[This Transcript is Unedited]


Subcommittee on Standards and Security

March 4, 2004

Hubert H. Humphrey Building Room 505-A
200 Independence Avenue SW
Washington, DC 20201

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


P R O C E E D I N G S [3:25 p.m.]

Agenda Item: Introduction – Dr. Cohn

DR. COHN: Welcome everyone, this is a meeting of the Subcommittee on
Standards and Security of the NCVHS, this is actually a one hour, probably it’s
actually a 45 minute breakout for the subcommittee, I am Simon Cohn, chairman
of the subcommittee.

Given that we are on the internet I want to start with just introductions
around the room. Be aware that we really have just a couple of items for
discussion today. One is to review the letter on claims attachment and make
modifications to it. Another item will be sort of final reflection on our work
plan for e-prescribing. And then we’ve been doing I think some work to try to
come up with dates for hearings for the remainder of the year to support our
e-prescribing work plan and other work, and I’m hoping by the end of this
session we’ll be able to announce those dates with at least, well, hopefully
we’ll be able to announce those dates. And we’ll obviously discuss them because
there are some options in a couple of weeks where you all have pretty good
availability, which I want to thank you for responding so quickly on that.

Let’s have introductions around the room, obviously if there are any items
coming before us today for which you need to recuse yourself please let us know
in the introductions. Jeff, would you like to introduce yourself?

MR. BLAIR: Jeff Blair, Medical Records Institute, vice chair of the
Subcommittee on Standards and Security, member of AIMA, ASTM, HL7, and HIMSS,
if CCR were to come up in the discussion I would recuse myself.

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

DR. FITZMAURICE: Michael Fitzmaurice, Agency for Healthcare Research and
Quality, liaison to the committee and staff to the subcommittee.

MS. FRIEDMAN: Maria Friedman, CMS, staff to the subcommittee.

MS. AULD: Vivian Auld, National Library of Medicine, staff to the

MS. PICKETT: Donna Pickett, National Center for Health Statistics, CDC, and
staff to the subcommittee.

DR. WARREN: Judy Warren, University of Kansas, member of the subcommittee.
I don’t think there’s anything on the agenda that I would have to recuse myself

DR. HUFF: Stan Huff with Intermountain Health Care and the University of
Utah in Salt Lake City. I would need to recuse myself from discussions of HL7
or LOINC or ICD-10-PCS.

MS. GREENBERG: Marjorie Greenberg, National Center for Health Statistics,
CDC, and executive secretary to the committee.

MR. REYNOLDS: Harry Reynolds, Blue Cross and Blue Shield of North Carolina,
member of the committee.

MS. SQUIRE: Marietta Squire, CDC, NCHS, and staff to the subcommittee.

MR. ROUDY(?): Dan Roudy, American Health Information Management

MS. ZIGMAN-LUKE: Marilyn Zigman-Luke, AAHP/HIAA.

MS. WILLIAMSON: Michelle Williamson, National Center for Health Statistics,

MR. LEVIN: Randy Levin, Food and Drug Administration.

MS. JANES: Gail Janes, CDC, staff to the Quality Workgroup.

DR. LUMPKIN: John Lumpkin, Robert Wood Johnson Foundation.

DR. BICKFORD: Carol Bickford, American Nurses Association.

Agenda Item: Claims Attachment Letter – Resolution of
any Remaining Changes – Dr. Cohn

DR. COHN: Well, I’m actually going to suggest we start off by looking at
possible revisions to our letter on claims attachments based on the input from
the full committee. And Maria will you help us with this one, you obviously
have it up on the screen, everyone is somewhat familiar with this having
approved an earlier version yesterday. It looks like most of the changes are
related to paragraph three and four, and probably five I presume also. Would
you like to read through it and sort of talk —

MS. FRIEDMAN: What I did in paragraph three was add a sentence, let me read
the first sentence to that paragraph and then let me read my addition so you
can see how the two fit together. The reason I added this sentence was not only
in response to comments but as a transition, kind of stage setter for the
recommendations that were below. So the first sentence, the one that we had
before reads subcommittee heard the need for demonstration projects and pilot
studies to document the benefits, costs, work flow requirements, implementation
challenges, privacy concerns and best practices associated with the claims
attachment standard. And then the sentence I added was testifiers also
emphasized the need for the industry’s ability to comment on the results of the
pilots and demonstration projects prior to promulgation of the final rule.

DR. COHN: Everyone comfortable so far?

MS. FRIEDMAN: That keeps the testimony piece together and then the
recommendations follow.

MR. BLAIR: Actually I’m not sure I feel comfortable with putting it there
because in my mind I thought that that is, that that sentence and the
indication of a sense of urgency to begin the NPRM are the two most important
sentences in our recommendations —

MS. FRIEDMAN: But the recommendation is still there —

DR. COHN: It’s later.

MS. FRIEDMAN: It’s later, it’s very similar.

MR. BLAIR: It’s very similar? Okay.

DR. COHN: This is just fact finding that we, the testifiers did indicate
that strongly.

MR. BLAIR: So in other words we’re going to be reiterating it down in the
next, okay.

MS. FRIEDMAN: And that’s a point to consider as we go through this, is that
too much reiteration because I thought to try and set the context for the
recommendations that we ought to have something in there that the testimony was

MR. BLAIR: Good.

DR. COHN: Harry?

MR. REYNOLDS: If you leave it there not only the testifiers but I think the
whole committee also felt that the comment was worthwhile and if you decide to
leave, if you wanted to take that out to Jeff’s comment we would say NCVHS
recommends in accordance with the testimony.

DR. COHN: Maria, you need to, can you scroll down a little bit because
actually that’s in the, at least I believe, the problem is we can only see one
page of this —

MR. BLAIR: If I understand what you did was you added the additional
sentence to indicate that the testifiers suggested this and you’re putting that
in up front in terms of what we heard, and then that same thought is then
reflected in our recommendation later in the letter, so it’s in both places.

DR. COHN: Harry, I apologize, not being able to read the whole thing you
sort of miss, do you want to take a look at that last sentence, and we may even
want to strengthen that.

DR. FITZMAURICE: I can’t read it exactly but I think I remember Maria saying
the ability to comment and I would suggest opportunity to comment, might work
out well there.

MS. FRIEDMAN: I think we said, I wanted to make the sentence a little bit
different from the recommendation as well. The recommendation sentence says we
also encourage the department to provide for public comments on the results of
the demonstration pilots before final rule is promulgated.

MR. REYNOLDS: Why don’t we say we recommend that the department? I think we
heard loud and clear that the if the NPRM is coming out and you’re going to
have these pilots, people want to have something to say before the final rule
comes out, I think that’s what clearly came out of that.

DR. COHN: So we’ve obviously got the recommendation as well as the
observation that we heard that in the testimony.

MS. FRIEDMAN: So I changed that recommendation sentence to read we finally
recommend that the department provide for public comment on the results of the
demonstrations and pilots before final rule is promulgated.

DR. COHN: So we’re okay so far? I realize we haven’t read through the whole
thing yet but we’re just sort of reflecting on that new addition and the

DR. WARREN: I had one. Are we making two recommendations? I mean if we’re
only making the one, which is what I think we are, then we don’t need the word

MS. GREENBERG: I thought you were recommending that they put out an NPRM.

DR. FITZMAURICE: Maybe finally comma, it seems like we’re making a final
recommendation, are there other recommendations that aren’t final.

MR. BLAIR: Maybe in addition instead of finally, in addition?

DR. WARREN: I like that a lot better.

MS. FRIEDMAN: Everybody back up to the stage setter and what we heard in
the testimony, that’s that third paragraph, this one here, the subcommittee
heard the need for demonstration projects blah, blah, blah, testifiers also
emphasized the need for the ability to comment.

MS. GREENBERG: The need for the ability for industry to comment, I’m just
having problems with that language for the industry’s ability to comment.

MR. BLAIR: Maybe it’s the need for public comment on the results of the
pilot tests.

DR. WARREN: Maybe just the industry’s comment.

DR. COHN: I think we’re talking about public comment, I agree with Jeff —

MS. GREENBERG: — I mean you’re not saying an NPRM, the need to provide an
opportunity for the industry to comment, to provide, not for again but the need
to provide, to provide an opportunity for the industry to comment.

MS. FRIEDMAN: Okay, the sentence now reads testifiers also emphasized the
need to provide an opportunity for the industry to comment on the results of
the pilots and demonstration projects prior to promulgation of the final rule.

DR. COHN: Sound okay?

DR. STEINDEL: This brings me back to something that Mike comment on
earlier, I think we want more then to provide a need, an ability for them to
comment, we actually want their comment.

MS. GREENBERG: Well you need to provide an opportunity for them to comment,
you can’t force them to comment.

DR. STEINDEL: That can be just a sheet a paper, I think we want —

DR. COHN: I don’t think we can do much more then provide them an
opportunity, recommend an opportunity, we can’t make them comment, this is a
free country. Steve, actually if you have other, is there a wordsmithing or an
additional statement —

MS. FRIEDMAN: Do you want to make it stronger to emphasize the necessity of
providing opportunity for the industry to comment?

DR. COHN: I think Steve was actually bringing up another issue which is
that you were trying to figure out a way for us to talk about creating an
environment where the industry would be making comments.

DR. STEINDEL: I would say something like testifiers also emphasized the
need to consider outside comments on the results of the pilots before —

DR. COHN: But I still don’t think that that —

DR. STEINDEL: That changes it too much.

DR. COHN: Yeah, I think that changes it too much and I think what we really
want, I think the point that we kept hearing is is that people wanted an
opportunity for public comment so why don’t we leave it the way it was there,
if we can come up with a better idea I’m happy to do it but, okay, so we’re
back to where we were there. Shall we go on to the next paragraph?

MS. FRIEDMAN: Okay. This is the one with the dreaded sentence, which I have
removed but I’ll read it when I get there. NCVHS urges the department to
encourage and support several different claims attachment demonstration
projects and pilots that would include a broad representation of effected
stakeholders. The dreaded sentence which is now gone just so you remember is a
pilot proposed by Empire Blue Cross and Blue Shield is an example of the kinds
of projects that should be developed and funded.

DR. COHN: That’s fine removing it.

MS. FRIEDMAN: Okay, because I pulled up the testimony in case anybody
wanted to keep that sentence in and flesh out what it was about. No? Gone. The
next sentence is NCVHS recommends that these demonstration projects and pilots
occur expeditiously so that their results and findings will feed into the
development of the claims attachment rule.

DR. COHN: Are we okay?

MS. FRIEDMAN: Now we come to more recommendations. NCVHS understands that a
Notice of Proposed Rule Making concerning electronic claims attachments
currently is under development. We urge the department, and I changed this, I
added something to this sentence, the original sentence was we urge the
department to issue this NPRM as soon as possible, and I added to that we urge
the department to issue this NPRM as soon as possible to provide the industry
guidance and direction, and then I modified the next sentence to say this in
turn will help motivate the industry to participate in pilots and demonstration
projects and invest in the needed infrastructure.

MR. BLAIR: I like that, just a style thing and I don’t know how you feel
about this, where we said HHS is currently, how would people feel about using
the word is already developing, or has already begun the development of the

MS. FRIEDMAN: Whatever, tell me what you want.

DR. STEINDEL: I think for the last five years the department has been
working on the development —

MS. GREENBERG: I think currently is better, already sounds like they just
started and it’s been going on for a long time.

MR. REYNOLDS: The third line down on the last, bottom, invest in the needed
infrastructure, if they participate in the pilot, I don’t know if, why is that
anything special that they invest in the infrastructure. We want them to
participate in pilots, I can tell you, I know very few people in the industry
are going to go out and start putting networks in place, they’re going to get
involved in the pilot to understand but I just don’t think you’re going to see
a lot of people sticking infrastructure —

MR. BLAIR: What was the thing you felt uncomfortable, which was it, the
word infrastructure or invest —

MR. REYNOLDS: I think it should just say this in turn will help the
industry participate in pilots and demonstration projects, period.

MR. BLAIR: The thing that I felt was important was getting the word invest
in there because they have, it’s not just that they come and participate, it’s
that they have to make an investment of time, people, and money to be able to

MS. FRIEDMAN: There was some discussion yesterday about kind of a chicken
and egg problem, do you do the pilots first then the NPRM and the point was
made that people are not going to want to participate in pilots and demos until
the NPRM comes out because they want to make sure that the government is
serious about doing this and what direction the government is potentially going
to take in order for them to consider participating and as Jeff said spend the
bucks to get the —

MR. BLAIR: And it was especially pertinent when one of the software vendors
was indicate we’re not going to be spending the money, and I think he
referenced like two to three years of investment, to wind up having the code
and testing it and designing it for claim attachments until he sees that the
NPRM has started, so that’s why I thought the word invest begins to indicate

DR. FITZMAURICE: Suppose we read it like this, this in turn will help
motivate the industry to invest in pilots and demonstration projects, period.
Does that get in what you want, Jeff?

MR. BLAIR: That’s good, the word invest was the one that I thought was

DR. COHN: I think what we’ve done is fine, I would observe that some of the
investment is probably not just investment at home in your facilities but also
the investments of vendors and software development and all of this stuff.

DR. STEINDEL: I have a problem with the clause Maria added, to provide the
industry guidance and direction. An NPRM, that makes it sound like the
government is committed to this route, where this is just a notification of
proposed rule making.

DR. COHN: Well, Steve then help us, I’m still, rationale for an NPRM should
not be so that you can do pilots, and that’s what we had before and we thought
that that was a very weak justification for somebody producing an NPRM. So help
us with those particular words. Should it be provide the industry guidance?

MS. AULD: Should it be initial guidance and direction?

MR. BLAIR: That sounds good.

DR. STEINDEL: That sounds goods.

DR. FITZMAURICE: Or how about replace possible with obtain, excuse me, as
soon as possible to obtain the industry guidance and direction. That’s what an
NPRM does, we want your comments coming in.

MR. BLAIR: Especially because initial implies that there’s going to be
something following it when we know more.

DR. FITZMAURICE: It may not say what you want it to say but —

MS. GREENBERG: It’s right though, I mean an NPRM works both ways, the
department signals what it’s thinking about doing and it gives people an
opportunity to comment.

MR. REYNOLDS: I’ll speak for somebody that if it comes out I’m going to
have to do something with it, it will give me direction and guidance because if
it’s coming you better clearly understand what it is and you better clearly
understand how you’re going to do it, so I think that’s very appropriate, that
says this is no longer a drill guys, it’s the real game.

DR. STEINDEL: With the exception of the word initial I’m happy.

MS. FRIEDMAN: So that sentence now reads we urge the department to issue
this NPRM as soon as possible to provide the industry initial guidance and
direction. And then we go on to say —

DR. FITZMAURICE: Put a with after industry, provide the industry with.

MS. FRIEDMAN: We urge the department to issue this NPRM as soon as possible
to provide the industry with initial guidance and direction. This in turn will
help motivate the industry to invest in pilots and demonstration projects. In
addition we recommend that the department provide for public comment on the
results of the demonstrations and pilots before a final rule is promulgated.

MR. BLAIR: Read the last piece again?

MS. FRIEDMAN: In addition we recommend that the department provide for
public comment on the results of the demonstrations and pilots before a final
rule is promulgated.

DR. COHN: Are we okay? Are we done with this one?

MS. FRIEDMAN: Mike’s not done.

DR. FITZMAURICE: I’m just thinking, the last sentence, if we’re saying
recommend the department to provide public comment on the results of the
demonstration we put out the NPRM, one, we put out NPRM, two, that says here is
it plus here’s the results of the pilots and demonstrations, and then we come
up with a final rule.

MS. FRIEDMAN: Maybe not an NPRM, it depends on the results of the pilots
and demonstrations, we had this discussion yesterday about if the pilots and
demonstrations show that the proposal works, that’s cool, if it shows that they
don’t work and something else is needed then we’d have to go out with another
NPRM. The jury is kind of out and that was why people felt that the
demonstrations were really important before anything is locked down to see if
the stuff really works.

DR. FITZMAURICE: I agree with that but how do we provide for public
comment? Do we have to go publish it in the Federal Register to provide them
public comment or just have a hearing on it, is that enough for public comment?

MS. FRIEDMAN: I think we’re silent on that, I think we recommend that the
government figure it out.

DR. FITZMAURICE: Can the government come back and say NCVHS if you have a
hearing on the results of this then that is sufficient public comment? We take
what comes back in, you have a panel of people comment on it and that’s good

DR. STEINDEL: I see what Mike is —

DR. FITZMAURICE: Or are we saying you have to come out with another NPRM?

MS. FRIEDMAN: Do we have to figure out the process right here and now?

DR. FITZMAURICE: Well we’re locking them in virtually to a second NPRM if
they have to use that to provide public comment.

MS. FRIEDMAN: I don’t know, I mean —

DR. STEINDEL: Can we just change from provide public comment to await
public comment? And that way we can actually be silent on it on what form the
public comment takes. Mike is right, when I read this we’re asking specifically
a provision of public comment which says that we have to do something formal,
the department has to do something formal, which usually involves a
notification in the Federal Register and blah, blah, blah —

DR. FITZMAURICE: You could say public input and so they could give that
input to the national committee —

MS. FRIEDMAN: What’s the difference between comment or input?

DR. FITZMAURICE: Comment is more like legalese for another NPRM, public
input means hey, here’s a hearing.

MR. BLAIR: One of the virtues of the way it’s written now, I don’t object
to your modification I’m just a little nervous that those modifications might
lose the link in the sentence that the public would be commenting on the
results from the pilots and demonstration projects and I feel it’s very
important —

MS. FRIEDMAN: Let me just read the change with Mike’s word there.

MR. BLAIR: Would we retain that then?

MS. FRIEDMAN: It says in addition we recommend that the department provide
for public input on the results of the demonstrations and pilots before a final
rule is promulgated. Steve’s suggestion was in addition we recommend that the
department await public input on the results blah, blah, blah before a final
rule is promulgated.

MR. BLAIR: Why do you feel like input is more valuable then comment?

DR. FITZMAURICE: Public comment is a legal term that is used for what have
you done in response to the NPRM, we took the public comments, we have to
address all the public comments.

MR. BLAIR: So you’re saying the comment, it could be done by mail or emails
but not necessarily be broad enough —

DR. FITZMAURICE: This may be recommending to the department they have a
formal way of receiving of public comment and it’s the formality, it’s the
Notice of Proposed Rule Making and then you publish the results and you say you
have a time period to comment on the results, and so you have another 60 day
comment period.

MS. FRIEDMAN: We’re afraid that it would be construed that the department
will have to issue another NPRM after the pilots and demos and I don’t think
anybody necessarily wants to go down that path.

MR. BLAIR: Okay, given what you’ve indicated about the difficulty of the
word comment the word input, and I’m not sure this is the right word, but what
about public feedback on the results?

DR. FITZMAURICE: Yes, that could be done at an NCVHS hearing.

MR. REYNOLDS: I would add appropriate in front of public, I’m worried,
let’s think about it a minute, if we’re recommending a pilot, I don’t
necessarily agree with the fact that there wouldn’t be another NPRM, if you’re
doing a pilot you’re going to find some changes —

MS. FRIEDMAN: There might be but that’s one of the options, a lot depends
on how the demos —

MR. REYNOLDS: Well, all I want to say is I think yesterday we agreed that
we wanted a thorough evaluation of the pilots before the final rule went out,
and I think we keep changing words in that last section to back that off to
where it could just, I don’t know.

MR. BLAIR: Well, if it’s public feedback on the results, which is I think
the words that are there, I think that the results imply that there’s some kind
of report of the results that the public is giving feedback on, but if you have
a better way of wording it then let’s do that.

MR. REYNOLDS: No, I’m just trying to make sure the committee is still where
we were yesterday.

DR. STEINDEL: I think we’re at the same place we were yesterday, we’re just
trying to make sure that the wording allows us to do that.

MS. FRIEDMAN: Okay, you want me to just read that whole section again? It
says NCVHS understands that an NPRM concerning electronic claims attachments
currently is under development. We urge the department to issue this NPRM as
soon as possible to provide the industry with initial guidance and direction.
This in turn will help motivate the industry to invest in pilots and
demonstration projects. In addition we recommend that the department provide
for public feedback on the results of the demonstrations and pilots before a
final rule is promulgated.

DR. COHN: I see people nodding their heads yes, is that yes or are they
just tired?

MR. REYNOLDS: Yes to both.

DR. COHN: So do we need a motion to accept this revised version for
forwarding to the full committee tomorrow?

MR. REYNOLDS: So moved.

MR. BLAIR: I’m happy to second that.

DR. COHN: Okay, further discussion?

MS. FRIEDMAN: I’m going to do the accept changes right now.

DR. COHN: Well, I think we can vote on it while she’s accepting the
changes. Any discussion? All in favor say aye?


DR. COHN: Opposed? Abstentions? Okay, so these are the modifications to it.

Agenda Item: Further Discussion of E-Prescribing
Work Plan and Agreement on Timelines – Dr. Cohn and Mr. Blair

DR. COHN: The next item is really related to I guess the work plan and the
hearing agenda for these coming six, seven, eight months. Now I guess I should
start off by asking everybody that you’ve all had a chance to reflect on the
skeleton of the work plan since yesterday, you’ve seen it being sort of put
into the idea of not these specific dates but sort of the time ranges for the
various hearings. Before I start mentioning dates or whatever I guess I should
anybody, have any of you come up with any really great ideas about either
changes, streamlining of the process, things that we need to take into account
as we’re talking about actually scheduling these dates? Or all you all
satisfied with the work plan and sort of the flow as we described yesterday?

MR. REYNOLDS: I would like to again today commend Jeff, I think it was very
thoroughly done, it got all the right constituencies, and I think it’s going, I
would feel comfortable hearing from them, I would be comfortable putting
forward some recommendation.

DR. COHN: Hear, hear, and obviously we just have to realize that this is
obviously a living document and I think once we’ve heard sort of our beginning
session on March 30th I’m sure that this will be evolving as we
learn more. Judy?

DR. WARREN: I had a question about the March 30th, somewhere on
my calendar I’ve got both the 30th and the 31st?

DR. COHN: I was just going to go through the dates that we have and are
going to come up with. So I’m hearing is that we’re accepting the work plan as
described, now we’ll talk about dates to sort of make that happen.

Now the first dates that we actually already have scheduled, which are
hearing dates on March 30th and 31st actually the
30th right now is scheduled as sort of an overview day, we’re
bringing experts in to sort of talk at a broad level about e-prescribing, sort
of the issues, what they know, what’s happening out in the industry, general
directions, we’re also getting some government perspectives from some of the
main agencies and that’s going to be all day on March 30th.

Now on March 31st, which is another hearing day, we actually
have the yearly meeting assuming that they’re available to meet with the
Designated Standards Maintenance Organizations —

MS. FRIEDMAN: They’re going to be here, I already talked to Karen(?) about
that, they’ll be here and the WEDI people want to come in and give us the
results of what was actually presented at their meeting in January.

DR. COHN: Maria, you need to get closer to the microphone so people can
hear you.

MS. FRIEDMAN: The WEDI people want to give come in and give us the kind of
industry pulse taking information that was presented at their meeting in
January, so we have those two folks on tap.

DR. COHN: Okay, good, and we also had discussed that we needed to have at
least a session to talk about, some about the request from the DSMOs related to
billing of supplies and pharmacies.

MS. FRIEDMAN: And that’s the logical follow-on since the person who’d be
involved in that is going to be here the day before for e-prescribing.

DR. COHN: Exactly, so I think we’re, that’s definitely a date that’s set.

Now the next set of hearings we have after that scheduled are on May
25th and 26th, and those have already been scheduled and
those relate to basically sessions about implementation demonstration projects,
reactor panels, e-prescribing vendors, hearing from physicians and hospitals,
along with some discussion time and that’s May 25th and

Now what we’ve talking about and what we’ve been asking you for help with
was to identify dates in July and August for likely two two-day sessions
relating, hearing from testimony from the various effected groups both
identified in the legislation and elsewhere to begin to get their input about
adequacy and gaps of standards from all their perspective and sort of what the
needs are. Now based on input from all of you it appears that, and you all know
there’s an NHII meeting occurring sometime the week of the 19th
through 23rd and I think now it’s toward the end of that week at
that point, 21 through 23, which I think an NHII hearing that last day likely

DR. WARREN: That’s the conference.

DR. COHN: The conference, exactly, which I think would be is on that Friday
will likely be a hearing of the NHII Workgroup.

Now the entire next week, the 27th through the 30th,
actually appears to be open for everyone and given that many of you will have
already been out for that first week I guess I would ask you about, I mean my
own preference would be to try to schedule it late in that week rather then
immediately turning around and coming back out to Washington again but we
really do have some flexibility there. Would people prefer to do the, I mean
the options would look like either the 29th and 30thSUP>,
which is a Thursday and Friday, or a 28th and 29th, which
is a Wednesday and Thursday. Do people have a preference on what we schedule?
The dates were, I would say probably just sort of thinking about it probably
the 29th and 30th, Thursday and Friday, just to give us
maximum time being back to get some work done before we fly out again. Is that
okay with everyone? Harry’s nodding his head, Jeff, please.

MR. BLAIR: And this proposal has positives and negatives, just a
consideration. The positive is the NHII dates are what days of the week?

DR. COHN: Wednesday, Thursday, Friday.

MR. BLAIR: Wednesday, Thursday, Friday, we’re looking at two days. My
thought was since it takes those of us from the Rocky Mountains and the West
Coast five, six, seven hours to fly out what if we were to consider the two
days before the NHII so we’re making one trip to Washington for the five days
instead of coming out, flying to Washington, then coming back home and then
flying to Washington again?

DR. COHN: I have to ask other subcommittee members on this one, we didn’t
check with you about your availability on the 19th and
20th. That would mean obviously many of you would be flying out on
the Sunday before and spending five days. My own preference is typically not to
spend five days in a row away from work but that’s just my own personal

DR. STEINDEL: I concur Simon.

MR. REYNOLDS: I concur.

MR. BLAIR: I think I’ve been outvoted.

DR. COHN: I don’t know, I’m looking at Judy now for a comment or Stan.

DR. WARREN: I can do either one.

DR. COHN: Okay, so it sounds like we’re sort of in agreement that we’re not
going to put five days together if we can avoid it.

MR. REYNOLDS: But we do approve Jeff staying if he chooses to.

DR. COHN: Am I hearing that we should do the 29th and
30th as full committee days?

Okay, now our next dates were actually in August and it appears that we
actually have a choice of a couple of different days, so let me give you the
option. We’re looking at Tuesday and Wednesday for a variety of reasons having
to do with people’s availability and it appears that there’s availability where
people are generally available on August 17th and 18th or
24th and 25th. Be aware that the next week, which is the
first week of, end of August first week of September is actually a hearing, is
a meeting of the full committee on the Wednesday and Thursday afterwards. I
think it’s the week after that. And once again, you appear to have general
availability, 17th, 18th, 24th or
25th so once again it’s a decision of everyone. Jeff you have your
hand up.

MR. BLAIR: I think that, did you say 17th and 18th? I
think that that would be better dates from this standpoint, probably they’ll be
several hours at the end of that day and a half session, I hope it’s a day and
a half session, when we as a subcommittee will be reviewing all of the
standards requirements and gaps and issues and considerations to try to pull
them together so that we could then send them to the SDOs and terminology
developers who would be testifying to us on those, their ability to meet those
requirements and address the gaps that, going to be September 22nd
or so, and probably after that meeting will probably take several days or a
week before we get that out to them in the form of a letter or an email or
whatever it is, so this would give them at least a month and there’s Labor Day
in there too, so to give them more time to prepare for September I would
suggest the 17th and 18th of August.

DR. COHN: Are people comfortable with the 17th and
18th as meeting dates? Looking around, going, going, gone, okay,
17th and 18th.

MS. GREENBERG: What are the dates agreed to for July?

DR. COHN: July is the 29th and 30th of July. Now as
I’ve commented we have full committee meetings on the 1st and
2nd of September, and we all know that September is a busy month, I
mean nothing has changed about that. I’m actually recommending, I mean we
checked for you for a number of dates in the middle of September, I’m hearing
that the 22nd and 23rd works for people, I mean people
are physically able to make it, I’m hearing sort of general availability. Those
were dates of the previous NCVHS meeting and so many people have reserved that.
Now Jeff I think that gives people time enough to, this would be where the
standards groups come back to give us a report, should give them enough time to
report, should also hopefully give us enough time before the November full
committee meeting to hear and sort of decide what we’re going to do. So is
everyone comfortable with the 22nd and 23rd, that’s
Wednesday and Thursday?

DR. WARREN: It would be better for me if it were Tuesday and Wednesday.

DR. COHN: I thought that you had to be gone on Friday.

DR. WARREN: Yeah but it’s going to be in Phoenix so I have to have time to
get there from here.

DR. COHN: You can get there from here if we do it on the 22nd
and 23rd, I’ve had actually experience with this particular one and
for better or for worse Judy you can do it.

MR. BLAIR: I don’t know if this will help you or not but I just flew from
Phoenix to Washington, there’s a 3:50 flight in the afternoon non-stop that
gets into Washington at 10:00.

DR. COHN: And there’s a 5:00 p.m. that goes non-stop back from Reagan.

DR. STEINDEL: You’re talking to pros.

MR. REYNOLDS: Judy that’s collaboration at its best right there.

MR. BLAIR: The flight is on America West by the way. But if you do fly
American West and you do take that flight don’t order the hamburger, it’s

DR. COHN: Okay, so are people comfortable with the 22nd and
23rd providing we are done early enough to enable people to make it
back west? Okay.

Now there’s two other sessions here, we may or may not need a face to face
meeting in October, I mean let me say that, we’ll have met a lot, I think Jeff
had postulated that we would just need a conference call to resolve items. Now
being a conservative sort I worry about expecting that we can in three hours on
a conference call settle what will be are described right now as interim
recommendations but will likely be really the first set of recommendations on
e-prescribing over the phone, and so my preference would be for us to schedule
two days of hearings, if we don’t need it we can always go back to a conference
call but as we know as it gets closer it’s going to be very hard, if we
suddenly in September discover that we need time in October, once again I’m
just sort of saying let’s put that in as a place holder if that’s comfortable
with everybody and if we can decide, sorry Jeff.

Now dates that I’m seeing and Jeff I think we need your help on this one a
little bit about when we think we might have the report done and what sort of
time we need to work on it. There’s two sets of dates that I’m seeing based on
people’s availability, these are both Tuesdays and Wednesdays, one is the
12th and 13th and the other one is the 19th
and 20th and I think I’ve got that.

MR. BLAIR: Of October.

DR. COHN: Of October, recognizing that our full committee meeting is on the
4th and 5th of November.

MR. BLAIR: If we can do it the earlier date where we could get the guts of
that recommendation, that interim recommendation letter agreed to, I think that
would be better for us, if there is clean up we could probably do the clean up
maybe by conference call if we need another shot at it and still get it
distributed in time for the full committee, so that would be my thinking on it.

MS. GREENBERG: As I said Donna and I are not available that week —

DR. COHN: Okay, as I said I had written it down here and I apologize
because I actually had asked you about that and somehow with all my
handwriting, which sometimes things get a little lost. With your forbearance is
it okay for us to do on the, you’d be okay?

MS. FRIEDMAN: What are those dates again?

DR. COHN: This would be the 12th and 13th, which by
the way is also the day after Columbus Day, so those of you who have Columbus
Day as a holiday, I guess I should ask, is this okay with everybody?

PARTICIPANT: State employees don’t have holidays.

DR. COHN: Actually Columbus Day is not a day that is within my organization
considered a vacation day either, I’m seeing that appears to be for many of us.
On Jeff’s recommendation we’ll do the 12th and 13th

DR. FITZMAURICE: Is that a Tuesday and Wednesday?

DR. COHN: Yes.

MS. FRIEDMAN: And I’m also getting this on this calendar which I will email
about to everybody, too, I’m doing it as we go.

DR. COHN: Now I’m finally recommending that we at least reserve some time
in December, and this is actually, my hope is is that it will be on
non-e-prescribing issues though we will have to see as it gets a little closer.
I mean there are a number of issues that we’re trying to deal with and
obviously I’m trying to provide enough time that we handle all of the issues in
addition to e-prescribing but I do know for example that we’ve been meaning to
have discussion around CEA(?), also CCR and other items, and I’m hoping they’ll
get done before December but if not we may very well be discussing it during
that time.

The dates that appear to be, I gave people a choice of two different weeks,
one was the 7th through the 10th and the other was 15,
16, 17, there seemed to be general availability knowing that it is December and
we will have not had a meeting all of November except at the very beginning
with the full committee. I think I was going to suggest that we do it early in
December just because the snow tends to fall plus on top of that people start
wanting to take vacations and getting into holiday mode. So once again knowing
that there actually is a fair flexibility I was at least going to suggest that
we consider the 7th and 8th of December. What do people

DR. FITZMAURICE: What days of the week are those?

DR. COHN: Those are Tuesday and Wednesday.

MS. GREENBERG: Which days?

DR. COHN: The 7th and 8th which is a Tuesday and
Wednesday —

MS. GREENBERG: I’m thinking that that conflicts with the NAHDO(?) annual
meeting which happened this year also.

DR. COHN: Does anyone go to the NAHDO? I mean you and Donna both then —

MS. GREENBERG: I have to go to that.

MR. BLAIR: Is that the whole week?

DR. COHN: Is that the whole week?

MS. GREENBERG: It’s the 7th and the 8th.

DR. COHN: Would people like to move it to the 9th and
10th then?

DR. FITZMAURICE: I don’t remember the exact dates, that may conflict with
the ANSI HISB meeting, I just don’t have the calendar for that.

DR. COHN: What would be the preference of the committee?

MS. GREENBERG: Actually it’s the 6th, which dates did you say?

DR. COHN: I said 7th and 8th.

MS. GREENBERG: Okay, the NAHDO meeting is the 6th and the

DR. COHN: So we do the 8th and 9th?

MS. GREENBERG: Again, that could internet with ANSI HISB, I don’t know.

DR. COHN: Is ANSI HISB usually having two day meetings now four times a

DR. FITZMAURICE: We’re having one coming up this month.

DR. COHN: Well, I would suggest why don’t we do the 8th and
9th and if we have to abbreviate the meeting on the 9th I
don’t think anybody is going to be too unhappy —

MR. REYNOLDS: Would that be a good time to take a look at the security rule
and see what the status is?

DR. COHN: Well, that may be an opportunity for that.

MR. REYNOLDS: With April of ’05 coming up probably wouldn’t be bad for us
to take a look at it just to get some people talking about is there issues, is
it going, not going.

DR. COHN: That may be actually even a little late for that.

MR. REYNOLDS: I know, but Jeff didn’t leave any other options open.

DR. COHN: Well, it actually may be, if we’re doing really well that could
be an issue in October, or even in September, it really depends on what we
find. The e-prescribing piece either our first priorities could either turn out
to be relatively straightforward or very, very complex and at this point I
don’t know, I’m sure it’s somewhere in between realistically but once again,
there may be some time in there for us to be following that along.

MS. FRIEDMAN: What were the dates in October again?

DR. COHN: October was the 12th and 13th. And so what
I think we’re deciding for December is the 8th and 9th,

MR. BLAIR: Simon, since we have so many new folks, both new committee
members and staff folks, and I don’t think this is a guarantee but maybe you’d
want to comment on what’s at least been our typical practice on the second day
of trying to end at around 1:00 or 2:00 or 3:00, because that might help their

DR. COHN: Yeah, maybe this is, and once again we won’t guarantee anything
given the e-prescribing stuff and even what I’m seeing coming up later on in
March with combination of a full day of e-prescribing background plus the DSMO
report, WEDI report, and some discussion around the various code sets related
to billing supplies. But generally what we like to do is we do a full day on
the first day that starts at 9:00 and usually ends, first day is typically a
first day, sometimes we do go beyond 5:00 like we did yesterday. The second day
we typically start at 8:30 in the morning, take breaks during the morning but
forego lunch and typically try to adjourn by around 1:30 if not 1:00, that’s
been our typical style. We’ve usually been able to make that happen on most
days but once again March may be an exception to that. Anyway that may help
people if they’re going to Phoenix or other places in terms of their planning
but also it’s something that you should just be sort of thinking about, it
means that you don’t have to do a 7:00 flight or back home or whatever. So
hopefully that’s okay with everyone, if any of you want us to make it later on
the second day I’m sure we can rethink that but I think most people have been
happy to forego lunch or have a late lunch to make that happen.

Okay, now I we’re running a little late for this one but obviously there’s
nobody coming in for another ten minutes. Are there any other issues we need to
be discussing today? I mean obviously it’s a very aggressive schedule for the
year, we do apologize, I kept struggling to figure out some way to remove some
of the hearings but, and we may be able to but I at this point don’t see it
happening. Comments or otherwise?

Well, I want to thank you all both in terms of us getting it scheduled and
it being done in less then three weeks is a great feat. I also really
appreciate the fact that you’re all willing to commit to this amount of work
this year, which is, as I said I think we’ll need to be making sure to treat
each other very nicely —

Okay, Maria, do you have any final comments?

MS. FRIEDMAN: No, I’ll be getting this revised calendar out to everybody.

DR. COHN: And Maria obviously I want to thank you very much for your help
and support, without all of this we obviously would not be really with all of
this project at this point. So thank you. Michael.

DR. FITZMAURICE: While we’re passing kudos around I think we ought to pass
kudos to you for keeping our nose to the grindstone, being willing to listen to
all of our comments whether you liked them or not and pushing us awfully hard
to get this calendar, you’ve done a very good job, Simon.

MR. BLAIR: Matter of fact I wouldn’t be surprised if our behavior during
these last few days was a real pain in the back —

PARTICIPANT: I would like to say we came out with product, which is a good
thing, we came out with a lot of product.

DR. COHN: Okay, well with that the meeting is adjourned, thank you all very