[This Transcript is Unedited]




September 8, 2005

National Center Health Statistics
3311 Toledo Road
Hyattsville, Maryland

Proceedings By:
CASET Associates, Ltd.
10201 Lee Highway, Suite 180
Fairfax, Virginia 22030

List of Participants:

  • Harry Reynolds, Chair
  • Jeffrey S. Blair, MBA
  • J. Michael Fitzmaurice, Ph.D
  • Steve Steindel, Ph.D
  • Stan M. Huff, M.D.
  • Justine Carr, M.D.
  • Donna Pickett
  • Wanda Goban-Jenkins


  • Committee Discussion

P R O C E E D I N G S (3:45 p.m.)

MR. REYNOLDS: My name is Harry Reynolds. I am Chairman of the Subcommittee on Standards and Security of the National Committee on Vital and Health Statistics. The NCVHS is a federal advisory committee consisting of private citizens that makes recommendations to the Secretary of HHS on health information policy.

On behalf of the subcommittee and staff, I want to welcome you to today’s breakout session from our full committee meeting. We are not over the Internet today. As is our custom, I would like to start with introductions, and then we will get into the agenda.

(Whereupon, introductions were performed.)

MR. REYNOLDS: Two or three things we are going to discuss today. The first is, we are going to go through the agenda for our September 21 and 22 hearing, make sure that everybody is aware of what is going to go on there, and we will be prepared for that.

Second, you each should have in front of you our charter plus our portfolio of things that we have to consider, because I think it is important for us to look at that again and make sure that we have four different categories of things that we look at, both future areas, understanding and evaluating new regs, oversight of current initiatives and updates from the industry and HHS. So we have got to make sure that as we go past our September agenda that we are keeping a clear look at the different things that we are supposed to be keeping an eye on.

I also want to talk a little bit about the ROI. We had some hearings earlier. We didn’t quite finish them. I noticed in the HIPAA report that came out, it mentioned our ROI hearings. Right now we are not exactly sure how we are going to close those, and we need to talk about that for a few minutes.

So unless anybody has got any changes, we will start through that.

Everybody should have in front of you the September 21-22, the second page of it, which lists Wednesday, July 27. Ignore that date. I will be the 22nd. It will be the day after the 21st.

We are going to cover, it looks like three or four subjects. The first one is matching patients to their records. As you all know, Judy Warren is coordinating that for us, so we will have that in the morning, and that will take us through to lunch. Three different sets of presenters.

After lunch we are going to have an update from CAQH on the core project. Further, we are going to have an update on the results of a survey on claims attachment ROI, and we still don’t know exactly who is going to be doing that. Then later that afternoon at 3:45 we have an update on key issues, especially as it relates to CHI, that are going to be covered.

Then the second day, —

MR. BLAIR: By the way, who is going to do the testimony on CHI?

MR. REYNOLDS: It is Beth Haley. Beth Haley is going to do that. Then the next morning, the 22nd, we are going to first have an update from John White and Maria Friedman on the e-prescribing pilot. Then we move into Stan’s agenda items, and we have three discussions on secondary uses of clinical data. Ken Spackman will do the first one, James Semino will do the second one, and Stan will do the third one.

So basically that is what we are going to be doing in September, so we have a multifaceted session coming in. Justice, since you are here from Quality, this is our second effort into secondary uses of clinical data. We had talked to Bob Hungate earlier, as to whether any of you would want to call in and listen to that segment, so we can start getting a sense of how we merge and interface with that.

MR. BLAIR: What is our adjournment on the second day, what time?

MR. REYNOLDS: Our adjournment on the second day is 12:15. Any comments or questions or issues related to that from anyone? Hearing no questions on that, let’s move to the next agenda item.

You have the chart in front of you of our portfolio of items. We will drop halfway down the left-hand side of the page, where we talk about future areas of interest. As you know, the first one listed there is secondary uses of clinical data, so we are still active in that. Matching of records to patients is the second one, we are still active in that. The grand strategy for terminology, we haven’t scheduled anything yet. AHIC, and exactly how that relates to us, we haven’t scheduled anything yet. Interoperability was listed there, and JELO was listed there.

MR. BLAIR: JELO, that should be clinical decision support. JELO is just a standard that would be an example of the issue of clinical decision support.

MR. REYNOLDS: So we should make that clinical decision support?

MR. BLAIR: Yes. Stan, do you agree?

DR. HUFF: Yes, I agree.

MR. BLAIR: We shouldn’t be listing it as JELO, we should be listing it as clinical decision support.

MR. REYNOLDS: That’s great, that is perfect, we will just list the clinical decision support. Does anyone else have anything that we would list? Are there any other areas of future interest that right now jump out at anyone that we should have on our list here, our portfolio that we are thinking about?

MR. BLAIR: To be candid with you, I am a little bit frustrated that we don’t have a better understanding of how our relationship with AHIC and with ONCHIT would be. I feel that we are very vulnerable to heading down some paths, and then having to switch paths abruptly if we learn that we are needed in some other area. But I guess they are doing their best to try to get in with Katrina. Maybe they had hoped to have that information for us today and just didn’t have it.

MR. REYNOLDS: I agree with your comment. I think the whole reason we are going through this list today is to make sure that we step back a minute, stay focused on the things we already have, and I am going to go through some others in the other categories, so that we make sure we don’t get running too fast.

We have two new subjects we are already running hard on, secondary uses of clinical data and matching records to patients.

MR. BLAIR: Correct.

MR. REYNOLDS: So my feeling would be that we shouldn’t take any more futuristic looks right now and start setting up hearings until we get a better sense of exactly what is going to come down.

DR. FITZMAURICE: One thing that might be under oversight of current activity initiatives, but will be coming out sometime soon, is claims attachments. We might want to keep that on a low radar screen.

MR. REYNOLDS: That would be on understanding and evaluating new regs, wouldn’t it? It is not even out yet.

DR. FITZMAURICE: Yes, or it could be oversight.

MR. REYNOLDS: It will be after it comes out, yes.

DR. FITZMAURICE: Okay, great.

MR. REYNOLDS: And what one was that one?

DR. FITZMAURICE: Claims attachment.

MR. REYNOLDS: Did you want to move it? It is listed under — it is the second one under understanding and evaluating new regulations or subjects. Steve, you had a question?

DR. STEINDEL: I just had a comment. When we were changing JELO to decision support, I would use standards for.

MR. REYNOLDS: Standards for clinical decision support?

DR. STEINDEL: Yes, because I don’t want people to get the sense that we are taking on the whole ball of wax on clinical decision support.

MR. REYNOLDS: Okay, that’s good. Let’s go through the next category, understanding and evaluating new subjects, harmonizing standards. Jeff, that could be something we could end up with out of the other. HIPAA attachments, Michael, to play off your point, that is something that will be coming soon.

MR. BLAIR: Again, we are thinking specifically of HIPAA claims attachments, is that correct?

MR. REYNOLDS: That is correct.

MR. BLAIR: So maybe we ought to add claims attachments.

MR. REYNOLDS: Okay. E-prescribing we had listed under there, as it rolls out past the pilots.

DR. FITZMAURICE: I would think about another term here. There are other HIPAA standards than just the claims. As the industry moves ahead on those, or as CMS moves ahead on those, we would want to be kept abreast of that. Things like the enrollment, the electronic funds transfer, a lot of queries and responses.

MR. REYNOLDS: I’d like to recommend that we put those under oversight or current initiatives, under HIPAA. Rollout contingencies, ROIs and current transactions.

DR. FITZMAURICE: I was just thinking they may be new regs or they may not be new regs. I just don’t know where to put it.

MR. REYNOLDS: We also have a whole other group that is the ones like the elimination and claims status and the others that haven’t billed out as fast.

DR. FITZMAURICE: That is what I mean.

MR. REYNOLDS: So current transactions, not 837, because a lot of the focus has been on the claims 837.

DR. STEINDEL: Harry, should we put on there in the discussion of the quote-unquote HIPAA world what might be augmented in the HIPAA world, not through regulation?

MR. REYNOLDS: What do you mean? I don’t know what you are talking about.

DR. STEINDEL: Like for instance, with claims attachments, I’ll use that as a specific example, while the claims attachment reg is going to come out with a set of very specific attachments, there can be business partner agreements or industry-wide agreements to add other claims attachments that aren’t regulated. We have heard examples where we might want to create — where partners might want to create transactions, more real time transactions or things like that, that are done more in the X-12 world.

MR. BLAIR: So are you suggesting that we change the matrix here somehow?

MR. REYNOLDS: Whatever you think you are saying, let’s put it under evaluating and understanding new regulations or subjects. Tell me how you want to term it.

MR. BLAIR: Michael already said other attachments.

DR. STEINDEL: No, but what I was thinking about is stuff that is in the claims process that would not be regulation. So maybe something like improving the claims process, or improvements to the claims process. And you might want to put parentheses, non-regulatory.

MR. REYNOLDS: Okay. We are going to talk about e-prescribing pilots in a minute. Does anyone see any of these that we need to start — none other one I didn’t mention was the HLM code mapping. Remember, that was a discussion we had that is listed here? That may be one that, if we move into a — after September, when is our next hearing?

MR. BLAIR: December.

MR. REYNOLDS: If we haven’t heard anything from AHIC, we will need to start putting together what we would think for December. So let’s hold on that for just a moment. Let’s make sure we have got everything in the categories that people might want.

DR. FITZMAURICE: I would support the look into the NLM code mapping. AHRQ is funding last year and this year quite a bit of that. It would be good to have the oversight and give them the opportunity to present again. I think Vivian did some of that earlier, and there is even much more going on.

DR. STEINDEL: Didn’t Susie Burke-Beebe request time the first part of next year?

MR. REYNOLDS: Okay, we will list that as a possible February.

MR. BLAIR: Let me get a clarification on Susie’s, because I believe what Susie was asking for was the review or testimony from the contract that NLM has with HL-7 regarding specific codes.

I don’t know, Stan, maybe you know more about that and can tell us more about what that is.

DR. HUFF: The contract with HL-7 specifically was to replace HL-7 internal tables with CHI terminologies and have those approved and become part of the standard for use in the U.S.. In a simple way it is saying anywhere possible, HL-7 code sets should be replaced by SNOMED, LOINC, RX Norm or one of the drug identifiers from the FDA, et cetera, instead of having any of those HL-7 code sets just be local to HL-7 wherever possible. There are some things as we get into it that you wonder how they would be generally useful outside of specific standard use. But that is the context. That is the terminology part of what the NLM has funded HL-7 to do.

MR. BLAIR: So that is really not the same as NLM mapping?


MR. BLAIR: But it sounds to me as if that might be a subset under our standards hospitalization topic, yes?

MR. REYNOLDS: Could be.

DR. HUFF: There are a couple of aspects. One is the mapping. Also, it overlaps with secondary data use, so there is mapping for the purpose of rollup and that sort of thing, which is not really mapping in a way, but I think people are calling it that name as we have talked about it.

Then the other thing is this quote-unquote grand strategy for terminology, which is how is this really going to work. If I am supporting my EHR, am I going out and getting a download from SNOMED and one from LOINC and one from somewhere else, and every facility is doing 20 downloads, or is there in fact a way that we can have one place and we understand the flow, so that the terminologies used in the EHR are maintained in one place, people are getting periodic updates from one source that covers everything they want to use in their EHR system.

MR. BLAIR: So you are thinking it would fit better under the grand strategy than standards hospitalization?

DR. HUFF: Well, I guess I am thinking it could fit anywhere, but somehow we need to either label it multiple things or recognize it is serving more than one purpose by talking about those mappings.

MR. REYNOLDS: Anything else anyone wants to add under understanding new regs or subjects, other than what we talked about?

Let’s go over to updates from HHS and industry experts. We will be getting an e-prescribing update from CMS on the 21st, so that is scheduled. Are there any others anyone can think of that we are going to need something soon from?

The ones that are listed here, Jeff, just to help you out quickly, under CMS we had HIPAA and e-prescribing. We have AHRQ listed, we have NLM, we have DEA, and WIDI, DISMOS, SDOs, et cetera.

MR. BLAIR: Yes. What is the CAQH that is on the agenda?

MR. REYNOLDS: That is on the agenda for the core process. That falls under HIPAA, where the industry is trying to set up agreed-upon standards for eligibility and those types of things. Robin Thomasauer is coming in to talk about that.

MR. BLAIR: Okay. I forget what CAQH stands for.

MR. REYNOLDS: Committee on Affordable Quality Health Care.

MR. BLAIR: Okay, thank you.

MR. REYNOLDS: We have one outstanding item. Let me comment, and then I see both your hands.

We do need to get an update on — we had the question outstanding on e-prescribing, and what was going to happen with scheduled drugs. There was supposed to be a meeting when we were in San Francisco, I don’t know if that happened. We don’t have Maria or Karen here today, so we don’t know what is going on or what is happening with that. So we do need to get an update. So I will touch base with Maria on that, to understand what the next step might be in that situation.

MR. BLAIR: I think we should add on the updates from HHS and industry experts, FDA. We need to find out what is going on with their medication terminologies.

MR. REYNOLDS: Okay, and that would be Randy, right?


MR. REYNOLDS: What was the subject again?

MR. BLAIR: This is the federal medical terminology set. They are actually going to release the first versions of it in October.

DR. STEINDEL: Is that SPLs, structured product labels?

MR. BLAIR: SPL, the terminology to support SPL.

DR. FITZMAURICE: FDA is also dubbing into device identification as an issue, like drugs are identified with NDC codes. There should be unique identifiers for devices, but there aren’t. So while FDA isn’t putting out a regulation, AHRQ is funding them to help develop guidance to the industry. So unique device identification may come about.

MR. REYNOLDS: Would that be over understanding and evaluating new regulations or subjects?

DR. FITZMAURICE: Well, it is not a regulation.

MR. REYNOLDS: Yes, but it is a subject.

DR. FITZMAURICE: It is a subject.

MR. REYNOLDS: That is what I am saying.

DR. FITZMAURICE: They have testified before. It has been about three or four years ago. An update on that would be good.

MR. BLAIR: Now, at one point codification for medical devices was listed under CHI standards. Is this not the same anymore?

DR. FITZMAURICE: I don’t recall that we have one under the CHI standards. At one point we were faced with a recommendation, and we didn’t know whether to go with — for classifying devices, UMDNS or GMDN. Our recommendation was to go out and try to merge each other together. They still haven’t done that. So we should ask FDA, what are you doing about that, and why support a worldwide standard like GMDN, and not support also a U.S. national standard of UMDNS. It is not a national standard, but it is the one most in use, it is an ad hoc standard.

MR. BLAIR: I thought it was a CHI.


DR. STEINDEL: The issue is the CHI issue. It is an open issue.

DR. FITZMAURICE: But it was not a standard, because the Secretary has not adopted anything on devices.

MR. REYNOLDS: We will talk about Randy about maybe getting an update on both of these items.

DR. FITZMAURICE: Randy is not devices. It would be somebody else on devices.

MR. REYNOLDS: He is our interface to FDA, right? I want to work through our staff interfaces on the subjects. He may not be the one to do it.

Let’s go to the next, oversight of current initiatives. Let’s talk about ROI for a minute. We had our hearings, and Jeff and I and Maria had put down five or six actions or possible recommendations that came out of those hearings. But we had talked about some other things. We had talked about having some other people come in and testify about the impediments that they were facing as far as trying to implement HIPAA. We have had a hard time getting — more and more of these companies, especially in these practice management systems, are buying each other up. The industry is changing quite dramatically on a regular basis. So every time we start trying to talk to somebody, there is somebody else, or they are gone, or they are getting pulled together.

So that is an outstanding item, but also, if you look at prefacing the document that we just agreed on a little bit ago as a full committee, it has a couple of paragraphs in here about ROI. So it is on the table. We have had some hearings, but now I would put it in limbo status.

So my question would be, we are in print that we are having it, we are in print that we are looking at it. We are in print that we have had some hearings, but we don’t have planned a letter or a closeout for those hearings. So I would like some discussion today from everyone on how do we close out this subject. Have we heard enough? Do we want to hear some more? If we want to hear some more, we need to close it in December and get it off the plate, because if we let this testimony sit much longer we are all going to be out of touch with what we thought we heard or didn’t hear, or how we ought to approach it.

Jeff, you have a comment?

MR. BLAIR: Yes. I think we ought to keep it on the list. I think we ought to pursue it. I find it interesting that we have having difficulty getting relevant people to testify to us on this issue.

MR. REYNOLDS: Mainly because we can’t. We don’t know exactly who to get hold of.

MR. BLAIR: I see.

MR. REYNOLDS: We had a bunch of people we tried to find and get hold of, and a few of them moved. It is just hard to get a short list that is going to be a long enough view.

MR. BLAIR: The reason that I think we should keep it frankly on our short list is, we never know when things will — the whole idea of transforming health care into the information age will be challenged. If we have hearings where we can somehow show whether return on investment is from HIPAA or a coherent justification for why it was impaired, that return on investment was impaired, then that could be very valuable to sustain and support any challenges to the movement or standards and EHRs and everything else that we care so much about.

So I think we have to keep it there, because we may need it for defense purposes.

MR. REYNOLDS: I agree. Any concerns?

DR. CARR: Harry, I see John Lumpkin is speaking at your hearing. He actually shared with us when he spoke to the Quality group about the ROI in Massachusetts. He had some very detailed dollars and cents return ROI information.




DR. CARR: Yes, the implementation of HIPAA. In Massachusetts the cost of a claim went from 12 dollars to three dollars or something like that. He has chapter and verse, very, very detailed, because they have been very organized. Marjorie had commented it is the most precise and compelling, optimistic measurement. So you might want to even ask him if he could share some of it with you.

DR. STEINDEL: I have a question and then a comment. They are not doing anything like eligibility checking and coordination of benefits in Massachusetts, are they, to any real extent?

DR. CARR: I can’t speak to that.

DR. STEINDEL: My guess would be no, because that is what we have heard, that those transactions are not in widespread use. What we have heard otherwise is that we are not going to be really seeing real ROI from HIPAA until we have coordination of benefits and eligibility checking. This is an example of where they have dropped things from 12 dollars a claim to three dollars a claim without that.

DR. CARR: It is very good news. I’m not doing it justice and I am not familiar with it, but —

MR. REYNOLDS: And that would be one set of providers, and they will be anxious to see —

DR. CARR: It is coordinated across Massachusetts, kind of initiative.

MR. REYNOLDS: So if we go down the oversight occurred initiatives, HIPAA, we could have some further ROI discussions. The current transactions, the status of those, I think that might be something that we could ask CMS to keep an eye on.

Obviously we have heard a lot from CMS on the 837 claims, but we have heard very limited from them on the 27X transactions which are eligibility and claim status. So we could ask them to include that in their standard updates that they give us.

DR. STEINDEL: If I recall correctly, at the NUCC meeting in the CMS report, they said that they were going to be focusing next on coordination of benefits.

MR. REYNOLDS: Well, yes. But again, if you look at it from an industry standpoint, eligibility and claims status are the ones on the table right now, that can reduce effort.

DR. STEINDEL: What we heard from it at NUCC was, this outside group that is working on developing industry standards, —


DR. STEINDEL: CAQA, yes, that’s right, that is where it came from.

MR. REYNOLDS: That is what it is.

DR. STEINDEL: And she gave a very good talk on what is being developed in that area.

MR. REYNOLDS: She is going to come in and talk to us. But it would still be good to get a sense, since obviously — CMS now has passed a milestone where they have pulled off the contingency on claims. They are looking at COB, but there are these other transactions sitting out there that it would be interesting to hear an update on, not to necessarily say we are getting anything special out of it.

Under e-prescribing, we are going to get the update on the pilot test. Do we want in December or so another update from NCPDP? I think some of those things are going to roll out in September or October to their board. That would be a good thing to maybe help close the year to make sure we understand if there is any good closure there that we would need to report anything on.

DR. FITZMAURICE: Plus it would be a good service to AHRQ and to CMS. If they get rolled out, then they will be available for testing under the pilot.

MR. REYNOLDS: There you go, exactly.

DR. FITZMAURICE: It is essential, Harry.

MR. REYNOLDS: So let’s schedule that for December then, okay?

MR. BLAIR: It is an opportunity to declare a victory.

MR. REYNOLDS: One of the other things we had listed here was security, rollouts and complaints. Does the committee see any reason that we need to be jumping in the middle of security right now? We are not hearing any issues, we are not hearing any concerns, we are not hearing any other things like that.

MR. BLAIR: Is John Houston here?

MR. REYNOLDS: No, he is not.

MR. BLAIR: If John wants to lead or tackle that, that would be great. But if he is not here, I don’t feel like we have expertise to go after it, or the energy.

DR. STEINDEL: It is my feeling on the security issue with respect to HIPAA, no, we don’t really need to hear anything about it, but we need to keep an open issue.

MR. REYNOLDS: No, I’m not going to take anything off of here. I just want to make sure that Jeff and I and Maria look forward, that we make sure that we know what this committee has decided are the key next steps. We keep the right things in play, because then all of a sudden if something changes with AHIC or ONCHIT or anybody else we might deal with, we have a good road map. Even if we had to do something for them, we still may want to have a half a day on some of these other things. We have already decided on things we have got to close.

I’m just trying to keep a one-page view of the world for us, so that if things start happening different than we expect or start jumping around, that we at least have our own template of what we are supposed to be doing. That is the reason I tried to put this together.

Now, let’s move to NPI, which is another one on here. Is there any reason yet that we should start hearing anything about any key milestones or any things that are coming up on NPI? We talked at one point when we first had the hearings, there is no question that we had recommended and discussed that there be significant education, so that people understand what this NPI is really about.

I continue to hear in my day job a significant amount about exactly what NPI means, as early as yesterday hearing that maybe people will have 50 NPIs. So it is a little bit like our PHR and EHR discussion. NPI was supposed to be a unique identifier. If somebody is going to have 50, I’m not sure you jump right out there with unique. It will be the same, but I’m not sure unique becomes the term.

So I think it might not hurt — I know CMS has some key milestones and other industry players have some key milestones in January. Maybe if we don’t get any major shift from AHIC or ONCHIT or anybody else, maybe in our spring hearing might be a time to get a look at this. One of the things that we tried to talk about is how can we take care of some of the impediments that occurred in the original HIPAA. Well, NIP is a full industry, full shop situation again. It might not be bad for February to have a discussion of that. Is that fair, from the committee?

MR. BLAIR: And we can list it as SPI instead of NPI, which is schizophrenic.

MR. REYNOLDS: What’s that?

MR. BLAIR: Schizophrenic, provider identifiers for multiple —

MR. REYNOLDS: Yes. Is there anything else anybody — are there any other subjects that we haven’t talked about that should be on our list as far as what we want to consider?

DR. FITZMAURICE: Harry, did you put this together?


DR. FITZMAURICE: This is an amazingly good way of looking at it. I really appreciate your efforts in doing this.

MR. REYNOLDS: Thank you. Remember, we talked about it. What is important to me is, especially the way the times may change, that we all have a one-page — and we will get it updated and sent back out, we all have a one-page of what we have agreed we are going to think about. If you look in the upper right-hand corner, we agreed to have a balanced portfolio. If we aren’t careful, we can get led off by any number of entities that could take us away from what our mission is.

What struck home today is, we have to do a yearly report to Congress on HIPAA. If we don’t have HIPAA here somewhere and we get jerked off onto other things completely, then we don’t have an update for Congress. We have already said we have some other things that are undone. So that is what this is all about.

DR. FITZMAURICE: I’m not sure Page can handle it; it might be useful to have another category called products. Some of the products might be a report on HIPAA, letters to the Secretary. It doesn’t have to be a specific letter, but a category of products so that we have some measure of what we do. Number of hearings held.

MR. BLAIR: Could we call it maybe deliverables instead of products?


MR. REYNOLDS: Yes, standard deliverable. No, our regular deliverable, how is that? We don’t want to call them standard. We don’t want to do that. Dawn, if you and Maria could help me with those so that we can update this, okay?

DR. STEINDEL: Harry, can we hold hearings on the constructs of what should go into the standards for the standard deliverable?

MR. REYNOLDS: Okay. One other thing came up that Dan Rode brought to my attention right before this meeting was — I don’t see a way to put it on here yet or whether we should, but it appears that there were some hearings in the Ways and Means Committee. One of the issues that is coming up is, instead of going to 40-50 on the 837, going to 50-10, because it is the launch platform for ICD-10. Out of these hearings, there appeared to be some discussion as to how should these updates to standards flow.

For example, does X12 want new versions to come out every year as a standard, rather than right now, when you have got a three year or so run-out to get something done. So that was just a flavor of what came out. I don’t plan to put anything on here yet. Jeff, please, you can override me if you feel we should, but I think it is the kind of thing — he just brought it up, so I at least want to make it clear to you.

MR. BLAIR: I think he touched on a subject, and it reminded me of something I had forgotten about, although right now I am forgetting a lot of things.

We had a request from Pat Gibbons. She asked to testify. She was one of the individuals that testified with Chris Schute to the House Ways and Means Committee. I gather from the e-mail — and I think I forwarded it to you.


MR. BLAIR: And to you, Stan. They are raising the issue of at one point to use SNOMED CT as that foundation, and whether or not we — do we need to go ICD-10 and have the mappings. Some people are talking about ICD-11, do we even want to think about that?

So the whole idea of that long term strategy for standards is where I think she would fall. She would like to come in September to talk to us. Is there room on the agenda, or are we full?

MR. REYNOLDS: I think we are full.

MR. BLAIR: Then maybe we could list her as a candidate for December.

MR. REYNOLDS: Is this a grand strategy for standards? Do we want to add this as another subject?

MR. BLAIR: Underneath that topic, at least for now.

MR. REYNOLDS: We will add a new one called grand strategy for standards.


MR. REYNOLDS: Okay, we’ll add that.

MR. BLAIR: Stan, did you have any thoughts or observation on that?

DR. HUFF: I visited with Pat a time or two, and I think it is a very interesting discussion.

MR. REYNOLDS: Is that for HIPAA standards, or just standards?

DR. HUFF: No. Well, it is broader.

MR. BLAIR: It also includes the clinically specific standards like SNOMED.

MR. REYNOLDS: What was her name again?

MR. BLAIR: Pat Gibbons.

DR. HUFF: The other issue it brings to mind is, there was the very controversial ICD-9, ICD-10 thing. Even somebody just take five minutes and say, it is progressing, or we have hit a roadblock, or it is dead. It would be a little interesting just to find out if there is anything we need to do there, or if there has been any progress, or any need for us to say anything more about that. It may just be bigger than us.

MR. REYNOLDS: CMS could do that, right? Is that correct? Do we want that to be a December —

MR. BLAIR: Maybe in the December time frame, Betsy Humphreys or somebody from NLM could also — because they do the mappings.

MS. PICKETT: We had indicated that the National Library of Medicine would come to the February meeting. So do you want to change that and move them to December?

MR. BLAIR: Maybe we need a little bit of both.

DR. FITZMAURICE: Let’s ask Donna. Who is the best person to report on how the move from ICD-9 to ICD-10 is being considered, that is, where the buck is stopping? What does it take to get it to the next step? Because most of us don’t know where it is stopped right now. NCVHS made a recommendation, went to the Department, and it disappeared.

One answer could be, it is on somebody’s desk who has recently been promoted, and the opportunity has not been taken to escalate it to any other level. If NCVHS simply asks what happened to it, we could get a report, and that might generate some activity, in the sense that somebody says to somebody else, NCVHS is asking about this, they made a recommendation, how do we respond?

What is your advice, Donna?

MS. PICKETT: I was just mentioning to Harry that perhaps I could speak with Jim Scanlon, because I think it would be an HHS response as opposed to an NCHS or CMS response. The letter from the committee went to the Secretary for Health and Human Services, so the response should at least appropriately — we should start with them in terms of a response.

DR. STEINDEL: Harry, in that particular area, we have asked several times over the — now it gets close to two years since we sent the letter, the unnamed person, this question. The answer that we have gotten is, I am reasonably certain, the same answer that we have gotten in the past. It is on the Secretary’s desk, and he is considering it.

The rumors that I have heard is that the Secretary has figured out a pathway to consider it, but I don’t know if that is true or not.

MR. REYNOLDS: Hearing some of this, if you look at our agenda, we have got some things for December and we are looking at February. If ICD-10 is with the Secretary, I think Katrina has that focus for a period of time, so that may be sometime around February when we take a look at it.

DR. FITZMAURICE: Maybe it is something to ask about in an update, to ask Jim what his advice would be.

MR. REYNOLDS: We will talk to Jim about it, yes.

DR. FITZMAURICE: Even if this regular update he could say, well, it is in the Department, or what do we do.

MR. REYNOLDS: Were there any other items?

DR. STEINDEL: The discussion about standards and the standard update process in HIPAA and everything, we had in our agenda before to look at how can the HIPAA process be improved. We were waiting for a reg from CMS that was supposed to address this. We may want to look into what the status of that is. We may want to look into what the status of that is.

This somewhat gets to the question of, can we have yearly updates to the standards without going through the regulatory process, et cetera.

MR. REYNOLDS: We listed some of that stuff in one of those letters, didn’t we?


DR. CARR: That idea about grid or non-grid or whatever, about what were our deliverables and what happened to them of interest.

MR. REYNOLDS: Right. Any other subjects?

MR. BLAIR: Let me just express my thought on this. On cases where we have made recommendations and we haven’t seen a response or an implementation on those, my feeling is that we need to keep those on our list, but that when we don’t get responses, that we ought to put our energies on blazing new trails, like the secondary use of patient records and matching patients to their records.

It may not be that they are being ignored. As long as we could move the ball forward with these new initiatives, I think that should have the highest priority.

DR. STEINDEL: Just to echo what Jeff is saying, I think in at least two significant letters and maybe three, one the NHII report, the other the PMRI message standards and then the PMRI terminology standards, I think the basic response that we got back on those letters was, thank you very much, we received the letter. But I think we all can see the impact of those letters.

MR. REYNOLDS: Anything else anybody wanted to add to the list? Anything else that anybody else wants to consider? If not, we will stand adjourned.

(Whereupon, the meeting was adjourned at 4:35 p.m.)