Hotel Monaco
Chicago, Illinois
The following people attended this meeting, which was open to the public:
The NCVHS Executive Subcommittee held a day-long retreat on Friday, July 26, 2002, in Chicago. The purposes of the meeting were to review recent activities and accomplishments, discuss goals and plans for the future, and set agendas for forthcoming meetings. These discussions extended the strategic planning work of two previous retreats, which focused on integrating the Committee’s activities and priorities, evaluating its structure and operations, and enhancing its working relationship with the Department.
Dr. Lumpkin began the meeting by remarking on the Committee’s extraordinary productivity and growing impact in recent years. He predicted that its heavy workload will continue and that conditions are propitious for making an even greater contribution in years to come.
The major themes that wove through this year’s discussion concerned how the Committee’s subcommittee and workgroup activities fit together; whether the full Committee should have its own work plan and projects; and how to more effectively support overall population health without undermining the ongoing work on the health of specific populations. The Committee’s mission statement, formulated at the 2000 Executive Subcommittee retreat and approved in September 2000, provided context for these discussions: The mission of the National Committee on Vital and Health Statistics is to advise on shaping a national information strategy for improving the population’s health.
Members agreed on the desirability of having overarching goals and issues for the full Committee. This theme became linked to a recognition that no NCVHS group currently is holder of the population health vision. The group agreed that pursuing the population health mission must begin by studying what is meant by “population health,” to help the Committee achieve a common understanding. They created a plan to accomplish this (see first set of Actions below). It was suggested that a clarified and more prominent population health framework can provide a frame of reference for assessing the success of all Committee projects.
A related question concerned the relationships among subcommittees and workgroups and between each of them and the full Committee. Members expressed interest in having clear mechanisms for these relationships and for integrating the Committee’s agenda. They agreed that more projects should be initiated at the full-Committee level, giving the entire group a chance to learn about a given issue and explore cross-cutting aspects before delegating the work on it to one or more subgroups.
There was widespread feeling that after years of having its agenda dominated by HIPAA assignments, the Committee as a whole and at least some of its subgroups can now move ahead on other priorities, while continuing to advise on HIPAA implementation and process.
The group discussed ways that various conceptual frameworks could aid their work. The framework outlined in the report on 21st century health statistics was put forward as affording the broadest perspective on population health and its determinants; within that, the framework of the National Healthcare Quality Report provides an unusually comprehensive approach to assessing healthcare, one contributor to population health. The NHII framework lays out the domains and overlaps for the personal, healthcare, and population health dimensions of health information. It was suggested that the NHII Workgroup has the breadth of perspective to help integrate the Committee’s activities and to fill in programmatic gaps as needed.
An important “sidebar” discussion concerned the need to hear more from consumer voices in the Committee’s future deliberations. Members agreed that it would be impossible to designate a single “consumer representative”; the idea is to seek out a range of consumer voices, from such sources as advocacy and support organizations.
To operationalize the population health mission and provide an overarching issue for the full Committee, the Executive Subcommittee agreed on the following actions:
The theme of coordinating subcommittee and workgroup activities carried over into the discussion of operational issues. A process for bringing issues to the full Committee and giving status reports was discussed but not formally adopted. These and the other operations-oriented discussions are reflected in the action items listed below.
Members considered ways to use full-Committee meeting time more effectively, to allow time to interact with presenters and explore issues. Dr. Lumpkin proposed getting a timeclock to help speakers stay within their time allotment; staff will investigate this possibility. The trade-offs were noted between wanting to hear a broad range of views on a given subject and wanting to achieve a higher level of understanding of issues and to interact in depth with speakers. Members thought that two or three panel members were probably the maximum possible for the second objective. The idea is to have the purpose of the session guide decisions about the approach.
The group also looked at resource issues relating to agency liaisons, new members, and staffing. Members were informed that CMS has appointed a new liaison to NCVHS, who is expected to start attending meetings in September. Also, Dr. Sondik has expressed strong interest in having a NCHS liaison, a role he hopes to fill himself. This was supported by the Subcommittee. The group explored the question of whether it should seek out other agency liaisons, and the related question of the criteria for such relationships. The importance of being clear about what the Committee is looking for was stressed. (It was noted that the ongoing AHRQ liaison, Mike Fitzmaurice, is an outstanding model.) After considering a range of possibilities, the Subcommittee agreed that while they would like additional ways to interact with HHS agencies, for now the Committee will invite new liaisons only from NIH and CDC. They asked Dr. Lumpkin to talk with the Data Council about other ways to interact with HHS agencies.
Regarding new members, it was noted that several NCVHS members have served well beyond their intended terms. However, the Secretary has placed a freeze on all advisory committee appointments. The Committee’s requests for needed expertise have been communicated, in anticipation of an eventual decision by the Secretary to appoint new members. In particular, the Subcommittee on Populations and the Workgroup on 21st Century Health Statistics need members.
The group discussed the need for additional staff support and various options for meeting this need. Subcommittees and workgroups were encouraged to take fuller advantage of the existing consultant capability to support their work, and to plan ahead to do this so as to incorporate them into Committee process and budgets at the appropriate time.
The Subcommittee on Standards and Security has been focused on code sets recently, and is working to reach consensus on a letter and recommendations on the transition to ICD-10-CM and ICD-10-PCS. On August 28-29 it holds the first of two hearings on patient medical record information terminologies, the second to be held in December. It hopes to bring PMRI recommendations to the full Committee in mid-2003. In October 2002, it will hold a hearing with Designated Standards Maintenance Organizations on HIPAA updates and tracking HIPAA implementation. Dr. Cohn said he hopes eventually to have more far-ranging discussions about improving the HIPAA process. The Subcommittee is also laying groundwork for partnering with the people involved in the Consolidated Healthcare Informatics (CHI) Initiative. It will devote day two of the August hearing to learning about that and other interoperability initiatives, with an eye to minimizing redundancy among them. CHI will also present to the full Committee at its September meeting.
The Subcommittee on Privacy and Confidentiality is hosting a series of hearings in the Fall to learn what covered entities need to be able to implement the Privacy Rule. It may develop a document that OCR can use for technical support. The hearings are October 29-30 in Columbia, SC (subsequently changed to Baltimore, MD), and November 5-6 in Salt Lake City. Because the goal is to produce a letter by the full Committee’s November meeting, imposing a time constraint, Mr. Rothstein asked the Subcommittee’s views about holding the third meeting in Boston on September 11. This date, while sensitive, is the only one workable for members. The Executive Subcommittee gave its support to going ahead with a hearing on this date.
During the earlier discussion on overarching themes, Mr. Rothstein had expressed a strong hope that the Privacy and Confidentiality Subcommittee could soon free itself from its preoccupation with HIPAA and address a concern about the migration of personal health information out of clinical settings and into other settings. He noted the overlaps between population health issues and privacy/confidentiality issues in this area. Executive Subcommittee members encouraged the Subcommittee on Privacy and Confidentiality to pursue this topic when time allows.
The Subcommittee on Populations is continuing its research into past NCVHS recommendations related to health disparities, and their disposition. It has engaged a writer to develop a report, with a product tentatively planned for February, 2003. The findings will be integrated into the Subcommittee’s planning for future projects. It is now engaged in a series of hearings on data needs related to health disparities. Dr. Mays said the scope includes not just race/ethnicity but also socioeconomic status, geo-coding, language, and the perception of discrimination. A hearing on Native Americans, and possibly Asian and Pacific Islanders, will be held in Denver on September 27; the next, to focus on state-level issues, is tentatively scheduled for November 8 in Philadelphia.
As part of its advisory role with AHRQ, the Workgroup on Quality held a hearing on July 25 to receive comments from professional societies on the National Healthcare Quality Report. The Workgroup plans to submit its own comments to AHRQ following the September NCVHS meeting. Ms. Coltin reported that the Workgroup is working on a report on data issues and limitations in measuring quality of care and will formulate its recommendations in September and present them for preliminary discussion at the November meeting. The final report and recommendations are slated for presentation to the Committee in February, 2003.
The Workgroup on 21st Century Health Statistics expects to submit the final edits to its report and recommendations (which were approved in June 2002) and related documents to the Executive Subcommittee for final approval by the end of September. Dr. Friedman will work with others to plan the series of presentations and discussions on population health described above. He said he hoped the Workgroup would continue, provided it could get new members with appropriate expertise. Subcommittee members were supportive of his suggestion that if a Board of Scientific Advisors is not appointed for NCHS, the Committee and Data Council should explore how the Center can be helped to move into its envisioned 21st century role. Another priority for the Workgroup is continuing to explore with its collaborators how to move their report and the Committee’s recommendations forward. The Executive Subcommittee agreed that the 21st century health statistics report and recommendations should be presented to the Data Council at its October meeting.
The Workgroup on the NHII is looking into how to promote and implement the recommendations in its NHII report. Dr. Lumpkin said he hopes to present the recommendations to a senior person in HHS before long. The Workgroup held a hearing on the personal and population dimensions of the NHII on July 24. It learned that the industry is looking for guidance on the development of a minimum data set for the personal record and on vocabularies, both areas in which the Committee can be helpful.
The group discussed with Ms. Kanaan the report she is writing on the Committee’s activities and accomplishments in 2000-2002. The report, which is broader in scope than the annual report to Congress on HIPAA implementation, has a wide audience; it is sent to the Secretary, the Data Council, and members of Congress, and is posted on the Web site. In addition to suggesting modifications to the proposed outline, members agreed that the report should reflect this retreat’s discussions and stress the growing recognition of and reliance on the expertise embodied in the Committee. The key message is that NCVHS has established a reputation for thoughtful leadership that has been recognized by the Department, Congress, and the industry.
Members and staff planned the September agenda. The following possible agenda items were discussed:
These items were proposed for November:
The Subcommittee agreed to have a conference call in the Fall. Dr. Lumpkin then adjourned the meeting.
I hereby certify that, to the best of my knowledge, the foregoing summary of minutes is accurate and complete.
/s/
John R. Lumpkin, M.D. 9/25/02
Chair Date