[This Transcript is Unedited]



June 16, 2010

Sheraton Crystal City Hotel
1800 Jefferson Davis Highway
Crystal City, Virginia

Proceedings By:
CASET Associates, Ltd.
Fairfax, Virginia 22030
(703) 266 8402


P R O C E E D I N G S (9:05 a.m.)

Agenda Item: Call to Order, Welcome

MR. REYNOLDS: Good morning. I would like to call to order the first of two
days of hearings for the National Committee on Vital and Health Statistics.
NCVHS is the main

health policy advisory committee to the Secretary on health information. My
name is Harry Reynolds, Chair of the committee. I work for IBM.

Before we start, I would like to go around the room and have the members
and staff introduce themselves. During your introduction, please note whether
or not you have any conflicts of interest. I have none. Jim.

MR. SCANLON: Good morning. This is Jim Scanlon. I am the Deputy Assistant
Secretary for Planning and Evaluation at HHS. I am the Executive Director of
the full committee, and I have no conflicts.

DR. SUAREZ: Good morning, everyone. I am Walter Suarez. I am the Director
of Health IT for Kaiser Permanente, and I am a member of the committee, and I
don’t have any conflicts.

MS. MILAM: Good morning. I am Sallie Milam, Chief Privacy Officer for West
Virginia’s Executive Branch. I am located at the West Virginia Health Care
Authority, and I have no conflicts.

DR. OVERHAGE: Good morning. Marc Overhage, Regenstrief Institute, Indiana
Health Information Exchange, a member of the committee, and have no conflicts.

DR. SCANLON: Good morning. Bill Scanlon with National Health Policy Forum
and member of the committee, no conflicts.

DR. STEINWACHS: I am Don Steinwachs, Johns Hopkins University, member of
the committee, no conflicts.

MS. TRUDEL: Karen Trudel. I am the liaison to the committee from the
Centers for Medicare and Medicaid Services.

DR. HORNBROOK: Mark Hornbrook from Kaiser Permanente. No conflicts, member
of the committee.

DR. GREEN: Larry Green, University of Colorado, no conflicts, member of the

MR. LAND: Garland Land, National Association for Public Health Statistics
and Information Systems, member of the committee, no conflicts.

MS. FRANCIS: Leslie Francis, Law and Philosophy, University of Utah, member
of the committee and no conflicts.

MR. HOUSTON: John Houston, University of Pittsburgh Medical Center, member
of the committee. I have no conflicts.

DR. WARREN: Judy Warren, University of Kansas School of Nursing, member of
the committee, no conflicts.

MS. GREENBERG: Good morning. I am Marjorie Greenberg, National Center for
Health Statistics, Executive Secretary to the committee. I want to welcome you
to the 60th Anniversary Week. I just want to especially thank Susan Canaan and
Debby Jackson for these gorgeous documents, as well as the whole program, which
we are looking forward to tomorrow.

DR. KYLE: Frank Kyle, American Dental Association.

MS. JAMISON: Missy Jamison, National Center for Health Statistics.

DR. VALDEZ: Emilio Valdez, Summer Fellow, National Center for Health

MS. KAHN: Hetty Kahn, National Center for Health Statistics.

MS. KANAAN: Susan Kanaan, writer for the committee.

MS. WILLIAMSON: Michelle Williamson, NCHS.

MS. JONES: Katherine Jones, National Center for Health Statistics.

MS. HORLICK: Gail Horlick, Centers for Disease Control and Prevention,
staff to the Subcommittee on Privacy and Confidentiality.

MS. JACKSON: Debbie Jackson, National Center for Health Statistics, CDC,
committee staff.

MS. DOO: Lorraine Doo, lead staff to the Standards Subcommittee.

MS. GARTH: Carrie Garth, CMS.

MS. LENHART: Cynthia Lenhart, intern with AHIMA.

MR. RODIE: Dan Rodie, AHIMA.

MR. CAZARRO: Cotton Cazarro, First Data Bank.

MR. DeCARLO: Mike DeCarlo, Blue Cross Blue Shield Association.

MR. REYNOLDS: Again, I would like to remind everyone that since we are on
the Internet, if you will make sure that you get close to a microphone when you
are making comments, so that those listening in are able to hear us.

An interesting agenda today and tomorrow, in that this morning we will get
our regular updates, and as I open my discussion tomorrow in an incredibly
exciting time to be on this committee, and in this environment. So as we get
these updates, it will continue to show the progress that is going forward, and
then tomorrow we will be able to talk quite a bit more about some of our
visions of what is coming up in the future.

This afternoon a little time for the subcommittees to get together to in
fact build off of the document. I would like to thank the population group from
the committee, for heading up the original efforts on that. Then everybody
jumped in, and it is now a full committee document that has been looked at in
many different ways. I appreciate everybody’s energy and effort in doing that.

Then tomorrow morning we will get some updates from the Community Data
Initiative, and then our subcommittee readouts, and then tomorrow afternoon, as
Marjorie has mentioned, we will be celebrating 60 years of what I call a
professional relay race that has been going on for 60 years, with star athletes
at every position. A lot of people before us have passed the baton to us, and
we will be passing it on to others as we move forward. So a pretty neat
environment to be in when you are playing with these kinds of people at these
levels. When I say we, I include all the staff that has been so very, very
helpful to us along the way. This is a big week, as we have done this for 60
years as a committee, so we will talk more about that.

With that, unless there are any questions? One other thing I will mention.
When Jeff Blair gets here, we will recognize him for his service on the
committee, if any of you want to say anything now. Then we are having dinner
tonight, and I would hope that some of you would have some things to say this

So with that, Jim, let me turn it over to you.

Agenda Item: Department Update

MR. SCANLON: Thank you, Harry. I think our last Full Committee meeting was
back in November, and we were sidetracked by the snowstorms in February, so let
me catch everyone up on a number of things. I have to say, many of these things
are areas that the committee has been pushing for and working on for a long
time. As Harry said, it is a relay race that never finished. It is a journey,
more than a destination, all this. I did want to announce, we have appointed a
Chief Technology Officer at HHS. I think some of you know him, Todd Park. Todd
was involved in the founding of Athena Health, which is an IT claims processing
organization that did very well. They provided back office operations for
originally pediatrics and obstetrics, and now more broadly. So Todd’s job at
HHS basically is to every day think about how HHS can use technology in its
internal operations, and how we can use technology to interact with our
stakeholders and our community. He is a very enthusiastic fellow. We have
already made a lot of progress as well; I will talk a little bit about some of
those initiatives.

The Secretary has announced a number of priorities. I will be talking about
those today. You have at your place, I believe it is nine priorities and some
other collaborations. Virtually every one of them involves data in some form. I
will talk a little bit about those so you can see where the policy is heading.
Obviously the first one is health reform; I will talk a little bit about that
as well.

Then I wanted to talk a bit about open government and the HHS open
government plan. All agencies in the federal government have been asked to make
their operations more transparent, more collaborative and more participatory.
HHS and other agencies have developed open government plans. A number of those
involve data and data transparency as well, so I’ll talk about that as well.

First of all, I hope you have at your place the back page. That basically
includes the Secretary’s priorities and strategic initiatives. I will go
through them very generally, but I wanted the committee to be aware of where
the work we do fits in.

Again, there are a lot of other things HHS does, as you know. Those go on,
and they are in no way diminished, but these are areas where the Secretary is
willing to spend some of her own time and the leadership to move things along.
I think they are viewed as large leverage kinds of areas, where if you can make
progress in some of these areas, you produce change more broadly as well. Let
me spend a few minutes on that, and then let me go to the open government plan.

The first of the initiatives is obviously transforming health care. This
involves implementing the health care reform plus a number of other specific
activities related to health care.

Obviously the Recovery Act, which we have talked about previously,
implementing that properly, getting the money out, promoting jobs and economic
growth, and to do some good public health wise as well. That is well underway,
and we have to be sure that those are implemented properly.

Another area of the Secretary’s priorities is less health as the early
childhood development and health and growth. That is another side of the
Department that we focus on.

Associated with each of these initiatives, I should say, is a task force or
a leadership assignment or some other mechanism that basically developed goals
and objectives, and then to move us forward as well.

Number four again is more of a preventive public health goal. It is to help
Americans achieve and maintain healthy weight, a number of activities aimed at
that area as well.

Another risk behavior focus is preventing and reducing tobacco use. Here,
despite a lot of progress, the U.S. seems to be stuck at about a 21 percent
prevalence every year. It is hard to get below that amount. There is a whole
class of new initiates every year out of high school and other places just as
others are quitting. I think we are trying to redouble our efforts and see if
there are not some new strategies to reduce that as well.

Number six focuses on preparedness health and safety of Americans and
public health emergencies, a longstanding priority.

Number seven is the scientific discovery area, to accelerate the process of
scientific discovery and to translate those findings to improve everyday health

Number eight concerns food safety. You have seen in the news virtually
every day some threat to food safety, so there are a number of activities aimed
at improving that system.

Then overall, insuring program integrity and stewardship.

There are several key interagency collaborations as well. One is to reduce
teen pregnancy and unintended pregnancy. Second is to support the national
HIV/AIDS strategy. A third area of interagency work is global health, improved
global health. Then the fourth is to foster open government. You will see
under that area, one of the goals is to leverage all the data we have for
maximum public good in public health.

I won’t go further into these unless you have questions. But basically
these are overall Secretarial priorities. As you can see, data is a big part of
all of them.

In addition, we are in the process of developing our HHS strategic plan.
This will be for the next five years. We will be posting that on our open gov
website in about two weeks. We are asking for public comment. We welcome the
comments of the committee. We are truly open to ideas here. If we have missed
areas, if there are other areas that are there, we are open for public comment.
This will be the strategic plan that will form the basis for many of our
actions over the next five years, so it is completely revamped and so on. We
are looking for everyone’s comments.

Let me spend just a couple of minutes if I have them on the open government
plan and the transparency initiative. The full plan is available on our open
gov website, hhs.gov/open.

The President issued an executive order asking all the federal agencies to
be more open and transparent in their activities, and to foster collaboration
and participation in their work. You can see from our priority goals and
strategic plan, HHS for the activities we undertake, we really couldn’t succeed
unless we involved all of the stakeholders and others as well. I think we are
going to try to do that even more.

But a bit part of the open government plan involves data and making data
that we have at HHS available more broadly. Some of you are familiar with a
government website, it is called Data.gov, established by OMB. All agencies are
directed to publish data sets and data tools there, and relatively without
intellectual property restrictions, and relatively unfettered in any other way.
Basically they are to be put there in open format source so that anyone can get
at the data and use it.

So far, in HHS we have posted about 114 data sets or tools. We are cautious
at HHS. We can’t simply post medical records on a website and walk away, so we
are cautious, and I think other agencies are as well. The data sets that are
published and made available are those that are pretty well scrubbed. Many of
them don’t even apply to individuals, they apply to physical assets or other
activities. But the goal is to keep making some of this data available.

So we have posted about 114 data sets as well. We will be posting between
now and the end of the year probably 30 to 40 more. Some of them are updates of
the past activities, but some of them are entirely new.

Let me mention three of these that are flagship initiatives. One of these
you will be hearing later today about for the community health data initiative.
This is an effort to take community level data that HHS holds. For the most
part it is county level data, but we will move forward to where we can look at
other data as well. So this could include public health measures, it could
include Medicare and Medicaid data, it could include mortality data, health
care data, quality data and so on.

We have made that available, this first wave, on a website. The idea here
is, we make it available, and we are encouraging a number of others, innovators
and others, to take the data and use it in applications that help individuals
understand health and health care in their own communities.

We have had a couple of meetings, where even some of the biggest software
innovators, Microsoft, Google and others, are interested in taking some of that
data and developing applications. So you can take your iPhone and maybe someday
you will be able to see how hospitals compare in your area, which I think we
can do that already. You can find information about the local situation in
public health and health care in your area.

So we have launched this. We have had two collaborations with the IOM to
get things moving. We have a website where these original data sets are posted.
We will be adding to those data sets as we get things ready.

Again, we are very much interested in your input. If you think we have data
sets, you are aware of data sets that could be made available or modified to be
more helpful, please let us know. We have a place set up on the website as
well. That is known as the Community Data Initiative, and I think Linda
Bilheimer is going to brief you more on that today.

We have a lot of data, as you know, in HHS. We collect it as part of our
programs. We conduct surveys and research as well. We have always made it
available, but it is always a challenge to new users and to make it available
easily. So this is a way of pushing that forward.

In addition, Medicare, CMS, has made available a beta version of a Medicare
dashboard. It includes the Medicare claims data largely and cost data. So for
your local area, for states, for hospital service areas, you can get Medicare
utilization data and Medicare cost data.

Folks like the Dartmouth Atlas and others have already taken this at an
aggregate level, but this provides it directly as well. We hope to be adding to
that as well. We will be adding, if it all works out, as we announced on our
website, some actual claims data sets as well. These will be deidentified and
scrubbed, and the variables will be checked to be sure that privacy is
protected, but the goal is to make a five percent sample available of the
various types of claims that CMS has, hospitals, ambulatory care, drug data and
so on, made available and posted on Data.gov, if it can all be done in a way
that protects privacy.

Just a short word now — I’m sorry?

MR. HOUSTON: Just one question. When you say it is deidentified, is it to a
zip code level?

MR. SCANLON: It will be at the national level. These are claims data. It
will be claims data sets. I don’t think it will have any geographic measure.
Hospital discharges.

MR. HOUSTON: It won’t identify by provider information?

MR. SCANLON: No, that is a whole other route. Karen can talk more. As I
said, this is the access through Data.gov. For those researchers and others
that want to get at more detailed claims data, there is a process. It involves
a data use agreement. As you all know, you can ask for the claims data. You
have to justify what goal you have in mind. CMS has actually operated that
program for a long time now. It is a very positive and forward looking program.
That is how the Dartmouth Atlas is developed, based on that data and others.
But you have to cite a data use agreement, and there are protections. It is
made available in a restricted manner. These would be very clean, slimmed down
files, a five percent sample without geographic indicators, as I understand it,
and they would be available for folks to work with.

MR. HOUSTON: Thank you.

MR. SCANLON: I just want to say a word about budget, and then I will finish

Over the last quarter just about of the fiscal year 2010, we are working on
the 2011 budget and the 2012 budget. Obviously a number of the health IT
initiatives were funded through the Recovery Act and through the budgets. Chuck
will update you on the HITECH Act and so on.

On the population health statistics side, I wanted to say that the National
Center for Health Statistics for example received an increase for this fiscal
year, so we are moving along there. I think Congress is looking at a fairly
sizeable 17 percent increase for NCHS in the 2011 budget. We will see what
happens there. Then 2010, we will have to see. To some extent it may be a
somewhat austere budget because of the deficit reduction and so on.

On the population health statistics side, NCHS’ budget is hopefully getting
up to the level that we should all be, the stabilization level.

So let me stop there.

MR. REYNOLDS: Any questions for Jim?

DR. WARREN: I have. On the priorities, you have the four interagency ones.
Can you tell us what agencies those are that HHS is going with, cooperating

MR. SCANLON: They are agencies within HHS, for example, reduced teen and
unintended pregnancy. Here we have several. On the human services side, we have
programs, we have CDC, we have an Office of Public Health and Science as well.
So here it is an interagency group of those offices within HHS, and we will be
working on that, including the White House and other agencies as well.

The idea here is, several agencies across HHS have interests in programs,
prevention or grants and so on, in these areas, and they will be working
together to do that. Global health of course is HHS. Virtually all the agencies
in HHS have some international dimension. We work with the State Department as
well and with the White House, more in terms of developing a global health
strategy, what are we trying to achieve in global health for the years ahead.

DR. GREEN: Another question, Jim, about the key interagency collaborations.
The fourth item, foster open government, could you say more about the very last
bullet there, about foster innovation? What is that about?

MR. SCANLON: Yes. As part of the open government initiative, remember I
talked about data transparency, making data available. Another goal of the open
government initiative was to use technology and innovation to help with our job
as well.

What we have done, and other agencies have done this as well, we have
created an innovation council where we are asking — if it the sort of thing
where, if you tell people, go ahead, you must innovate, you have lost the
point. It has to be something where we are trying to encourage the best ideas
among our agencies. Part of this are activities that are software related, that
are already available in the research community. For example, there are ways
internally that the research community uses. There is idea share software that
folks can under protected circumstances share ideas, discuss research issues
and so on.

But we will be looking at how we can apply — in this case, it is largely
software technology, to provide more of a climate for innovation across HHS.
For example, even on teen pregnancy, there are probably half a dozen agencies
within HHS that have experts in these areas, so this would provide a more
informal way of communicating and sharing ideas, in addition to the formal

We are also looking at, are there ways to foster — as you know, we are
using all the social media as well. We are trying to get public input, we are
trying to use crowd sourcing techniques. We are trying to use analytical
techniques to look at in terms of comments and ideas that we get over the Web
or other places. There are software analytical techniques, for example, that
allow you to — pattern recognition and so on that identify the major themes
and so on.

So in many ways the innovation is not related so much to the — though it
is certainly part of this — scientific discovery and so on. That is another
part of the initiative. This is more the software structures and the social
structure in a sense, to encourage folks to innovate, bring ideas to their
agencies, and so on.

It is in its early stages, but it is focusing largely on software,
innovation related software for now.

DR. SUAREZ: Thank you, Jim, for this great summary. It used to be that —
and I am not saying that as a way of pointing any fingers, but it used to be
that health information technology

was one of the top priorities within the Department. It doesn’t show in the
nine or so priorities, but I would assume that health information technology
continues to be a priority and it is just embedded across all this?

MR. SCANLON: I think it is considered to be a number of these. Certainly
transforming health care is part of that as well, and it is part of the
Recovery Act implementation as well. HITECH as you know was part of the
Recovery Act, the basic foundation and the funding. So it is clearly still part
of them.

I think there were three areas that were considered to be related to health
reform, as supporting health reform and transformation. One of them was health
IT, one of them was comparative effectiveness, and what is the third? I am
forgetting the third. Oh, prevention and wellness, that I talked about
previously under the Recovery Act. All of those continue as essential parts of
transforming the health system as well.

MR. LAND: In regards to the National Center increase, it is in the budget,
but have you had any sense of how Congress is going to react to that? A
continuing resolution, or do you think they are going to pass the budget?

MR. SCANLON: I don’t know. You don’t want to bet on what they are going to
do. Obviously for October 1 we will need a budget, an appropriation. But I
think it is still slated. If current trends continue, unless something major
happens, I think there is all likelihood that NCHS will get that. Some of it is
slated for the vital statistics infrastructure. But again, it is hard to
predict. We never count the dots until we actually have it.

DR. CARR: I should introduce myself. My plane was late, and I apologize to
everyone. Justine Carr, Caritas Christie Health Care, no conflicts.

I have a question. Jim, going back to the innovation center and health
statistics, is there thought to using the innovation center to supplement the
ways in which we get population health information? You mentioned social media
and all of that. Is that part of the thinking in the innovation center, that we
may rely on newer sources?

MR. SCANLON: Again, you have to be careful here. You know this better than
I. Crowd sourcing and social media I view as an additional perspective. I don’t
view it as a substitute for social science research. It is just another
perspective. We have talked about that previously.

I think it is the goal to try to use social media and technology
innovation, as we should, as anyone should, to support the mission and to give
us a better perspective and to promote collaboration and open government

In addition there is technology that is related to data collection,
obviously. We have been using it in the NHANES program for a long time now. It
is almost entirely automated, the NHANES program.

In our surveys, it is coming along a little bit more slowly, but there is
computer assisted interviewing and so on, and audio equipment as well. I think
the agencies are employing technology in their surveys and research as they go
along. There are even instances where if you could do it properly, we can
collect web based — we can have web based data collections. But it is an issue
of, is it largely qualitative and that is how you treat the data, just another
perspective, or are you trying to make generalizations and you are trying to
hypothesize and you are trying to employ regular social science.

There are clearly instances where we can do both. It is just that you have
to know what you are doing. Many of the data we get from the social media, we
have to regard it as qualitative, largely. There are ways to analyze it, but
you don’t know what it represents exactly, it is just another perspective. If
you want to now the prevalence of something in the U.S. or incidence or
something you can generalize on a scientific basis, you have got to use
probability theory and regular scientific methods.

But clearly crowd sourcing, blog information, qualitative information, we
are clearly interested in that, and it will be used as part of another

MR. REYNOLDS: Jorge, you need to introduce yourself. It is a pleasure to
see you back at the table with us.

DR. FERRER: Thank you, good to be back. Jorge Ferrer from the VA staff.
Jim, is the innovation center only going to be looking at social media type of
data, or can they do clinical data, administrative data and so forth?

MR. SCANLON: I should mention, this is the Innovation Council within HHS.
There is a council at the White House as well. In addition, CMS is creating a
center for innovation as well, a little bit down the road, in the
Medicare-Medicaid program.

But the innovation focus here is, there is really nothing that is off the
table. In a way, defining what to focus on is a priority first, and maybe the
most difficult part of this, but it seems to be emerging that the initial focus
is on software type technology, web based social media type technology, both
internally in HHS and externally, to help, number one, experts and others share
ideas in terms of innovating, and secondly, to open up the processes a bit to
get participation and collaboration as well.

An example, we are looking at software, and there are various products that
will help us analyze large numbers, thousands of comments or ideas that may
come in over the web or crowd sourcing arrangements or something like that. So
we started this before, but now it is a more focused effort. There is nothing
off the table.

DR. FERRER: Is the goal then to have softwares that are produced as a
product or meaning that the government and private entities come together
innovatively to create these type of solutions?

MR. SCANLON: The latter mostly, or commercial stuff that are available.
There are several of our agencies that use — and I am forgetting what it is
called, but it is basically an internal way of sharing ideas among experts. It
is not email, it is obviously more than that.

On any one issues area you decide, we probably have experts all over HHS to
know about that. We have work groups and councils where we can coordinate and
work together, and task forces. But this was meant to support all of that. On a
somewhat more informal and current basis, that communication could be done. I
don’t think we are envisioning producing software. I think we would probably be
looking for what may be available.

DR. FERRER: And the innovations then, how does that fit in with the current
existent HITECH? The money is out there, they are doing a lot of things.

MR. SCANLON: Not related financially. It is a lot of separate. The HITECH,
Chuck will update you, but the grants and all the activity there and the
incentive program, they are moving along for HITECH. That is an externally
focused adoption initiative. This is not really related directly or financed
with HITECH. This is normal operating funds.

MR. REYNOLDS: Jim, thank you. Exciting stuff. Karen Trudel, you want to
update us on the magical mystical world of CMS these days?

Agenda Item: CMS Update

MS. TRUDEL: Yes, indeed, it is both. Let me start with something that is
somewhat less exciting, but possibly of interest in any case.

We recently completed an internal realignment. The intent of this was to
put us in a better place to address some of the challenges coming our way
through health care reform. But we have combined all of our program integrity
functions in one center, Center for Program Integrity, so we will be for the
first time looking at Medicare and Medicaid program integrity together.

We have also got a Center for Strategic Planning, which is a combination of
our policy office, our research and demonstrations, and as Jim said, under
health care reform there is a requirement for a Center for Innovation, and it
will be housed in that center. Then we have also combined all of our external
affairs and beneficiary services, so that our media relations, our partnership
relationships, our early phased-in websites and 1-800 Medicare will all reside
under the same roof. So that is food for thought.

Let me talk about meaningful use for a little bit, since we haven’t met for
quite awhile. The proposed rule was published in January, and the comment
period ended in March. We received comments from about 2,000 different
organizations, and have been very attentively going through, trying to find
some commonalities.

One of the things that we very clearly heard was that the requirements were
extremely challenging, perhaps too much for some organizations, that we had
taken an all or nothing approach, you meet all of the criteria or you don’t
pass, that the percentages we had set were too high, and just in general that
we needed to provide a little bit of extra flexibility.

Of course, on the flip side of that, other commenters said, this is a lot
of money. We need to take a quantum leap forward, so don’t dilute the
requirements so much that you get a number of people who have electronic health
records, but they are not doing very much with them that is going to translate
into meaningful use and quality improvements.

So we are trying to forge a balance there. We have had very extensive
discussions within the Department. We have been talking to OMB. We have been
listening to a wide variety of voices, and we are moving towards the end of the

I know someone is going to ask when the final rule is going to be
published, and I have to say I am not sure, but we are very close, I think.

Moving on to ICD-10 and the 5010 implementation. We had a very successful
vendor conference a few months ago, where we got a lot of vendors together,
some that had really never been on the radar screen before, brought them
together and talked to them about what the deadlines are, what the interim
deadlines are, what their clients are going to need, and how they are groping
to have to support them. We got a lot of really good feedback. We think we will
probably have additional similar conferences, and we are signing people up for
listserves, so they can keep in touch with what is going on.

Interestingly, when we did some of our focus groups with physician offices,
we did a focus group meeting in Baltimore, and when we asked people how they
were going to deal with 5010 and ICD-10, they said, Bob is going to do it. Bob
apparently is a vendor of billing practice management software in the local
area. We finally tracked Bob down and we invited him to the conference. He was
very articulate. So it is trying to reach out to folks like that who really are
providing the services to pretty much the lifeblood of the industry.

MR. REYNOLDS: Does Bob have the answers?

MS. TRUDEL: He is working on it. We have also stood up a website on ICD-10
on the CMS outward-facing website. It is cms.gov/icd-10. We have a number of
other pages that lead from that. There are pages that are focused towards
vendors, towards providers, towards Medicaid, towards health plans, and we will
continue to add to that content over time.

We are encouraging people. We have met with a number of partners. We had a
good call with AHIP yesterday, and we are encouraging partners to link to it
and to use the materials.

We will move on to the Accountable Care Act. This is clearly going to
provide for a certain amount of workload for the NCVHS for the coming years,
starting this summer.

There are administrative simplification provisions in the Accountable Care
Act. The first two that are coming down the road are the plan I.D., which was
an original HIPAA requirement, which we for a variety of reasons did not get
around to publishing, and a requirement to phase in over time operating rules,
which are more detailed than the standards and the implementation guides, that
sit under them and allow providers to be better able to anticipate what any
given plan is going to do.

Because we also have the ability to do this by interim final rule, as
opposed to NPRM, we need to be very sure that we have done all of the outreach
and listening to every voice that we can find. So we have been working with the
Standards Committee to set up a three-day hearing in mid-July, the 19th through
the 21st. We will do a day and a half on plan ID, what the industry thinks the
plan ID should be, how it should work, what it should do, what are we trying to
accomplish with a plan identifier, and another day and a half on operating
rules and similar questions, what are we trying to accomplish, how should we do
this, who are the players.

It will be a very intense three days worth of hearings, but we will do as
much pre-briefing of the attendees as we possibly can to make sure that they
have materials in advance, and have some thoughts and context before we get
there. I think we are hoping that others in addition to the Standards Committee
members might be interested in attending and providing some input into these

Another interesting thing that the Accountable Care Act did was to make the
ICD-10 GEM tables, which are basically crosswalks to ICD-10 and ICD-9, to make
them a part of the code set standards. The provision also said that we needed
to have a public meeting no later than January of 2011 to get public input on
the crosswalks and any improvements that might be needed to them. We would then
make those improvements and post the revised crosswalks to the CMS website.

To begin to obtain that input, we decided to take some time in the ICD-9
coordination and management meeting, which will be in September, I believe it
is the 15th and 16th, at CMS in Baltimore. We will be inviting attendees to
bring whatever analysis they have about the GEMs and the shortcomings for
potential improvements to the crosswalks at that time. So we will begin to be
able to look at what really needs to be done to make them optimal and usable
for the industry.

MR. REYNOLDS: Questions?

DR. WARREN: For the Accountable Care Act, we are having hearings in July.
We have gotten permission and money from Marjorie. We feel that some of the
discussion that will come out will be across all the subcommittees, so we have
been authorized to get one representative from the other three subcommittees to
attend those hearings.

So when you do your breakouts today, find out who that person might be. We
already have some people that are members of Standards and members of other
committees, so take that into consideration, or go ahead and pick another
person if you have already got someone on your committee that does that,
because we really would appreciate it. We are going at this very fast and need
all the help we can get. Just to show you how fast, we have to have a letter to
the Secretary for the health plan identifier to pass in September.

MR. REYNOLDS: So the relay race, because of some of these integrated
subjects, is also becoming part of a sack race, too. In other words, most of
the subjects are not clean as we organize as a team. So I think it is
important. Even if you don’t feel you are an expert in that, I promise you, you
will end up contributing. You will end up hearing things that will fall into
that. Our document we just did on health information was a perfect example; it
touches everything.

So all these subjects, as committees reach out, I think it will be
important for everybody to make sure that you don’t just look for somebody else
on your team to do that. Two or three volunteers would be great, and then
whoever might be the most suitable at that time, because this stuff is heavily
integrated, especially ICD-10 and some of the other things that are going on.

DR. HORNBROOK: Just for the benefit of the ignorant, I assume that this
plan identifier question is whether you have a unique identifier for the
contract that you are as a person enrolling in, for the underwriter of that
contract or for the administrator of that contract? Are you going to have all
kinds of different entities called?

MR. REYNOLDS: And it may be all of the above.

DR. WARREN: So part of the question is, what is a health plan?

MR. REYNOLDS: Yes. Any other questions? Karen, thank you. You guys have
been busy. We appreciate what you are doing, and look forward to seeing what
comes out.

With that, we would like to turn it over to Dr. Friedman to update us on
the things going on with the Office of the National Coordinator.

Mr. Blair, you have joined us. Would you please introduce yourself? You
need it for the record, but not for the room.

MR. BLAIR: It is so nice to be back here. I am no longer a member of NCVHS,
but I still retain all the wonderful memories, and I am looking forward to
being with all of you tonight as we roast our Chair.

I am Jeff Blair. I am Director of Health Informatics at Loveless Clinic
Foundation in Albuquerque, New Mexico. We have a health information exchange
network. I think that about does it.

MR. REYNOLDS: After Dr. Friedman is done, we will remind you of some
conflicts we had with you as we celebrate you.

Agenda Item: Update from the Office of the National

DR. FRIEDMAN: It is a pleasure to have a chance to speak with you this
morning. I asked Harry if I could have a little more time than the customary
update, because there is something fairly important, at least from my
perspective, that I would like to introduce to you as a concept and as a
potential initiative going forward, and get your reactions to it. So I am very
appreciative to have the additional time to do that.

I put this slide in every one of my talks these days. The film is very much
in the cutting room. There are some pieces of film on the floor. There are some
pieces of film we know are going to make it into the final cut, and then there
are a lot of other pieces of film with status unknown at this point.

I don’t know if you have seen, tell me if you have, the latest data from
the most recent — or the 2009 data from the adoption survey that was the
supplement to the NAMSES that is conducted every year.

In case you hadn’t seen the latest data, I just wanted to share with you
the 2009 data points. This is obviously before any of the HITECH program has
had a chance to take any kind of meaningful hold.

The number of adopters continues to increase. The very large number of
respondents to the question, do you have any system at all, which we don’t
think is a very specific or discriminating question, basically is being
answered as, do you have a computer in your office, we believe, has risen to
about 44 percent. But far more important, the number reporting that they have
the minimal constellation of functionalities described as the basic system has
risen to 20.5 percent, and the number that have the larger constellation of
functionalities that constitutes a fully functional system has risen to 6.3
percent. I think the take-away remains that in terms of office practice in the
U.S., we have a long way to go.

MR. REYNOLDS: And Chuck, will we get copies of the slides?

DR. FRIEDMAN: Oh, yes, of course.

MR. REYNOLDS: Chuck, do you want to take questions as you go?

DR. FRIEDMAN: Oh, sure. There is always the danger we won’t get through, so
I might limit them, but how can I refuse a question from John?

MR. HOUSTON: Based on the rate of adoption, I know that safe harbor for
Stark anti-kickback is set to expire at the end of 2011, which will allow
hospitals to donate EMR to physician practices. Is there any thought of asking
to get that extended, or you don’t have any insight on that?

DR. FRIEDMAN: I think it is very important you brought it up, John, so it
stays on the radar screen. I had frankly forgotten myself that it is a
time-limited provision. As I think through its interaction with other
components of HITECH, I think it interacts positively with those, so we should
definitely revisit that and be sure we keep that expiration date on our radar
screen. So thanks for bringing that up.

Here is a slight modification of the figure that was published in David
Blumenthal’s article from January of this year called Launching HITECH. I don’t
know if all of you have seen this figure, but it is very, very useful to keep
score and map the playing field, in addition to giving an overall sense of what
the entire strategy comprises.

I described it in the ONC CMS program, with CMS playing a critical role in
that yellow box relating to the incentives and penalties, but there are many
agencies involved in this on the federal side in addition to advisory
committees and others. So just calling it an ONC CMS program does not give full
credit to the parties involved.

Just to give you a quick sense of where things are, what I would like to do
this morning is just give you a quick overview, and then dwell on three aspects
of this that I hope you will find interesting, and one especially.

Regional extension centers. We have now funded 60 regional extension
centers. We funded them in two separate groups, 36 and then 24 more. Of the two
billion dollars that was appropriated to us in HITECH, I don’t recall the exact
amount, but something in excess of $600 million is invested in the regional
extension centers.

I am going to speak more about the workforce training program in a little
bit of detail. We have awarded four grants — we have completed awards in four
grant programs to address the absolute critical need to expand the health IT
workforce. Karen has spoken of the progress relating to the definition of
meaningful use, and the soon to occur issuance of the 2011 meaningful use stage
one rule that will be the foundation for the implementation of that program.

We have awarded grants to 56 states and territories to assist them in the
role states and territories must play in moving toward a national program
supporting health information exchange of the $2.564 billion that are invested
in the state HIE program. We are working diligently. The interim final rule
relating to standards is a piece of this on a more comprehensive standards and
certification framework, which is an essential underpinning of a system of
health information exchange and the target of interoperability, and we are also
working actively on a privacy and security framework. There will be more to be
announced about that soon.

Underlaying those programs which target themselves specifically at adoption
and exchange as denoted by the diagram, are two what I call transcendent
programs. One of these is the program called SHARP. It is a program of research
to enhance health IT, and I am going to speak a little more about that. Then in
addition, another transcendent program is the Beacon Community program, where
we recently awarded 15 grants, actually cooperative agreements, to communities
for the purpose of demonstrating what is possible as a result of meaningful use
of health IT and of course other supporting activities, and driving
improvements in the quality and efficiency and safety of care. We have a
funding opportunity announcement on the street to award a small number of
additional cooperative agreements to create some additional Beacon communities.

I am going to talk a little bit more about workforce training, about SHARP.
I am going to talk about a nascent program which we have code named element
three. I think I made references to this in previous presentations, but I am
prepared to say a lot more about this now.

It is specifically directed at the end goal of the program articulated in
David’s diagram as improved ability to study and improve health care delivery,
in other words, creating a learning health care system, which has been widely
articulated as a result that could be realized in part through interoperable
health IT and the programs of the HITECH Act.

Let me stop here before I do a bit of a dive into workforce, SHARP and
element three, and ask if you have any questions about the program as a whole.

MR. REYNOLDS: You mentioned 60 regional extension centers. Some of these
numbers are more than the numbers of states. Are states breaking into pieces?

DR. FRIEDMAN: Yes. The regional extension centers program did not follow a
state logic.

MR. REYNOLDS: It can, but it doesn’t have to.

DR. FRIEDMAN: It can. Some of the extension centers have a statewide scope,
others do not. They come under these catchment areas.

MR. REYNOLDS: But are you requiring each of them to follow the same
standards, so that within an environment you don’t have one educating the
doctors and others on one set of standards and another in the same state doing
something different, as they try to work together in a state.

DR. FRIEDMAN: I think a good summary answer to that question would be yes,
Harry. We don’t want every extension center, regardless of where it is and
which practices and hospitals it happens to be serving at that moment, to be
following the exact same procedures. But I think at an appropriate level of
generalization, the activities of the extension centers are being standardized,
so they all work in pursuit of the same goals.

MR. REYNOLDS: I was interested more in outcomes than structures and

DR. SUAREZ: Every time I think about where we were even a year ago, it is
amazing that the amount of work that has been done in building all the
infrastructure components that we will see over the next ten, 20 years, will
put us where we want to be.

One aspect that I wanted to ask you about is the standards and
certification framework. Each of these boxes are just gigantic in terms of the
scope and the size, but the standards and certification framework, there has
been a lot of work being done to reposition perhaps or to re-engineer,
restructure, the concept of harmonization, use cases and selection of
interoperable standards.

Out there, there is about 11 task orders that have been issued to address
11 different elements in this standards and certification framework. I wanted
to ask you if there is any — or if you could share with us the status of
those, have there been any finalization of that process and the work in each of
those major task orders is about to start, or are we still in the process of
selection? Can you talk a little bit more about that particular part of the
standards and certification?

DR. FRIEDMAN: I am tempted to go back to my film still in the cutting room
slide, because that is where profoundly where this is. Frankly it changes from
day to day in terms of what is on the street, what is being reviewed, what has
been awarded. Even if I had it in my head, I’m not sure today’s breakdown of
where the horses are in the race would be helpful.

But let me say as a generality that we are making progress, and also to say
that there are some very key initiatives developing out of this. One I would
like to call out, you all may have heard of it, is NHIN Direct. Am I saying
something you all have heard about? Okay.

So I would call out NHIN Direct, without going into too much detail about
it, as one consolidated theme relating to the standards and certification of
the framework. NIHN Direct represents an attempt to insure that some of the
very basic information exchange capabilities that are required by what is
anticipated to be in the 2011 meaningful use criteria, can be implemented by
eligible providers and hospitals that seek to be meaningful users in the near
term. So we really are focusing the program on immediate needs and aligning our
priority structure with meaningful use as best we can surmise the final
representation of it will be.

MS. FRANCIS: Could you comment a little bit more on the development of the
privacy and security framework time line and the role of what I gather is
called the tiger team in working on that?

DR. FRIEDMAN: I don’t have too much more detail I can share, Leslie. I can
tell you, I think everybody on this committee knows that we have appointed a
chief privacy officer, Joy Pritts. Joy is taking an increasingly important
leadership role in this domain. Some specifics about this will be forthcoming
soon, but I am really not at liberty to give any more details at this point,
I’m sorry.

DR. FERRER: Chuck, your first graphic depicted the adoption, dismal rates,
because they are very low. In five years from now, after all you funded, what
do you think will be an acceptable adoption rate in numbers? That is the first

The second one would be, usability tends to be a relatively troublesome
issue for electronic health record adoption rates. How are you addressing that?

DR. FRIEDMAN: Point one. The President has articulated a goal that every
American should have care supported by an electronic health record by 2014. We
are aiming toward that goal. We are seeking to attain it. Any fractional
attainment of that goal will be a fractional measure of success.

At the same time, forward progress is forward progress, and to the extent
that there is more meaningful use of health IT driving quality of care, that is
progress. But we have a goal and that is what we are seeking to achieve.

Regarding usability, we hear that point. We are working with NIST and with
AHRQ and with other agencies to develop a coherent program focused on
usability. To that end, there is going to be a major usability meeting, some
have called it a usability summit, at NIST on July 13. You might think about
this as a formal startup of this program as a collaboration with national

DR. FERRER: So you are having a meeting on usability. You funded already
the research. You have already funded for people to adopt the tools, but now we
are going back and re-looking, because usability tends to be a problem, is that

DR. FRIEDMAN: Well, we are moving things along in parallel. I think a major
priority of this particular focus on usability is going to be an exploration of
ways usability can be measured. Usability is a construct.

DR. FERRER: Usability is not a construct. Usability is how you are
affecting the clinicians at the point of care using the tools. So if you are
asking clinicians to change how they practice medicine, that is not a
construct, that is how people practice medicine.

So I am trying to get it from the abstract into people using them so your
adoption rates go higher.

DR. FRIEDMAN: I think we are going in the same direction. But unless we can
measure usability, if you can’t measure it, I don’t think you can improve it.
So I think a focus of this initial meeting, I’m not 100 percent certain of
this, but it is very likely that a focus of this initial meeting will be to
identify the steps that are necessary, so we can measure usability. Once we can
measure usability, we can see where we are and figure out how to improve it.

I take every point you have made about the centrality of this concept.

MR. REYNOLDS: So Chuck, why don’t you continue?

DR. FRIEDMAN: Okay. So seeing what time we are at, let me just go quickly
into workforce. I think this is — one of the reasons I am emphasizing this in
my presentation is that this is a critical but possibly easy to overlook aspect
of the need and what consequently may need to be done to address the need.

The HITECH Act did specify that we would have a workforce program. I
applaud that. We set in motion the development of one. A key initial step we
took in developing a workforce program was to articulate 12 key workforce
roles, all of which one could surmise, if they weren’t underpopulated at the
moment, once HITECH took hold and adoption began to increase, would be
flagrantly underpopulated if nothing were done to increase the training
capacity in the nation.

HITECH required us to look at those kinds of training programs and those
kinds of roles for which six months preparation for people with appropriate
backgrounds might be appropriate. So we articulated six goals, very much
aligned with support of the EHR adoption process, and the ongoing support in
practices and hospitals of the technology that is supported there. We believe
that these six roles could all be trained for with a six month program if
someone brought to that training either some significant background as a health
care practitioner or some significant background in information technology,
with the idea that the program would give them that piece of it that they
didn’t have.

We also articulated six roles, equally important, possibly less needy in
terms of numbers. These roles would require a one to two year preparation,
training even of that longer duration would assume that the trainees came into
the program with some relatively background. An exemplary role in this group is
the role of chief clinical information officers, chief medical information
officers, chief nursing profession officers and chief public health information
officers, but also software developers who specialize around the needs of
health IT applications, and also researchers and specialists in the fields such
as security of systems.

We have put in place for integrated programs. All of these were announced
in November and December, and funded in April. We have created five community
college consortia, pretty much covering the nation, operating in five regions.
There are approximately 80 community colleges who are participants in these
five regional consortia. We have funded a set of culture development centers to
help fast track and educational programs being brought up in these community
colleges by producing high quality instructional materials for them. We are
also developing a competency examination to assess individuals skilled in the
competency areas addressed by that first set of six roles, for which six months
of training could be seen as adequate.

We funded a separate program. We funded nine cooperative agreements. It is
more than nine institutions, because some of them are consortial, to provide
training, one to two years in duration, going at those other six roles for
which a more lengthy and more in-depth training might be required.

So all of this work is off and running. The community colleges are to stand
up their training programs no later than September 30 of this year. There will
be a major event in Oregon in August to train community college faculty in the
use of the materials being produced by the culture development centers, and all
of the training sites for the university based training will be recruiting
trainees into their programs starting in the fall semester.

So the gun has gone off, and the race to produce the workforce has begun at
full capacity. The community college training program is designed to produce a
minimum of 10,500 trainees per year to address a need that has been estimated
to be at least a shortfall of 50,000 as the program takes hold.

Any questions about the workforce program?

DR. HORNBROOK: Chuck, I don’t see anything here unless I a misreading it
about training champions inside the current medical care system, that is,
people who are clinicians who want to learn something about health IT. Are they
supposed to be folded into some of these pathways?

DR. FRIEDMAN: The chief clinical information officer program, while it is
advertised and focused on training CMIOs and CMIOs, is going to provide
training very appropriate for that champion role. This is for someone with a
medical degree, for example. This would be a year of training in health IT and
health informatics and leadership and other topics. That would be a preparation
for that role as well.

DR. HORNBROOK: We have a CMIO who is in that job pretty much full time.
Then we have a series of physicians who elected to change their certain
careers, went back and got masters degrees in informatics, have come back and
now work as the champions inside, in order to not be totally controlled by the
systems programmers at Epic.

DR. FRIEDMAN: We hear you. This is very much in line with the intent of
that program. Anything else on workforce?

MR. REYNOLDS: Please continue.

DR. FRIEDMAN: Okay. In the interest of time, I am just going to go very
quickly through the SHARP program.

This goes to Jorge’s comment about usability. One of the things that we are
doing as we think about HITECH and how to roll it out is to skate to where the
puck is going to be. We are contemplating improvements in the technology itself
that are going to be necessary to efficiently support the more sophisticated
aspects of meaningful use that everybody anticipates will be part of stages two
and three as those take shape.

We have identified four areas in which it was felt that research that we
have audaciously described as breakthrough research will be necessary to insure
that the technology itself is as good as it needs to be to support these more
sophisticated aspects of meaningful use that are clearly coming down the chute.

The four themes were first, patient centered cognitive support. For those
of you who saw last year’s study that came out of the National Academies of
Science on challenges for health IT, the need for patient centered cognitive
support is a component of health IT. So as more and more data become available
to clinicians, we actually make their jobs easier rather than forcing them to
drink from a fire hose, and how we create decision support that is compatible
with the way people think as opposed to the way machines are programmed, is the
crux of this theme.

A second theme is security. I don’t believe I have to elaborate very much
on the need for advancements in security, from a technological perspective, to
help build the necessary thrust in information stored and processed in
electronic form.

Secondary use or enhanced use of information in EHRs, a topic near and dear
to this committee, and one I am going to return to in a moment, is the third

The fourth theme is extremely interesting. It looks at whether there are
different technical models, different platforms than the ones currently in use
today that might be bases for, that grease the innovation skids as health IT
develops and matures.

So we organized four separate competitions, intending to make one award of
a cooperative agreement of about $15 million in each one. The applications were
multiple and extremely high in quality. We funded after competitive review the
University of Texas at Houston, University of Illinois at Champaign-Urbana,
Mayo Clinic and Harvard to be our four SHARPs. Since SHARP has the P word in it
for projects, saying SHARP projects would be redundant.

I would just encourage you to check our website if you want to see more
detail about these projects. I will particularly point out the Harvard work
being done by Zack Ohaney and Ken Mandel and their team as being particularly
innovative and forward leaning. They are looking to see if something analogous
to an iPhone type of platform into which substitutable applications can be
plugged, unplugged and replaced, could evolve as a platform architecture
supporting health IT in the future with all of the appeal and flexibility that
we see in the iPhone then being manifested in future health IT systems. If you
didn’t like the user interface that you were using, and you wanted a different
user interface, you could swap the use interface you had out and put the user
interface you want in, to cite one very crude but I think illustrative example.

MR. REYNOLDS: Before you continue, Leslie, I don’t think I let you ask your
question earlier, did I?

MS. FRANCIS: You did.

DR. SCANLON: I was wondering if there are any plans to fund more
institutions along these themes, particularly in the area of secondary use.
Secondary use involves a broad range of things, and I can imagine that a
clinical perspective is one perspective to it from, but there are other
perspectives as well. It is not quite a thousand flowers that you want to
bloom, but you want multiple flowers.

DR. FRIEDMAN: Right. It is a great point. We are obviously hoping that that
will be the case. My printing press however does not print money, I wish it
did. I would have loved to have funded several of the applications that we got,
but what we had was funding for one in each of the categories. We are obviously
hoping that something can be done to enhance the magnitude of the program in
the future.

Let me move now to element three. I think in my last presentation to this
group, I suggested that we could think about the HITECH program — and this
aligns with that playing field diagram I showed you earlier — as consisting of
two elements. Element one, which is promoting adoption of health IT systems,
and element two, establishing a trusted pathway for health information

I think I made the point in my previous presentation that if you
superimpose the two elements thus described and add a very direct extension on
health information exchange, that is, the ability for a report out to some
entity that would receive quality measures, then in elements one and two we had
all of the statutory bases for meaningful use, adoption, exchange and quality
reporting. You see that here. What is on the top of the diagram I showed you
earlier is element one, the programs leading to adoption. What is toward the
bottom are the constellation of programs that comprise element two.

Just to tell a little bit of a story, about six or seven months ago, I was
asked to give a talk at the Institute of Medicine. They were having a meeting
on developing a learning health system for cancer. I was asked to give a talk
on how ONC’s HITECH program would establish a learning health system for

As you can see here, we even articulated as a goal of our program words that
could be equated with the establishment of a learning health system.

So I scratched my head for awhile, thought about what I had to say on this
topic that I had agreed to speak on, and suddenly realized that the only honest
answer I could give is that it won’t. The programs we had in place, elements
one and elements two, and even the transcendent programs, were not going to in
and of themselves be sufficient, although they would take us part of the way
there, to create an environment where the kinds of entities you see depicted on
this slide, research institutes, public health agencies, practices, federal
health agencies, health center networks, IDS’s, Beacon communities, could
efficiently exchange information for the purposes of carrying out all kinds of
research, the activities of public health writ large, and to envision the kind
of closed loop learning system where quality of care data could be aggregated,
studied, and the result of those studies fed back to drive quality improvement.

Yes, the standards would help. The adoption would certainly help. Health
information exchange would certainly help. But the admixture of all of those
was not sufficient to get us to an end goal that we had articulated.

I gave my talk, and this slide is right from that talk that I gave, and I
have used it ever since. I basically said, we need something else. We have
element one, we have element two, we need an element three. I have yet to come
up with a better name for it, because element three in words is those
components of an infrastructure, including technology and policy, that are
necessary above and beyond meaningful use to support public health, research,
and create a learning health care system.

Since I have yet to be able to come up with any way to say that in fewer
words, we have just agreed to persist for awhile with the code name of element
three. I took some comfort in hearing the story about how Part D of Medicare
became the official name for that program, so maybe element three can become
the official name for this program, although I think everybody is hoping that I
will come up with something better.

So what is this? It is all well and good to draw pictures, but in a little
bit more detail, we have articulated and are now developing as a major
component of ONC’s coordinated program to work in collaboration with many
others, this element three as a major feature of why we are going forward. We
have articulated for now the highest level goal that by 2015 we would create a
federated integrated learning system for health care quality improvement and
population health.

It is at this point that I would say another value of calling this element
three is that people think I need a dose of it. But I think this is a fair goal
to articulate.

Yes, Mark?

DR. HORNBROOK: Somewhat tongue in cheek and somewhat seriously, I think
there is one word missing, and that is affordable.

DR. FRIEDMAN: Yes, and that is a great point. One of the things that makes
it affordable is meaningful use will take us a significant amount of the way
there, if we do this right. We can build this on the shoulders of meaningful

So if you meant affordable for the country, that is one point I would want
to make. We are not talking about doing this as a separate effort which will
start in its own swim lane at the starting line. This will work on the
shoulders of meaningful use, and other projects that I will get to in a moment.

DR. SCANLON: I was going to interpret affordable in a very different way.
You are talking about whether the learning system is affordable. I am worried
more about the issue of the affordability of health care.

One of the key things for me around element three is that we contribute to
understanding the provision of health care so much better that we can achieve
Jim’s second objective from the Secretary, reduce health care costs by
promoting high value effective care.

So I think efficiency, value, et cetera is part of what we need to be
talking about in terms of a goal.

DR. FRIEDMAN: Yes, thank you. I don’t think we can get there without
something like this.

DR. SCANLON: I agree with you completely on that.

DR. SUAREZ: In this day and age of sensitivity to privacy issues, as one
reads this statement of a federated integrated learning system, I can think of
people that would think we are building a gigantic database in the sky,
integrated and federated, but still a gigantic database.

DR. FRIEDMAN: And that is exactly what we are not doing.

DR. SUAREZ: Exactly. So I think it would be very important to somehow
incorporate into the statement, because everything is in short statements, and
that is what people remember, something about privacy and security, the concept
that it is a private secure protected federated integrated learning system.

DR. FRIEDMAN: That is a great point. I think you might have also heard, as
I said, this is as much about policy as it is about technology. Obviously the
security aspects would be central to that policy structure.

Harry, maybe we will take Jeff’s comments, and then can I go on for a few

MR. REYNOLDS: Yes, and then Larry and Marjorie will be the first —

DR. FRIEDMAN: We are going to run out of time.

MR. BLAIR: Chuck, element three is exciting. When I listen to you, I am
mapping it a little bit against stage one, stage two, stage three of meaningful
use. So I am thinking that on stage three, when we get to the point where we
have adoption of the clinically specific terminologies, that that would be very
supportive for element three.

But I don’t know if I am reading in something that is not there or not. Do
you see a relationship like that, or is there a different way that you are
looking at it?

DR. FRIEDMAN: No, it is exactly how I am looking at it. I think element
three — any interoperability exercise requires standards. I think element
three will inherit the standards needed for public health, quality studies and
research, a lot of them, but not all of them, from the stages of meaningful use
and the larger sets of standards that will be required to support those stages
of meaningful use. So I am right with you.

Let me just move on very quickly. Here is the kind of element three
scenario which I hope makes it clear that we are really talking about a
federation or a grid, not anybody building a centralized database.

The element three scenario is that any authorized person, where what
authorizes you would have to be based o a solid policy foundation, could
broadcast to other members of this learning system a question, and have that
question applied; I want to modify automatically, maybe in some cases
automatically, but maybe in other cases not, to relevant data distributed at
these various sites across the nation.

The idea here is that if the question is a simple question requesting a
numerator-denominator answer, the answer could come back, out of 137 X’s, we
have 42 who have Y. That could come back as a rolled-up answer. For a more
complicated question, what would be necessary would be the sites returning
fully deidentified data in the form of a local data matrix, which based on the
standards in place could be superimposed with comparable data from other sites
aggregated, analyzed and then probably disposed of. So there would be no
persistent store the way I am viewing it, and nothing like a centralized
database that would be part of this.

Just some very quick observations. As we have said, meaningful use is
necessary but not sufficient for element three. I have discussed persistent
databases already after Walter cued me, but I would have done it anyway.

The ONC interoperability framework service being built into the NHIN will
also be technical bases which will be expanded to support element three.

Then another point I would like to make. It is not like we are starting
from scratch here. There are islands of element three all over the country
already, and we have to leverage those as well. C.A. Bigg is an island
development three. The wonderful things Kaiser Permanente has done is another
island of excellence in element three, and there are many others. We really
need to leverage those.

We were developing an element three plan. It has got four components. First
of all, building generalized recognition of the need. That is possibly harder
with some groups than others. We need a signal technological architecture to do
this. Probably at the end of the day we can’t have 13 architectures for this
competing with each other. We can’t have different federal agencies, even
though they might all be doing it, doing differently, using different
technology what in effect could be done once. We obviously need explicit data
definitions and standards, and above all we need a policy and governance
structure to resolve consent issues, privacy issues, data ownership issues,
governance issues such as how can you be authorized to ask questions, and so on
and so forth.

My final slide is to let you all know we have contracted with the Institute
of Medicine to hold a series of element three multi stakeholder workshops. They
are not calling it that. They are using the longer language of an
infrastructure to create a learning health care system in support of population

You will be hearing more about this, but there is going to be a — they are
holding a sequence of three workshops, one in late July, one in early September
that is likely to be an event completely open to the public, and a smaller
event in October, to distill what has been heard into a set of findings that
will be conveyed in a report issued by the IOM, at least a short version of it,
no later than the end of this calendar year. So there will be an element three
manifesto on the street from the IOM by the end of the year clarifying a lot of
the issues that admittedly were muddy in this presentation, in part because
they are still a little bit muddy in my own mind. We are going to need the
thinking of a lot of very smart people who come from a diversity of backgrounds
to clarify the muddiness that currently exists in some key areas.

So let me stop here, take a few more questions. Thank you for your interest
in this. I think this concept goes to a lot of what this committee is about and
has historically been focused on.

DR. GREEN: Chuck, I completely agree that what you have been talking about
here in the last few minutes goes right to the heart of the committee.

I am sensing that we lost momentum by missing our February meeting, and are
ever going to regain it at this meeting. So I am reluctant to make too sweeping
a change. I’ll just speak for myself here.

I love this report. This is a fantastic report from my perspective. This is
movement in a direction for reasons. It is action oriented. It is not sitting
around talking about a lot of stuff. What you have laid out here today is
absolutely inspiring to me, and I want to express appreciation for the work
that you are doing.

I want to flag two things. One is related to the ONC and the other is
related to the NCVHS.

For the ONC, I would flag one opportunity to deal with what you presented
as a key rate limiting step to achievement, which was the lack of adoption in
physician offices. Dr. Ferrer brought this back up again.

Maintenance and certification is not a theoretical construct anymore, it is
an implementation strategy by ABMS. It touches every board certified physician
in the United States. The American Board of Family Medicine has every board
certified family physician in that process as of January 1, 2010. There has to
be an opportunity to put a serious dent in that adoption problem by working
with the physician certifying boards.

What I would flag for NCVHS is element three. It is out there. I am from
Colorado. I love to fly fish in streams, particularly in August. For you guys
that don’t know about this, when you have a high floating drive fly about three
inches off the bank in a stream in Colorado in August, trout find it
irresistible. They just can’t help themselves. And element three for this
committee is like a dry fly floating four inches from the bank right now, and
we ought to get going on this sucker.

This is about — the NCVHS’ purchase in my view is the epistemology of it,
the ontology of it, the classification and ordering principles that can lead to
quality improvement and improving population health, and knowing the
population’s health improved. That is our territory, as I understand it, and we
ought to get going. But we should try to have our pace, not yours.

DR. FRIEDMAN: Thank you, Larry. This is why I thought it was so important
to have the extra time to talk to you about this in morning.

MR. REYNOLDS: As they would say in Parliament, hear, hear.

MS. GREENBERG: I think Larry and I are a bit of a tag team here, because I
will follow up on what Larry said.

Yes, we did lose momentum but no, not as much as we could have, because as
I think everyone knows, we have been straining the resources of AT&T or
whoever else controls the phone resources in this country, for the last six
months or so, in lieu of having been able to meet in person.

So I think we are coming on a parallel path here. So it is great that you
have presented this. When you said element three, I said to Judy, that is our
paper for tomorrow, partly at least, to enhance information capacities for

I have to understand a little bit more what you have in mind, but I think
this idea of integrating this meaningful use and leveraging the opportunities
brought forward by the HITECH and meaningful use to improve health and health
care, and to leverage those information capacities, is what we were attempting
to talk about. If we were just going to call this element three, we could have
saved ourselves a lot of time, because it was an incredible amount of time, but
well spent, I think.

So I think we are with you. What I think we need to talk about with you and
among ourselves, but really with you as well, is how we can as Larry said
really bring these things together. I think that is not only the territory of
the National Committee, but this idea of population health research and health
care, the integrated view, is clearly what we are trying to talk about and
think about in this 60th anniversary.

Is this something that one of your two FACAs embracing or responsible for?
Or is there some — how do you see us not just agreeing with you, but actually
being a part of it? Like, I had not heard about any of these workshops at IOM,
but maybe others here had.

DR. FRIEDMAN: This all just developed in the last like four to six weeks.

MS. GREENBERG: So can we be involved with those? Can we have participation
in them? Can we engage with you about how we can make this document and what we
are wanting to take forward and integrate it? I’m not saying we wouldn’t have
other things as well, because this group has to decide, but have this all work

DR. FRIEDMAN: Well, thank you for that, Marjorie. I will take all the
sentiments that have been expressed here right into a planning committee called
at the IOM at one o’clock today. So I think it is very important that NCVHS and
several of its members be engaged in this as quickly as possible.

As the fog clears, I am starting to see things that have to be done to move
this forward in more detail. One of them I would just hang out there is the
fact that element three is going to need standards. For example, how do you
standardize questions that are not being contemplated by the meaningful use
process? Why would meaningful use require a standard for asking a question?

One of the things that I see that is going to require the kind of work that
this committee has done in the past, just to pick up an example is this whole
area of what is a question, how do you standardize a question.

Just one idea. I think there are several others. As we navigate and the fog
clears, I think lots of ideas and ways to work together will emerge.

MS. GREENBERG: Obviously this requires more discussion. You are just here
this morning?

DR. FRIEDMAN: I am here this morning. I hope to be here tomorrow morning.

MS. GREENBERG: And then tomorrow afternoon?

DR. FRIEDMAN: I am hoping to be here tomorrow afternoon. It depends on
factors beyond my control. But my plan is to be here tomorrow morning if I
possibly can.

DR. WARREN: Marjorie pointed out some of my stuff. I was going to ask about
the workshops and about some of the work that we have done on our various
committees and being involved in that, because I think it will enhance some of
the things.

Then have you started coming up with criteria for invitations of people?
You have got multi stakeholder there, so I think that is going to be a critical
factor, that we get the right assortment of folks there, and not have them
predominantly in one area that usually are people that show up to a lot of
these things.

DR. FRIEDMAN: Right, multi stakeholder is absolutely key to this. We have
identified a range of stakeholder groups. I do have to say that the way the IOM
operates, they have put together a planning committee for these events. We from
ONC participate in the meetings, but we are not the members of the planning
committee. Ultimately once we have contracted with IOM to do this work and put
its imprimatur on it, our role in the actual planning of the activities is
limited. But we certainly have input into the process.

DR. WARREN: So given that, because that helps a lot, to know where ONC’s
role is with IOM, how would you see then us participating? Would that be a
request that ONC would make as part of its agreement with IOM, that there be
representatives from NCVHS?

DR. FRIEDMAN: I will fold that into the planning process. What I am trying
to say is, I can’t control the outcome of it, but I can certainly raise the
idea as a good one.

DR. MILLETT: In addition to the areas that Larry identified for
intersection with NCVHS in element three, privacy and security is very rich.
There is a lot of interesting application.

When you think about deidentification, states’ organizations approach it
differently based on a variety of allowable factors within HIPAA, based on
organization and risk levels. So when we think about storing that sort of
information in a common deidentified manner, it would be helpful to have
privacy and security standards that everybody would play to at that level with
respect to what they need to do internally.

DR. FRIEDMAN: Yes, and that will clearly need to be part of the policy
structure that supports that. Without that, the policy structure will be too
brittle and the system won’t work.

MR. REYNOLDS: Jorge, last question, and then I’ve got one comment.

DR. FERRER: You mentioned NHANES a few times. What about the Connect

DR. FRIEDMAN: The Connect initiative is an implementation of the NHIN
standards and services that was initiated by a consortium of federal agencies,
but in fact is an open source piece of software that anybody can use.

Connect is alive and well. Agencies are using it. What they are using it
for is the information exchange use cases which we are now calling NHIN
exchange, which are the use cases like patient lookup, exchange of a summary
record, that were the focus of the NHIN demonstrations that took place in late
2008. So that cooperative of entities that participated in those 2008
demonstrations and others, because the group is growing, continue to
participate around a set of use cases we are now calling NHIN exchange,
contrasted to the simpler use cases we are calling NHIN direct, which are
mostly push scenarios.

The Connect software is an implementation of the exchange, NHIN exchange
centers and specifications. That is one way to skin the cat, but not the only

MR. REYNOLDS: Chuck, one comment. This is real exciting, but to the overall
stakeholders that are trying to drive the industry, that are around the room
here, that are everywhere, the concept of chase the committee is a hard thing.
So when you talk about ONC working with IOM and where is NCVHS, and NCVHS ought
to chase that committee and somebody ought to do something and something else,
it starts to be unclear to the entire ecosystem how to play.

So I think as you take that message back, making sure that as this comes
up, if the IOM has workshops and what is going to follow that workshop and
where is that going to go, otherwise there is so much exciting stuff going on
that people are just chasing it. So I think it is going to be extremely
important for NCVHS and ONC to be real crisp on which pieces are where and what
are they doing, and what is the process, so that some of the people that are
sitting around the edge of this room as well, whether it is hospitals, doctors’
groups or anything else, don’t have to attend 26 meetings to figure out which
one is going to be the one that says now, now we are going to decide, no, I
want to testify.

So the excitement is incredible, what is going on is real exciting. If we
can stay in structure as all of us that are these committees that are making
these decisions, so that that communication is clear, it is going to help
people get behind it a lot faster. Nobody will be able to yell, I don’t
understand, I didn’t know the process, you left me out, I didn’t get there, you
didn’t include this, you didn’t include that.

I think that is going to be extremely, extremely important as NCVHS and
especially ONC works together to draw those lines in some kind of honorable

DR. FRIEDMAN: And that is the intent, Harry.

MR. REYNOLDS: I was not alluding that it wasn’t, but if you just look at
that one slide, then what would happen after December. Is December when it is
over? Is December when it is just starting?

DR. FRIEDMAN: December, I would characterize, is when enough of the fog has
cleared and the muddiness has disappeared that we have a path going forward.

MR. REYNOLDS: I wasn’t pushing you for an answer. If you are sitting in
this room, you want to lean forward and say, now what does that mean, so that
you know whether to play between now and December or get involved in December,
of what do you do.

So, great discussion. Is this your last slide?

DR. FRIEDMAN: Yes. But write to me. Harry, to your point, if you ever think
we are falling into that pattern of chase the committee, write to me or pick up
the phone and call me.

MR. REYNOLDS: No, I think that’s great. You want everybody to support all
of this, so do we, and I think we have got to help them with the structure.

DR. SUAREZ: On the NHANES side, we have NHANES Connect and Direct and
NHANES exchange, which you can probably wrap all that around something called
NHANES everywhere. I think that is truly what we want to see happen in reality,
is that NHANES is everywhere.

But anyway, on that NHANES side too, I want to ask you very briefly about
NHANES governance and the path towards forming some sort of a nationwide
governance around NHANES. What comments can you make about that?

DR. FRIEDMAN: It is another work in progress, Walter. A proto governance
exists around the cooperative that is doing NHANES exchange. NHANES exchange is
actually live, and several members of that cooperative are exchanging data in
real time, based on covenants that they all have signed and agreed to.

So in some sense there is governance for some NHANES functions already in
place. One way this could go is, we could grow out of that, but the way it will
go — I’m not sure — one thing that is certain is that we were charged in
HITECH to set up a governance for the NHIN, and we will set up a governance for
the NHIN.

DR. HORNBROOK: I just wondered whether the committee needs to add a focus
on human engineering factors, human factors engineering, rather. Culture,
sociology, psychology of informatics are very, very critical. You are ruining
peoples’ lives, you are causing them to escape or retire, leave the profession
because of this revolution. So there are people who are die hard resistant
because they don’t want to change or can’t accept change, physicians, nurses.

You are also changing things like, collecting more data electronically,
make it more accessible, means there is a lot more inspection going on. I see a
lot of resistance among practitioners to sharing data amongst themselves
because people are seeing data that they have never had a chance to see before.

So even something as simple as oncologists recording performance status,
Karnovsky performance scores. Our oncologists resist putting it in the
electronic medical record system because they don’t want somebody else seeing
those performance scores and then seeing what they decide in the way of
treatment for somebody who a higher level performance score. They are worried
about people looking over their shoulders.

There is a whole social psychological impact of having data out there.
Information is power.

Then the final area that I am worried about, that I am seeing things
creating tensions in the health care system, is the fact that informatics can
totally redefine what it means to practice team medicine. All of a sudden, the
boundaries between medicine, nursing, pharmacy get blurred, because in order to
practice medicine efficiently inside this environment, all of you have to have
redundant functions inside the EMR to make it work. All of a sudden your work
as a physician has got to be very well integrated with everybody else on your

You say that makes sense, but sometimes the reality of having that happen
gets backlash. So we haven’t thought about some of these issues, about what it
means at the point of care for peoples’ behavior, attitudes, sense of
well-being, as providers, when you add all the rest for patients.

DR. CARR: I just want to underscore, I think that the human factors
component to this implementation, this grand scheme, is the critical factor.
You couldn’t have said it better.

MR. REYNOLDS: Chuck, thank you. Obviously this afternoon in your breakout
sessions we have a whole set of new things to think about. That is a perfect
time to spend a little more time with the playing groups.

So we have done our document. We have heard the future here. We have heard
what CMS is doing from Karen and we have heard Jim. So I think we have got a
nice overview to go to our breakouts.

We are going to take 15 minutes, be back at 11:20, and then we will move

(Brief recess.)

MR. REYNOLDS: The thing we want to do before we get started with this
section is, we want to recognize one of our extremely, extremely important
colleagues. That would be Mr. Jeff Blair. I’ll let Jim talk about that more,
but as I have prepared my comments for dinner tonight, the theme of my comments
is, be like Jeff. I don’t care who you are, what age you are. There are some
interns in the room. There are some young people. There are people that are
aspiring to be different things. If you just spent your life being like Jeff,
you will get to be whatever you want to be and probably more.

So Jim, let me turn it over to you.

MR. SCANLON: Well, Jeff, I am sorry to see you go after all this time. I
realize now that you probably are our longest serving member. I think you had
three full terms beginning in March of 1997. So I think Jeff is probably —
1997, remember when we were in our 30s?

But at any rate, in recognition of your service and leadership, Jeff, the
Secretary has issued a letter of appreciation and a certificate of appreciation
for your service. I would like to read this.

MR. REYNOLDS: I want you to read it, absolutely.

MR. SCANLON: This is to Jeffrey Blair. Dear Mr. Blair, it gives me great
pleasure to award you this certificate of appreciation for your 12 years of
service to the Department of Health and Human Services as a member of the
National Committee on Vital and Health Statistics.

The Committee is one of the oldest and most prestigious advisory groups
serving the Department. Its recommendations have helped shape health
statistics, health data standards, health information policy and public health
for our nation. Your knowledge, expertise and experience have contributed
greatly to the excellent work of the committee. We wish to comment you
particularly for your kind leadership effort and advice you provided as a
member of the Executive Committee, co-chairman of the Subcommittee on
Standards, as well as a member of the NHI ad hoc work group as well as the full

She concludes, only the very best are asked to serve, and we are proud to
have had the opportunity to associate with you in this endeavor.

As always, she feels free to call on you for free if the need arises in the
future. Thank you very much.

The certificate itself reads, For dedicated leadership, service and major
contributions to the advancement of national health information policy as a
member of the National Committee on Vital and Health Statistics, March 13, 1997
to May 7, 2010. So I think you do have the record for contributions and

MR. REYNOLDS: So Jeff, congratulations. You will hear a lot more from your
friends tonight. Some of it might not be for public view. Some people
contribute, some people are legends and some people are amazing, and I think
you fall into all three of those.

MR. BLAIR: Thank you.

MR. REYNOLDS: Marjorie has something to say here, too.

MS. GREENBERG: The NCHS staff also is recognizing you with a plaque to
Jeffrey S. Blair, MBA, for outstanding leadership and guidance of the National
Committee on Vital and Health Statistics as co-chair of the Subcommittee on
Standards, providing critical insights to address aspects of HIPAA, the
Medicare Modernization and Improvement Act, and meaningful use of health
information technology. June 2010.

MR. BLAIR: Very nice. Thank you so much.

MR. REYNOLDS: Jeff has to make a call. That is why we wanted to do this
quickly. He is still acting important on us, and he has got an 11;30 call, so
we will let him continue to do that. We will talk to you later, buddy. Thank
you and congratulations.

MR. BLAIR: Thank you, Marjorie, thank you, Jim, thank you, Harry. I will be
back this afternoon.

MR. SCANLON: Let’s take a few more minutes to honor our Chair. Probably
this will be your last meeting as Chair, Harry.

Harry again is one of our long-serving members, as a member and as Chair.
In recognition of your service and leadership, Harry, the Secretary has written
a letter for you as well, and a certificate. So let me read this as well.

This is to Harry Reynolds. It gives me great pleasure to award you this
certificate of appreciation for your seven years of service to the Department
of Health and Human Services as a member of the National Committee on Vital and
Health Statistics.

The committee is one of the oldest and most prestigious advisory groups in
the Department, and its recommendations have helped shaped health statistics,
data standards, health information policy and public health information. Your
knowledge, expertise and experience have contributed greatly to the excellent
work of the committee.

We wish to commend you particularly for your leadership and counsel as —
and this is a long list of compliments — chairman of the committee, obviously,
co-chairman of the Subcommittee on Standards, member of the Executive
Subcommittee, Subcommittee on Privacy, Confidentiality and Security, as well as
a member of the NHI work group and the secondary use ad hoc work group. So that
is a very long and distinguished set of accomplishments.

Only the very best are asked to serve, and we are proud to have had the
opportunity to associate with you in this endeavor. Sincerely, Kathleen
Sibelius, Secretary of Health and Human Services.

The certificate. To Harry Reynolds for outstanding leadership, service and
major contributions to the advancement of national health information policy as
a member of the National Committee on Vital and Health Statistics, November 1,
2003 to June 9, 2010.

MS. GREENBERG: Not to be outdone. I have to tell you, we have had cyclones,
we have had volcanoes, we have had blizzards. This was due to some type of
tornado. HIPAA got left out on both of these. So it will be mailed, the
corrected version.

To Harry L. Reynolds, Jr. for outstanding leadership and guidance as
Chairman of the National Committee on Vital and Health Statistics in advancing
health information policy, promoting HIPAA standards and being a tireless
advocate for health data stewardship. June 2010.

I guess you might want to officially announce who will be our next Chair.

MR. SCANLON: Yes. I think you know this already, but the Secretary has
asked — as Harry is leaving today, the Secretary has asked Justine Carr to
serve as Chair. It is a two-year term obviously, and Justine in a moment of
weakness has graciously accepted. So Justine, we welcome you.

DR. CARR: Mr. Chairman, may I speak? I want to say first that I was humbled
to be asked. I am honored to serve, and I am hopeful that you are all going to
help me. Thank you.

MS. GREENBERG: If you want to know just how much a moment of weakness this
was, she was at the airport waiting to fly over to meet her new grandchild, her
first grandchild, when I got her on her cell phone to ask her if she would
consider this. So you can imagine, in her state of euphoria, she was not
responsible for what she said, but we held her to it.

Agenda Item: Plans for the NCVHS 60th Anniversary

MR. REYNOLDS: The most exciting thing about the committee is, it gets
better and better. So thank you. Let’s move on now to the discussion about the
60th Anniversary Symposium.

Each of you have at your table the program for tomorrow. I would like all
the staff that worked on this program, including our document, to stand up,

MS. GREENBERG: Anyone on the NCVHS team please stand up, because this is a
team. Those of you who haven’t yet stood up, please do.

MR. REYNOLDS: That is the amazing thing about this committee. A lot of us
have worked on committees where you didn’t have any kind of support like this.
It is a magical thing, to have this kind of support from so many people that
are true professionals, and in all cases peers on the committee. So thank you.

I am going to turn it over to Marjorie to give you the exact details so I
don’t get you lost as to where you are going. We will be presenting though the
paper. I will be summarizing that and turning it over to the existing co-chairs
of the subcommittees to talk about the past and the future of what is going on.

Having been a part of what Marjorie and the group that just stood up did at
Charlottesville, Virginia, I think you will enjoy the comments from the past
chairs, as we were all interviewed and had a roundtable and so on. So you will
get a sense of what it means to be part of something for 60 years and what it
means to be a part of something that is going to be ongoing and truly making a

So Marjorie, let me turn it over to you.

MS. GREENBERG: As some of you know, I had to join Facebook when my
grandchildren, particularly the second one, was born, because it was the only
way I could see pictures of them. So I put on Facebook, I think it was on
Monday night, that I was excited about this 60th anniversary of the National
Committee this week.

I had been working with the National Committee since 1982. Then I put in
parentheses, or is it 1949? Anyway, that is the way I feel. It is hard to
believe that we have actually come to this moment, but as Harry said we have
all come together holding hands across the telephone lines and across the ages.

So many people have contributed to this, but I will just briefly let you
know what is happening. Tonight we are having the dinner, in which we will
recognize Harry and Jeff. Can I just have a show of hands as to how many people
will be coming to the dinner? That is going to be at Legal Seafood, so it
should be fun. We can’t promise everything we saw will be legal.

MR. REYNOLDS: It won’t be on the record.

MS. GREENBERG: Off the record remarks, but it is Legal Seafood. Then
tomorrow we are meeting. This afternoon you all will be working on finalizing
your slides.

Then tomorrow we will be meeting from nine to 11:30; you have your agenda.
Then there will be a shuttle bus or a bus or something that will take us all
over to the Keck Center. I don’t know if any of you are staying overnight here
and then leaving after the event tomorrow afternoon, so you have to think about
whether you want to take your suitcases or what have you.

We will convene at one. Do we know how many people we have signed up for
the symposium tomorrow? Eighty? We will have all the former chairs who were in
Charlottesville with us. We are expecting all of them, as well as, Bob Hungate
is joining us. I don’t know if there will be any other former members.

If you look at the agenda, there will be the welcomes, including from the
Chair of the Committee on National Statistics, so that is nice, and Ed Sondik
from the National Center will also be making some remarks. Then Harry is going
to present some slides regarding — I don’t know if it is element three or more
than element three, but it is towards the enhanced information capacities for

I really do have to recognize Bill Scanlon, for whom this was at least a
part time job

DR. SCANLON: A moment of weakness.

MS. GREENBERG: And of course Susan Canaan, who has the patience of Job with
our group. Everyone has this document. I think it is a nice high level concept
paper that will hopefully be well received.

Then each of the subcommittees is going to present their current and future
thinking about projects. The paper itself ends with something about each
subcommittee, which Harry will not present, but we will go into the
subcommittees’ presentations. Then after that we will have a break. It is our
understanding that the cafeteria is only open until three, so we have to get a
cup of coffee or a soft drink.

Then we will have a discussion. We will open it up to whoever wants to
comment. If you know anybody who is going to be there and you want to plant a
question, you can do that. If there isn’t that much comment from the audience,
members can comment as well.

Then we are going to have the Charlottesville video, which I love. In many
ways I had nothing to do with it, other than getting the idea. A huge amount of
work went into pulling off the event, which was then video’d, including through
our colleague Bob Phillips of the Robert Graham Center, Larry’s support, et
cetera, just getting this all together down in Charlottesville.

I am forgetting the oral histories which we also have on all the chairs. I
was interviewed as well. We had about two and a half hours that we had to get
down to about 20 minutes. I would have enjoyed watching all two and a half
hours, but we didn’t think anyone else would, at least not all 80 people. So
Debby and Catherine worked with — first of all, they did a bang-up job, the
videographers at the University of Virginia, so let me recognize them.

But to try to work with them on editing it when they were down in
Charlottesville and we were here was going to be complicated. So through our
own information services folks, we worked with a group called —

MS. JACKSON: (Comments off mike.)

MS. GREENBERG: So we worked with this group. I say we; Debbie and
Katherine, and they showed me a version, which I was thrilled, but we did a
little more work on that then. Video Ed Productions worked with us, and now we
have 22 minutes or something like that.

I think you will all enjoy it. We do plan to then post it on the website.
Also, you can look at it during the reception. On the monitor there will be
clips from the oral histories. We may put that on the website as well, we have
to decide.

Then we will open it up, probably call on the former chairs, at which point
Harry will almost be a former chair. It was rather clever of you. We don’t have
to keep saying the former chairs and the chair, we can just call you all former
chairs, and open it up to them and anybody else who wants to make any comments.
Harry will have the final word and we will adjourn, and then we will go to the

We wanted to give you time today to finalize your slides, so those will be
posted on the website, but nobody is going to get copies of them at the event

In this lovely booklet, I do call your attention to something called the
National Committee on Vital and Health Statistics 60th Anniversary Documents
and Events. As you know, I have suggested probably two years ago, that although
we would be working towards this event at the National Academy, we should think
in terms of a series of events and activities, et cetera. Several people took
us up on that.

We have the history, we have this document, we have two presentations that
Judy Warren made. We have the conference that we held in Salt Lake City. We
have the talk about Lisa Iezzoni, everything in Charlottesville. I have perhaps
overdone it, but I have done a poster and a few papers.

Then we will have three events after this week. Next week is the North
American Collaborating Center Conference on enhancing our understanding of the
international classification of functioning, disability and health. That is
being cosponsored by NCVHS, your long work on supporting functional status
data. At that point our new Chair, Justine, will be making a presentation to
the folks. I think we are going to have 100 people there. But it is also going
to be videocast. So we will make sure you all have the videocast URL in case
you want to tune in on any of it, or your students or your friends or your
mother or whoever to do so.

So we have that two-day meeting next week, the 23rd and 24th, also in
celebration of the anniversary.

Then we are going to have a session at the National Conference on Health
Statistics, which is what I used to call the data users conference. It is
celebrating the 50th anniversary of the National Center for Health Statistics,
which was established in 1960, although some of our programs predate that,
certainly Vitals and even the National Health Interview Survey.

So we will have a session. I am going to give a paper on the 50-year
partnership between the National Committee and the National Center. Don is
going to present some version of this document.

DR. STEINWACHS: Once I hear Harry present it. Then I will know what to say.

MS. GREENBERG: And whatever the Populations Committee of the full committee
wants him to say.

Then Wesley is also making a presentation on privacy and security in this
new electronic age, and drawing I’m sure from tomorrow’s remarks, as well as
the conference. So that is on August 18th, the last day.

This conference is free. There is no registration, as is the ICF
conference, since we are on the Internet here, is also free. In both cases you
are asked to register so we know who is coming but there is no registration
fee. If you look at some of the things that you get on your e-mail and you see
what people are charging for registration for meetings, I think these are going
to be real bargains. Not just that they are free, but there is going to be a
huge amount of information.

There are going to be tutorials. The first day we will have a tutorial on
ICD-10CF and ICF, and there will be tutorials on all of our systems, all of our
NCHS data systems, in some cases hands on as well. So I really encourage you or
your students or your colleagues to think in terms of that conference, which is
August 16-18.

Then I am presenting a paper about national committees in Milan, Italy in
November, at the 16th Congress of the International Federation of Health
Records Organizations. This is something I have been interested in. As you know
I am very involved with IFHRO, so I was going to go anyway, but as you know
this committee came out of a recommendation of the World Health Organization in
1948, that countries should have committees on vital and health statistics,
national committees.

In the ’70s we know there were quite a few of them. Our history shows us
that, but we really don’t know what is going on currently. I am doing a little
survey with the Pan American Health Organization as well to all my fellow
center heads to find out what types of advisory committees are out there on
national health information policy. So I would like you folks to fill out a
survey. It shouldn’t take very long. It is mostly multiple choice questions, a
preliminary look at this on the two new FACA committees and on the National
Committee, so that maybe we will identify some groups that we would want in the
future to communicate with more.

DR. CARR: Healthy People. We had talked about that at the meaningful
measurement hearings, a Healthy People advisory committee.

MS. GREENBERG: Yes. One of the areas that PAHO is very interested in is
indicators, committees that are addressing indicators. So that maybe will
enhance our international work in the future, but I will certainly share that
paper with all of you.

At that point, by the end of the calendar year, we will officially call the
60th anniversary of the committee done, and starting off the next decade.

Are there questions about the rest of these two days or about any of the
other things that we have done already or have planned? Okay, that is all I
wanted to say, really.

MR. REYNOLDS: I gave a speech in Minnesota a couple of weeks ago to 600
people. They had somebody standing beside me for the hearing impaired. I want
you to visualize tomorrow when I am presenting this. Justine and I worked
closely on a lot of things here. Picture her beside me with a bullhorn, really
saying what I am saying. So it will take a little longer to present tomorrow,
because she is going to be editing everything I say as I say it. So it should
be fun.

(Remarks off the record regarding breakout session locations.)

Unless there are any other comments, we will break for lunch, start again
at one. Thank you very much.

(Whereupon, the plenary session was adjourned.)