[This Transcript is Unedited]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS
Subcommittee on Standards and Security
November 16, 2005
Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, D.C. 20201
CASET Associates, Ltd.
10201 Lee Highway, Suite 180
Fairfax, Virginia 22030
P R O C E E D I N G S (4:25 p.m.)
MR. REYNOLDS: Do we have to go through introductions and everything again?
PARTICIPANT: Maybe just to validate we have a quorum, I guess, you know.
MR. REYNOLDS: Okay. Do quick introductions of each member of the committee, do a quick introduction.
I am Harry Reynolds, Blue Cross/Blue Shield, North Carolina.
MS. WARREN: Judy Warren, University of Kansas, member of the subcommittee.
MR. HOUSTON: John Houston(?), member of the committee.
MR. COHEN: Yes, Simon Cohen, member of the subcommittee.
MR. BLAIR: Jeff Blair, member of the subcommittee.
MR. STEINDEL: Steve Steindel, CDC. Staff to the subcommittee.
MR. HUFF: Stan Huff, Intermountain Healthcare, University of Utah, member of the committee – subcommittee.
MR. FITZMAURICE: Michael Fitzmaurice, Agency for Healthcare Research and Quality, staff to the subcommittee.
MS. CARR: Justine Carr – Asthmatical Center, member of the committee, joining the subcommittee.
MS. CARR: Well, would you like me?
PARTICIPANT: Yes, absolutely.
PARTICIPANT: Of course.
MR. REYNOLDS: Well, we’ll have to have a silent vote later –
MS. FRIEDMAN: Maria Friedman, CMS, lead staff to the subcommittee.
MS. PICKETT: Donna Pickett, NCHS, CDC, staff to the subcommittee.
MS. JENKINS: Wanda Gobain Jenkins(?), CDC, NCHS, staff to the committee.
MR. REYNOLDS: Okay. The first items we are going to try to get through today in this brief hour are the – we are going to revise a letter, based on what we covered this morning –
PARTICIPANT: No, we are not, because I don’t have a mouse – I can’t do it.
MR. REYNOLDS: Well, we are still going to revise the letter, whether you can do it or not, because we’ve got to have one in the morning.
PARTICIPANT: I’ve got a mouse.
MR. REYNOLDS: The second is to validate our December hearing and what we are going to be doing there, and the third is our going-forward position of our next year’s meetings, as well as any other goals we want to make sure that we put in place for next year. So –
I need to wait a minute, because I need Maria on each of the first few subjects. So –
Okay. We have the letter?
MS. FRIEDMAN: Maybe. Hopefully, it has been loaded.
MR. REYNOLDS: Letter in front of you, correct?
MS. FRIEDMAN: Um-hum.
MR. REYNOLDS: From this morning, if you would, please.
From my notes from today – and please help me if not – we didn’t really have any changes, ‘til we got to the fourth paragraph.
MR. HUFF: Well, the first paragraph needed a period.
MR. REYNOLDS: Where –
PARTICIPANT: At the end of the first paragraph.
MR. REYNOLDS: Okay. All right. In the fourth paragraph, we had the first sentence listed here –
MR. HUFF: The third paragraph, there’s – a(?) changed to one.
MR. REYNOLDS: Yes, I’m sorry. Right.
Okay. Then the fourth paragraph, we had – there was a recommendation to consider striking the entire first sentence. Then, there was discussion about whether we should compliment them for getting it out. Another question was what do we agree with, and then later in that paragraph, the idea we will work with the department to further look at some of this flexibility.
So let’s start at the first sentence. Does everybody agree it should be stricken?
PARTICIPANT: The whole sentence or just the last –
MR. REYNOLDS: The recommendation was the whole sentence, but I am open for discussion here.
MR. BLAIR: The reason that we had the problem with the second part of the sentence was because of the first part of the sentence. So if we struck both of them, the whole sentence, then the problem with the second half of the sentence goes away.
MS. WARREN: But don’t we want to make a comment that we specifically are not commenting on the technical specifications for here – committee that recommended some of these things.
MR. REYNOLDS: Right. And we further note that there is significant industry attention to this on those matters? I don’t know.
MR. COHN: I guess I have one thought here. I mean, the first part of the sentence, I guess I am sort of seeing – going, well – we are not going to support the actual standard itself, but we are sending them a letter which is basically what the first part of the sentence is, and I think we should be supporting them.
I guess I am wondering whether we really need to get rid of – Where is it? Where is that sentence? Okay. Basically, we have this piece which says, but having only a limited time to review the standards offer no specific comments.
I am actually wondering if this is solved by getting rid of, but having only a limited time to review the standards, instead say, but offer no specific technical comments –
PARTICIPANT: Can you make that like that 120 percent?
MR. COHN: What?
PARTICIPANT: A little bit larger for those – yes.
MR. COHN: Steve, what do you think? Does that –
MR. STEINDEL: Simon, I think that is fine.
I was the one that actually put that wording in it, and the reason why I put the limited-time part of the wording was I just wanted people to understand why I was doing that, and, you know, striking it is fine. It doesn’t add that much.
MR. COHN: Striking the whole thing?
MR. STEINDEL: No, but – just – yes, that whole clause.
MR. REYNOLDS: Which whole clause? Which whole clause?
MR. STEINDEL: But having only a limited time. We should say, but offers no – just say, but offers no specific comments.
MR. REYNOLDS: Everybody in agreement that we support –
MR. STEINDEL: No specific technical comments.
PARTICIPANT: And offer no specific technical comments.
MR. STEINDEL: Because, you know, some of the other areas we have already commented on in our previous letter, like, for instance, the use of X12 and HL7 for claims attachments, and so – you know – I think some of the areas that Karen was alluding to that we already have discussed and we are prepared to comment on, we have already commented on, and I think the most significant thing is the six attachment types, and that is what this sentence supports.
MR. COHN: Yes, maybe it is no additional technical comments.
PARTICIPANT: That is what I was going to say.
MR. STEINDEL: Okay.
MR. REYNOLDS: Okay.
MR. COHN: Is that okay?
MR. STEINDEL: Yes.
MS. FRIEDMAN: And also –
MR. REYNOLDS: As set forth in the NPRM.
MS. FRIEDMAN: – one other comment –
MR. REYNOLDS: No additional technical comments.
MS. FRIEDMAN: Yes, okay – services that we are talking about here, is it more appropriate to say six types of claims?
PARTICIPANT: Six types of attachments?
PARTICIPANT: Of attachments, yes – attachments.
MR. REYNOLDS: All right. Maria, if you’ll read that again, please.
MS. FRIEDMAN: Just let me finish making this change and I will.
Okay. NCVHS supports the proposed standards for the electronic transmission of attachment information for the six types of claims attachments as set forth in the NPRM and offers no specific additional technical comments.
PARTICIPANT: Is it and or but?
PARTICIPANT: I would say but.
PARTICIPANT: I would, too.
PARTICIPANT: Why the but?
PARTICIPANT: Maybe try page width. However? And, but, however.
MR. FITZMAURICE: We support it, but we always are critical. We have no critical comments at this time?
MR. STEINDEL: Well, the but –
MR. BLAIR: Steve, why do we need to say what we are not saying? Because, you know, the letter says what it does say. Why do we need to make a statement saying that we are not including something?
MR. STEINDEL: My problem is that there are numerous technical areas that are within this standard that, as Harry phrased earlier, there is a lot of industry discussion around, and that industry discussion, at this point in time, is not clear, and I don’t think we have spent enough time focusing on the issue to just blindly say something that might be interpreted as supporting the whole NPRM, because it could be read as we support everything in it.
MS. PICKETT: And I think that is the concern that Karen had raised earlier was just not making a blanket statement that says we absolutely support everything. Whereas, there are some things that we are not prepared to comment on are probably better waiting for the industry to provide their input.
MR. STEINDEL: And I think most of what we are prepared to support at this point in time, we actually supported in a previous letter.
MR. REYNOLDS: Then my other question is are we basically saying that we support the six types of services as set forth in the NPRM? That is what we are saying. Not going any further than that. The fact that they picked those –
MR. HUFF: No, wait a second. That is what I want to question. I mean, we know enough to know that they proposed the use of CDA. They proposed the use of LOINC. They proposed the use of these X12 messages, and I think, at the level we understand that, we are in agreement with that – right? – or we would say not.
Now, whether there are two LOINC codes missing or – you know – there is something wrong in the format of CDA, we haven’t done that detail, but, I mean, if we are saying we disagree with the major tenants, we ought to say the things that we disagree with.
MR. STEINDEL: Stan, we said we already agreed with those –
MR. HUFF: Okay.
MR. STEINDEL: – when they were going forward and they asked for our advice if they should proceed, in particular with the change from the previous HL7 standard to the HL7 standard using CDA, and we commented in our March 5th letter that, yes, go forth. We think this is a great idea, and, as a matter of fact, one of our comments in that letter concerned the use of CDA2, instead of CDA1, and that is actually addressed in the NPRM.
MR. COHN: You know, the longer I look at this one, the more I actually like Steve’s initial wording, which, if you remember, was – we were arguing about it, because we might be in a position where people might expect a second letter.
Now, given that we are sending this letter before any sort of an additional period occurs and that there will not be another letter, I think what we are saying is entirely accurate in the moment, and I think, basically, sort of circumscribes the – and I guess I am, looking back at this, again, after we wordsmithed this 12 times, and wondering – I would defer to others, but we may actually be okay just leaving that alone.
MR. FITZMAURICE: But if CMS should extend it for 60 days, are we now kind of committing ourselves to offering these technical comments?
MR. COHN: Why would you –
MR. FITZMAURICE: Because we no longer have a limited time.
MR. REYNOLDS: The only reason I have trouble with the no time is we are considered a reasonable advisory body, and they came out with a new rule, and we basically said, We don’t have enough time, so have a nice day. That could come across as you don’t care. It could come across you are not going to get involved. It could come across all kinds of ways.
So the point is we do agree with the general premise. Of the reg, we agree with the six things they have picked. We agree with the things we have already mentioned in previous letters, period.
MR. STEINDEL: Harry, in response to that, in terms of the original NPRM, and without any date extension, I don’t see any way that we could have mobilized a way to produce a more detailed letter, and I think it is up to the chairs of the subcommittee to decide if we give it an extension, if we do want to have a hearing and explore some of these technical details and respond further in the period of time that they are allowing it an extension, but, at the time this letter was drafted, we did not know about the extension.
MR. FRIEDMAN; I am concerned about what kind of additional technical comments that we would have, other than the ones on the – that you pointed out.
MR. REYNOLDS: The issue to me – the only thing I think we – there are – in the actual NPRM, there are business processes discussed, and the technical nature of those business processes is where a lot of general industry is going to be – Okay? Not – back to Stan’s point. Not what is LOINC and not what is other things. Some of those issues that arise are some business processes recommended and some other things, and those are where there is going to be a lot of discussion. I am not sure we would weigh into that.
MS. FRIEDMAN: You are saying, Harry, that it is for the industry to weigh in on that and not necessarily us?
MR. REYNOLDS: I am not sure we can have enough hearings to weigh into that, because we would be voting for things we would have to know a whole lot more about, and we’d be picking sides and other things, and I just – I don’t think that is our –
MR. STEINDEL: I think there is one area where we could, and possibly should, weigh in, and I am not totally certain it is standards and security, but that is around the issue of minimum necessary, especially with respect to the human readable variant.
MR. REYNOLDS: Okay. Let’s stay on the sentence. I don’t disagree with you – Let’s stay on the sentence. What do we want to say? Do we or don’t we support it? Do we or don’t we like the six types? Do we or don’t we – have we or have we not told them enough, and are we or aren’t we bailing out? I mean, let me summarize it right there.
MR. FITZMAURICE: I would put in we support it, and we offer no additional specific technical comments. In other words, we support it. We are bailing out. We have said as much as we could say.
MR. BLAIR: – the six attachments that were selected.
MR. FITZMAURICE: Yes. Yes.
MR. REYNOLDS: No further specific technical – Do we want to reference any other letter?
PARTICIPANT: We did.
PARTICIPANT: We referenced –
MR. REYNOLDS: Where is that?
PARTICIPANT: Carol –
MR. REYNOLDS: Oh, I’m sorry. I thought you were pointing at the – I said, Did we? and you pointed to Carol. Thank you, Carol – Please.
MS. BICKFORD: Carol Bickford, American Nurses Association.
What you may want to say is the first portion of the sentence, which talks about you support their six types of claims attachments as set forth in the NPRM and look forward to industry comment on the technical or look forward to industry response during the technical comments. So it affirms that you are waiting for industry’s response.
MR. FITZMAURICE: Does that imply that we are encouraging the industry to come to us with their comments? I mean, if we are waiting for it.
MR. REYNOLDS: That is what that would say, but we are not waiting for that.
MR. FITZMAURICE: Yes, we are not waiting for them to come to us. They can go to the Secretary.
MS. BICKFORD(?): For a submission from industry.
MR. FITZMAURICE: Industry just knows a lot more about this than we do, and it would take us a while to come up to the technical speed that they have.
MR. REYNOLDS: We commented earlier. We sent letters earlier. We do support that this is out. Fair? Everybody agree? Please nod your heads. Everybody agree. We support this is out.
We also support these six types – We don’t have anything to say. We would not support the six types. Everybody agree with that?
Then why don’t we put period? After NPRM, period.
PARTICIPANT: Sounds good.
MS. FRIEDMAN: You want to delete the rest?
MR. REYNOLDS: Huh?
MS. FRIEDMAN: You want to delete this rest?
MR. REYNOLDS: Absolutely. I mean, we agree to that. I mean, we want to put stuff in the letter that we firmly agree with.
Now, we do recommend – and then we talk about what else we recommend. Okay? And that is the flexibility, and so, now, do we want to maybe take out the do? Yes, we recommend.
All right. So does everybody agree or not agree with – on the – Does everybody agree on what we do or don’t feel as it relates to the rest of those sentences, if we take do out of that line?
I’ll read it: We recommend flexibility for adopting new claims attachments, transmission and messaging standards and additional types of attachments. In particular, we recommend a streamlined process that –
MS. FRIEDMAN: I modified that, Harry, because there were comments about the development of a streamlined process.
MR. REYNOLDS: Why don’t you read it, then?
MS. FRIEDMAN: In particular, the NCVHS recommends the development of a streamlined process for adding new standards and attachment types and for modifying existing standards.
MR. REYNOLDS: Okay. Now, for the last sentence. The committee urges the department to investigate other ways that adoption of new versions could be accomplished without the need for the lengthy – Why don’t we just put for the current rule-making process? Do we –
PARTICIPANT: It is lengthy and it is cumbersome –
MR. REYNOLDS: Do we want to flagrantly say lengthy and cumbersome?
MR. REYNOLDS: No, that is fine. Making sure. That is what we want to say –
MS. FRIEDMAN: I think it makes the point.
PARTICIPANT: We can find a few more adjectives –
MR. REYNOLDS: No, that is fine.
Now, do we further want to add – Based on one of the comments earlier, do we further want to add that we – Hold on. (Whistles). We’ve only got a short time. Do we further want to add, based on one of the comments earlier, that we are going to begin some hearings, which we are going to talk about, as far as our December. We are going to look into that, what that flexibility might be and would possibly come up with further recommendations.
PARTICIPANT: Is that a new sentence or was that already there?
MR. REYNOLDS: What’s that? No, this is in addition. Somebody mentioned earlier that we should add to that – in our full discussion – we should add to that that we will work with the department. Okay? That’s what was added, and also we now have had a subsequent discussion, Simon and I and Maria, about a second morning where we may have people come in and testify, since we didn’t have our second morning full, have people from the industry come in and testify on what that process may or may not be.
MR. BLAIR: Now, this is the issue of not having to go through an NPRM, if a new version, in fact, is compatible.
MR. REYNOLDS: Yes, yes, that is correct.
MR. BLAIR: What more do we need to know about that, other than making that recommendation?
MR. REYNOLDS: Well, I think one of the things, Jeff, that is completely outside of that is you can’t make it a free-for-all. If you approve a new version without lawmaking, then how do people go to it? When do they go to it? When does it take effect? Who really has jurisdiction over making it have effect? You build it and nobody has to come.
Right now, we have built a lot of HIPAA and people haven’t come all the way yet, under regulation. So, now, we put something out there and say, Okay. It is now 50/10. People go, Well, who is going to come and get me?
MS FRIEDMAN: I think the issue has been that we put forward something a little bit different in the e-prescribing rule, and when we did the HIPAA rule, you know, there is no backward compatibility with HIPAA. It is rule making just about every single time all the way down, and the question is, you know, now that times have changed and we have now put out on the street a little bit of flexibility with e-prescribing can we go – should we go back and revisit that with HIPAA and see what people think about doing that?
MR. COHN: Yes, and I think we want to talk to the industry and see what the impacts are.
MR. STEINDEL: Harry, I have a question for Maria on this.
Isn’t CMS in the modification rule-making process, and can you address – can CMS be asked to address the question?
MS. FRIEDMAN: That is one of the reasons why we would like to have some input, because we are –
MR. STEINDEL: So you would be looking at industry input on this.
MS. FRIEDMAN: Yes. We are right at that critical juncture with the modifications rule. Before we buff it up and put into final clearance, now that we have this experience with e-prescribing, this is our last chance to revisit this before we go forward, and we think it is an important enough issue to ask people to come back in one more time.
MR. STEINDEL: So we have had hearings. We have gone on record on this before, and if you think it is timely to do it again, I totally agree.
MR. REYNOLDS: Okay. So one of the things –
MS. FRIEDMAN: And also things have changed in the interim before of what we have done with e-prescribing.
MR. REYNOLDS: Okay. So, Maria, on the last sentence, you have, On our part, we will continue to –
MS. FRIEDMAN: Hold hearings, to investigate, to –
MR. REYNOLDS: Investigate and recommend possible means of – I don’t know. Possible – What do we want to say there?
MS. FRIEDMAN: To investigate – improvements to the –
MR. REYNOLDS: The standards process.
MS. FRIEDMAN: Adoption and versioning?
MR. REYNOLDS: There you go. How is that?
PARTICIPANT: That looks very good.
MR. REYNOLDS: Okay. Back to one of Simon’s earlier points. That lets us continue what we are supposed to be doing as a committee. It does not put us out there as saying anything we are going to do, but we will continue to move forward, and CMS and others want us to do that. That make sense? Okay.
MS. FRIEDMAN: Is everybody okay with what we have so far?
MR. REYNOLDS: Okay. Let’s go to the last – the bottom paragraph and the only recommendation there was that – about halfway through the paragraph, there is a sentence, NCVHS, therefore, recommends that pilot – we put projects, since we had used projects previously.
MS. FRIEDMAN: Or how about just pilots?
MR. REYNOLDS: Well, we used pilot projects earlier, so the recommendation was to stay consistent.
Then there was one – the other comment from everyone was in the last sentence was to clarify it. The committee expects that the department will be able to leverage partnership opportunities with the private sector that should be stimulated by rule making in the areas of claims attachments.
MS. FRIEDMAN: And here is the man who didn’t understand that sentence.
MR. REYNOLDS: Well, as I look it, the comment is, since we are recommending there should be more pilots, is that not an extemporaneous comment? We are recommending that they do more computer variant and LOINC and human variant. Is that a necessary statement, because we have already recommended that they do more pilots? That is a question not a directive.
MS. FRIEDMAN: How about if we say the committee expects that the department will continue to partner with the private sector for additional pilot studies in the area of claims attachment?
MR. REYNOLDS: But do we care that it is the private sector?
MS. FRIEDMAN: I think one of the take-aways from the claims-attachment experience was we had this very small-scale pilot with Empire, and everybody kicked in. We had some small money in it, and everybody else provided services in kind or some other things, and it actually worked very well, and instead of having the federal government, you know, develop and fund all these studies, I think it is important to say that, you know, these partnerships –
MR. REYNOLDS: Well, are we talking about, then, instead of leveraging, encourage partnership opportunities with the private sector to be pilots, to –
MS. FRIEDMAN: I forget what I said before.
PARTICIPANT: You said that the committee would partner with the private sector, and that is what I was confused about.
MS. FRIEDMAN: How about will encourage federal or public/private partnerships?
PARTICIPANT: And those partnerships were for the purpose of pilot testing?
MS. FRIEDMAN: Yes.
MR. REYNOLDS: To expand the pilot opportunities. How is that? How about to expand the pilot opportunities?
PARTICIPANT: To expand the pilot testing opportunities?
MR. REYNOLDS: Yes.
MR. REYNOLDS: Is that where we were heading?
MS. FRIEDMAN: Opportunities in the area of claims attachment?
MR. REYNOLDS: Yes.
Comments from everyone?
PARTICIPANT: Could you just read it back, Maria?
MS. FRIEDMAN: Okay. The committee expects the department or the committee expects that the department will –
MR. REYNOLDS: Or recommends. Should we recommend?
MS. FRIEDMAN: Recommends?
MR. REYNOLDS: Do we want to expect it from them or we want to recommend?
MR. REYNOLDS: It is recommends.
MS. FRIEDMAN: That the department encourage public/private partnerships to expand the pilot-testing opportunities in the area of claims attachments.
MR. REYNOLDS: Everybody okay?
MR. REYNOLDS: Steve, you don’t look okay.
MR. STEINDEL: No, I’m not. I mean, it is the wording, public/private. I would say when we recommend that the department partners with the private sector. We have already implied that it is a public/private.
MR. REYNOLDS: That’s right.
MR. STEINDEL: And so I think public/private is redundant.
MS. FRIEDMAN: You want to say encourage additional pilot testing in the areas of claims attachment?
MR. STEINDEL: I thought your key was that you wanted to bring in that this would be a partnership.
MR. REYNOLDS: No, the them was to encourage the private sector to step up, not have it all be generated by the government.
MS. FRIEDMAN: And if you take all that out, that is not the way that reads now.
MR. STEINDEL: Read it.
MS. FRIEDMAN: It says, The committee recommends that the department encourage additional pilot testing in the area of claims attachment.
MR. BLAIR: How about pilot testing involving the private sector or involving the industry or something like that or with the industry?
MR. HUFF: Why don’t we say, The committee recommends that the department partner with private organizations to –
MR. STEINDEL: Yes, I mean, the way the sentence reads now, I don’t see what incentive they are going to have to do a pilot test.
MS. FRIEDMAN: Partner with –
MR. HUFF: The private sector or whoever – industry or whoever –
MS. FRIEDMAN: Industry in additional pilot tests.
Okay. This now reads, The committee recommends that the department partner with private industry in additional pilot tests in the area of claims attachment.
MR. REYNOLDS: Everybody agree?
Okay. In the last paragraph, the second line, it was recommended to – where it goes, to take necessary time to address, it was to comment on.
MS. FRIEDMAN: Where?
MR. REYNOLDS: Second line, next-to-the-last paragraph, last two words.
MS. FRIEDMAN: To comment on?
MR. REYNOLDS: To comment on.
The only other thing that was there – Simon, I think you may have mentioned it, and before we finish it, we will work to help. We included – We took that sentence and put it above.
MR. COHN: Yes.
MR. REYNOLDS: So I think that’s probably settled then.
MR. COHN: I think that’s –
MR. REYNOLDS: That issue that was out there.
All right. Any other comments from the committee? Anybody else comment?
And, Carol, we appreciate your input earlier. Thank you. No, I am serious. We do. Thank you.
Okay. Then this is what we will take forward to the committee tomorrow for consideration. Okay?
Let’s move on to the next item, and that is our December hearing, and, Maria, do you have the chart in front of you? Let me give you one.
MS. FRIEDMAN: I regret that I don’t have drafts of – my working draft to disseminate to the subcommittee. The internet is down today. Outlook is down, and I couldn’t print anyhow. So I’ll just have to give it to you what I have from memory.
Right now, the morning opens with kind of an overview from Karen, again.
MR. REYNOLDS: Overview from who?
MS. FRIEDMAN: Karen, another CMS update.
MR. REYNOLDS: All right.
MS. FRIEDMAN: And then I had a 45-minute slot to fill, and then I was going to do HIPAA RLI. I have invited WEEDIE(?) to give us their input. They had just done a study and a report out on that, and I think we had one other testifier that I have to look into. Then there was lunch.
After lunch, there was an e-prescribing update, and Lynn Gilbertson would talk about the industry in general. Tony Sheath(?) would report out on prior auth, and Laura Toper would report out on the codified sig, because those are just about ready for prime time.
MR. BLAIR: Could it be that the – I’m not sure, but the testifier that we couldn’t identify in the morning could that have been on matching patients to their records?
MS. FRIEDMAN: That was one possibility, and I was going to leave that open, because I have also been in discussion with Randy Levin from FDA to see what he wanted to – if there was anything that was relevant cooking over at FDA we needed to bring forward –
MR. BLAIR: And then there was also that lady from the Mayo –
MS. FRIEDMAN: Yes, we have asked her to delay her testimony.
MR. BLAIR: Oh.
MR. REYNOLDS: We had Randy listed earlier as possible medication terminology and device identification.
MS. FRIEDMAN: Right.
MR. REYNOLDS: We had question marks – If you look at our chart, we had question marks on when we could get those, and we did talk about whether or not – Judy, you had been contacted on whether or not we had another person on matching patient records.
MS. WARREN: Yes, Maria and I had been talking – and I am blocking on names – there was a person recommended to us from Blue Cross/Blue Shield to come in and talk about matching records.
One of the things that came out last time was a request from the committee to offer some balanced testimony.
MR. REYNOLDS: Yes.
MS. WARREN: So I have been out looking for someone who would be willing to come in prime time and say, We really do need a unique patient identifier, and I have found a person. However, that person is very controversial, and so before I extended an invitation, I wanted to be sure that we were – that there wasn’t any –
PARTICIPANT: Can we have the hearing in Chicago?
MR. REYNOLDS: Simon, you want to –
MR. COHN: Can I be somewhere else? No.
MS. WARREN: Simon knows who this is.
MR. COHN: Yes, I am aware of this one.
I think that this is really not a conversation for the subcommittee. I think this is really something that we need to take to our director and all of this stuff, because, in my view, this begins to get to be that question of are there restrictions on – from the Congressional Appropriations rules and things like that about exactly where and how we go in all of this, and so I think we can talk about it, but I wouldn’t have us reach any conclusions about all this, and I actually hadn’t realized that we were having a single – I mean – sort of a single presentation to get –
MR. REYNOLDS: Well, we were continuing. In other words, remember, we have had these two subjects continuing.
MR. COHN: Right.
MR. REYNOLDS: We have had Stan continuing to bring people in, and as we – In other words, our goal was to continue to learn on these two subjects.
MR. COHN: Okay.
MR. REYNOLDS: Okay? So that is why we had selected someone else again, not just to fill time.
MR. COHN: Okay. I just –
MR. REYNOLDS: We had agreed on these future things to continue to learn, you know, not just blast them with a couple of –
MS. WARREN: There are about three or four other people that I have identified that we probably need to hear from, but, I mean, they don’t have to come in December. They can come at our next meeting.
I mean, those people are Sean Grannis(?) from Indiana University and Clay Sherkey(?), and then this person from Blue Cross/Blue Shield, who I am blocking on the name of.
MS. FRIEDMAN: Well, let me bring this up, and hold that thought, because what I was going to close with on the first day was an ONC update, but we had one today from Brailer(?) himself, so do we need another one? And I think he pretty much covered what I thought we were going to cover.
MR. STEINDEL: I think at the rapid pace they are moving, yes, I think we need one.
MS. FRIEDMAN: Just in a month?
MR. STEINDEL: Yes, in the rapid pace that they are moving.
MS. WARREN: Especially on standards. On standards work. Is that what you are talking about or just in general?
MR. STEINDEL: Let’s see. We are meeting on the 7th. Actually, on standards, there may not be that much, because the standards harmonization board doesn’t meet until the 13th.
PARTICIPANT: Oh, but the AHIC will be meeting on November 29th and they will be deciding use cases for standards. So at least there is one good nugget there.
MR. REYNOLDS: So, basically, you are talking about ONK(?) and AHIC kind of together. So what happened at the last meeting and how does it reflect any other things.
MR. BLAIR: I guess it depends on our next discussion a little bit, but if our next meeting is not going to be ‘til April, I sort of feel like we could really miss some momentum. ONK has already indicated one of their areas of great interest is matching patients to their records, and I think we’d have something to offer if we have additional hearings in December on matching patients to their records. I just hate to miss that opportunity.
MR. COHN: You know, I guess I am seeing here sort of struggling a little bit only because I am not sure that – I mean, first of all, we are about a month away, I guess – I guess, we are getting, I guess, closer to all of this. So – you know – it is sort of an odd conversation for us to be having the full committee – subcommittee trying to figure out what the agenda is for the next set of hearings.
I guess I am – I would sort of, in some ways, defer to Jeff and Harry and Maria about this issue versus the other issues that are coming forward. I guess I am hearing a) that there is – at least what I am understanding is it sounds like there is an important issue that has some time sensitivity to it related to issues related to administrative simplification and streamlining.
MR. REYNOLDS: Yes, and that would be – and just to help you with it, that would be our second morning.
MR. COHN: Well, I don’t know if it is a morning or whether it is longer than that. I mean –
MS. FRIEDMAN(?): It is at least a morning.
MR. COHN: That is at least a morning, and I think – sort of going back from the strategic issue back to – you know – how we go into the schedule, so I think that issue we need to be dealing with in a thorough fashion. I think we have been talking about HIPAA ROI. Now, if there is something that we can finish up in December for February – in terms of February deliverable, I think that would be great.
MR. REYNOLDS: Yes, and I think that would be ROI, because this would complete our set of hearings that we wanted on ROI. We had already messed with a bit of a draft, things we had heard, you know, five or six things. This would put us in a point to consider a draft letter, you know, that we could bring forward –
MR. COHN: Okay. So I think we ought to sort of – I’m just sort of trying to think from a very tactical level what could we finish versus what is sort of long term and what –
MR. REYNOLDS: Does everybody have the chart? I mean, these are –
MR. COHN: Yes. I would say, third, I mean, Steve talked about hearing from ONC, I think it might actually be very valuable before we start going too far down the line. For example, on MPI, we might want to hear from, for example, I mean, see if we can get, for example, John Lunsk(?) or something like that, who is, I think, for example, doing the NHIN architecture contract.
Oh, is it Karen Bell? Okay. Well, whomever – whoever is involved in those architectures – Well, the question is is we might want to ask them what they are doing as well as find out from them how they are approaching – you know – what some of their initial thoughts are on MPI.
MR. REYNOLDS: And I think – And you said NPI? No, you said MPI.
MR. COHN: That’s what I said –
MR. REYNOLDS: Okay. Remember, there is an NPI. I thought you said NPI.
MR. COHN: No, no –
MR. REYNOLDS: Okay. I am just making sure.
MR. COHN: I meant MPI.
MR. REYNOLDS: Those are two –
MR. COHN: Yes, I know.
MR. REYNOLDS: – two real different subjects.
MR. COHN: And so it might be a real useful piece that might help us move forward to sort of understand – knowing that they are going to have to be dealing with this one way or another – to sort of see if there is some way for us to get a handle around the different approaches –
MS. WARREN: Well, I like that idea, because on the Connecting for Health Report, they did have some implications for architecture, and so that would fit in nicely.
MS. FRIEDMAN: Is it too soon, though? I mean, they just awarded those contracts, and those contracts aren’t up and running, and so I don’t know the details of the contracts enough to be able to say, you know, at this point, will they have anything to talk to us –
MR. STEINDEL: At the rate that they are going, yes.
MR. REYNOLDS: Well, the only thing I am thinking is is on – as these things get going, you know, we are not having our next meeting ‘til –
MR. COHN: Well, I don’t know when we are having our next meeting –
MR. REYNOLDS: April.
MR. COHN: Well, April.
MR. REYNOLDS: As it stands right now. So the point is this is going to move – We need to stay current with it. For example, it really was great hearing from David today, but we may ask other people more questions than we asked David. You know, we kept a lot of our questions for David at the full committee level.
MS. FRIEDMAN: Right. And I am also looking at who – I have made the request, and if I could get into my email, I can see it is there. I just can’t get to it. I think they have identified a potential testifier. I just want to see who it is and is it somebody who can address a range of questions or, given the particular person, if we would have to limit the set of questions, just because of their knowledge base, because the way it is working, at least from what I know, is each of the directors there, you know, has their own – is managing their own set of contracts –
MR. REYNOLDS: Let’s do this. We are talking about what we are not going to do. Let’s get down to what we want – If we need to help you get people we can do that.
MR. COHN: Yes. What I was going to suggest, obviously, I mean, the NHIN is an area – Once again, I have no idea, I mean, you guys know when you are scheduling the meetings and I don’t, though I am sitting here wondering how we are – how we have a four-month hole like that, but if, indeed, that is the case, obviously, the issues are – I mean hearing from – once again – and maybe it is John Lunsk talking about standards or whatever or maybe it is whatever, but maybe we need an update on what is happening in that area, but – I mean, and you are right, whether it is at the director level or whether it is –
MS. FRIEDMAN: Let me find out who is available –
MR. COHN: – how best to put that together.
MS. FRIEDMAN: – and what their thoughts are, but I – they did promise me somebody.
MR. BLAIR: Can I ask this? Does this need to be either/or? I mean, I think we need to hear from – and their staff on these subjects.
My thought really was that we’d gotten some really good information except on matching patients to their records. If there are issues or concerns sort of the other side of the story and we’d be in a position, even if we didn’t recommend something different than what we heard, if we at least understood the caveats, the limitations, the concerns – Stan, I believe you mentioned that – you know – Intermountain Healthcare has a different perception than some of the testimony we heard. I just really –
MR. REYNOLDS: Let me recommend an approach. We definitely want some key information based on AHIC, ONK and any of these things like the MPI or NHI. So get some substantive discussion on that. Everybody agree that’s one idea, one substantive discussion there.
MR. BLAIR: Yes.
MR. REYNOLDS: Judy, if you continue our education with somebody on matching –
MS. WARREN: I need some direction on – I mean – Okay.
MR. REYNOLDS: Let me finish the structure, and then we can take it apart.
Next is we want to complete this ROI so we can, in fact, put it to bed. I mean, we wait much longer than the ROI on our remembering anything or ROI – doing anything is going to be greatly diminished. We are going to finalize for this year exactly what all got completed on e-prescribing, you know, from NCPDP. So that closes it, and then we are going to deal with this flexibility issue and put a group together to come in and at least kick off the discussion for us on its flexibility. Now, is that structure satisfactory?
MS. FRIEDMAN(?): Tell me again.
MR. REYNOLDS: The flexibility – the whole thing we just talked about.
MS. FRIEDMAN(?): Oh, okay.
MR. REYNOLDS: Okay.
MS. FRIEDMAN(?): Versioning and updating.
MR. REYNOLDS: Yes.
MS. FRIEDMAN(?): Thank you.
MR. STEINDEL: Yes, I am not sure – Given what you laid out for the meeting, I am not sure if we have really time to hear on matching patients, you know, another set of half morning, half-session hearings on this from two or three people, and we may want to defer it, but I don’t believe like Jeff commented that we have heard enough on it. We have heard one vendor’s view.
MR. REYNOLDS: No, we totally agree, and, again, if you remember, the whole reason we got this chart – which nobody is looking at – is that our future areas of interest, what Stan covered today in – records of patients are, and we had agreed we would both look forward as well as we would look back. So e-prescribing, we are pulling this way. We are looking forward at these other things. So we are trying to get a balanced portfolio of what we are looking at. So that is kind of what I have been trying to –
MR. BLAIR: And the other piece, Steve, I might agree with you if it turned out that it was a whole morning, but I suspect that it is going to only be one panel and not a whole morning, just, you know, an hour-and-a-half.
MR. REYNOLDS: Okay. Well, let’s – Simon.
MR. COHN: Yes. I was actually just going to bring up another issue which I think I talked – Jeff, I think I talked to you about it, and, once again, since I don’t know what we are doing in 2006 –
MR. REYNOLDS: Well, you want me to tell you what we are doing in –
MR. COHN: Why don’t you – Yes, why don’t you tell us, only because there are issues that I think need to be brought up.
MR. REYNOLDS: Okay. Fine.
MR. COHN: But I guess I thought they were being – in January.
MR. REYNOLDS: Okay. The polling went on. It got lost in the wash somewhere. So let’s talk about where it is right now. Okay?
The first meeting that everybody was available was April 4th and 5th. Okay? We had polled January, February, April, July, September, October and December. All right?
MR. STEINDEL: I mean that is saying something about everybody’s schedule.
MR. REYNOLDS: It’s what?
MR. STEINDEL: It is just saying something about everybody’s schedule.
MR. REYNOLDS: Well, I understand, but let me tell you what we have, and then everybody can adjust what they want to do. April 4 and 5. We have July 27 and 28. Thank you, Judy, for adjusting that. We have October 10 and 11, and we have December 13 and 14. Those are the four meetings.
Now, the other thing that we are dealing with – Jeff has already voiced a concern – we are actually only budgeted for three meetings next year. Okay? So we are at four now, and then we have to decide whether or not we would need more, and we’ll need to work that through the budget process.
So, yes, Simon.
MR. COHN: Okay. I guess I have a couple of comments and suggestions. I am obviously fine with you leaving all of these on the books. I am actually – and I think I commented on this at least to Marietta when I sent back my email – it may not have gotten through to you – sort of trying to scratch my head about given our full committee is meeting on November 28-29 in 2006 the value added of having a full committee, subcommittee meeting two weeks after seemed to me that unless there is something really critical – Yes, I mean, this – a slightly different year in the sense that the full committee is meeting so late.
However, having said that, I mean, we should leave it in place, since we obviously have the dates.
Obviously, I am – some level of concern that, indeed, I think, as Steve has commented, things are moving relatively rapidly and that we have basically a four-month hiatus in our meeting schedule.
Now, I am not suggesting that we necessarily need a day-and-a-half of whatever as a separate activity. You know, we may want to consider, in some way, for example, tacking it onto the NCVHS meeting in February or something else different, because we obviously are allowed – I mean, you know, because of our budget, they do not want us to start having additional fly-in days, but I think it is easy enough to add an additional day –
MR. REYNOLDS: When is that meeting in February?
MR. COHN: That meeting is the 22nd and 23rd, and actually – you have committed to a privacy meeting on the 21st, as I understand. So I think we are talking about maybe the 24th if we are to do it.
And, once again, I mean, it is not my decision. It is the decision of the subcommittee, but it sure sounds like an awful long time between now and April.
MR. BLAIR: Harry, I think you’ve got the matrix there.
MR. REYNOLDS: Yes, for example, Simon, we – if you would look at your calendar, we do have February 1, 2 and 3 available for the rest of the committee. So I don’t know what – In other words, what we did – And, again, as I say, we will improve – we will get better at this – is we targeted where people – everybody was available. That is how it kind of fell.
Now, I’ve got the chart in front of me that shows that in February – in January there are a number of days, but since we have one in December, we have decided not to do January.
We did February. Everybody – if you would look at yours – everybody is available 1, 2 and 3.
As we move to April, we got the earliest April dates, so if we did February, April, we’ve got July, we’ve got October, we’ve got – maybe can the December one for next year. Then we’ve got ourselves in a situation where maybe that February added – February, April, July and October. Now, I think we’ve got maybe a better spread.
And, again, we just got this today. So –
MR. COHN: You just saw that today.
MR. REYNOLDS: Yes, sir.
MR. BLAIR: So we can do it February 1st, 2nd, 3rd?
MR. COHN: Well, I can’t, but you can all do it.
MR. REYNOLDS: Okay.
MS. FRIEDMAN: Do we have a quorum? We’ll have a quorum. It’s just Simon can’t make it.
MR. REYNOLDS: But the question is – and I guess now that we have told you the dates and we have admitted we didn’t do as good a job as we could have, now, tell me, so, as you look at the spread –
MR. COHN: Yes.
MR. REYNOLDS: – does that spread make you feel more comfortable that we are set up in a more expeditious fashion to deal with or do we wait ‘til April or do we do what we do?
MR. COHN: Well, I mean, once again, I think we could have a conversation with Marjorie. I mean, you know, before this other meeting that we are talking about – You are talking about four meetings without this one. Now, you are adding a fifth –
MR. REYNOLDS: No, I would take the – we would probably recommend taking December off, if we move one to February.
MR. COHN: Okay. But then we are still at four.
MR. REYNOLDS: Yes.
MR. COHN: I think you need –
MR. REYNOLDS: And we are only budgeted for three.
MR. COHN: And we are only budgeted for three.
MR. REYNOLDS: No, I agree. Yes, we need to work it out.
MR. COHN: Yes, so –
MR. BLAIR: Now, the email – Is Marjorie here?
MR. REYNOLDS: No.
MR. BLAIR: You know, when Marjorie indicted to me we are only budgeted for three, I asked if we could go ahead and at least reserve the dates on everybody’s calendar. In case ONKIT(?) was asking us to work on some of these other high-priority issues, at least we have the dates reserved and if they asked us for more dates than three, then we could – say, yes, we reserved the time, but we don’t have it in the budget. Can you help us with the budget? And Marjorie said that was a reasonable approach. So –
MS. FRIEDMAN: But the other thing is, as Simon pointed out, it is the fly-in costs that really make it tough, and if there is any way to piggyback on some of these other meetings, that helps.
MR. REYNOLDS: Give me – As the ultimate chair, give me some guidance on how you want us to approach this and we will absolutely make it happen.
MR. COHN: Well, you know, I am just hearing about these dates right now. So I am obviously – haven’t had time, really, to think about them.
You know, I am sorry that the scheduling appears to be so difficult. Obviously, I am concerned that you have a full month hiatus, because I think this is an important subcommittee, and I – you know – on one hand, I’m sitting here going, Geez, we seem to be having a lot of trouble filling up a December schedule and then here we are with this long lag.
I think one obvious opportunity would be – you know – try – I mean, it would be certainly, if people are available, it would be reasonable to schedule something knowing that we typically finish the full committee up in the afternoon of – which would be Thursday. We could do Thursday and Friday in late February after the NCVHS meeting, and that one would probably be a no-brainer.
MR. REYNOLDS: What are you saying the full committee is Tuesday and Wednesday or Wednesday and Thursday?
MR. COHN: Wednesday and Thursday, at this point, and so that would be –
MR. REYNOLDS: Then we would do Thursday and Friday.
MR. COHN: Yes, I mean, that would be sort of a no-brainer.
Certainly, we can also consider that early February date, and I have no objection. It is just that, at this point, I mean, the problem is that we are not – I mean, Jeff is obviously bringing up a very valid issue, but, you know, since we don’t have the – we don’t know exactly what that work looks like at this point.
MR. REYNOLDS: Well, gee, I think –
MS. WARREN: Only scheduled for three meetings, there is going to be a fourth-month hiatus between each one. Three into 12 is four.
MR. BLAIR: We are budgeted for three.
MR. COHN: Well, unless we add one to a full meeting.
MR. REYNOLDS: Jeff, go ahead, please.
MR. BLAIR: Yes, I guess, you know, my thinking is that if we are responsive on important issues and – is demonstrated, it gets down to the fact later next year if ONKIT still wants our support and help that they would help pay for the meetings, and, if not, then at least we have made a contribution.
MS. FRIEDMAN: That being said, I still think we need to find something in February, though. Later, if other things come up toward the end of the year –
MR. REYNOLDS: We will take that responsibility to find something in February – okay? – and we’ll try to get everybody – Yes.
MR. STEINDEL: Just a clarification. When you say find something in February, you mean other than tacking a day on to the full committee meeting or is that one of the many options –
MR. REYNOLDS: Nobody has agreed that they can tack it on. Some of us, it is already tacked on on the front.
MR. BLAIR: Is it possible for us to ask folks while they are here?
MR. REYNOLDS: Well, yes, we can, if people are willing to do that, yes.
MR. BLAIR: And you have the calendar there, I think, and do we have indications –
MR. REYNOLDS: It wasn’t even listed there.
MR. BLAIR: It wasn’t listed.
MR. REYNOLDS: Those dates weren’t listed.
MR. STEINDEL: So, Harry, Privacy is meeting on the Tuesday before?
MR. REYNOLDS: That is fine. I mean, there’s only a couple of us –
MS. FRIEDMAN: So that would be about a full week for people who – there is a lot of overlap in those committees.
MR. REYNOLDS: Well, there’s me and Sama(?). There’s me and Sama.
MS. FRIEDMAN: Just you guys?
MR. REYNOLDS: So we are looking at February of ‘06? All right. We’ll do this. We’ll try to tack that on. Okay? We’ll work that out. Everybody please let me know before the end of today if we can – tomorrow we can do that.
PARTICIPANT: So just say what date, so –
MR. REYNOLDS: We would stay the 23rd and the 24th. So we would have the afternoon of the 23rd and the day of the 24th.
MR. COHN: Right. And probably leave – I mean, hopefully, finish off in early afternoon.
MS. FRIEDMAN: Right. Be essentially a day –
MR. REYNOLDS: Well, that would give us a day plus a breakout session.
MR. STEINDEL: Yes, the week before, you couldn’t do it.
MR. REYNOLDS: Day plus a breakout session.
MR. STEINDEL: The week before, you couldn’t do it because it is HIMS(?).
MR. REYNOLDS: That is fine. That is fine. Okay.
So we’ll plan to tack that day on. Okay?
MR. BLAIR: I have only one question about that. That means we are meeting right after the full committee, right?
MR. REYNOLDS: Yes.
MR. BLAIR: So anything we come up with we have met after the full committee could have approved it, like a letter, like the ROI letter.
MR. REYNOLDS: Well, no, the ROI letter, hopefully, we are far enough along, I think, in the ROI that we should be able to work that prior to the February meeting.
MR. BLAIR: All right.
MR. REYNOLDS: Okay. Now, Simon, I would like to make one comment. Since we are running short on time, I would like to make one comment.
We had all agreed on an approach – okay? – and you and I had a little bit of this discussion yesterday. I think we have plenty to work on. I think we have been diligent not to take on anything overly sized until we understood a little more about – And, for example, had we gone berserk and had everything filled up, we could not have done the flexibility thing that we just did. So one of the things we are going to do is I want everybody to look at this future areas of interest, because those are the things we are going to – those are the future things, and that is one of the things you had asked us to try to do, keep the old stuff going – that is e-prescribing and ROI – look at the new stuff, so we never loose our charge of looking at the new stuff, but be willing to adjust, and so I think we actually did that for this next meeting, not as great, not as smoothly as we would like, but I think we have put ourselves in that position to where we are going to be a lot further along in this flexibility versioning and everything than we would have been if we’d have walked in here today and said, We got all these people set, and we are going to have to cancel them because we can’t do it.
Okay. So I ask you – ask everybody to have a little temperance for it, because we are still working in murky waters, and we are also the committee that is probably going to get hit a lot by what comes out of ONK and other things, and so we’ll have to kind of – we may not – we were so focused on e-prescribing and we are so focused on the other stuff, that, you know, we kind of had gimmes as far as what we were really interested in. Now, we have a little bit of room to play, but we are also liable to get some things handed to us, and we don’t want to have to cancel a bunch of people –
MR. COHN: Oh, sure.
MR. REYNOLDS: So that is just –
MR. COHN: No, and I want to just sort of comment, because I – I want to apologize if I am any way being –
MR. REYNOLDS: No.
MR. COHN: – sort of pushy –
MR. REYNOLDS: Good honorable discussion. That’s –
MR. COHN: and certainly, I think that – I mean, none of us were sort of looking at the single page –
MR. REYNOLDS: At our page, yes.
MR. COHN: At our page. So I do want to apologize.
MR. REYNOLDS: Okay. No, no, no. You don’t need to. No. It was good, honorable debate. No, we gotta all stay focused, because we got – stuff to do.
So, okay, so we have covered what we are going to do in December. We’ll get an actual fax out to everybody, once we get it solidified. We have talked about the going forward.
Now, the last question I would have, so we can finish this right on time, we want to do the ROI letter. Do we want to set some kind of preliminary shot at whether or not we would want to do any kind of letter on secondary uses and any kind of recommendations or anything on matching patients to records? Because, you know, we can have educational discussions over the next couple of years on these subjects, and then, based on – Carol is sitting over there – based on some of the things that came up earlier, you know, are these subjects that we really want to stay focused on and deal with our standards part while others are looking at in different ways, but back to this letter idea, since we do spread out when we meet, if we are looking for letters in secondary uses or matching patients to records, we need to start solidifying some stuff.
MR. STEINDEL: My comment on that, Harry, is I think we should be prepared to send some type of letter regarding matching patients to their records in the summertime frame. I don’t know exactly what dates, whether we would start working on it in the July meeting or start working on it in the meeting before and finish it up in the July meeting, and I am primarily saying that because of the NHIN contract and it moving forward, and it will be at a place where our input might be useful to that contract. I don’t know whether it would be our final letter on the subject, but I think that is timely.
As far as secondary uses of data, I personally see putting off a letter a little bit further. We still really haven’t decided how much of the whole committee is going to be focusing on that area.
MR. REYNOLDS: No, I don’t disagree, but anytime we start talking letters, we gotta start making sure –
MR. STEINDEL: Right.
MR. REYNOLDS: – we do all the right things prior to that and then look at when the next big meeting is. So that forces a little longer planning horizon than the others.
MR. BLAIR: I generally agree with Steve, but I would modify it.
Every health information exchange in the country right now is struggling with matching patients to their records. It is very hard and very urgent, and so my thinking is that it would be much more timely if we could produce that letter in April, rather than the summer.
MR. REYNOLDS: We have a second from a visitor.
PARTICIPANT: A consumer of that.
MR. REYNOLDS: Okay. Well, then that means let’s go back to process again. That means that if we don’t hear anything in – if we hear something in December, that we are going to need to hear something in February. We are going to actually start having to be drafting a letter in February.
PARTICIPANT: That’s right.
MR. REYNOLDS: And IMITI, the next time they meet is in April. So, I mean, you know, so you start moving it back there, now, you start clearly establishing our process and steps we have to go through, which is fine, but if we decide that, our agendas have to align.
MR. STEINDEL: I just don’t know if we are going to hear enough information to have a letter in April.
MR. REYNOLDS: Oh, I am not disagreeing. I am not agreeing or disagreeing. I am just saying once we pick it, it sets our process. I don’t have a problem with that. So is there a recommendation? Jeff, you still hanging with April?
MR. BLAIR: I think we should do everything we can to try to have it –
MR. REYNOLDS: Well, then let’s say – let’s see if we can approach it this way. All right. So in December we are going to hear on matching patients. We will then plan to have at least a half a day in February when we meet. Then we can decide what our time frame might be, because, at that point –
MS. FRIEDMAN: Half a day additional testifiers?
MR. REYNOLDS: Huh? Yes.
MS. FRIEDMAN: That means we’ve got to get busy –
MR. REYNOLDS: Okay. That’s what I am saying. So no matter when we are going to do it, let’s plan – We got one, Judy, for December and you got at least – you got two –
MS. WARREN: And we talked about December being various things, whether you wanted to bring in some of these people who were identified or whether you wanted to bring in the new AHIC group that is starting to talk about architecture and its implications for matching patients, and I kind of thing we need to hear from the architecture guys in December, so that we can figure out where the holes are and what needs to happen in the next –
MR. REYNOLDS: We’ll work on which way we go –
MS. FRIEDMAN: Let me find out if they are actually prepared to talk about that or whether they are just going to – sometimes we just let contracts and let the contractors –
MR. STEINDEL: Maria, the contractors would be ready –
MS. FRIEDMAN: They’d be ready in December?
MR. STEINDEL: And they bid on it.
MR. REYNOLDS: Yes, and we do have access to some of that. So –
All right. Is the structure amenable? We have our letter for tomorrow. We’ve got our dates – tentative dates. We are going to get rid of next December, put in February at the end of the full committee.
Is there any other business anybody wanted to have, so I can keep Simon – so he can talk on NHII?
MR. HUFF: Say the rest of the dates. Make sure I got them right.
MR. REYNOLDS: Yes. Okay. We are February, the afternoon of the 23rd and the day of the 24th. We have April 4th and 5th. We have July 27 and 28 and we have October 11 and 12 is what we are set at right now.
MS. WARREN(?): December is a questionable –
MR. REYNOLDS: And December, yes – Yes.
MR. HUFF: Keep the 13th and 14th?
MR. REYNOLDS: Yes, keep December 13 and 14.
Okay. And, Simon, I will have Marietta send this email out to everyone confirming this tomorrow. Okay?
Any other business, so we can let NHII do their deal? Okay.
MR. COHN: Harry, thank you very much.
MR. REYNOLDS: Thank you very much.
MR. COHN: Great work.