[This Transcript is Unedited]

Department of Health and Human Services

Meeting of the Subcommittee on Standards

September 17, 2013

National Center for Health Statistics
Auditorium A and B
3311 Toledo Road
Hyattsville, MD 20782

P R O C E E D I N G S (8:02 a.m.)

Agenda Item: Welcome

DR. SUAREZ: We should get started. My name is Walter Suarez. I’m with Kaiser Permanente and one of the co-chairs of the Standard Subcommittee and I don’t have any conflicts.

MR. SOONTHORNSIMA: Ob Soonthornsima, Blue Cross Blue Shield Louisiana. Co-chair, no conflicts.

DR. CHANDERRAJ: Raj Chanderraj, practicing physician. Member of the subcommittee, no conflicts.

DR. SCANLON: Bill Scanlon, National Policy Forum. Member of the Subcommittee and no conflicts.

MS. GOSS: Alix Goss, program director for the Pennsylvania E-Health Partnership Authority. Member of the Full Committee, member of the Subcommittee for Standards and no conflicts.

MS. KLOSS: Linda Kloss, Health Information Management consultant. Member of the Full Committee, co-chair of the Privacy Subcommittee, member of the Standards Subcommittee. No conflicts.

MS. FARRAR: Good morning. Kamahanahokulani Farrar, CMS staff. No conflicts.

MS. GREENBERG: Marjorie Greenberg, National Center for Health Statistics, CDC, and Executive Secretary to the Committee.

(Introductions around the room)

DR. SUAREZ: So our agenda is primarily to go over first of the all, the letter that we presented yesterday to review the edits based on the discussion. And then we have a couple more items, review the proposed outline of the HIPAA report to Congress which we also reviewed yesterday very briefly and then the proposed sort of agenda strategy for the Public Health Data Standards Hearing that we are planning to hold in November of this year. And then based on time we can recap some of the plans for tomorrow’s roundtable.

The letter I emailed to pretty much all of you yesterday and the modifications were done based on the comments that we received. Basically, as I mentioned in the email, based on the comments and the notes that Kamahanahokulani and Ob and I took, I think I sent that draft and we can start going through that draft when we get it up on the screen.

But basically the main changes were we basically took out of the letter some of the sections that we included in the draft that really didn’t have either recommendations or were really things covered during the hearing itself. And then we modified the letter by bringing up at the top the ICD-10 portion, organized the recommendations under ICD-10 into three main groups of recommendations. And so we’ll go through it at the podium there so let me go there.

Okay, so this first part we didn’t change anything, and I know Kamahanahokulani sent me some comments but we haven’t incorporated those in here. So we can go over and see if we capture all the things.

So the first change was in this introduction to the recommendations, this is sort of a high-level summary. What we did was we changed the description of bullet number two to focus on ICD-10 so staying the course on ICD-10, code sets compliance deadline.

And then we modified a little bit the defining a roadmap for standards to explain that mandates typically have post-implementation issues if not suffering delays or incomplete implementation and adoption. Delays or incomplete implementation from one mandate affects others and so due to the competing mandates, priorities, changing standards and evolving policies, we noted that it is imperative for HHS to rationalize the pace, scope, scale and timing of the initiatives. So that’s the first major change we did.

The second one was on the organizing of the ICD-10 recommendations. So we brought ICD-10 to the top and then basically organized the recommendations into three. The first one the same and I don’t think we modified the language too much but I’ll cover a few of the things. So number one recommendation should continue emphasizing it’s not intending to the change deadline.

Number 2, CMS should establish and publicize a series of realistic and actionable interim testing milestones. we didn’t change that recommendation but we made it the large number two that is focusing on testing, and then all these recommendations that follow were the same recommendations we had before except now organized under this number two. So the only wording change, recommendation 1 was the Medicare Fee-for-Service testing, number 2 was the sharing of the plans from clearinghouses. Number 3 was the participation in the HIMSS WEDI pilot. Number 4 was the Medicaid reassessment. And then number 5, exploring the possibility of using education and training centers.

So those were the recommendations so we didn’t change anything really in the wording. Yes, Bill?

DR. SCANLON: Sorry for not catching this earlier but in the Medicaid recommendation, the idea that the Medicaid systems drive local change, it seems that’s too much of a stretch. Less than half the doctors participate sort of in Medicaid so I think a word softer than drive; important to, impact, that would be fine – but drive is just too strong.

DR. SUAREZ: You said, impact?

DR. SCANLON: Impact is fine.

DR. CHANDERRAJ: The main recommendation 2 is change CMS from HHS.

DR. SUAREZ: This one we didn’t change. This ones were all CMS, and we confirmed that it’s okay for these to be CMS rather than HHS because they are very specific to CMS activity. We did change the other HHS.

MS. KLOSS: I like what we are doing in terms of grouping similar recommendations, but it seems like recommendation number 2, the header is all about testing but the sub-recommendations go beyond the testing issues.

And so I’m wondering if there might not be another break because 2.1 fits, 2.2 doesn’t exactly fit under testing because we were communicating that these groups really need to make their software development and solution release plans explicit, and I think that’s not a testing issue.

DR. SUAREZ: Testing is part of it, right?

MS. KLOSS: It is, it is, you’re right.

DR. SUAREZ: So we can add; testing, testing and transition plans.

MS. KLOSS: That would help.

DR. LAZARUS: Going to 2.5. (comment off microphone)

DR. SUAREZ: Yes, we understand that and we talked about it in the subcommittee. Still there was a sense that some of them might find ways to continue operating under other venues and so we thought it would be still valuable to include them as a reference point.

Okay. And then recommendation 3. This one is a new text for recommendation 3, to cover 3.1 and 3.2 which were the original recommendations 9 and 10 in the original letter. So I’ll read it.

Recommendation 3; CMS should work with the health plan industry to disseminate their ICD-10 related claim payment policy guidelines aimed at ensuring payment equivalency when moving from ICD-9 to ICD-10 code sets.

So the intent here is to communicate that the health plans should proactively, and CMS should work with them to disseminate their claim payment policy guidelines that are based on ICD-10. So recommendations 3.1 talks about Medicare and Medicaid ICD-10-related payment policies, and then 3.2, that CMS should share the HCCs.

So then we have the DSMO section. We didn’t change major things in this language. We corrected a few typos and things.

Recommendation 4 now which only changed the following way, basically we added some time in 2017 or later, that was the change that we made here.

MR. SOONTHORNSIMA: I am not sure I’m being too specific here. Going back to recommendation 3 real quick, when we say that CMS should work with the health plan industry to disseminate their ICD-10-related claim payment policy guidelines aimed at ensuring payment equivalency. I wonder if “ensuring” might be too strong because the payment would not be exact.

I wonder – “preserving”?

MS. GREENBERG: Enabling.

MR. SOONTHORNSIMA: Because at the end of the day it’s about financial neutralities, it’s reimbursement neutrality.

MS. BUENNING: If you have a concern about getting into payment equivalency issues, what you can do is just cut it off after payment policy guidelines when moving from ICD-9 to ICD-10 and cut out, guide aim and ensuring payment equivalency.

MR. SOONTHORNSIMA: Do you think claim payment policy guideline is clear enough that we’re really talking about financial neutrality? Because payment policy could be anything. It could be timeliness, it could be other things.

MS. BUENNING: It depends. If you want to go to payment equivalency issues.

MR. SOONTHORNSIMA: I’m worrying about the word “ensuring” because it might be too specific.

MS. BUENNING: Claim verifying or aimed at clarifying payment equivalency or aimed at – it is kind of an interesting –

MS. GOSS: Or is it revealing? It has to do with revealing. If there’s going to be a change from ICD-9 to 10, reimbursements because of this shift from ICD-9 to 10, than that’s what really people want to understand what’s going to be the impact moving forward.

MS. GREENBERG: So I liked clarifying. Although this is really a mouthful. And I’m not sure – if we’re not even clear what it says, I’m not sure that anyone else will be.

DR. SCANLON: It’s also not clear whose payment policy is being disseminated, CMS or the health plan industries?

PARTICIPANT: It’s depending on who’s paying.

MS. BUENNING: Well, it kind of dovetails off of 3.1 because it’s saying that Medicare and Medicaid should share their information and private payers should do the same. So I think you’re talking about both.

DR. SCANLON: But then the issue is private payers should do the same. Who is the industry then? We’ve got this issue of industry being a vague term here too.

MS. BUENNING: Or does it say health plans.

DR. SCANLON: Well, but the private payers, aren’t they the ones that are the industry being referred to and we’re sharing this related claim policy with themselves? I mean there’s some circularity here. I’m thinking that you’re trying to bring providers into this, but you’re not doing it explicitly.

MR. SOONTHORNSIMA: They are supposed to because they are supposed to do testing with their providers to demonstrate that –

DR. SCANLON: That makes sense but I think the way the recommendation is written it’s very hard to sort of glean all of this.

DR. FITZMAURICE: I think Bill’s right about it’s not clear whether it’s CMS’s health-related claim policy or somebody else’s. I would put – replace “their” with “its”, first of all, but secondly I’d replace it with CMS’s policy. CMS should distribute its own policy to health plans. Health plans will disseminate or will enforce their own policies.

DR. SUAREZ: Recommendation 3 is intended to say, CMS and the health plans should disseminate their. So both CMS and the health plans. And that’s why 3.1 is even more specific. So 3.1 is even saying more concretely, CMS should share its Medicare and Medicaid and private payers should do the same. So that’s what it’s trying to –

DR. FITZMAURICE: CMS and the health plan industry should disseminate their claims-related policy guidelines.

MS. GREENBERG: Right. Related to the transition from 9 CM to 10 CM, so that would then show that it wasn’t related to some other thing.

DR. SUAREZ: So how about this. CMS and the health plan industry should disseminate their –

DR. FITZMAURICE: ICD-10 related claims payment policy guidelines when moving from ICD-9 to ICD-10. I also would take out the “aimed at ensuring the payment equivalency”. That will happen or it won’t happen.

MS. GREENBERG: We already have ICD-10-related but maybe it would be better to take that out there and put it at the end. Disseminate their claims payment policy guidelines related to the transition from 9 CM to 10 CM.

MS. GOSS: I really think that if we’re going to deliver the message that people are concerned about the payment changes from ICD-9 to 10, you can’t take out the clarifying the payment equivalency because that’s what this is really all about. The whole point of everything of the testimony was provider wants to know how they’re going to get hurt under the 9 to 10 changes.

MR. SOONTHORNSIMA: There are two points. One is a policy would state that they will not accept 9, because some plans might actually accept 9. The second policy is when we’re not accepting 9 and we’re going to ensure that there’s financial neutrality. Those are two separate points.

MS. GREENBERG: Part of the problem I think is you all know what you mean here but if you look at the findings, none of them state what Alix just stated. That there was concern about payment.

MS. GOSS: And so let’s make sure everyone agrees with my statement.

MS. GREENBERG: I think they do. So I think that needs to be in the finding.

DR. SUAREZ: There is one in the findings. There is one that talks about –

MS. GREENBERG: Well, it says they’re concerned about correct code selection, clinical documentation, potential loss of productivity, I don’t see a statement that they are concerned about how it will affect their payment.

DR. SUAREZ: Well, we can insert in there they are concerned about correct code selection payment equivalency.

PARTICIPANT: It is just saying, in the prior section.

MS. GREENBERG: The fourth dot point. Maybe if you add it there than it would link in better with what you’re trying to say here.

DR. SUAREZ: That is what I’m doing in this bullet – there are still concerns among providers about correct code selection payment equivalencies, I guess.

PARTICIPANT: On page two, at the bottom it says, in sharing ICD-10 related health plan payment policies in advance with training partners.

DR. SUAREZ: We can still maybe add the point about payment equivalences in this fourth bullet.

MS. GREENBERG: I don’t think it needs something there. But that is only about CMS and then this gets into the recommendation has to do with the industry more broadly.

DR. SUAREZ: That is why by adding payment equivalencies in this fourth bullet I think ties it back to not just CMS but everybody.

MS. GOSS: Walter please stop. Stop Walter. Period at end of the last bullet missing. Clearinghouses, practice managements, the one at the top of the screen.

DR. SUAREZ: Any other changes on this ones? So then the next section is the DSMO report. I don’t think we changed anything here. Again, I already mentioned recommendation 4 we added or later at the end.

Then we move to the recommendation 5 which is about identifying 4010 users and targeting outreach efforts. We didn’t change anything in this part. We didn’t change anything on the recommendation six which is acknowledgements.

And then on the operating rules I think we added a new point based on the feedback we got here regarding this bullet on page six. The fifth bullet, it says another concern raised by testifiers was the impact that organizations not subject to meet HIPAA standards, such as practice management vendors, have on the adoption of this electronic standards. So this was pointing to the concern about entities that are not subject to really meet the HIPAA requirements, like practice management vendors, the impact they have and the fact that they don’t have to comply with all the implementation of electronic standards.

MR. SOONTHORNSIMA: Do we need to make a for example, vendors, PMS vendors – oh you did. You did say that, I’m sorry.

DR. SUAREZ: Anything else on this bullet?

MS. GOSS: It is not really having the punch I think that Gwen was really trying to communicate yesterday.

MS. KLOSS: I don’t think we need the word meet – not subject to HIPAA standards – so that would help it read a little more –

MR. SOONTHORNSIMA: How about the concern is the fact that non-covered entities are not subject to HIPAA standards?

DR. LAZARUS: I think it is valuable to add the, “such as practice management vendors” as an example so people understand who they are talking about.

MR. SOONTHORNSIMA: You are right. It needs more punch.

MS. GOSS: For me, if you really want to make it – the dynamic here is that you’ve got players that are influencing the success of covered entities that aren’t in fact covered entities and it creates a disconnect of motives and alignments related to your frameworks.

MS. BUENNING: Maybe have on the adoption of “these electronic standards by HIPAA covered entities”. It seems like we just kind of cut it off there – because it would say who was affected by this.

MS. KLOSS: Maybe another concern raised by testifiers was the impact that entities not subject to HIPAA standards such as practice management vendors.

DR. SUAREZ: Entities instead of organizations?

MS. KLOSS: Organizations doesn’t work there for me.

MS. GOSS: But I like where you are going because if we could switch maybe the end to kind of blend with what you’re saying with Denise’s comments about it’s the role of those non-covered entities on the adoption.

MS. BUENNING: It is not just the electronic standards, it is HIPAA standards.

DR. SUAREZ: So is there anything else on this bullet?

MS. BUENNING: Another concern raised by testifiers was the impact that non-HIPAA covered entities such as practice management vendors, have an adoption of HIPAA standards by providers.-

DR. SUAREZ: Non-HIPAA covered entities such as practice management vendors have on the adoption

MS. BUENNING: — have an adoption of HIPAA standards by providers.

MS. GOSS: I also think yesterday part of the comment that Gwen made was also about products. It was about tying the non-covered entities to the services they delivered with the products in this space. I’m not sure that we get necessarily the products aspect in there.

DR. SUAREZ: How about “and their products.” Such as “practice management vendors and their products”.

MS. KLOSS: On the adoption of HIPAA standards, not only electronic.

DR. SUAREZ: So it reads, another concern raised by testifiers was the impact that non-HIPAA covered entities such as practice management vendors and their products have on the adoption of HIPAA standards by providers.

MS. BUENNING: Can we put a negative impact assuming that an impact is negative?

MS. KLOSS: That was the sense of the testimony.

DR. SUAREZ: The negative impact that non-covered entities such as practice management vendors have on the adoption – but we need to explain why it’s a negative because otherwise it gives the impression that it’s always negative. The negative impact that non-HIPAA covered entities such as practice management vendors and their products have on the adoption –

MR. SOONTHORNSIMA: Inconsistency –

PARTICIPANT: By failing to incorporate HIPAA standards into their products.

DR. SUAREZ: By failing to incorporate HIPAA standards into their products.

MS. GOSS: And I think we might want to clarify when we talk about standards that we’re talking about more than just transactions here.

DR. SUAREZ: We can say transactions here.

MS. BUENNING: I would say, “After practice management vendors”, take out “and their products” because we are adding it onto the end.

DR. SCANLON: I have to say there’s a face validiy issue about this point which is, that why is it that these providers, who are subject to the HIPAA requirements, are victims of these entities? As opposed to saying, we are going to comply because we have to comply. Do these people – are these entities have such a lock on the market that there is no alternative available?

MS. BUENNING: When you have a practice management system, there’s a considerable amount of money incorporating into your practice and you’re depending on that to kind of help you do everything electronically. When a vendor comes back and says, oh, I’ve got a product but it doesn’t have ICD-10 in it but we can add that on later, at a considerable expense, you have to stop and think about what the impact is on that practice and look to GMA and some of the other practice management associations, they’ll tell you. They are pretty much dependent on these systems. Since there is no certification and there’s no regulation of the vendors who offer these products, you don’t have any kind of leverage with them – the only leverage that’s out there quite frankly is well, if you don’t like the product, you can change vendors, but that’s a real expensive proposition – that a whole other discussion though.

DR. SCANLON: This is a very interesting discussion of sort of what should be the role of government versus the market.

DR. SUAREZ: One of the points actually made during the hearing was, and it was reiterated, it had been reiterated a number of times, was that practice management vendors are not required to be certified for HIPAA as part of the HIPAA program just compared to what Meaningful Use does which is requiring providers to buy a certified product. And the HIPAA providers are required to meet the HIPAA standards and look for products that meet them but the products are not required to be certified. So there was that discussion as part of this point of there is a negative impact when those non-HIPAA covered entities don’t meet the requirements or don’t help providers meet the requirements. So any other comments on this bullet?

DR. LAZARUS: I did find one comment to make on this bullet. We use the expression practice management vendors, it should be practice management system vendors, that’s how they’re known.

DR. SUAREZ: So no other comments on this bullet. So we can move on – Steve.

DR. LAZARUS: One comment that applies in four places including three of these bullets and that is to ask that we change CAQH to CAQH CORE everywhere it appears in this recommendation. And it’s in bullets one, seven and eight. And then in the recommendation itself.

DR. SUAREZ: We will have to spell out CORE in the first one. So it’s always CAQH CORE. So we’ll add it in the letter.

(Miscellaneous wordsmithing comments)

DR. SUAREZ: All right, anything else on this one. And then, recommendation eight, the change we made was we originally had four points in recommendation eight, we combined three and four –

DR. FITZMAURICE: Walter, should we change using electronic transactions, using HIPAA transactions? For example, the privacy rule is not really electronic, it’s everything.

DR. SUAREZ: And then again on recommendation 8, we combined 3 and 4 and made a new 2. We combined 2 and 3 and made a new 2 so that the new 2 reads the value on benefits of adopting operating rules that apply to multiple transactions rather than establishing operating rules on a transaction by transaction basis so that end-to-end administrative and business processes are optimized. So it kept the three concepts of saying we should explore adopting operating rules that are cut across multiple transactions that are not focused on a per transaction basis only and that are addressing end-to-end administrative processes.

MS. KLOSS: Could we add after multiple transactions that comprise business processes.

DR. SUAREZ: That apply to multiple transactions that comprise business processes. Okay, any other changes?

DR. FITZMAURICE: I would suggest replacing optimize with efficient but it’s a matter more of style than of misleading anybody.

DR. SUAREZ: So that end-to-end administrative and business processes are efficient –

DR. FITZMAURICE: What’s being optimized?

MS. GOSS: I think the point is that the optimization comes from looking at an entire process over doing specific chunks discretely. By looking at a totality of a set of business processes you can make it better by making it more efficient to your point but you are – the goal is to make our standards and our operating rules work better together.

DR. FITZMAURICE: Isn’t the end goal efficiency?

DR. SUAREZ: Improving efficiency, not just efficiency.

PARTICIPANT: And effectiveness. In other words,

DR. SUAREZ: I think we are trying to optimize as a way of saying more efficient, not just efficient but more –

DR. FITZMAURICE: It is just a matter of style, that’s not something I feel strongly about it’s just other people won’t understand is being optimized.

DR. SUAREZ: So that end-to-end administrative and business processes are optimized – are made more efficient and optimized. If people don’t feel too strongly, I think optimize –

DR. FITZMAURICE: Leave it optimize.

DR. LAZARUS: In the first line can we change CAQH to CAQH CORE.

DR. SUAREZ: Thank you. We will do the final read with details on commas and things like that. And then the last item here was the WEDI Report. We didn’t change any of the language here. And we thought it would be helpful and important to include and still keep this section on the impact of the Health Insurance Exchange capabilities on standards because I think this is one of the things that we as a subcommittee are going to have to monitor – is how does the insurance exchange and the start of the health reform, knock on wood, October 1st, will have with respect to standards. How are the standards performing as we start these insurance exchanges? So that’s something that our subcommittee will be monitoring. That’s what we are saying here, we will need to review and monitor the implications that the new insurance exchange will have on current and future standards.

DR. FITZMAURICE: I like it but I would take out the parentheses around and other forms of payment reform. I would just put, “and bundled payment, and other forms of payment reform.” I think it stands well by itself.

DR. SUAREZ: Okay, any other final comments? We didn’t change anything on the concluding comments.

DR. LAZARUS: Core requirements. Steve Lazarus, former chair of WEDI. Actually Louis Sullivan spearheaded the development of the 1992 WEDI report. He was no longer Secretary in 1993. The original report was formed in response to his initiative which was in 1992.

DR. FITZMAURICE: Was there a 1992 Report?

DR. LAZARUS: Yes, there was a 1992 Report which was submitted to Secretary Shalala who was the Secretary when it was completed and then WEDI on its own completed a 1993 Report with no input from the Secretary.

DR. FITZMAURICE: So by changing 1993 to 1992 we’d be accurate.

DR. LAZARUS: That is correct.

DR. SUAREZ: Thank you. Any other final changes? Okay. Well, thank you very much. Thank you.

So we are going to spend the last few minutes of this meeting on a couple of the other points. We presented yesterday the proposed outline of the 2013 HIPAA Report and you all have a copy of it in your materials. It’s a one page – in any case –

So the outline of the report is as I explained yesterday to the full committee is divided into five sections, the executive summary, an introduction and then section three and four which are the base, most significant sections. So section three is the highlights of administration certification advancements in 2012 and 2013 and it covers basically the entire realm of administration certification activities including HIPAA and ACA operating rules.

So we have sections on administrative transactions, the adoption of the transition to 5010, the adoption of electronic fund transfer standards, the operating rules, the code set, particularly the transition of ICD-10. So we have the entire spectrum, and we include privacy and security so we will be working with the Privacy and Security Subcommittee on drafting that section.

And then also a standards administration certification on population health. We have a subsection there to look at things like all payer claims databases and community health data initiatives which is part of – so this is an opportunity to really link all these processes really and data that is being enhanced in terms of capturing and content across the spectrum including public health and population health and quality spectrum. So that’s section three.

And then section four is what we call the journey forward, a vision for the future and this will be a description of some of the forward thinking visioning of information exchanges to support administrative processes.

MS. KLOSS: Walter, the elements – I didn’t go back and look – but are the elements in this journey forward consistent with the tenth report.

DR. SUAREZ: Yes, actually.

MS. KLOSS: Okay, because I think it would be good to circle back to that and one of the points that I know we made in that was the need for some not just measuring success in terms of the benefits of standard but progress. Measuring progress.

DR. SUAREZ: Any other comments on the outline?

In terms of the process, we announced yesterday that we’re very fortunate that CMS has assigned a person to work with our subcommittee on drafting this. So we will go into drafting mode starting, well, after this meeting.

And we will be convening our regular subcommittee calls to review progress in the drafting of the various sections so we’ll probably have a first draft of a sketchy document rough draft of the document with the various sections built in to it and subsections and then we’ll begin to add and refine content.

The goal is to present this to the NCVHS Committee in November for action and be released before the end of the year. All right.

And then lastly the hearing on public health data standards. So we have started to organize this and we’ve put together and I want to acknowledge Michelle, Michelle Williamson who worked with us in developing and drafting this. As you recall, last June, Michelle presented on the status of the work that NCHS has done in helping develop nation, international indeed electronic standards for meeting public health functions like vital records and reporting and others. And so building in part on the work that has been done and in part on the great really interest and need to focus on what is the current status of standards in public health across the board and how it relates to the many other standard work and adoption that is happening in the country including Meaningful Use and electronic health record standards as well as administrative transaction standards.

That’s what created the need and the interest in starting this with a hearing. The expectation is that it might not be a single hearing, this might be a one hearing of maybe a couple that would be done in the next 6 to 9 months.

We described the purpose in this first page of the agenda, the proposed agenda, so you can review the more specific elements of the purpose, the scope and some of the concepts around how the hearing would be structured.

Very, very quickly, the purpose is to gather industry input on the state of health data standards using and needed in public health and population health programs. The scope of the hearing will include standards for pretty much the whole spectrum of activities and data in public health, so data coding, including education, socioeconomic status, and other data elements. The document type standards, the CDA, the HL7 CDA, clinical document architecture, that is actually using in messages for public health structure and format standards, transport standards, vocabulary and terminology, data management across various public health functions and activities that are included but not limited to all these public health functions, from vital statistics to biosurveillance to environmental health and others.

So that’s the overall goal and scope. The idea is to bring in to the hearing, and you can see the agenda, several panels to discuss the topics of the standards on public health. So we had structured it into a panel of public health data standard organizations including the various organizations that work in data standards, you see them there, the Public Health Data Standards Consortium, the Joint Public Health Informatics Task Force, JPHIT, AASHTO, NACCHO, NAPSIS, CST, NADO.

And then a panel on data standard developers. So these are the standard developer groups, HL7, X12, IHE, Coding and vocabulary and terminology like CDC and other coding standards. The CDC BioSense Initiative for transport and SNI framework initiative related to public health standards like DHRI and the Structure Data Capture SDC.

And then a third panel on state initiatives and readiness for standards implementation so we will invite a series of representatives from state and local public health to talk about how they see and where they are with the implementation of electronic standards for public health reporting.

And a panel of software and application vendors – so these are vendors that work with both providers and others submitting data as well as public health agencies receiving the data and exchanging the data. So we have a number of entities preliminarily identified as vendors.

And then a panel of users, data users, privacy and security and public health data standards. So we’re beginning to put together sort of that panel.

So, as you can see we have public health data standard organizations or organizations that promote the adoption of standards, organizations that develop the standards, state initiatives and state and local initiatives that implement standards, vendors and users.

So that’s the overview of the agenda and then we’re beginning to identify the questions and very importantly, we are going to be working with our other subcommittees on putting together this so we’ll be working with the Population Health subcommittee as well as the Privacy and Security subcommittee. So, Marjorie?

MS. GREENBERG: Two comments. One is we promised we would be out of here by 8:55 so I’m going to have the last word because they need to set up for the full committee.

I think this is very important obviously. It’s near and dear to my heart. Public health data standards. I think as – and you did give me an opportunity to comment initially on it, but I think as you said, this cannot really be one hearing. This is too much actually for one day and there are things missing from here. I think we should definitely include Meaningful Use, that’s one thing that needs to be here. I heard a wonderful presentation by someone from public health department related to the challenges with Meaningful Use.

And I think with the idea of the convergence theme we want some people here also from the health care industry interacting with the public health folks in what the challenges are. So my main thing though is that I think you’ve got at least two hearings here. We don’t have 2 days so I think we need to talk about that offline but let’s get started and I think it is very important and it’s an area that has been certainly, in many ways, overlooked so I think it’s right smack in the responsibilities of the National Committee.

And now I ask that we clear our seats so that they can set up for the full committee.

DR. SUAREZ: Thank you. We will be talking about it in more detail in our follow-up calls with the subcommittees so we’re certainly very excited to begin to prepare this. Just one minute of any public comment before we adjourn the subcommittee meeting. Any public comment? All right, hearing none, I think we stand adjourned. Thank you and we’ll transition to the full committee.

(Whereupon, the subcommittee adjourned at 8:55 a.m.)