[This Transcript is Unedited]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS
SUBCOMMITTEE ON STANDARDS AND SECURITY
June 30, 2005
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20001
CASET Associates, Ltd.
10201 Lee Highway, suite 180
Fairfax, Virginia 22030
- Jeffrey S. Blair, MBA, Co-Chairman
- Harry Reynolds, Co-Chairman
- Simon P. Cohn, MD
- Judith Warren, PhD, RN
- Steven J. Steindel, PhD, CDC
- Michele Williamson, NCHS
- Marie A. Friedman, DBA
- Vivian Auld, NLM
- J. Michael Fitzmaurice, PhD, AHRQ
- Tony Schueth
TABLE OF CONTENTS
- Introduction – Jeff Blair, Harry Reynolds
- Planning for Future Hearings – Jeff Blair, Harry Reynolds
P R O C E E D I N G S 8:05 AM
MR. REYNOLDS: I would like to officially welcome you. Good morning. My name is Harry Reynolds. I am from Blue Cross Blue Shield, North Carolina and Co-Chair along with Jeff Blair of the Subcommittee on Standards and Security of the National Committee on Vital Health Statistics.
The NCVHS is a federal advisory committee consisting of private citizens that makes recommendations to the Secretary of HHS on health information policy. On behalf of the Subcommittee and staff I want to welcome you to today’s breakout session of this Committee.
We are being taped but not broadcast over the Internet. Is that correct?
MR. BLAIR: That is correct.
MR. REYNOLDS: As is our custom we will begin with introductions of the members of the Subcommittee and staff and guests and I would invite the Subcommittee members to disclose any conflicts of interest.
So, let us go ahead and begin that .
MR. BLAIR: Okay, I am Jeff Blair of the Medical Records Institute, Co-Chair of the Subcommittee on Standards and Security and at this point I am not aware of any conflicts of interest.
DR.HUFF: Stan Huff with University of Utah and Intermountain Health Care in Salt Lake City and as far as I know I don’t have any conflicts with any or potential conflicts even.
MS. AULD: Vivian Auld, National Library of Medicine, staff to the Subcommittee.
DR. WARREN: Judy Warren, University of Kansas, School of Nursing, member of the Subcommittee and I am not aware of any conflicts either.
DR. COHN: Simon Cohn, member of the Committee and Subcommittee. The only conflict I would have is when we start having heated conversations about the CPT.
MS. FRIEDMAN: Marie Friedman, CMS.
MS. WILLIAMSON: Michelle Williamson, CDC, NCHS.
MR. REYNOLDS: Okay, we have a short period of time today. So, let us go ahead and get going. Today we want to discuss our July hearing as well as establish agendas for the rest of the year.
In relation to our July hearing it was scheduled to discuss e-prescribing, particularly authentication, security and diversion risk that relate to scheduled type drugs. HHS and the Department of Justice continue to discuss our previous recommendations and are not prepared for us to proceed with our hearing.
So the subject of e-prescribing will not be covered in July.
Our first discussion, therefore, is whether we use the proposed hearing dates in July for other agenda items or cancel the hearing. So, I would like to have Jeff and Maria jump in at this point and let us talk about what are the other agenda items we have.
We will open it to the floor.
DR. COHN: May I just ask a question because the issues relating to the signature actually was mentioned in the whole world of e-prescribing.
MR. REYNOLDS: Yes.
DR. COHN: I am talking about standards that we are shepherding through which I don’t know what is going on.
MR. REYNOLDS: And the status of where NCPDP is. yes, I agree with that.
MS. FRIEDMAN: I did talk to the DEA yesterday and they are proceeding to have a separate meeting which will be in the middle of August. So, I will keep everybody apprised of the whys and wherefores and we are going to be working to develop a joint invitation list.
MR. BLAIR: So, the question is whether they are going to invite us or subpoena us.
MS. FRIEDMAN: Or not invite you at all.
DR. FITZMAURICE: Has CNS talked to DEA about what kind of protection is needed for all drugs versus scheduled drugs?
MS. FRIEDMAN: No, they are very focused on their own particular agency needs.
DR. FITZMAURICE: And they refuse to meet with us?
MS. FRIEDMAN: It is not that so much. They thought it was inappropriate for our Subcommittee to look at their issue and I respectfully disagreed in that while they are the regulators of controlled substances that you cannot look at risks and gaps and costs and all that related to medication security need prescribing in a silo, that all of that needs to be considered as a whole because otherwise whatever recommendations come forward from our side are not completed or not totally informed.
MR. REYNOLDS: Since we have limited time today, in other words I think there were a number of discussions yesterday and other things that we are not, they are not ready for us to have a hearing. They are going to have their own. So, we have to decide what we are going to do in July and/or going forward. So, I want to make sure with our short period of time we do that and then whatever other discussion we want to have about that subject, if we have other time then I think that would be good.
Otherwise we are going to end today and not know what we are doing in July.
MR. BLAIR: You are moving right along with your agenda. Let me identify the topics that we had considered for this July meeting prior to the request that we focus on authentication.
One of the items was we were going to hear an update from NCPDP regarding the status of the development of NCPDP script standards for I believe it was formulary information and medications and —
MR. REYNOLDS: And SINK(?) —
MR. BLAIR: And SINK could be part of that as well, sure and so that was one topic.
A second topic that we had been thinking of was the beginning of the explorations of how do we move forward on capturing information; what is the at the point of care with derivatives of that information being used for other purposes that Stan Huff would be providing leadership on.
A third was this return on investment issue on HIPAA and a fourth was — I am just listing them all
MR. REYNOLDS: And the RO1 was based on getting some of the practice management people in to talk about what had been the stumbling blocks.
DR. COHN: As well as the use of other factions.
MR. BLAIR: Right and then the fourth topic was going to be exploring what entities might be out there that could provide coordination or harmonization of standards.
DR. COHN: I think we should take that one off the table.
MR. BLAIR: So, anyway those were the four items that we were considering, and I think that Simon’s observation on the fourth one reflects the fact that the standards harmonization RFP has gone out and AHEC and it just doesn’t look as if that is going to be useful for us anymore.
So, does everybody sort of agree to scratch that one?
MR. REYNOLDS: We may end up with it at a later point after it occurs but not right now.
MR. BLAIR: And then the other one and I almost listed them in a sense at least in my idea in terms of likelihoods that we could do things useful.
The next one was the HIPAA return on investment issue with trying to hear from the practice management system vendors as to why they did that.
Harry, what if we solicit thoughts about whether we should still have any input from them?
MR. REYNOLDS: I am sorry, Jeff, give us that subject you just mentioned?
MR. BLAIR: This is Item No. 3 which was HIPAA return on investment and the essence of that was to hear from the practice management system vendors as to why they had not implemented some of the HIPAA regs.
MS. FRIEDMAN: I have a comment on that, In trying to set up the hearing before I had actually talked to people and invited a couple here and there but I am still having a hard time getting people to focus on HIPAA ROI and part of the reason I have been told over and over again is that contingency plans are still in operation and the real ROI comes from the different transactions and so —
DR. COHN: I think hearing from practice management was very important and it would be nice to hear to just sort of understand how they are doing it.
MR. REYNOLDS: Past and future.
DR. COHN: Yes. I think that is No. 1, but No. 2, I want to reflect on the plan which does talk about things like, I mean he talked about registration which I sort of define as eligibility as being part of the 500-day plan and other things and I think that there may be some value for us to sort of not just look at the 837, and I maybe took what i heard from the last ROI conversation differently than you all did but I thought that there were interesting political issues and contention around the 837 about making it perfect but that was like a 5 percent issue or an 8 or 10 percent issue, but there was like this 80 percent issue of value and opportunity related to the other transactions and so I am sort of thinking that that is really the value and so it is sort of like gee, what is CAQH doing around eligibility at this point.
MR. REYNOLDS: And they are doing a lot.
DR. COHN: And they are doing a lot and I think maybe we need to hear from them again if we could. We could hear from others around those and to me it would be really nice to hear about management vendors but I don’t see that as quite the key issue there.
I guess that was sort of my view on that.
MS. FRIEDMAN: There was certainly a batch of key stakeholders we hadn’t heard from.
DR. COHN: I think it would be great if you would just tell me how you are having trouble finding them.
MS. FRIEDMAN: Yes, and also just a point is I am not so sure I can get people invited and get their testimony vetted in time at this late date.
MR. REYNOLDS: That was the purpose of making sure we discussed that this morning.
What could we get ready for July?
MS. FRIEDMAN: I don’t know. I would have to go back and —
MR. REYNOLDS: No, I am saying we are going to talk about what subject we would like and then the next question is can we get it ready and if we can’t then we cancel the hearing. That is what we are saying.
MR. BLAIR: Harry, what if we hit it, instead of, I was going from the bottom up in terms of what we eliminate; what if we go from the top down which is I sort of feel like the top of the list for our remaining topics is hearing from NCPDP and so that may be Lynn Gilbertson and maybe do we still have a reasonable chance that we could hear from her?
MS. FRIEDMAN: I don’t know.
DR. COHN: I expect we could either hear from her in person or via phone.
MR. REYNOLDS: Or someone else. That should be a pretty clean status as to where they are or where they aren’t.
DR. FITZMAURICE: She has always been very cooperative and she always has a list of everything that is going on, very well organized.
MS. FRIEDMAN: The other thing is she had asked for an hour when I had talked to her before and I was trying to schedule this hearing and I think maybe I would have to talk to her again but I want to make sure we have time for discussion because I think it is very important for people to get their questions answered.
MR. REYNOLDS: Stan, having adjudicated that a little bit on this clinical data derivatives I would love to hear your thoughts and, Simon you mentioned something to me yesterday about some things you heard. So, why don’t we vet those for a minute and see what we think could come out of it and again we can walk away from July. We could change July or whatever.
So,I mean that is what we have got to figure out between now and eight-fifty.
DR. HUFF: In our previous discussions there were several interested parties. AHIMA was interested in talking about.
MR. BLAIR: Stan, the air-conditioner vent just turned on. Maybe I ought to get closer to you or could you talk a little louder?
DR. HUFF: Yes, there were folks from AHIMA, the American Health Information Management Association. They are interested in, you know what they are talking about is auto coding which is related but then there were a number of other well, we talked about that Jim Campbell in Nebraska was doing some interesting things, that Chris Shute had already talked about. You know Chris Shute talks frequently about, quote, aggregation logics which is how you represent logic that would allow you to automatically generate these codes based on — and I should have looked at my notes. We had several, some other folks. There were federal initiatives i think, too.
DR. COHN: Yes, I think it would be a question of hearing from NLM to find out what they are doing around mapping and all that. Don Detmer has indicated that he has some very interesting ideas and potential things that I think he would like to, and now, of course, I don’t know if he is available that date, but assuming he was I think there would be things he would want to at least vet to the Subcommittee around potentially sort of what the end state might look like.
MR. REYNOLDS: We had also discussed doing a primer with a group on that first as a group to make sure we all kind of understood the subject.
MR. BLAIR: I thought that when Stan was mentioning Chris Shute and Campbell —
MR. REYNOLDS: I just wanted to make sure if we were going to do a primer make sure if we got five or six people then we would pick those people first so that those of us that need that primer aren’t lost from day one.
MS. FRIEDMAN: It is also a question of what they say. I mean do they talk to us about what they are doing or do they give us the primer. You need to understand the landscape before you hear the presentation on what their projects are.
DR. COHN: You are right. I guess I can see it as a definition in which gets into their views of what you deal with, how you deal with it.
MR. REYNOLDS: As long as they start off at a high enough, I mean that is fine. Obviously if we invite them we would want to hear what they are doing but if they could spend a little time up front because the subject for some of you who are doctors might be clear. To some of us it is not.
MR. BLAIR: I sort of am leaning towards the idea of seeing if we could focus on two topics so that we don’t get too fragmented because I tend to think of the practice management system vendors. That can be quite a bit and I would almost like to sort of dedicate time maybe in September to that issue.
If we could maybe focus on NCPDP and on the derivatives topics for this upcoming July meeting that may be all that we could handle reasonably and have discussion time. What are your thoughts on that?
MR. REYNOLDS: We are looking at a day and one-half. In other words we would not meet Monday as we had talked about. We would not meet Monday. We would meet Tuesday, finish at noon Wednesday and then NHII kicks off Wednesday afternoon.
MS. AULD; What dates are these?
DR. STEINDEL: It is the 26th and 28th, around the 28th.
DR. HUFF: Is the NHAI just a half day?
DR. COHN: Whenever this meeting finishes, it starts and probably would go until mid-to-late morning the next day.
DR. HUFF: On Thursday?
DR. COHN: On Thursday and obviously if this group finishes a little earlier we would sort of bump up the start of the other meeting.
MR. BLAIR: Am I being too, I don’t know. I almost feel as if, I know we could probably do a little bit more time. I am not sure we could fill up a day and one-half with those two topics but I sort of feel if we start to get into practice management that is not just another 2 hours or 3 hours. I feel like that is at least one-half day if not a whole day but what are your thoughts?
MS. FRIEDMAN: How many practice management attendees were you anticipating having?
MR. BLAIR: I think it is a really sensitive issue. So, my thought was in order for us to really figure out what is going on there we need to have some practice management systems that are stand-alone systems, some that are integrated with electronic health record systems and we also need to hear from the clearinghouses to understand what actions they have taken where they have encouraged and in some cases they have acquired practice medical system vendors.
MR. REYNOLDS: I have had a call from Tom Gilligan who represents the clearinghouses. So, he was attuned to what we had to say last time and was very focused on that. So, I think we could get the clearinghouses involved. I know that I had already given Maria the name of Mysis which is prominent in these systems both from a stand-alone basis and from an integrated EHR basis. So, I think they could do that but again let us —
DR. COHN: That is like a September topic.
MR. REYNOLDS: Yes, so, let us explore. The other possibility and I don’t know those of you in the West whether if we started at noon on Tuesday since you have to be here for NHII I don’t think that helps you. I wanted to at least discuss it because otherwise,now could you start NHII sooner so that if we had a 1-day hearing on Tuesday —
MR. BLAIR: Yes, that would be cool.
MR. REYNOLDS: I think what we are all saying is we want to do something but we are trying to make up a day and one-half and we are struggling and we are going to have so many topics or —
DR. COHN: Let me say something? We are happy to be a little flexible on any of these and I say that with Joe in the room but whether we start at noon or 1 o’clock or 10 a.m,, on the second day depends on what is going. I am actually not hearing anything so far that I am hearing as struggle. I know in terms of struggling putting together an agenda. What I am hearing is we need to hear from NCPDP and we need to hear around how all that is going and how the new standards are working out and all of this stuff.
I think I am hearing that actually a primer conversation around clinical, on derivatives, followed by discussion of what we are going to do next around all of that and I could easily see a half day if we assume that AHIMA is willing to talk and others are willing to talk as a panel and I mean then the question of well we need to have some time since this group has not met since April to sort of figure out what the work plan is for the sort of going forward and then we haven’t even talked about whether we would put some of the other transactions on the table to get an update on those which may be more appropriate as a September issue but I am sort of hearing we could easily go, I mean we may not go until noon but we could go to 10 o’clock the next day or whatever but it sounds to me that there is potentially a fair amount of things we need to be talking about.
MR. BLAIR: Could I just modify what you have said slightly?
DR. COHN: Sure.
MR. BLAIR: My thinking is from what I am hearing, my sense is that the Subcommittee on Standards and Security probably could have a full day. I would think that NHII probably could begin the next day in the morning.
MR. REYNOLDS: That was my point. That is where I was going. I didn’t want to struggle to fill a day and one-half.
MR. BLAIR: And I have a personal bias here for openness which is that I would be delighted with that because if my flight doesn’t leave until three-forty-five on that afternoon it means that it gives me a chance to be in on the NHII thing for most of the day or up until maybe 1 o’clock or one-thirty or something like that.
MR. REYNOLDS: Let us start with the topic. We have agreed to —
DR. WARREN: I was going to say that I like the idea of Simon’s piece of planning some time just for us to do some more planning because with each one of us you asked us to look up some areas and mine is kind of the more distant one but I am beginning to talk to some people to come up about how do you aggregate and maintain confidentiality and stuff which is what you asked me to look at which kind of flows kind of right after the derivative work. You know, if we can get the derivative work, now we need to know how we know people are without knowing who they are, at least what data to aggregate as the same individual.
So, I would like some planning time in there. I don’t know whether that is morning or whatever.
MR. BLAIR: I would think it would be the late afternoon and we could have 2 hours worth of planning.
DR. WARREN: Yes, and that is what I am lobbying for is sufficient time.
DR. FITZMAURICE: I would like to suggest something that ties into what we have been doing for the past 2 years and that is you might want to hear an update on how things are going with the pilots, the electronic prescribing pilots. That need not take a lot of time but you still probably want to hear about whatever can be said.
MR. BLAIR: I am confused. The pilots don’t begin until —
DR. FITZMAURICE: January but you still have to know what are the plans for the pilot. You may have something to chew over by that time.
MR. BLAIR: Oh, you know something we don’t know.
DR. FITZMAURICE: No, I don’t.
DR. COHN: You are in charge of that.
DR. FITZMAURICE: I don’t know if that has been openly stated. We are working together.
MS. FRIEDMAN; We are working together and just like everything else we hope to have it out soon.
MR. REYNOLDS: Michael, at some point you may want to be on the agenda and, Maria you will work with him and let us know if that is the case.
DR. FITZMAURICE: Or the appropriate person. It may be someone else.
MS. FRIEDMAN: One more thing. It is also possible we might have Stark(?) and Safe Harbor out by then, too.
DR. FITZMAURICE: What may be out by then?
MS. FRIEDMAN: The regs on Stark and Safe Harbor.
PARTICIPANT: As someone who is working on standards right now I can tell you that one of the things that we are really struggling with is in getting to systemic interoperability, Simon that you mentioned, is vocabulary, is differences in vocabulary, and I am working on prior authorization and one of the things we are trying to do is code prior authorization and every time we come across an area such as allergies and we say, “Where is the standard code set for allergies?” and I am wondering if that is really interoperability and I am wondering if that is an area that you want to address..
DR. WARREN: May I interrupt? That is a good one because I know that Snowman and term info out of HL7 are both working on trying to come to grips with some of the needs for some of these sub, you know, terminologies whether it is terminologies for a sig(?) or for the allergies, the allergy reactions, FOB’s. It might be good to see if those two guys could give us an update.
MR. REYNOLDS: Simon, help us from the standpoint of your discussions with the Secretary and AHEC and the Committee for Systemic Interoperability. We took harmonization off because it was kind of a subject that was out there with RFPs. Does interoperability fall into the same category?
DR. COHN: Interoperability falls into a category we don’t have a committee.
MR. REYNOLDS: I am trying to learn how we are drawing boxes around —
DR. COHN: I think what has been described is well within the scope of the Committee to investigate and provide guidance on, at least as far as I am concerned, and I think these are issues that we don’t have an answer to, and I remember when we were writing the prescribing letters allergies kept showing up as a next step item, so just as an example, and I think any of these groups could provide, I mean once there is an answer obviously a group can provide leadership and say, “Yes, that should be the industry solution,” but I think really the things that really need some hard thought we already have really a wonderful group to provide some guidance in terms of how this might best play out.
MR. REYNOLDS: Vivian and then Steve?
MS. AULD: Health informatics is just starting up a new work group specifically looking at allergies. So, it would be interesting to hear.
PARTICIPANT: Which group?
MS. AULD: Consolidated CHI.
DR. STEINDEL: That is what I was going to say. There is a lot of work going on right now at HL7 in the area of allergies. There has been a lot of information on vocabulary that has served. There has been a new thread started on prior authorization codes on the HL7 listserve. CHI is kicking off an allergy work group that should report very quickly because VA and DOD have an immediate need for this and have been pushing CHI to do it.
So, if we really want to talk about these subjects which I don’t think is inappropriate I think it might be best left until December.
MR. REYNOLDS: What happened to September?
DR. STEINDEL: Because I think in December is when these groups will be ready to present cohesive statements. MR. BLAIR: Were you here when Tony was suggesting that we look from an e-prescribing standpoint at some of the terminology issues, and he was suggesting that we consider allergies?
DR. STEINDEL: I just heard that and I am saying that there is a tremendous amount of work moving forward very quickly in the area. I think if we ask people to come in September what they are going to say is that there is a tremendous amount of work moving forward very quickly, and I think if we ask them to come in December what we might get is more of a status and a problem list with regard to the work which we can focus on better.
MR. BLAIR: Could we just hear from Tony and Stan on this particular topic to see if everybody agrees with that?
PARTICIPANT: What we could do as part of the NCPDP presentation we could give you a problem list relative to what we would encounter with prior authorization.
I agree with you, you know. They are probably not ready. There is going to be a lot of work that is going to be done between now and December, but if we could lay some things out and then you know keep the process rolling and keep up the momentum so that in December they could talk more about the progress that they are making.
DR. STEINDEL: We need to do a stage-setting thing and the July meeting you can mention that it is happening and in the September meeting we could mention some status and then you know either one of those two meetings we could say that we are looking for an updated report and more detail from the groups in December and that gives them a date to work towards.
MR. REYNOLDS: Also, basic things like allergies would be helpful as you look at a personal health record and other things. So, some of this stuff is going to start to be useful in other ways, drop down boxes or —
DR. HUFF: I agree with what has been said. I think what I see now, you know, if you ask, if you have a meeting soon in the next few months what people would say is they will be able to give you a list of things that they are starting to work on but they probably won’t have proposed solutions for those things yet.
If you do it in December you know later in the year then they will probably have proposed solutions or say, “Oh, and this is a gap,” or that sort of thing.
So, I think if you do it at either point, if you do it early you are going to get a list of the things that people are interested in and if you do it later then you are going to get proposed solutions and gaps and more in-depth discussion.
DR. FITZMAURICE: I would suggest if you do it early you get not only a list but a timetable. If you do it later, the timetable might not have been met.
DR. STEINDEL: From somewhat of a political point of view based on what we heard about CHI yesterday it might not be bad to put this on the table. Then we can push CHI to give a preliminary report to NCVHS in September on what they have seen in the allergy space and that is a little bit more than stage setting. It puts a target out there.
MS. FRIEDMAN: I have a follow up on that. Where are we with CHI? I know in the past, I know where CHI is but I am talking about where we are in recommendations on what they come out with.
At some future point if they come out with a vocabulary for allergies will we then talk about recommending that as a standard? What is the process? Are we not doing that anymore? Where are we with that?
DR. STEINDEL: I will give you the definitive answer after the July 6, meeting where we are going to be voting on the charter. The last version of the charter did not have going to NCVHS formally, but I just casually mentioned that in Phase I we found it to be a good process and maybe we should replicate it.
MS. AULD: Several people agreed it would be —
DR. STEINDEL: Yes, so it is in the new version of the charter. So, the charter is supposed to be approved on July 6. So, in that case we will be doing the exact same thing we did last time.
MR. REYNOLDS: The other example think you could use, Steve is that since CHI apparently is going to be used as part of new standards, a good example, attachments is coming up, and Lohnquich as mentioned in CHI is part of that standard which then falls into not just the government side but it falls into everybody because everybody does attachments; this is a body that can at least discuss it.
So, we have got 10 minutes. Let us go back to, so we are going to have a July hearing. It is going to be, let us fill one day first and then let us figure out if we spill into the next morning and what that means.
So, let us fill the first day.
DR. COHN: General updates.
MS. FRIEDMAN: I have got NCPDP, the pilots and reg update assuming Stark and Safe Harbor are out.
MR. BLAIR: How much time do you feel that you need for that?
MS. FRIEDMAN: An hour.
MR. BLAIR: NCPDP might be alone an hour.
MS. FRIEDMAN: Alone and are we going to ask for anything special that you want to hear a more full report from the Sig(?) work group because they are pretty far along?
DR. HUFF: I would like to hear about that. I would, also, like to hear about the HL7 script mapping. I don’t know if that work has progressed but it is important. Ross Martin and those guys, I want to hear about the new standards, the RX hub and —
MS. FRIEDMAN: That would be part of that.
MR. REYNOLDS: Do we want the problem list at that point?
PARTICIPANT: Yes, understanding the issues they are encountering.
MR. REYNOLDS: So, we understand what we might need to deal with.
DR. COHN: It is the issues list you are talking about.
MS. FRIEDMAN: An issues list for allergies.
DR. COHN: Issues list, period, for everything. It isn’t just for, yes, I guess it is interoperability. It is to make everything work.
PARTICIPANT: Like yesterday or Monday I was at a conference and they were demonstrating between all scripts and health vision and they were talking about some of the vocabulary challenges that they were having with transferring a CCR between the two, you know and they were, anyway, I think you could get a follow-up.
MR. BLAIR: Is it my understanding that we are talking about interoperability from the viewpoint of the prescribing rights? Is that it?
MR. BLAIR: Okay.
MS. FRIEDMAN: And you all think the time is right to at least tee this up anyway for the future?
MS. FRIEDMAN: Okay.
MR. REYNOLDS: All right, then you mentioned the pilots.
MS. FRIEDMAN: Right and Stark and Safe Harbor if they are out.
MR. REYNOLDS: So, if the first one took 2 hours or an hour and one-half —
PARTICIPANT: With the first one being?
MR. REYNOLDS: All the things we listed on e-prescribing.
MS. FRIEDMAN: You want a recap? Jeff, that would be?
MR. BLAIR: So, that is hearing from NCPDP, hearing the mapping between NCPDP script and HL7. That is hearing about the Stark laws, right.
MS. FRIEDMAN: Let me kind of —
MR. BLAIR: Okay, you have got them listed.
MS. FRIEDMAN: NCPDP is just a general update on where they are with things including where they were with RX hub protocols, where that is in balloting and all that good stuff.
MR. BLAIR: And that is an hour for that.
MS. FRIEDMAN: Well, there is more.
MR. REYNOLDS: We are still on the same subject.
MS. FRIEDMAN: Sig work group, an update from them because we haven’t heard about that for a while and they are progressing rapidly and of course if you recall that was one of the standards that the group had asked to be pilot tested. So, we need to find out where they are and then there is the HL7 script mapping and then there is all this other stuff with interoperability.
MR. REYNOLDS: Okay, so how much time are we going to block for that?
MS. FRIEDMAN: That is a morning.
DR. WARREN; I think you need at least 2 hours.
MR. REYNOLDS: Then we add the pilot updates.
MS. FRIEDMAN: And the reg update.
MR. REYNOLDS: That will take us to lunch, eleven to twelve. All right now let us move to the afternoon.
Stan, what do you think we need to do for the afternoon?
DR. HUFF: I think we can easily if people are available, you know a combination of a report from AHIMA and Chris Shute and Kim Campbell, you know what the NLM is doing in terms of mapping between terminologies, the mappings that are under way, Don Detmer, you know.
MR. REYNOLDS: Why don’t we just plan that Maria and Stan will coordinate the afternoon? That way who should come and because some of them may be available but you guys will take the lead on making sure we get the right people in the afternoon, and then we could —
DR. HUFF: I feel like I am forgetting some. If I get my notes from the previous —
MR. REYNOLDS: Fine. In other words you two have the ball on making that afternoon be what we need it to be.
DR. WARREN: I would like them to have plenty of time to do that. I mean this may take 2 or more hours if we add any questions that we have.
MR. REYNOLDS: They have the whole afternoon.
DR. WARREN: Got it.
MR. REYNOLDS: Let me make one other comment, Steve, and then the next morning we would spend the first couple of hours, in other words we could start at eight-thirty or whatever, let you start NHII at say eleven, ten-thirty or eleven and so we could take that 2 hours back to your point and spend the 2 hours the next morning going ahead and just using some time for the Committee to discuss things
MR. BLAIR: Could I suggest one modification? If Stan and Maria are able to fill the entire afternoon then I think that is exactly what we will have.
On the other hand, if it turns out that they are not able to fill the, if they can’t get the people to fill the entire afternoon then maybe we will wind up having that 1-or-2-hour discussion period in the late afternoon of the first day.
Maybe we could just be a little flexible and just see how people line up and adjust accordingly and we have got the flexibility.
MR. REYNOLDS: Right, but the main thing is we are telling the Committee you are probably staying partially through the next morning for planning purposes.
MR. BLAIR: And the next morning would either be all NHII or maybe NHII won’t begin until ten or eleven or twelve.
MR. REYNOLDS: Right, but again if we don’t have some clear structure, in other words this Committee is probably going to meet some the next morning. People need to make plans and NHII, I mean some of the people in the room represent NHII but there are other people and we are going to have to tell them when to get here and if we don’t tell them when to get here everybody is going to be sitting in the room waiting for us to get the heck out of the way.
DR. COHN: And I guess the one question I would have here is I am actually fine at the end of today’s meeting or whatever leaving things a little loose about when we start NHII because we are starting it on, the NHII meeting is starting on the twenty-seventh and whether they are starting at 1 o’clock or 10 o’clock or 9 o’clock one can determine but there will need to be a time where we make that decision.
DR. FITZMAURICE: Do we have testimony for NHII that has to be scheduled?
DR. COHN: We may but not —
DR. FITZMAURICE: So, that is why it can be flexible.
MR. REYNOLDS: Let us plan this. As soon as Stan and Maria get a sense of who is coming then we will know whether or not they have filled the afternoon. If they didn’t then we will immediately work it out.
DR. STEINDEL: Stan, I want to see if I understand the scope of what you are doing. You are going to be looking, this is secondary use of data but from the list of speakers and everything it sounds like you are focusing in the translations of clinical terminology to administrative terminology at this point.
DR. HUFF: That is one dimension.
DR. STEINDEL: No, that is fine. I am just asking. The reason why I am asking is because I am envisioning that the FHA public health surveillance work group is probably going to want to come to this group sometime in the future to start asking about secondary use of data for mapping into population health statistics. We are not queued up to do that yet.
MR. REYNOLDS: Let us do this. One of the things we have kind of talked about as a group is Jeff had e-prescribing. Stan was going to take this topic. Judy is going to start working on a topic. So, basically if anybody in the Committee has any comments about what else they think should be included in this subject then they should go to Stan. I think that would be a good way to do it.
Then he and Maria can continue to build the subject and report to us as to what those subjects are and what is included. Then that way we continually make sure we have a complete sweep of what everybody thinks.
DR. COHN: And I think, Steve to help maybe also answer your question, I think this is the evolving area. So, I don’t think we have to have the answer before we start.
DR. STEINDEL; No, what I was actually trying to do was focus it just on what Stan was focusing on and make sure that we didn’t drift in this session.
MR. REYNOLDS: One last summary before we finish. So, we are going to meet starting on Tuesday, not on Monday. We will have all day Monday. We will have a partial day Tuesday.
PARTICIPANT: All day Tuesday.
MR. REYNOLDS: I am sorry, all day Tuesday, partial day Wednesday, probably early morning.
Then it will move to NHII. Stan and Maria have the afternoon. Maria has got the morning and we will have discussion on the second morning or late first afternoon depending upon how many speakers we have.
Is everybody in agreement?
Then during that discussion that we have on that second day we will decide then obviously our September and December and so on building up based on what we are hearing from everything else. It is obviously happening fast. We will make sure and then we will know a little more about what is going on with the DOJ.
DR. COHN: And I think we referenced that certainly in September it sounds like there is some ROI conversations around HIPAA.
MR. BLAIR: Simon, you didn’t tell them that you scheduled Secretary Leavitt to speak to us for lunch on Tuesday.
DR. COHN: Maybe he could speak to us at breakfast. We will make ourselves available.
MR. BLAIR: Any other questions or items?:
Okay, meeting adjourned.
Thank you very much.
(Thereupon, at 8:45 a.m., the meeting was adjourned.)