. Brailer and Dr. Yasnoff, kind of next steps. And
then NCVHS will continue on with regards to any questions, follow-up questions,
other information. So that’s really the agenda with regards to the NHII ’04
meeting and the health summit.

MR. BLAIR: What time on Friday?

MS. CRONIN: We have slated for NCVHS 4:15, I don’t know if you need that
time but we have you from 1:00 to 4:15 to continue deliberations, ask
questions, have a break, that sort of thing so depending on what your agenda is
you can have a shorter meeting.

Just to kind of get you up to speed because we do want your help as always
with the NHII ’04 we have also a handout, it’s about three pages long, of all
the entities that are endorsing this meeting so if you have any recommendations
of who else should be asked to attend that would be wonderful, we’d really
appreciate it. And Susie, want to talk about them?

MS. BEBEE: We’re asking that the endorsers also participate in the poster
session and out of the 61 endorsers that we have so far about half of those
have confirmed with the poster session. And we’re also asking them to
disseminate information about the meeting, that’s been very successful and
they’re doing it in many different ways, journals, newsletters which are even
weekly, website URLs, list serves, so we’ve been real happy with getting the
information out about the meeting.

As you can imagine with Dr. Brailer’s addition to this activity and now our
new office there’s been a heightened interest and we’ve been fielding all those
calls and emails as well. And that includes people wanting to come on board and
endorse the meeting so that’s been a pleasant piece of work that we’ve been
dealing with.

There’s another piece of paper too that is a handout that shows the number
of individuals that have registered, we’re down to 34 days and counting so
we’re expecting in the last 30 days that we’re going to have a rush for
registration if it’s true to form, that’s the way it was last year. And you can
see in this handout the breakdown as to the interests of the people that are
registering. And so the breakdown for instance registration category is about
an 80/20 split for the private industry being actually 75 percent, federal
government is at 19 percent, state six percent and local government one
percent. And the highest registration for a topic area is standards and
architecture, over 40 percent. Stakeholder affiliation is running about three
of them close system developer, health care organizations which are actually
institutions, and then the health care provider such as physicians, those are
all running in the 20 percent.

MS. CRONIN: And so again I think it’s important, I mean I’m pretty impressed
with the kind of mix of people, they’re less from the government and more from
the private sector and there’s a significant number in the health care provider
domain. The other thing is that many are requesting for the tutorial so it
implies that many of these are new to the whole concept of the NHII and that’s
very important, and that many, almost 70 percent, are interested in actually
participating in the community of practice, also kind of giving a sense of
where they may be with regards to the actions and where they may want to be
starting to perhaps think about implementation. So again, it’s interesting with
regards to looking at these numbers and what that might mean.

But what it also means though is that we would like your help and actually
all the attendees that are also sitting here to make recommendations with
regards to how to target certain groups that are under represented here and to
be effective and making sure that it really truly is a diverse stakeholder
meeting so we can really get the most out of it and we can get everyone
perspective incorporated in the things that get reported out to all of you.

MS. GREENBERG: I’m sorry I was a little late, I was up at Populations, but I
know there’s been some concern expressed about the, I guess there were about
what, about 45 people from public health which is actually better then I
anticipated so maybe it’s picked up a little but with this very small number
from local and government and a pretty small number from state too. To the
extent that the registration and travel are a barrier for folks like that any
thought or any of the sponsors willing to contribute, I mean is there any
thought about waiving registration or lowering registration fees for those
groups, or getting any of these sponsoring organizations to maybe sponsor some
scholarships or something?

MS. RIPPEN: Well actually, that’s actually a good point and I will turn it
around to many of you who have maybe opportunities to help facilitate that. As
you know we have a very tight budget and for us to actually carry on, to
actually do the conference and to pay for the food alone and for the
facilitators and the planners it’s a half a million dollars and that’s all of
the money that we have. And so we are looking to have organizations that may be
able to provide scholarships to do so. If there’s any recommendations with
regards to who those organizations may be because I think we have had requests
from certain entities, especially from the public health sector, and consumer
groups actually with regards to being able to not only pay for their tuition
but also their travel. So again, I think it’s really important, we welcome any
ability to do that and if you have any recommendations as far as how to
accomplish that we would love to hear it.

DR. DEERING: I was only going to share your pain as a government office
that’s put on national conferences and that question always comes up to those
around the room who are not in the government it is virtually impossible, it’s
a non-starter for the government to almost ever be able to even make a dent in
that issue and certainly can’t directly touch it at all. And I know of almost
no circumstances unless it’s a direct sponsorship effort of one particular
sponsor who says I really want to pay to bring these people in but otherwise,
CDC has sometimes in the past decided that they would be able to bring in X
number of people from the states but otherwise there aren’t any other options.

PARTICIPANT: We have been seeing a lot of contact from LeapFrog group and
LeapFrog is GE, Wal-Mart, Microsoft, why don’t we ask them to put their money
where their mouth is? If they are so concerned about improving the quality of
care, if NHII is one of the key fundamentals for improving quality of care
let’s reach out and touch them, they can afford to do this.

MR. HOUSTON: It’s a little late for this year to try and go solicit funds
like that.

DR. RIPPEN: Unless somebody has it, they don’t have to get approval, that
line budget $50,000 kind of —

MR. HOUSTON: What was the attendance last year?

DR. RIPPEN: About 600 or 700.

MR. HOUSTON: We would expect we’re going to be above that for this year,
correct? Does that help the budget situation knowing that —

DR. RIPPEN: We budgeted for up to 1,000 people.

MS. BEBEE: We did it in chunks of 600, 800, and 1,000, and even discussion
of having 2,000 people —

MR. HOUSTON: But the economics still are pretty tight. How about the Robert
Wood Johnson Foundation?

DR. LUMPKIN: A couple of quick ideas, we can talk, some organizations that
aren’t on the list that probably ought to consider, National Medical
Association, the Asian and Pacific Islander Americans Health Forum, and I can’t
remember Jane Delgado’s group, they’re based here in D.C. —


DR. LUMPKIN: No, they changed their name to Alliance for Expanding Health or
something like that. If you send —

DR. DEERING: If you search on Jane Delgado you’ll find it.

DR. LUMPKIN: Those are ones that just come to mind, and my guess is they
will also have suggestions, there’s the Association of Black Cardiologists,
there’s a whole list of minority health groups that I think ought to be

DR. DEERING: Has Markle been able to suggest any consumer oriented groups? I
know they tried to find people from time to time and I don’t know what the
status is of their success in tapping into any consumer groups. Are you aware
of any?

DR. LUMPKIN: But mentioning that, AARP —

MS. RIPPEN: They are actually sponsors.

DR. LUMPKIN: I didn’t see them on here, but maybe I just, maybe because you
spelled out their name.

DR. COHN: Helga, just a question about the make-up of the whole, probably
the issue of your trying to provide resources for under represented, it’s so
hard to know who’s represented. Obviously I can tell consumers, health care
providers has a number of different meanings —

DR. RIPPEN: Yes, it does.

DR. COHN: It can mean hospitals or it can mean physicians or it can mean
neither, and health care organizations overlaps with all of that. Do you have
any insight? A different way to do this where when you have a better sense of
whether —

DR. RIPPEN: We have the organizations so we’ll take a look at that.

DR. LUMPKIN: Following up on that there’s the Association of Community
American Primary Care Association or something like that, the community health

DR. DEERING: Oh, the community health centers, that’d be a good one.

DR. LUMPKIN: There’s the American Public Welfare Association, you can check
with Peggy Hamburg about, there’s the American Public Welfare Association and
then there’s the State Medicaid Directors Association.

DR. DEERING: I notice that you have IHS as having been asked about a month
ago but given the fact that they are moving forward on their electronic health
record with VA it might be worth really prodding them some more, not even so
much about their being a sponsor as helping to promote it to the people who are
working out in the field.

MS. BEBEE: We’re trying to also, David Brailer was meeting with all the
federal agency heads so we’ll be getting those —

DR. DEERING: And certainly the same for VA which is rolling out its care in
the community projects, their VISNs, I don’t know what it standards for.

MS. BEBEE: [Inaudible.]

DR. LUMPKIN: AHPA, I don’t see them on there.

DR. RIPPEN: There are other non-physician providers they did not tap into, I
could take a look at —

DR. LUMPKIN: And you may want to also look at the membership, particular
consumer membership, of the NQF.

DR. BICKFORD: If you’re looking at the CAM providers, a whole new venue,
they should be partners in this discussion.

DR. DEERING: National Health Council is an umbrella for a lot of consumer
voluntary organizations, National Health Council.

Helga, I have a question about the papers that are being written. Would you
mind going over for us who, I take it the facilitators are the authors or are
those different people?

DR. RIPPEN: No, they’re different. Okay, the facilitators are hired
professional facilitators that are not involved in the topic area. We have the
co-leads who are writing the paper and they’re not actually only writing the
paper, they’re coordinating writing the paper with a team of experts, six
experts that are working with them so that makes eight, and they’re the ones
that are going to be giving the presentations to the groups, to the topic
groups. They are also responsible for selecting a reporter, the reporter cannot
participate at all in the discussions and evolution of the paper but they’re
identified as an expert and their role then is to participate in the meeting
and to work with the facilitators in capturing the discussions and the
recommendations of the group.

This was done to prevent any appearances of conflict with regards to having
a vested interest in the original paper which was a concern during last year
where some people thought that opinions were already formed and that it was
just being moved forward. We have the professional facilitators because we know
that it’s important that everyone kind of feels that they’re part of the
discussion and many times leaders in the field are not necessarily known to be
the best in facilitating discussions and so this would allow everyone to be at
an equal footing. So again, that’s really the structure.

There is no additional vetting for the materials, these are the works of the
leads and the team that was assembled and the vetting will occur at the meeting
where there will be discussions, obviously we’ll take a look to make sure
nothing’s inflammatory or obviously wrong or anything like that because again,
this is not our, it’s not our material, it is the communities and it’s up for

DR. DEERING: Do you have the names of the paper authors that you could —

DR. RIPPEN: Yeah, we do, I think that they were actually listed, they’re
listed on the site so if you want the website has all of them, and so I have a
copy of them here, we can go through them or you can just take a look at them,
there’s a lot of names. There’s a listing of topic leaders but then also who
has participated in writing, so the experts. And also topic reports so
everybody’s name, affiliation, so people can see where the bias may or may not

DR. DEERING: I was also thinking and I’m sure we’ll get back to this after
we take on Kelly and her ONCHIT, but depending on how much time the workgroup
thinks it wants for the open hearing afterward I mean the issue will be do we
go back only to those people and give them more time now to talk to us or if we
think we’re going to try and have an open hearing and sometimes we go out and
we solicit even additional participation, we certainly then don’t want to
overlap there so from a staffing point of view of the folks who will be helping
the workgroup decide who it wants to hear from in the afternoon it would help
us to get a feel for what the universe is.

DR. RIPPEN: There actually may be an additional consideration given that
these papers will be posted in a very short amount of time and there will be an
opportunity for people to review them, that again depending on what kind of
public comment period you want or how you want to use your meeting, people that
may or may not be attending the meeting or have comments, it might be an
opportunity to provide them. So I just throw that out that there will be
something to react to even before the meeting.

Now what is presented versus what is finally presented to NCVHS may have, it
might be significant, it might be something that you don’t even recognize, and
that actually happened last meeting too where some people, what people came up
with was totally ignored and then people just went on. So again, there’s no
prediction but there’s more food for fodder.

DR. LUMPKIN: Why don’t we take this sort of slight lull and use it to have
Kelly give us an update on her new location, and if you could just tell us how
to pronounce that acronym.

MS. CRONIN: There’s already been many variations, the one that seems to be
sticking is ONCHIT, it doesn’t really roll off the tongue.

Agenda Item: Update on CAHIT – Ms. Cronin

MS. CRONIN: Well, as you all know we’ve had only about a month or so to try
to get somewhat organized, and after talking with Dr. Brailer yesterday to
figure out what the scope of the conversation should be today we thought it
would be a good idea just to focus on what was in the executive order given
that he’s presenting to the entire committee tomorrow and will give you a much
better idea on perhaps where we’re going in terms of principles for the
strategic plan and some of the early thinking around the framework.

But just to get back to the executive order, as everybody probably knows it
was established, or it went out on April 27th, and it not only
established this new position for the National Coordinator for HIT but it also
established this new office that we’ve been working very diligently on to try
and get organized which has been quite challenging. But specifically the
executive order does spell out that the coordinator has responsibility for
directing HHS HIT programs and I think in interpreting that one realizes that
an office of say between ten to I don’t know what the upper limit would be,
FTEs, you would not be able to actually directly have hands on involvement in
managing any of these programs but we would like to think that we’ll be working
to coordinate and get involved as needed to make sure that from a design and
implementation perspective that things are in line with the overall strategic
direction. And there will be some link, formal link to the budget process too
in terms of evaluation and how it fits with the strategic plan.

There’s also a specific charge that says that the new office will coordinate
outreach and consultation by executive branch agencies with interested public
and private parties. So what we’re thinking in interpreting that right now is
that our primary agencies outside of HHS that we’ll be most involved with will
be the Veteran’s Administration, DOD, and the Office of Personal Management,
and all three of those had very specific charges within the executive order
too. VA and DOD are working now to figure out how they can use their know-how
and their technology to improve reach to rural providers and OPM is now
considering various options for incentives to accelerate adoption of HIT as a
major purchaser for the government.

We’re also supposed to be providing comments and advice regarding these
various programs, not just HHS programs but programs across the government, and
while I think there’s already a structure to the coordinating function in place
for bio surveillance at the White House and elsewhere it’s likely that we’ll
want to make sure that we’re involved to the extent that we can ensure that any
kind of future architecture discussions or planning, especially through the
federal health architecture, allows for sort of everyone operating in a uniform
direction so that if DHS has a major program along with CDC that everyone is
sort of mapping to where we’re going as we move forward and that we’re not
creating a lot of stovepipes essentially.

There’s some specific details in the executive order that we have to report
to the Secretary within 90 days with progress on the development and the
implementation of the strategic plan. Now we’re already to the point where we
do have a preliminary outline that we’ve vetted with agency heads as of
yesterday but we really have not gotten to the point where we have anything
that’s sharable with the public. But it specifically requires us by basically
July 21st for the summit that we’re going to be reporting on this
progress. Now given that that’s only a month away it’s not likely we’re going
to have our final, final plan on how we’re going to make this happen in ten
years but our preliminary thinking and certainly a framework will be presented
at that time along with specific actions that the agencies and the private
sector can take that they feel comfortable and ready to talk about.

The executive order also specifies that we need to ensure that key
technical, scientific, and economic issues effecting public and private
adoption of HIT are addressed. Obviously we’ll be considering a lot of these
issues as we move forward, it’s not likely we’re going to have any
sophisticated new cost effectiveness or cost benefit analysis done before
anything is released on the 21st but obviously this is something
that we’ve been supporting through AHRQ and ASPE through various research
projects and will continue to do within this new office. We also need to be
addressing privacy and security issues as this committee has in the past and
we’re actively trying to seek input from OTC and OCR to make sure that our own
internal expertise is being used appropriately. And we need to include
measurable outcome goals obviously which we’ve actually done quite a bit of
thinking on in just the recent week.

And we’re specifically not to rely upon additional federal resources to
accomplish this program and that obviously presents us with some challenge but
one that we’re willing to take on at this point. Helga’s already talked about
the summit so that was covered, everyone probably also is familiar with the
goal that was set by the President which is a nationwide interoperable health
information infrastructure and electronic health records available to most
Americans within ten years. Of course people would like to think that we’re
going to be able to do it before then but that’s our definitive goal.

The specific agencies that we plan to be working with I mentioned outside of
HHS, DOD, VA, and OPM, there could be others, right now that’s our focus.
Internally it’s still the agencies that we’ve already been working with under
CAHIT, which include CMS, AHRQ, Indian Health Service, NIH, CDC, FDA, HRSA, and
SAMHSA, so we will be reaching out continuously to all of them to make sure
they’re included in the development of the strategic plan and that it’s
representing everyone’s collective ideas.

I think it’s probably premature again to get into principles, David is going
to be covering those tomorrow, but one decision that has been made recently is
to have a link with the federal health architecture since there’s going to be a
lot of emphasis on that in the next couple of years. And it was actually sort
of informally done with the NHII group in previous months, we’re now going to
move forward and make sure that that effort is closely coordinated with all of
the HHS operating divisions but also the other departments that we’ll be
reaching out to. And it will also provide a link with CHI and the standards
that have been adopted through that effort.

We still haven’t figured out exactly how CAHIT and some of the other
coordinating functions will be institutionalized but we have an intention to
figure that out in the short term, we just have so many things on our plate
right now, one of the many. And I think I mentioned also before that they’ll be
a definitive link to the ’06 budget process and the strategic plan will inform
that as well.

So that’s sort of the very general overview and if anyone has any questions
I can attempt to answer them.

DR. DEERING: How about a link to the ’05 budget?

MS. CRONIN: That’s a good question, I mean you know the $50 million of
additional funds is already in the budget, it’s likely that that will go
through, it’s not, obviously we don’t have a crystal ball but no decisions have
been made about exactly how that would be distributed. But in terms of
informing other decisions made within ASBTF that has yet to be determined.

MR. DAVIS: Lynell Davis, Blue Cross/Blue Shield Association, in getting that
plan ready for the July timeframe you talked about the private sector, what
process are you vetting that plan through the private sector to ensure their
comfort and coordination with that, whatever you’re laying out?

MS. CRONIN: That’s a good question, we have been seeking in put from
organizations but there also are public/private collaboratives as was covered
in the last NHII Workgroup meeting, Connecting for Health, which represents a
lot of different stakeholders, is working on an integrated roadmap and that
process and the content that is coming out of that is informing in part what
we’re doing. And we have been as inclusive as our schedule will allow to try to
meet and talk with anyone who does have ideas that they’d like to introduce.

DR. RIPPEN: The other is the meeting itself will provide an opportunity to
provide direct feedback into the process and through NCVHS so that’s why it’s
important to get as many stakeholders together.

MS. CRONIN: And I think you’re also aware that there’s been a series of
stakeholder meetings that ASPE has held over the last year and that gives us
sort of a basis from which to work as well.

DR. RIPPEN: In the end the private sector has to decide what they’re going
to agree to do obviously.

MR. DAVIS: And I guess the reason I bring that up is I guess representing
the payer community I’ve worked within Blue and quite surprised it’s just Blue
and I’m a little concerned that a lot of the other payers haven’t quite gotten
on this train yet and I’m not sure if they’ve been at some of those meetings,
and I know we haven’t because within the association we are getting on board
with this but I’m concerned where’s the rest of the payer community because
there’s a lot of financial incentives we already do and those really ought to
be integrated closely with some of the incentives you’re working on. It’s not
clear to be that coordinating is happening and that coordination could probably
be very powerful.

DR. RIPPEN: And I do know that from OPM’s perspective they are actually
reaching out obviously to the payer community given their charge too.

MS. CRONIN: I think moving forward NCVHS will obviously be another place
where we’ll continue to get input, in fact the meeting right after the meeting
in July will provide another sounding board so to speak.

DR. LUMPKIN: Let’s perhaps massage the agenda a little bit and suggest that,
what I can do is a very quick update on where Connecting for Health is and then
let’s have a discussion about that Friday, the agenda for the Friday workgroup
meeting because I think we can bring a lot of these pieces together.

Agenda Item: Update on Connecting for Health – Dr.

DR. LUMPKIN: Actually Kelly has told you all the relevant factors that we
discussed at our last meeting, Connecting for Health is developing that short
term roadmap and have made significant steps in that direction. We had a
presentation from Carol Diamond at our last meeting, what they’re attempting to
do is go through those forks in the road that she talked about and to identify
which ones it appears that the broad based public/private partnership that
Connecting for Health will recommend, and again the roadmap, the forks in the
road were presented as a do this or do that and that doesn’t mean that the
choice will be to pick one of those two because there may be another choice in

At the June 30th, just a few weeks away, steering committee they
hope to have a rough draft, high level version of that roadmap which will then
be submitted as part of the development process for the conference and there
will be reports at least I think from the architecture workgroup that has been
working on trying to develop some sort of consensus architecture addressing
many of the issues that we came up with of how LHIIs, other kinds of
connectivity work in a new environment as well as some other work products that
will be submitted for some of the breakout sessions.

The intent will be then in the fall to have the more fleshed out work plan,
roadmap, adopted, which would then, I think we have a meeting in November, it
should come to us in November, so that’s sort of the plan there.

MR. HUNGATE: Does that plan have contingency points in it, what are the
hurdles, when it has a branch is there something there that’s an obstacle to be
overcome that determines which of the branches just in a content of that work

DR. LUMPKIN: Well, right, that’s what the roadmap is really to look at,
where there are those forks in the road, do we go with completely the group
architecture, do we go with the highly structured, there’s obviously neither
one of those is going to work out so there needs to be some sort of thought on
that, issues related to Stark(?), how are we going to approach that because
that creates a barrier to hospitals and physicians working together to develop
information systems. So those are the kinds of issues that were brought up and
having not seen it yet but we hope to have it fleshed. So thinking about this
we really have three things that will be on the table at the time of our
meeting, we will have a Connecting for Health high level, sort of this is what
we’re thinking about moving towards the roadmap —

MS. GREENBERG: Are we talking about the meeting next week?

DR. LUMPKIN: No, this is our meeting, our Friday meeting, the July
23rd meeting —

DR. STEINDEL: When you say our next meeting you mean the July meeting.

DR. LUMPKIN: The July 23rd of this group. We have the reports
from the workgroup which we will hear the various work sessions that we’ll hear
in the morning and then we’ll have the ONCHIT strategic plan. So it’s the
conference work, it’s ONCHIT and Connecting for Health.

So my thought on that is that we may want to, we will have heard
presentations from all three of the groups, we will not formally have heard a
report, and again just not knowing the overlap because I won’t be there except
for the last day, our board of directors is meeting, they pay my paycheck, I
think I’ll need to be in Princeton, and again so I’m not sure if there’s
overlaps. My thought would be is that we could have two presentations in the
afternoon and then proceed to kind of walk our way through the work groups, so
the two presentations would be from the Office of the National Coordinator for
Health Information Technology on the plan, presentation from Connecting from
Health, and then we would walk through the eight reports that we just received
to identify those areas that we think we may want to bring together into what
we’re calling NHII-2, so I would see that really more as a planning meeting
trying to synthesize what we heard and re-crafting our agenda as we move
forward towards trying to develop our report in sort of a methodical fashion.
The afternoon session, we have approximately three hours.

MR. BLAIR: Will there be any discussion or description about the fact that
up until now we’ve referred to this initiative as the National Health
Information Infrastructure but the office is National Health Information
Technology Coordinator and why it’s different? And I’m not opposing it’s
different, actually I think there’s certain reasons why that might be a good
choice but now we have two different, well, we have an initiative which isn’t
totally congruent with the name of the office.

DR. LUMPKIN: I don’t think that that needs to be, in fact that probably
would be more confusing if it were because in a sense my guess is, and correct
me if I’m wrong, what I’m hearing on the focus, the initial focus for the
ONCHIT will be on the provider, the health care provider dimension, that’s
going to be the initial focus. I’m not saying that they’re going to ignore the
population base dimension and they may or may not have time to focus in on the
personal health dimension, but my guess is that’s going to be their focus. Is
that a fair statement?

DR. RIPPEN: So I guess I want to clarify what the question is, the question
is really that you have a National Health Information Infrastructure activity
and you have something called —

MR. BLAIR: Office of National Health Information Technology, and why is it
that the names are not the same?

DR. RIPPEN: Well actually I think I can, even from a before perspective
there is an effort that really needs to occur within the federal government
with regards to the coordination of all activities and funding and research and
actually that was one of the issues with the federal health architecture with
regards to their internal things and they have to somehow be interfaced with
the external. Per Bill Yasnoff his kind of conceptualization of what that was
was really the private sector and that it was a more facilitating discussions
amongst the private sector with regards to how to move this forward. And so
actually with regards to that then ONCHIT is then in a very nice position to
then be able to interface a private kind of sector push as far as activity and
then marry it with the internal activities so that then there’s a seamless

Now with regards to what does that mean for a complex topic such as health
information technology and diffusion and yet another acronym, yes, from a
marketing perspective, there’s some significant issues. But with regards to the
concepts that I think we’re talking about it’s not I don’t think, it makes okay
sense from my perspective. But I don’t know if that answers your question.

MR. BLAIR: That’s fine, it just —

MS. CRONIN: I think also it’s important to keep in mind with new leadership
comes new ways of thinking and with that will come new terminology as well. So
I would just be patient and wait to see how the next couple of months fall out.

DR. RIPPEN: And actually because again the NHII was not a government created
term, it’s actually a term created by NCVHS, the question is then from your
perspective even in recommending here what does that mean.

DR. LUMPKIN: I think where I was trying to go in a very fumbling fashion was
that what I think we’re looking at in our vision is broader —

MR. BLAIR: Yes, and it included legal issues and ethical issues and cultural
acceptance —

DR. LUMPKIN: Which the more ONCHIT does the better but there still needs to
be that marrying of the private sector and other forces and other issues that
we may identify as being important address. So I think the fact that there is
such an office, which as I mentioned earlier was partially our fault, certainly
is I think an encouragement for us to continue our efforts rather then to be a

Conceptual model thoughts, that’s just a straw model I’m throwing up for
what we want to do on that Friday. We could spend all the time looking at the
reports of the workgroups, we could —

DR. DEERING: We are in the morning, tentatively we have two specific
sessions to hear the reports in the morning.

DR. LUMPKIN: But it’s all them talking to us and so at some point, and what
we’ve kind of learned in our process is to the extent that we can spend some
time talking to each other and synthesizing what we’ve heard before we all
leave and forget and lose the essence of it what I’m proposing is is that we
kind of do it in a structured way to try to figure out what we’ve heard and how
that has impact upon what it is that we want to do in preparing our report.

DR. COHN: John, I’m still trying to think of what this is all going to look
like, there will be a 1,000 people at this meeting and presuming they’ll be a
1,000 people at this Friday morning activity —

DR. LUMPKIN: Friday morning, yes.

DR. COHN: I’m presuming that there won’t be 1,000 in the afternoon but we
might have 300 or 400 people out there and we’re going to need to figure out
some way, I don’t know that it’s going to work with us just all talking around
the table with 400 people down there —

DR. LUMPKIN: You don’t think we can put on a good show?

DR. COHN: We could, I think we can actually put on a show, the question is
is how we may want to involve them or not, or whether we want to do something
more structured, and I just bring that issue up.

DR. LUMPKIN: Well I can’t ask you to be on this committee because you
already are, like we did with the other troublemaker down the table.

DR. COHN: Well, these are just sort of things we need to think about.

DR. LUMPKIN: No, I think it’s a good point, I’m not sure I have, okay, now
Simon, you’ve got a solution for this?

DR. COHN: No, I wasn’t hearing the solution, I just realized there was sort
of —

DR. STEINDEL: Picking up on what Simon is saying, I think sometime in the
afternoon session we should have an open period for the audience to contribute
thoughts to us.

DR. DEERING: Maybe they may need to sign up in advance as happens in the
case with many other advisory committees, that they have X days and sometimes
it’s one week in advance or two days in advance or whatever the guidelines are,
but they actually need to register —

MS. GREENBERG: I think that probably wouldn’t work because —

DR. STEINDEL: I think we want them to react to what’s being presented and
we’re not going to know that until —

MS. GREENBERG: They can tell, the only thing is if there are 300, I mean
it’s never been a problem in the past when we say okay, everyone, we’ll talk
public comment and three minutes per person and maybe if ten sign up, I don’t
know, ten have never signed up, you’d only have 30 minutes. But let’s say 100
sign up, well three minutes is still more time then we have.

DR. STEINDEL: Maybe it would be a good idea to pick some reactor people or
groups and sort of seed the discussion and say immediately after lunch we’d
like two minutes or three minutes from your groups on your reactions to what
you heard this morning.

MR. BLAIR: Would it be possible since we can’t control how many people would
sign up or would not sign up that we have a limited amount of time and maybe we
could hear 30 some odd folks, and if more then 30 sign up then we indicate to
those folks that we didn’t have time for to invite them to please send us an
email with their comments —

MS. GREENBERG: First come, first served.

DR. LUMPKIN: But I think the question is what we are asking them to react
to, the panel reports in the morning are going to be them telling us what
they’re thinking. The only two things that I don’t think that they’ve had an
opportunity to react to, and the first one is going to be, I think isn’t going
to be our call, I think that’s going to be the ONCHIT call, whatever, CHIT
call, and that is at that particular point given how fresh this is do you want
in a public forum to get responses to this newly rolled out plan, and is it
going to be far enough evolved. The second thing that I don’t think the
audience will have necessarily had an opportunity in that structure to talk
about will be the roadmap. So if we think about it that way as having audience
participant, if we’ve got three hours, we could open the mic and let people
comment on those two ideas and then spend the last hour talking about next
steps for us as a workgroup.

DR. STEINDEL: I’m assuming that in the breakout sessions that there will be
discussion of the strategic plan, so we probably will get comments on the
strategic plan in the reporting out from the breakout groups as it relates to
their areas. Now whether the meeting planners are planning for that to happen
or not I’m not certain —

DR. LUMPKIN: I think they will come but not necessarily in a structured way

DR. STEINDEL: No, I don’t think they’ll be structured.

DR. LUMPKIN: There will be imbedded in the reports from the workgroups and I
think there’d be some benefit of getting structured feedback. My guess would be
is that as this plan is being implemented, assuming that HHS wants to get
feedback, it will be our responsibility to help participate in structuring that
feedback and that may be one of the ways to do that.

MR. DAVIS: As one of the folks that’s going to be in that audience and have
gotten several plans to come, let me support Steve’s idea and also add to that,
I’m a member of National Uniform Billing Committee, the committee where we go
out of our way to make sure there is a broad representation of the various
stakeholders. I think it’s incredibly important that you make sure key
stakeholders, and I would urge you to look at your sponsor group to make sure
some of those actual sponsors know in advance you’re going to get a chance to
talk because as you said you want to be able to get real feedback and talk
while it’s fresh, I would encourage you to get some fresh feedback from some of
the key stakeholders, like the providers, like the plans, some of the folks
that are interested in this because trust me, I know I will be polling my group
and we will get in a little caucus group and throw ideas back and forth and I
guarantee you you’ll hear something that’s got a Blue perspective and I got to
imagine the providers and other groups would do the same thing if they knew in
advance we were going to get a chance to get some fresh feedback into this
group. Trust me, they’ll work together to give you some really good feedback.

DR. LUMPKIN: Let me push back on that though, we’re going to have a couple
of hundred people here, whether we ask you to do it or not I know we’re going
to get written comments from WEDI, and they’ll be structured and if we wait a
couple of days they’ll be even better then if we ask somebody to come to the
microphone that afternoon. That’s going to be true of the Blues, that’s going
to be true of the AMA, that’s going to be true of the hospital association and
a bunch of other groups. So the question is we have this time, how can we best
us it to hear from folks that we may never hear from otherwise in the way we do

MR. HOUSTON: Assuming that the reports from the workgroups do accurately
reflect the discussions at the workgroup sessions themselves, the breakout
sessions, I would think that everybody’s interests should be reflected or at
least the discussion should be reflected in those reports. I would hope that
there isn’t a lot of new discussion that arises at these meetings or these
particular sessions.

MS. GREENBERG: Well, that’s the role of the facilitator, to make sure that
all viewpoints get —

MR. HOUSTON: So is it extraneous or are we just going to hear rambling, I
mean I hate to say it that way but are we going to hear things that are already
being considered in the workgroup reports, are we already going to hear things
that —

DR. LUMPKIN: The question I have, and I don’t think we know but I don’t know
to what extent the facilitators are going to be, I mean they’re going to be
instructed to try to get something out of that group and it may not be to
respond to the new plan.

MS. GREENBERG: It may not be what?

DR. LUMPKIN: To respond to the strategic plan, and so I don’t know to what
extent that feedback that we’re going to hear in the morning is going to
actually give us insight into how this broad group that’s there at the
conference view on first blush because my guess, I don’t even know if it’s
going to be even printed up as much as presented orally this new concept that’s
being put out.

MS. CRONIN: I think it will be certainly disseminated on the 21st
but there will be no lead time to review it, or process it or get any kind of
consensus amongst individual stakeholders. My sense is there might be a lot of
very good discussion the first day too given that they’ll be four reactor
panels. So there might be some very interesting comments that you would get but
my sense is that it may not be as structured as you would like if you’re really
looking for something that would formally represent most of organized medicine
or the large part of the payer community.

PARTICIPANT: One of the things we’ve already planned for in our organization
is to meet afterwards to discuss the impact and how it faces what we’ve been
dealing with for the last five years. You all have been dealing with NHII as a
concept for well over five years and I think what would be helpful to us as an
organization and others is I’d like to hear your reflections and your questions
after that morning session and I’d like to hear your questions that we might
respond to as we get a chance to let this soak in and reflect back to you in
writing, it will make it a little easier then another hearing, but to give you
some feedback but since you’ve dealt with it for so long, you’ve had various
integration with this whole process, I think it would be helpful to hear your
thoughts and then be able to reflect both on what we pick up from the meeting
and yourself.

MR. HOUSTON: If we want to get meaningful feedback, if we limit the length
of the responses, we ask for short, something that’s manageable, then we can
take that back and review after the fact in some type of structured fashion,
all the different comments and try to incorporate them into —

MS. GREENBERG: May I just ask a question that was stimulated by what Kelly
just said about the reactor panels? There’s a federal agency reaction panel,
right, private industry and then a legislation, but there’s nothing from state,
local, community —

MS. CRONIN: The federal is intending to represent public health as a whole
but we have not branched out beyond that.

DR. LUMPKIN: I’m sorry, Jeff asked if you could repeat what those three
panels were, the reactor panels —

MS. GREENBERG: Federal agency, private industry, and then legislative, it
said Congressional staff —

MS. CRONIN: Not staff members —

MS. GREENBERG: Congress.

MR. LARSON: Can I ask what the role of NCVHS is on an ongoing basis with
NHII and the strategic plan, one of the things of excitement in the industry is
with Dr. Brailer’s appointment that things will move forward, obviously there
has to be consideration with the proposals. But you talked about a fall
meeting, what will NCVHS do based on the input from the NHII conference and
these three sources, what will your deliverable and contribution then be?

DR. LUMPKIN: Whatever the department wants it to be.

MS. GREENBERG: I won’t accept that answer.

DR. LUMPKIN: No, I think it has to be put within the context, we are in the
process, we’ve begun the process of developing a follow-up report to our
original information for health and what we will do is look at what the
department, the directions they’re going and make suggestions, support the
directions we think are good, make suggestions in areas that we think they may
have overlooked, and other new areas that we think ought to be explored. So
really that really has been our role, the role, and I just go back to my roots
in Illinois, if you’ve ever been out in a soybean field you see these, every
now and then you see these little stalks of corn, they call it volunteer corn
because no one asked it go out and do that, it just volunteered. And we just
volunteered on the NHII. Our charge is to advise the Secretary in relationship
to health information policy and we choose to do that in regards to the overall
concept and implementation of the National Health Information Infrastructure.

MR. HOUSTON: So therefore there would likely be a recommendation letter out
of NCVHS to the Secretary regarding NHII direction or —

DR. LUMPKIN: Well, I think that there are any number of things depending
upon what we hear. First of all as a FACA committee what comes out of the
conference can go directly to the Secretary in a way that the department can
act on, FACA, Federal Advisory Committee Act, and so that gives it a certain
weight, additional weight, as it moves through the process, it moves directly
to the Secretary, so that’s a really important role that we play in listening
to that, and we then synthesize what we hear at the report and then they make
take in addition to the specific text of those say here are our recommendations
based upon what we heard. That really is our role.

DR. STEINDEL: I was going to suggest that what I’m hearing is a need for a
meeting in the early October timeframe to put this all together.

DR. LUMPKIN: See I’m not necessarily hearing that, because there’s a
conversation we need to have with Dr. Brailer and that is October may not be
soon enough.

DR. STEINDEL: Oh, if you want to do it sooner, I was —

DR. COHN: Were you thinking of a September letter?

DR. LUMPKIN: I think we need to understand the timeframes better which we
don’t right at this moment and I don’t know why, the guy’s only been there for
30 days, I mean been there for all of 30 days already, he should have all these
pieces together. But no, I think that we need to figure that out as time goes
on and we get closer to the meeting what our timeframes are for helping him and
the office provide meaningful input onto this plan. So it could be that we may
need to look at doing something even much sooner and trying to come up with
something by September —

MR. HOUSTON: — start laying in the dates if you’re going to get written
document —

DR. DEERING: I think it depends on what the document is, if it’s a letter, I
mean the NCVHS has done both short letters that are highly —

MR. HOUSTON: I understand that, my point is that if you want, if the
structure or the process we’re going to go through is that we are going to ask
questions and elicit input, written feedback, then we need to have deadlines
established that are reasonable for people to then provide feedback based upon
the questions we ask. And then we have to have a chance to review those and
then take those and distill them down into these recommendations that we’re
going to make. I mean that’s, that could take some time and we have to then to
get buy-in from Brailer and whatever —

DR. LUMPKIN: Let me see if I understand, if I understand the direction
you’re going in you’re kind of leaning towards what we would do in the
afternoon is sort of synthesize and begin to construct questions based upon
what we heard from those three sources.

MR. HOUSTON: I just sort of sense that there might be, that might be a
direction we take where we do have, need more information or like to get more
information and put those questions out for written comment or written, I mean
I think Dan was sort of, I don’t know, that was what I sort of heard, I’m open,
rather then trying to get people to stand up and say something in front of a
microphone, an open mic for however long, which chances are we’re not going to
get a lot of really valuable feedback in that forum because we will not have
had an opportunity to really distill down what they heard at the conference. If
we sort of throw some things on the table which we see as immediately being
issues that warrant some type of feedback a lot of people who go away and then
provide written feedback based upon those questions, then we need time to look
at that and then use that to formulate our recommendations. Again, that’s how I
thought the way it was sort of proceeding.

DR. STEINDEL: And I think we have to allow reasonable time for that, for the
feedback to come in.

DR. BICKFORD: As you were talking about what should the NCVHS be doing in
that afternoon it seemed to me that this would be a perfect opportunity to
showcase the think tank, the advisory capacity this group is engaged in that
people who have no concept of what NCVHS is about who may be staying can maybe
hear the discussion. I have a concern that this is an opportunity for NCVHS to
do its work in public —

And as they do that you’re synthesizing the questions that people are going
to have to respond to or they choose to respond to, that would be a powerful
experience for students who may be participating in this, who’ve not seen the
committee working, it allows the consumers to appreciate it, it’s sort of like
you’re on the hot spot.

DR. DEERING: I was first thinking in terms of the structuring and helping to
guide the input that we wanted to receive just to make it easier for people to
give us meaningful feedback, but I think the same thing I was thinking might
apply also to the committee itself which is it would be possible to come up
right now with a generic structure of how we want people to address the issues,
what were the things that you’ve heard that you really, really think are top
priority, what were the things that you heard that jump out at you as
problematic, what are your priorities, I mean if you gave people a little, if
you told people to be thinking actively and again, trying to anticipate what
would be most useful to the Secretary, because some people would perhaps
appreciate being told what would be most useful as opposed to just standing up
and going off on a little factoid that might or might not be helpful. In the
spirit of an open hearing of course you don’t want to guide things but I’m just
putting on the table whether there could be value —

DR. LUMPKIN: Well, when we think about what we’re going to hear and the kind
of recommendations that will be coming forth we have a series of breakout
groups and I don’t have the list of the stakeholders but —

MS. GREENBERG: I’m a little confused, who’s going to be reporting back, not
the stakeholder groups but the —

DR. LUMPKIN: The topic groups.

MS. GREENBERG: The topic groups who are supposed to have incorporated into
their, the stakeholder, then what’s this last one here, breakout five,
stakeholder tracks?

MS. BEBEE: That’s supposed to be topics, that’s a typo, it’s still a topic.

MS. GREENBERG: Oh, that shouldn’t be stakeholder.

MS. BEBEE: Back to topic.

MS. GREENBERG: This is a topic, thanks.

DR. LUMPKIN: So the reports will be in four, in the eight topical areas that
are listed here.

MR. BLAIR: For my benefit, would you mind reading —

DR. LUMPKIN: Yes, I will. Personal health, governance, incentives, standards
and architecture, confidentiality, ethic, privacy and access, measuring
progress, population health and clinical research. My guess would be that given
what we’ve done the issues that would be ours in a sense would be to talk
about, four of those come to mind as kind of rising to the top. Personal health
we’ve always had an interest in, governance, incentives, standards and
architecture, measuring progress, and I don’t want to slight confidentiality,
ethics, privacy and access but I think that we probably just want to mention
that, discuss what we’ve heard, and flip those off to the Privacy Subcommittee.

DR. STEINDEL: When you mean by us you mean this workgroup.

DR. LUMPKIN: This workgroup, yes that is the us.

MS. GREENBERG: I think in light of what we’re seeing I think this, this
could be a lot of people and they’re not going to understand the nuances of
this as the NHII Workgroup, one workgroup of the whole national committee. So
although that’s what you are there I think it would be important to articulate
that you’ve got the national committee addresses all of these so population
health, research, privacy, all of these, I mean otherwise if you tried to
circumscribe it it would come through that’s what the national committee —

DR. STEINDEL: I think we have to receive information on all eight but when
we’re synthesizing we’re going to look at those areas that are from the
workgroup domain.

MS. GREENBERG: You’re doing this for the full committee.

DR. LUMPKIN: No, we’ve got three hours and if it’s going to be a meaningful
exercise for us and for the audience to see how we work and identify what are
the key issues that we want to hear feedback on I’m not sure that spending two
hours for would that be 15 minutes apiece would do that justice.

MS. GREENBERG: Yeah, but population health is one of your dimensions too, I
don’t know you would pick personal health and not population health.

DR. LUMPKIN: Now you’re getting into details, I think let’s decide on the
concept and then we can pick out of those I would think we probably would want
to pick four —

PARTICIPANT: You mean to discuss in detail, is that what you mean?

DR. LUMPKIN: To spend some time and identify questions on, or not because
I’m hearing some —

MR. HUNGATE: Let me come from a different corner and try another cut at the
same thing. This is a big deal, this meeting, I’m not going to be there this
time unfortunately because I’m going to be off salmon fishing in British
Columbia and I’m not coming home. That said, there are these eight topic area
feedbacks and there’s two customers for that, one is the new office that really
is doing this and they’re going to take that information and react to it and
NCVHS has had ongoing agendas that relate to all this and our agenda may shift
a little bit based on what occurs. And so I’m wondering whether what we should
be talking about is how does this change what we do, where are we now, what
does it change about what our mission work and its maybe broader then just
NHII, it maybe is the whole, and so that took me back to wondering whether this
was an NCVHS hearing or a workgroup hearing. It’s a two level discussion
because the momentum has changed from where it was when I came on the
committee, the situation is different, and I don’t know how much, what that

DR. LUMPKIN: Let me try it again a different way. We’re going to have the
strategic plan, could we use that as the structure that we would take what
we’ve heard in the morning and then try to work our way through the strategic
plan in trying to frame questions that will tease out what we’ve heard in the
morning in a more structured way to fit within the plan. My guess is the plan
will probably have some structure and we can pull it, we pull it apart into
maybe four different areas that will allow us to then synthesize what we heard
in the morning and trying to develop appropriate questions to ask.

MS. CRONIN: I think you can map the domains to the strategic framework
pretty easily.

MS. GREENBERG: I just would think that your questions should be cross
cutting in a sense across all of these rather then focusing on four of the
eight or something.

DR. LUMPKIN: Right, and I think that’s the way we get around that by using a
different kind of structure for that two and a half, three hours that we have.
So I see a lot of people nodding their heads —

MS. GREENBERG: And where does Connecting for Health fit in?

DR. LUMPKIN: We’ll have to figure that out.

DR. COHN: Are they presenting their roadmap during the meeting?

DR. LUMPKIN: I don’t know if they’re presenting it at the meeting or —

MS. CRONIN: I think they just have to fit it in a time slot.

DR. COHN: Kelly, help me with this one, I don’t know what not independent of
time slot means, is it a topic that is going to be considered and you just
don’t know where it’s on the agenda, or is this something that we really
actually need to talk about on Friday afternoon after the conference is over as
something that wasn’t discussed.

MS. CRONIN: It’s likely that a lot of the people participating in the
meeting will be very familiar with what’s in the roadmap if they haven’t been
directly involved, so it will be a lot discussion about it but I don’t think
that there’s a time on the agenda, and Susie correct me if I’m wrong, that
actually allows Carol Diamond or anyone else who could speak on behalf of the
effort to give an overall summary of what’s been accomplished. So it’s probably
something you may want to consider as part of your agenda.

DR. BICKFORD: Is that part of the workgroup’s discussions? Is it background
material that goes into participants at that level and they need to be
referencing it?

MS. BEBEE: It’s not prepped into the background material, no —

MS. CRONIN: But it will be available.

MS. BEBEE: As Kelly’s just described it there will be people in the audience
that will be very familiar with it and will be part of the topic discussions
and stakeholder discussions so I’m sure it will be folded in.

DR. COHN: I was just going to comment, I will apologize, as the day goes on
my thought process gets more disordered. But I guess I’m sort of struggling
since, I mean we obviously have an opportunity here and I think we’re having
trouble figuring out how to structure the session, but part of the formation
that I think is happening is is that maybe there needs to be some discussions
that do deal with sort of longer range how can we help as a workgroup, what is
the government need and what timeframe, I mean if there’s really some sort of
an expectation that we need to do the hurry up offense and have a letter in
September, that I think really changes how we may work this versus something a
really much more long term planning exercise. And it seems like, John, maybe
you have an occasion to have some conversations with staff and others to sort
of figure out really what would be helpful and then we can sort of devise an
agenda and process to meet it.

DR. DEERING: I was just think as a staff who helps —

MS. POKER: I was just going to segue what Simon said, if you use the
strategic plan and you’re going to map into it whatever the breakout groups say
would you want to go from there where the role of NCVHS could be pivotal for
the different breakouts? In other words kind of like emphasize, I don’t know,
population, this is what we’re doing and this is what our goals are, or this is
the current ongoing activity and kind of get feedback for the individual
subcommittees. In other words kind of use the synthesis that you get from there
and see this is what we’re doing, is this the direction, kind of put it out
there for them. I mean this is just a thought.

DR. LUMPKIN: Here’s kind of where I think I’m getting at after this
discussion. First of all I think the issue that you’re raising says to me in
just looking at the schedule we need to open this hearing on Friday morning
with an explanation of who we are, why this hearing is happening, and why we’re
doing it and what the NCVHS hopes to get out of this. And then the morning
session flows into the afternoon session and so again realizing the morning
session is we’re actually hearing from broad groups of folks, at that point we
may want to look at how this fits into the time schedule for the strategic plan
and including getting something from Connecting for Health, then this
afternoon, the afternoon, where it’s going to be us discussion whatever, my
suggestion on process is that we try to set up a conference call for as many of
the committees as we can pull together having benefited from this discussion,
by the time we do the conference call somewhere a week or two before the
meeting we should be able to have the bare bones, what Connecting for Health
will have, that will have come out of the steering committee, that should be
available after the 30th of June, that will give me an opportunity
to touch base with David or have ONCHIT an opportunity to kind of decide, have
an internal discussion on what it is and how they see our role. So then we can
have a conference call to further structure that based upon those two important
bits of information that we don’t have at this time.

MR. BLAIR: Kind of building on what you’ve said and paraphrasing it a little
bit, the role of the NCVHS as an advisory body to Health and Human Services has
been to mostly gather information from the private sector, not exclusively, and
try to pull together some thoughtful recommendations that could assist health
information policy. Now the thing that is a little different about this
situation we’re heading into is that the principle recommendations that we’ve
made on the NHII have essentially been adopted and now this meeting in July
Health and Human Services is hosting a group of people to gather reactions and
information, in other words a lot of the functions that the NCVHS might be
doing this meeting is doing in the two days before we meet, which is actually
good because it’s being done now on a scale that is far beyond what we would be
able to do and that scale is important to do so it’s doing something that we
didn’t have the resources to do and so I think that that is something where we
don’t want to duplicate it, we don’t want to be redundant with it, and they’re
going to be getting feedback on these eight different groups as well. If it
turns out that your suggestion that the area we focus on, something that would
be appropriate for the time that we have and appropriate for the make-up of the
NCVHS in terms of the skills we have to be able to contribute, is strategy, for
us to give feedback on the strategy, and if we give feedback on the strategy in
a manner that tends to be a little bit consistent with the things we’ve done
well in the past where maybe we have a reiteration of the strategy and we have
a targeted selected group, either a folks or ways or framework to get public
feedback, not just our own but public feedback on the strategy, followed by our
questions to the people that are reacting and then maybe a little bit of a
discussion on our own as to how we feel about the strategy, then that becomes
consistent with what we do well, it might be a piece that is reasonable to bite
off where it’s not too big or not too small, and I don’t know, Kelly and Helga
and Susie, do you think that that’s a good fit where we’re complementing what
you folks are doing?

PARTICIPANT: I think that sounds perfectly in sync, this is Jennie, I think
when you see the strategic plan I think there will be parts of it that will be
easy to identify that will be kind of bitable chunks, pieces that you could
clearly focus on, and then as you’re suggesting, or at least what I’m hearing,
think I’m hearing you ask for, is some feedback on those large bitable chunks
at the time of your meeting in July as well as some additional feedback from
other folks as time goes forward and then being able to synthesize that and
then provide back to David Brailer’s office, I think that would be very, very

MS. CRONIN: I think it would also be very helpful though to have a follow-up
meeting when you’ve had more time to think about your future scope and how it’s
going to fit because this is really evolving week by week and conceptually it
does seem to have a really good, a good idea to have some strategic feedback
and based on structured input from the various stakeholders and your
interpretation. But I think it probably warrants more consideration then what
we can give it right now.

MS. BEBEE: I have a question, some of the answers to what the opportunity or
role of NCVHS was in this meeting, there was mention of a letter but also
you’ve been talking about a new report so my question to you is how does this
fit into that bigger role that Kelly just referred to, the scope that you have
and the new report that you’ll be working on.

DR. LUMPKIN: Well, I think I see the role of the committee is to serve, and
if we don’t get the report out within our timeframe and a little bit longer
because we expended a little bit of time doing something more focused and
quicker that has impact on the strategic plan which will have a very long range
impact, I would see that as being a better choice in that within that context
the environment is totally different then even when we started working on the
second phase. So I’m comfortable with the fact that we may change our agenda
and our schedule and our work plan to try to produce something within the
timeframe that’s going to be meaningful with the new office. Marjorie?

MS. GREENBERG: I had a question but first I wanted to make a comment about,
I think the executive subcommittee retreat, which will be August 6th
I think, is also an opportunity to try to have some discussion about this in
that that’s already scheduled. I mean Bob, well you won’t be there —

MR. HUNGATE: I’ll be there the 6th.

MS. GREENBERG: But you’ll be at the retreat right? And you’ll bring some
salmon and all that, Simon will be there, of course you’ll be there, and it’s
even possible that if we wanted to bring in some of the other members of this
workgroup by conference call we could, or bring them even to the meeting but we
can’t devote the entire, but I mean this is, we’ve had discussions in the past,
in particular I remember we’ve had discussions like with Susan Canaan when we
were writing the reports, is the NHII part of, almost like a sum of all the
committees, or is it smaller then the committees, is it bigger then the
committees, but in some ways as we looked at these topics it does cut across
all the foci of the committee. So it would seem for the executive subcommittee
to, this would be an opportunity of a meeting that’s already scheduled.

DR. LUMPKIN: I think we really need to get a feel for the timeframe which we
don’t have. If it’s a choice of putting off and saying moving the executive
subcommittee to the rest of the agenda items and have another retreat meeting
in November/December, somewhere around there, versus kind of upserting that
meeting in August, which many of us already have on our calendar, I’m saying
having the meeting in August but we may change the focus.

MS. GREENBERG: It’s just an already scheduled meeting with a number of —

DR. LUMPKIN: So we need to remember that meeting because the day after that
I’m going to be gone for three weeks so trying to find the time when we can
come together, that may be a time that’s already kind of sitting there. Steve.

DR. STEINDEL: Those were somewhat magic words because the executive
committee retreat is about what, two weeks or one week after the NHII
Conference and if you’re gone for three weeks and we’re actually getting
together again in early September just about the time you come back —

DR. DEERING: I like the thought that I’m sure you will get additional
feedback in prior to the 23rd from David and from staff and
everything to think through exactly what we need and will be very focused. And
the reality is I’m sure that you will indeed get input from some of the other
subcommittees on some of the more technical aspects here, that’s a foregone
conclusion probably that the Privacy Subcommittee is one that you’re going to
turn to and you’re going to say, you’re going to task them to do that, and
you’ll turn to Simon in his dual role, so I think that that’s a reality. And
then I started to say thinking of the kinds of letter reports and things that
have been given back I’m just imagining that this is going to be fairly
concise, it’s probably going to be focused on really key issues, this is not
going to be a general oh we love it, this is fine, it’s going to really be
focused on what are the key strengths, weaknesses, gaps, concerns, that you see
in the report. It’s going to be really straightforward and so there again, I
think to the extent that people are tasked with listening with those ears so
that by the time we get to August 6th people should have done some
homework maybe in those two weeks along those two questions or whatever those
questions, what are the questions you want answered, tell us, and then we can
have something —

DR. STEINDEL: Just from a practical point of view during that two weeks
period Simon Legree(?) over there is bringing together the Standards and
Security Subcommittee for three days to accelerate the e-prescribing letter,
and we’re repeating that in mid-August.

MR. BLAIR: While our fearless leader is having this vacation we’re having
another e-prescribing standards meeting in later August.

DR. LUMPKIN: I’m actually doing work for two of those weeks, out of the

MS. CRONIN: I think there will be a level of detail in the report that will
require a lot of technical expertise and a lot of thought and it could have
something that’s way beyond what was specified in the report a couple years ago
so I think that alone would make you want to have a little more time for
consideration. I also think that this is going to be a living document and like
any good strategic plan it should not be something that sits on the shelf never
to be looked at but something that really is going to be an implementation tool
and react to needs as they arise over time. So they’ll be plenty of opportunity
is my sense right now for you to contribute to that as things develop. But it’s
probably best to circle back with David.

MS. GREENBERG: Can I just ask a question because I realize I came in late
but I’m trying to understand how all this fits together and for the topic
breakout sessions it says presentations of submitted topic track draft
recommendations, are these being, these are the things that are being developed
by the facilitators?

MS. BEBEE: Where is this Marjorie?

MS. GREENBERG: I’m sorry, I’m on, right after the legislative panels and
when the breakout sessions start. People are going to be discussing, each track
is going to have some kind of a paper, right?


MS. GREENBERG: And those are being developed by —

MS. BEBEE: The people leading those groups.

MS. GREENBERG: The facilitators —

MS. BEBEE: The facilitators are paid —

MS. GREENBERG: Right, they don’t know, so the technical leads, they’re
developing these and how —

MR. HOUSTON: There’s a group of leaders and subject matter experts.

MS. GREENBERG: And then how do these connect with the strategic plan that’s
being developed.

DR. LUMPKIN: Parallel tracks.

MS. GREENBERG: They’re doing their papers here on these topics, they’re
doing the strategic plan here, okay, so they’re not —

MS. CRONIN: There’s likely going to be very similar concepts and ideas but
there’s not a parallel process in terms of, I mean there’s not a lot of
communication between those processes.

MS. GREENBERG: Okay, so there will be a need to integrate —

DR. LUMPKIN: And as was discussed as happened last year, what goes into
those breakout sessions, which are the papers, and what comes out, may be two
different things. And very likely will be.

MS. BEBEE: These papers are only five pages long, the papers are only five
pages long.

MS. GREENBERG: And those are going to be distributed prior to the meeting?

MS. BEBEE: They’re going to be posted prior.

DR. LUMPKIN: As I understand it the goals of the papers are to encourage the
breakout groups not to rehash old territory but to move into new territory with
brand new issues.

MS. BEBEE: And catch anything that wasn’t caught already.

MS. GREENBERG: Okay, thanks.

DR. LUMPKIN: Okay, so I think if I can summarize where I think we are with
our plan, that over the next two weeks or three weeks we’re going to try to
have a conference call sometime mid-July or so. The purpose of the conference
call is to sort of, by then everyone will have a chance to see the roadmap from
Connecting for Health and I will have had an opportunity to have a conversation
or conversations with David Brailer about where we see the role of the
workgroup and the committee in the livingness of this strategic plan. That will
give us the scope of what we need to accomplish in the timeframes. Based upon
that we’ll have a conference call and we’ll structure the day actually, the
workgroup reports are kind of fixed but there’s the introduction and then the
afternoon session. That will also determine and we’ll discuss in the conference
call what we do on the already set August 6th meeting and whether or
not we need to plan on doing something for our September meeting.

DR. DEERING: The conference call will be of the workgroup only?

DR. LUMPKIN: Workgroup.

DR. DEERING: Because the workgroup, are there any members here who are not
on the executive committee who may not have it on their calendars, so the point
is that the August 6th will be just of the executive committee

DR. LUMPKIN: Well, I think that anybody who is on the workgroup who is not
on the executive subcommittee I would ask that you would at least try to hold
the 6th until our conference call, just in the event that there, at
the very least it will be a short conference, there will be a conference call
with the executive subcommittee and at the most there would be more extensive
involvement of the workgroup with the executive subcommittee.

MS. BEBEE: John, is there a possibility that, I understand you have a
meeting in September, there would be further activity, hearing, or something
along those lines depending on these other two issues?

MS. GREENBERG: But this workgroup doesn’t have a meeting, the full committee
has a meeting, 1st and 2nd.

MR. HOUSTON: The reports are going out, the reports are being done on
Thursday, correct, in the morning? From the different workgroups?

MS. BEBEE: I don’t know, when is it?

DR. LUMPKIN: I’m sorry, which reports?

MR. HOUSTON: Two levels.

MS. BEBEE: The reporting out of the eight topics —

DR. LUMPKIN: Friday the 23rd.

MR. HOUSTON: On Thursday they have preliminary session, never mind, because
I was thinking we also have, not to make work for people the night, we have
Wednesday night and Thursday night if we, we could spend a half hour or an hour
just following the sessions if we needed to convene to decide to finalize what
we’re going to get on Friday based upon, I’m just, I’ll shut up.

DR. LUMPKIN: I’m getting in some time that evening.

MS. BEBEE: The purpose of that summary is because we’re then getting ready
to have the breakouts for stakeholders so it’s trying to get everybody on the
same page before they, about the topic issues, before they go into the

DR. DEERING: Can I ask a question for Jackie and Marjorie’s sake? This has
to do with the physical logistics to get back to the very mundane, what I’ve
heard us confirm is that, and I know Jackie I think you’ve already been over
there and I think you’re already working with them about space on Friday, I
think we just need to be sure that what we’ve heard is that we may not know
until after our conference call whether we need a physical set up that
accommodates open mics, that we have not yet made that decision or have we in
fact decided against it? Or will we wait until our conference call to make that

DR. LUMPKIN: I can’t think of a scenario that would not involve some open
mic time with the workgroup so I don’t know what the balance is going to be but
I think we need to have the capability to do open mics. And a limited number of
open mics, I’m thinking two, so people can line up in front of the mics if
we’re going to do that but if we have too many mics it’s just the control
factor gets lost.

DR. DEERING: But also I don’t know, I haven’t seen this room, have you seen
the room where we’re going to be Jackie? Are we like up on a stage? Or is it a
huge room and we’re —

MS. ADLER: Low risers.

DR. DEERING: Just on risers.

DR. LUMPKIN: And the accommodation, how many people can the room

MS. BEBEE: 1200.

DR. LUMPKIN: For the afternoon?


DR. LUMPKIN: So we’ll stay in the same room and —

MS. BEBEE: Actually the room, there are three rooms and it’s laid out in a
rectangle and it’s going to be horizontal, not vertical, so actually it is
theater but actually we could close off two of the rooms, so I mean that’s
logistically the capability.

DR. COHN: Well, it depends on who’s there though.

MS. BEBEE: Exactly, it’s set up for the whole 1200 capacity in three rooms.

DR. LUMPKIN: I’m just thinking and hoping that it being a Friday afternoon
that when that session closes at noon that people are going to be —

DR. STEINDEL: I think that’s a safe assumption.

MS. GREENBERG: It’s another reason to give some background on the committee
at the beginning.

DR. LUMPKIN: Well, of course, of course —

DR. COHN: We know Dan’s going to be there.

DR. DEERING: You know by definition those who are there would really like to

DR. LUMPKIN: Right. Okay, I think we have a plan and we’ve run out of time
but I think this has been —

DR. COHN: I guess we’ll figure out the dimensions later on.

DR. LUMPKIN: Yes, we may have time to think about that as our agenda seems
to be getting upserted by the conference.

[Whereupon at 6:03 p.m. the meeting was adjourned.]