[This Transcript is Unedited]
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TABLE OF CONTENTS
Agenda Item: Call to Order, Welcome
MR. REYNOLDS: Good morning. I would like to call to order the first of two days of hearings for the National Committee on Vital and Health Statistics. NCVHS is the main
health policy advisory committee to the Secretary on health information. My name is Harry Reynolds, Chair of the committee. I work for IBM.
Before we start, I would like to go around the room and have the members and staff introduce themselves. During your introduction, please note whether or not you have any conflicts of interest. I have none. Jim.
MR. SCANLON: Good morning. This is Jim Scanlon. I am the Deputy Assistant Secretary for Planning and Evaluation at HHS. I am the Executive Director of the full committee, and I have no conflicts.
DR. SUAREZ: Good morning, everyone. I am Walter Suarez. I am the Director of Health IT for Kaiser Permanente, and I am a member of the committee, and I don't have any conflicts.
MS. MILAM: Good morning. I am Sallie Milam, Chief Privacy Officer for West Virginia's Executive Branch. I am located at the West Virginia Health Care Authority, and I have no conflicts.
DR. OVERHAGE: Good morning. Marc Overhage, Regenstrief Institute, Indiana Health Information Exchange, a member of the committee, and have no conflicts.
DR. SCANLON: Good morning. Bill Scanlon with National Health Policy Forum and member of the committee, no conflicts.
DR. STEINWACHS: I am Don Steinwachs, Johns Hopkins University, member of the committee, no conflicts.
MS. TRUDEL: Karen Trudel. I am the liaison to the committee from the Centers for Medicare and Medicaid Services.
DR. HORNBROOK: Mark Hornbrook from Kaiser Permanente. No conflicts, member of the committee.
DR. GREEN: Larry Green, University of Colorado, no conflicts, member of the committee.
MR. LAND: Garland Land, National Association for Public Health Statistics and Information Systems, member of the committee, no conflicts.
MS. FRANCIS: Leslie Francis, Law and Philosophy, University of Utah, member of the committee and no conflicts.
MR. HOUSTON: John Houston, University of Pittsburgh Medical Center, member of the committee. I have no conflicts.
DR. WARREN: Judy Warren, University of Kansas School of Nursing, member of the committee, no conflicts.
MS. GREENBERG: Good morning. I am Marjorie Greenberg, National Center for Health Statistics, Executive Secretary to the committee. I want to welcome you to the 60th Anniversary Week. I just want to especially thank Susan Canaan and Debby Jackson for these gorgeous documents, as well as the whole program, which we are looking forward to tomorrow.
DR. KYLE: Frank Kyle, American Dental Association.
MS. JAMISON: Missy Jamison, National Center for Health Statistics.
DR. VALDEZ: Emilio Valdez, Summer Fellow, National Center for Health Statistics.
MS. KAHN: Hetty Kahn, National Center for Health Statistics.
MS. KANAAN: Susan Kanaan, writer for the committee.
MS. WILLIAMSON: Michelle Williamson, NCHS.
MS. JONES: Katherine Jones, National Center for Health Statistics.
MS. HORLICK: Gail Horlick, Centers for Disease Control and Prevention, staff to the Subcommittee on Privacy and Confidentiality.
MS. JACKSON: Debbie Jackson, National Center for Health Statistics, CDC, committee staff.
MS. DOO: Lorraine Doo, lead staff to the Standards Subcommittee.
MS. GARTH: Carrie Garth, CMS.
MS. LENHART: Cynthia Lenhart, intern with AHIMA.
MR. RODIE: Dan Rodie, AHIMA.
MR. CAZARRO: Cotton Cazarro, First Data Bank.
MR. DeCARLO: Mike DeCarlo, Blue Cross Blue Shield Association.
MR. REYNOLDS: Again, I would like to remind everyone that since we are on the Internet, if you will make sure that you get close to a microphone when you are making comments, so that those listening in are able to hear us.
An interesting agenda today and tomorrow, in that this morning we will get our regular updates, and as I open my discussion tomorrow in an incredibly exciting time to be on this committee, and in this environment. So as we get these updates, it will continue to show the progress that is going forward, and then tomorrow we will be able to talk quite a bit more about some of our visions of what is coming up in the future.
This afternoon a little time for the subcommittees to get together to in fact build off of the document. I would like to thank the population group from the committee, for heading up the original efforts on that. Then everybody jumped in, and it is now a full committee document that has been looked at in many different ways. I appreciate everybody's energy and effort in doing that.
Then tomorrow morning we will get some updates from the Community Data Initiative, and then our subcommittee readouts, and then tomorrow afternoon, as Marjorie has mentioned, we will be celebrating 60 years of what I call a professional relay race that has been going on for 60 years, with star athletes at every position. A lot of people before us have passed the baton to us, and we will be passing it on to others as we move forward. So a pretty neat environment to be in when you are playing with these kinds of people at these levels. When I say we, I include all the staff that has been so very, very helpful to us along the way. This is a big week, as we have done this for 60 years as a committee, so we will talk more about that.
With that, unless there are any questions? One other thing I will mention. When Jeff Blair gets here, we will recognize him for his service on the committee, if any of you want to say anything now. Then we are having dinner tonight, and I would hope that some of you would have some things to say this evening.
So with that, Jim, let me turn it over to you.
Agenda Item: Department Update
MR. SCANLON: Thank you, Harry. I think our last Full Committee meeting was back in November, and we were sidetracked by the snowstorms in February, so let me catch everyone up on a number of things. I have to say, many of these things are areas that the committee has been pushing for and working on for a long time. As Harry said, it is a relay race that never finished. It is a journey, more than a destination, all this. I did want to announce, we have appointed a Chief Technology Officer at HHS. I think some of you know him, Todd Park. Todd was involved in the founding of Athena Health, which is an IT claims processing organization that did very well. They provided back office operations for originally pediatrics and obstetrics, and now more broadly. So Todd's job at HHS basically is to every day think about how HHS can use technology in its internal operations, and how we can use technology to interact with our stakeholders and our community. He is a very enthusiastic fellow. We have already made a lot of progress as well; I will talk a little bit about some of those initiatives.
The Secretary has announced a number of priorities. I will be talking about those today. You have at your place, I believe it is nine priorities and some other collaborations. Virtually every one of them involves data in some form. I will talk a little bit about those so you can see where the policy is heading. Obviously the first one is health reform; I will talk a little bit about that as well.
Then I wanted to talk a bit about open government and the HHS open government plan. All agencies in the federal government have been asked to make their operations more transparent, more collaborative and more participatory. HHS and other agencies have developed open government plans. A number of those involve data and data transparency as well, so I'll talk about that as well.
First of all, I hope you have at your place the back page. That basically includes the Secretary's priorities and strategic initiatives. I will go through them very generally, but I wanted the committee to be aware of where the work we do fits in.
Again, there are a lot of other things HHS does, as you know. Those go on, and they are in no way diminished, but these are areas where the Secretary is willing to spend some of her own time and the leadership to move things along. I think they are viewed as large leverage kinds of areas, where if you can make progress in some of these areas, you produce change more broadly as well. Let me spend a few minutes on that, and then let me go to the open government plan.
The first of the initiatives is obviously transforming health care. This involves implementing the health care reform plus a number of other specific activities related to health care.
Obviously the Recovery Act, which we have talked about previously, implementing that properly, getting the money out, promoting jobs and economic growth, and to do some good public health wise as well. That is well underway, and we have to be sure that those are implemented properly.
Another area of the Secretary's priorities is less health as the early childhood development and health and growth. That is another side of the Department that we focus on.
Associated with each of these initiatives, I should say, is a task force or a leadership assignment or some other mechanism that basically developed goals and objectives, and then to move us forward as well.
Number four again is more of a preventive public health goal. It is to help Americans achieve and maintain healthy weight, a number of activities aimed at that area as well.
Another risk behavior focus is preventing and reducing tobacco use. Here, despite a lot of progress, the U.S. seems to be stuck at about a 21 percent prevalence every year. It is hard to get below that amount. There is a whole class of new initiates every year out of high school and other places just as others are quitting. I think we are trying to redouble our efforts and see if there are not some new strategies to reduce that as well.
Number six focuses on preparedness health and safety of Americans and public health emergencies, a longstanding priority.
Number seven is the scientific discovery area, to accelerate the process of scientific discovery and to translate those findings to improve everyday health care.
Number eight concerns food safety. You have seen in the news virtually every day some threat to food safety, so there are a number of activities aimed at improving that system.
Then overall, insuring program integrity and stewardship.
There are several key interagency collaborations as well. One is to reduce teen pregnancy and unintended pregnancy. Second is to support the national HIV/AIDS strategy. A third area of interagency work is global health, improved global health. Then the fourth is to foster open government. You will see under that area, one of the goals is to leverage all the data we have for maximum public good in public health.
I won't go further into these unless you have questions. But basically these are overall Secretarial priorities. As you can see, data is a big part of all of them.
In addition, we are in the process of developing our HHS strategic plan. This will be for the next five years. We will be posting that on our open gov website in about two weeks. We are asking for public comment. We welcome the comments of the committee. We are truly open to ideas here. If we have missed areas, if there are other areas that are there, we are open for public comment. This will be the strategic plan that will form the basis for many of our actions over the next five years, so it is completely revamped and so on. We are looking for everyone's comments.
Let me spend just a couple of minutes if I have them on the open government plan and the transparency initiative. The full plan is available on our open gov website, hhs.gov/open.
The President issued an executive order asking all the federal agencies to be more open and transparent in their activities, and to foster collaboration and participation in their work. You can see from our priority goals and strategic plan, HHS for the activities we undertake, we really couldn't succeed unless we involved all of the stakeholders and others as well. I think we are going to try to do that even more.
But a bit part of the open government plan involves data and making data that we have at HHS available more broadly. Some of you are familiar with a government website, it is called Data.gov, established by OMB. All agencies are directed to publish data sets and data tools there, and relatively without intellectual property restrictions, and relatively unfettered in any other way. Basically they are to be put there in open format source so that anyone can get at the data and use it.
So far, in HHS we have posted about 114 data sets or tools. We are cautious at HHS. We can't simply post medical records on a website and walk away, so we are cautious, and I think other agencies are as well. The data sets that are published and made available are those that are pretty well scrubbed. Many of them don't even apply to individuals, they apply to physical assets or other activities. But the goal is to keep making some of this data available.
So we have posted about 114 data sets as well. We will be posting between now and the end of the year probably 30 to 40 more. Some of them are updates of the past activities, but some of them are entirely new.
Let me mention three of these that are flagship initiatives. One of these you will be hearing later today about for the community health data initiative. This is an effort to take community level data that HHS holds. For the most part it is county level data, but we will move forward to where we can look at other data as well. So this could include public health measures, it could include Medicare and Medicaid data, it could include mortality data, health care data, quality data and so on.
We have made that available, this first wave, on a website. The idea here is, we make it available, and we are encouraging a number of others, innovators and others, to take the data and use it in applications that help individuals understand health and health care in their own communities.
We have had a couple of meetings, where even some of the biggest software innovators, Microsoft, Google and others, are interested in taking some of that data and developing applications. So you can take your iPhone and maybe someday you will be able to see how hospitals compare in your area, which I think we can do that already. You can find information about the local situation in public health and health care in your area.
So we have launched this. We have had two collaborations with the IOM to get things moving. We have a website where these original data sets are posted. We will be adding to those data sets as we get things ready.
Again, we are very much interested in your input. If you think we have data sets, you are aware of data sets that could be made available or modified to be more helpful, please let us know. We have a place set up on the website as well. That is known as the Community Data Initiative, and I think Linda Bilheimer is going to brief you more on that today.
We have a lot of data, as you know, in HHS. We collect it as part of our programs. We conduct surveys and research as well. We have always made it available, but it is always a challenge to new users and to make it available easily. So this is a way of pushing that forward.
In addition, Medicare, CMS, has made available a beta version of a Medicare dashboard. It includes the Medicare claims data largely and cost data. So for your local area, for states, for hospital service areas, you can get Medicare utilization data and Medicare cost data.
Folks like the Dartmouth Atlas and others have already taken this at an aggregate level, but this provides it directly as well. We hope to be adding to that as well. We will be adding, if it all works out, as we announced on our website, some actual claims data sets as well. These will be deidentified and scrubbed, and the variables will be checked to be sure that privacy is protected, but the goal is to make a five percent sample available of the various types of claims that CMS has, hospitals, ambulatory care, drug data and so on, made available and posted on Data.gov, if it can all be done in a way that protects privacy.
Just a short word now -- I'm sorry?
MR. HOUSTON: Just one question. When you say it is deidentified, is it to a zip code level?
MR. SCANLON: It will be at the national level. These are claims data. It will be claims data sets. I don't think it will have any geographic measure. Hospital discharges.
MR. HOUSTON: It won't identify by provider information?
MR. SCANLON: No, that is a whole other route. Karen can talk more. As I said, this is the access through Data.gov. For those researchers and others that want to get at more detailed claims data, there is a process. It involves a data use agreement. As you all know, you can ask for the claims data. You have to justify what goal you have in mind. CMS has actually operated that program for a long time now. It is a very positive and forward looking program. That is how the Dartmouth Atlas is developed, based on that data and others. But you have to cite a data use agreement, and there are protections. It is made available in a restricted manner. These would be very clean, slimmed down files, a five percent sample without geographic indicators, as I understand it, and they would be available for folks to work with.
MR. HOUSTON: Thank you.
MR. SCANLON: I just want to say a word about budget, and then I will finish up.
Over the last quarter just about of the fiscal year 2010, we are working on the 2011 budget and the 2012 budget. Obviously a number of the health IT initiatives were funded through the Recovery Act and through the budgets. Chuck will update you on the HITECH Act and so on.
On the population health statistics side, I wanted to say that the National Center for Health Statistics for example received an increase for this fiscal year, so we are moving along there. I think Congress is looking at a fairly sizeable 17 percent increase for NCHS in the 2011 budget. We will see what happens there. Then 2010, we will have to see. To some extent it may be a somewhat austere budget because of the deficit reduction and so on.
On the population health statistics side, NCHS' budget is hopefully getting up to the level that we should all be, the stabilization level.
So let me stop there.
MR. REYNOLDS: Any questions for Jim?
DR. WARREN: I have. On the priorities, you have the four interagency ones. Can you tell us what agencies those are that HHS is going with, cooperating with?
MR. SCANLON: They are agencies within HHS, for example, reduced teen and unintended pregnancy. Here we have several. On the human services side, we have programs, we have CDC, we have an Office of Public Health and Science as well. So here it is an interagency group of those offices within HHS, and we will be working on that, including the White House and other agencies as well.
The idea here is, several agencies across HHS have interests in programs, prevention or grants and so on, in these areas, and they will be working together to do that. Global health of course is HHS. Virtually all the agencies in HHS have some international dimension. We work with the State Department as well and with the White House, more in terms of developing a global health strategy, what are we trying to achieve in global health for the years ahead.
DR. GREEN: Another question, Jim, about the key interagency collaborations. The fourth item, foster open government, could you say more about the very last bullet there, about foster innovation? What is that about?
MR. SCANLON: Yes. As part of the open government initiative, remember I talked about data transparency, making data available. Another goal of the open government initiative was to use technology and innovation to help with our job as well.
What we have done, and other agencies have done this as well, we have created an innovation council where we are asking -- if it the sort of thing where, if you tell people, go ahead, you must innovate, you have lost the point. It has to be something where we are trying to encourage the best ideas among our agencies. Part of this are activities that are software related, that are already available in the research community. For example, there are ways internally that the research community uses. There is idea share software that folks can under protected circumstances share ideas, discuss research issues and so on.
But we will be looking at how we can apply -- in this case, it is largely software technology, to provide more of a climate for innovation across HHS. For example, even on teen pregnancy, there are probably half a dozen agencies within HHS that have experts in these areas, so this would provide a more informal way of communicating and sharing ideas, in addition to the formal structure.
We are also looking at, are there ways to foster -- as you know, we are using all the social media as well. We are trying to get public input, we are trying to use crowd sourcing techniques. We are trying to use analytical techniques to look at in terms of comments and ideas that we get over the Web or other places. There are software analytical techniques, for example, that allow you to -- pattern recognition and so on that identify the major themes and so on.
So in many ways the innovation is not related so much to the -- though it is certainly part of this -- scientific discovery and so on. That is another part of the initiative. This is more the software structures and the social structure in a sense, to encourage folks to innovate, bring ideas to their agencies, and so on.
It is in its early stages, but it is focusing largely on software, innovation related software for now.
DR. SUAREZ: Thank you, Jim, for this great summary. It used to be that -- and I am not saying that as a way of pointing any fingers, but it used to be that health information technology
was one of the top priorities within the Department. It doesn't show in the nine or so priorities, but I would assume that health information technology continues to be a priority and it is just embedded across all this?
MR. SCANLON: I think it is considered to be a number of these. Certainly transforming health care is part of that as well, and it is part of the Recovery Act implementation as well. HITECH as you know was part of the Recovery Act, the basic foundation and the funding. So it is clearly still part of them.
I think there were three areas that were considered to be related to health reform, as supporting health reform and transformation. One of them was health IT, one of them was comparative effectiveness, and what is the third? I am forgetting the third. Oh, prevention and wellness, that I talked about previously under the Recovery Act. All of those continue as essential parts of transforming the health system as well.
MR. LAND: In regards to the National Center increase, it is in the budget, but have you had any sense of how Congress is going to react to that? A continuing resolution, or do you think they are going to pass the budget?
MR. SCANLON: I don't know. You don't want to bet on what they are going to do. Obviously for October 1 we will need a budget, an appropriation. But I think it is still slated. If current trends continue, unless something major happens, I think there is all likelihood that NCHS will get that. Some of it is slated for the vital statistics infrastructure. But again, it is hard to predict. We never count the dots until we actually have it.
DR. CARR: I should introduce myself. My plane was late, and I apologize to everyone. Justine Carr, Caritas Christie Health Care, no conflicts.
I have a question. Jim, going back to the innovation center and health statistics, is there thought to using the innovation center to supplement the ways in which we get population health information? You mentioned social media and all of that. Is that part of the thinking in the innovation center, that we may rely on newer sources?
MR. SCANLON: Again, you have to be careful here. You know this better than I. Crowd sourcing and social media I view as an additional perspective. I don't view it as a substitute for social science research. It is just another perspective. We have talked about that previously.
I think it is the goal to try to use social media and technology innovation, as we should, as anyone should, to support the mission and to give us a better perspective and to promote collaboration and open government transparency.
In addition there is technology that is related to data collection, obviously. We have been using it in the NHANES program for a long time now. It is almost entirely automated, the NHANES program.
In our surveys, it is coming along a little bit more slowly, but there is computer assisted interviewing and so on, and audio equipment as well. I think the agencies are employing technology in their surveys and research as they go along. There are even instances where if you could do it properly, we can collect web based -- we can have web based data collections. But it is an issue of, is it largely qualitative and that is how you treat the data, just another perspective, or are you trying to make generalizations and you are trying to hypothesize and you are trying to employ regular social science.
There are clearly instances where we can do both. It is just that you have to know what you are doing. Many of the data we get from the social media, we have to regard it as qualitative, largely. There are ways to analyze it, but you don't know what it represents exactly, it is just another perspective. If you want to now the prevalence of something in the U.S. or incidence or something you can generalize on a scientific basis, you have got to use probability theory and regular scientific methods.
But clearly crowd sourcing, blog information, qualitative information, we are clearly interested in that, and it will be used as part of another perspective.
MR. REYNOLDS: Jorge, you need to introduce yourself. It is a pleasure to see you back at the table with us.
DR. FERRER: Thank you, good to be back. Jorge Ferrer from the VA staff. Jim, is the innovation center only going to be looking at social media type of data, or can they do clinical data, administrative data and so forth?
MR. SCANLON: I should mention, this is the Innovation Council within HHS. There is a council at the White House as well. In addition, CMS is creating a center for innovation as well, a little bit down the road, in the Medicare-Medicaid program.
But the innovation focus here is, there is really nothing that is off the table. In a way, defining what to focus on is a priority first, and maybe the most difficult part of this, but it seems to be emerging that the initial focus is on software type technology, web based social media type technology, both internally in HHS and externally, to help, number one, experts and others share ideas in terms of innovating, and secondly, to open up the processes a bit to get participation and collaboration as well.
An example, we are looking at software, and there are various products that will help us analyze large numbers, thousands of comments or ideas that may come in over the web or crowd sourcing arrangements or something like that. So we started this before, but now it is a more focused effort. There is nothing off the table.
DR. FERRER: Is the goal then to have softwares that are produced as a product or meaning that the government and private entities come together innovatively to create these type of solutions?
MR. SCANLON: The latter mostly, or commercial stuff that are available. There are several of our agencies that use -- and I am forgetting what it is called, but it is basically an internal way of sharing ideas among experts. It is not email, it is obviously more than that.
On any one issues area you decide, we probably have experts all over HHS to know about that. We have work groups and councils where we can coordinate and work together, and task forces. But this was meant to support all of that. On a somewhat more informal and current basis, that communication could be done. I don't think we are envisioning producing software. I think we would probably be looking for what may be available.
DR. FERRER: And the innovations then, how does that fit in with the current existent HITECH? The money is out there, they are doing a lot of things.
MR. SCANLON: Not related financially. It is a lot of separate. The HITECH, Chuck will update you, but the grants and all the activity there and the incentive program, they are moving along for HITECH. That is an externally focused adoption initiative. This is not really related directly or financed with HITECH. This is normal operating funds.
MR. REYNOLDS: Jim, thank you. Exciting stuff. Karen Trudel, you want to update us on the magical mystical world of CMS these days?
MS. TRUDEL: Yes, indeed, it is both. Let me start with something that is somewhat less exciting, but possibly of interest in any case.
We recently completed an internal realignment. The intent of this was to put us in a better place to address some of the challenges coming our way through health care reform. But we have combined all of our program integrity functions in one center, Center for Program Integrity, so we will be for the first time looking at Medicare and Medicaid program integrity together.
We have also got a Center for Strategic Planning, which is a combination of our policy office, our research and demonstrations, and as Jim said, under health care reform there is a requirement for a Center for Innovation, and it will be housed in that center. Then we have also combined all of our external affairs and beneficiary services, so that our media relations, our partnership relationships, our early phased-in websites and 1-800 Medicare will all reside under the same roof. So that is food for thought.
Let me talk about meaningful use for a little bit, since we haven't met for quite awhile. The proposed rule was published in January, and the comment period ended in March. We received comments from about 2,000 different organizations, and have been very attentively going through, trying to find some commonalities.
One of the things that we very clearly heard was that the requirements were extremely challenging, perhaps too much for some organizations, that we had taken an all or nothing approach, you meet all of the criteria or you don't pass, that the percentages we had set were too high, and just in general that we needed to provide a little bit of extra flexibility.
Of course, on the flip side of that, other commenters said, this is a lot of money. We need to take a quantum leap forward, so don't dilute the requirements so much that you get a number of people who have electronic health records, but they are not doing very much with them that is going to translate into meaningful use and quality improvements.
So we are trying to forge a balance there. We have had very extensive discussions within the Department. We have been talking to OMB. We have been listening to a wide variety of voices, and we are moving towards the end of the process.
I know someone is going to ask when the final rule is going to be published, and I have to say I am not sure, but we are very close, I think.
Moving on to ICD-10 and the 5010 implementation. We had a very successful vendor conference a few months ago, where we got a lot of vendors together, some that had really never been on the radar screen before, brought them together and talked to them about what the deadlines are, what the interim deadlines are, what their clients are going to need, and how they are groping to have to support them. We got a lot of really good feedback. We think we will probably have additional similar conferences, and we are signing people up for listserves, so they can keep in touch with what is going on.
Interestingly, when we did some of our focus groups with physician offices, we did a focus group meeting in Baltimore, and when we asked people how they were going to deal with 5010 and ICD-10, they said, Bob is going to do it. Bob apparently is a vendor of billing practice management software in the local area. We finally tracked Bob down and we invited him to the conference. He was very articulate. So it is trying to reach out to folks like that who really are providing the services to pretty much the lifeblood of the industry.
MR. REYNOLDS: Does Bob have the answers?
MS. TRUDEL: He is working on it. We have also stood up a website on ICD-10 on the CMS outward-facing website. It is cms.gov/icd-10. We have a number of other pages that lead from that. There are pages that are focused towards vendors, towards providers, towards Medicaid, towards health plans, and we will continue to add to that content over time.
We are encouraging people. We have met with a number of partners. We had a good call with AHIP yesterday, and we are encouraging partners to link to it and to use the materials.
We will move on to the Accountable Care Act. This is clearly going to provide for a certain amount of workload for the NCVHS for the coming years, starting this summer.
There are administrative simplification provisions in the Accountable Care Act. The first two that are coming down the road are the plan I.D., which was an original HIPAA requirement, which we for a variety of reasons did not get around to publishing, and a requirement to phase in over time operating rules, which are more detailed than the standards and the implementation guides, that sit under them and allow providers to be better able to anticipate what any given plan is going to do.
Because we also have the ability to do this by interim final rule, as opposed to NPRM, we need to be very sure that we have done all of the outreach and listening to every voice that we can find. So we have been working with the Standards Committee to set up a three-day hearing in mid-July, the 19th through the 21st. We will do a day and a half on plan ID, what the industry thinks the plan ID should be, how it should work, what it should do, what are we trying to accomplish with a plan identifier, and another day and a half on operating rules and similar questions, what are we trying to accomplish, how should we do this, who are the players.
It will be a very intense three days worth of hearings, but we will do as much pre-briefing of the attendees as we possibly can to make sure that they have materials in advance, and have some thoughts and context before we get there. I think we are hoping that others in addition to the Standards Committee members might be interested in attending and providing some input into these hearings.
Another interesting thing that the Accountable Care Act did was to make the ICD-10 GEM tables, which are basically crosswalks to ICD-10 and ICD-9, to make them a part of the code set standards. The provision also said that we needed to have a public meeting no later than January of 2011 to get public input on the crosswalks and any improvements that might be needed to them. We would then make those improvements and post the revised crosswalks to the CMS website.
To begin to obtain that input, we decided to take some time in the ICD-9 coordination and management meeting, which will be in September, I believe it is the 15th and 16th, at CMS in Baltimore. We will be inviting attendees to bring whatever analysis they have about the GEMs and the shortcomings for potential improvements to the crosswalks at that time. So we will begin to be able to look at what really needs to be done to make them optimal and usable for the industry.
MR. REYNOLDS: Questions?
DR. WARREN: For the Accountable Care Act, we are having hearings in July. We have gotten permission and money from Marjorie. We feel that some of the discussion that will come out will be across all the subcommittees, so we have been authorized to get one representative from the other three subcommittees to attend those hearings.
So when you do your breakouts today, find out who that person might be. We already have some people that are members of Standards and members of other committees, so take that into consideration, or go ahead and pick another person if you have already got someone on your committee that does that, because we really would appreciate it. We are going at this very fast and need all the help we can get. Just to show you how fast, we have to have a letter to the Secretary for the health plan identifier to pass in September.
MR. REYNOLDS: So the relay race, because of some of these integrated subjects, is also becoming part of a sack race, too. In other words, most of the subjects are not clean as we organize as a team. So I think it is important. Even if you don't feel you are an expert in that, I promise you, you will end up contributing. You will end up hearing things that will fall into that. Our document we just did on health information was a perfect example; it touches everything.
So all these subjects, as committees reach out, I think it will be important for everybody to make sure that you don't just look for somebody else on your team to do that. Two or three volunteers would be great, and then whoever might be the most suitable at that time, because this stuff is heavily integrated, especially ICD-10 and some of the other things that are going on.
DR. HORNBROOK: Just for the benefit of the ignorant, I assume that this plan identifier question is whether you have a unique identifier for the contract that you are as a person enrolling in, for the underwriter of that contract or for the administrator of that contract? Are you going to have all kinds of different entities called?
MR. REYNOLDS: And it may be all of the above.
DR. WARREN: So part of the question is, what is a health plan?
MR. REYNOLDS: Yes. Any other questions? Karen, thank you. You guys have been busy. We appreciate what you are doing, and look forward to seeing what comes out.
With that, we would like to turn it over to Dr. Friedman to update us on the things going on with the Office of the National Coordinator.
Mr. Blair, you have joined us. Would you please introduce yourself? You need it for the record, but not for the room.
MR. BLAIR: It is so nice to be back here. I am no longer a member of NCVHS, but I still retain all the wonderful memories, and I am looking forward to being with all of you tonight as we roast our Chair.
I am Jeff Blair. I am Director of Health Informatics at Loveless Clinic Foundation in Albuquerque, New Mexico. We have a health information exchange network. I think that about does it.
MR. REYNOLDS: After Dr. Friedman is done, we will remind you of some conflicts we had with you as we celebrate you.
Agenda Item: Update from the Office of the National Coordinator
DR. FRIEDMAN: It is a pleasure to have a chance to speak with you this morning. I asked Harry if I could have a little more time than the customary update, because there is something fairly important, at least from my perspective, that I would like to introduce to you as a concept and as a potential initiative going forward, and get your reactions to it. So I am very appreciative to have the additional time to do that.
I put this slide in every one of my talks these days. The film is very much in the cutting room. There are some pieces of film on the floor. There are some pieces of film we know are going to make it into the final cut, and then there are a lot of other pieces of film with status unknown at this point.
I don't know if you have seen, tell me if you have, the latest data from the most recent -- or the 2009 data from the adoption survey that was the supplement to the NAMSES that is conducted every year.
In case you hadn't seen the latest data, I just wanted to share with you the 2009 data points. This is obviously before any of the HITECH program has had a chance to take any kind of meaningful hold.
The number of adopters continues to increase. The very large number of respondents to the question, do you have any system at all, which we don't think is a very specific or discriminating question, basically is being answered as, do you have a computer in your office, we believe, has risen to about 44 percent. But far more important, the number reporting that they have the minimal constellation of functionalities described as the basic system has risen to 20.5 percent, and the number that have the larger constellation of functionalities that constitutes a fully functional system has risen to 6.3 percent. I think the take-away remains that in terms of office practice in the U.S., we have a long way to go.
MR. REYNOLDS: And Chuck, will we get copies of the slides?
DR. FRIEDMAN: Oh, yes, of course.
MR. REYNOLDS: Chuck, do you want to take questions as you go?
DR. FRIEDMAN: Oh, sure. There is always the danger we won't get through, so I might limit them, but how can I refuse a question from John?
MR. HOUSTON: Based on the rate of adoption, I know that safe harbor for Stark anti-kickback is set to expire at the end of 2011, which will allow hospitals to donate EMR to physician practices. Is there any thought of asking to get that extended, or you don't have any insight on that?
DR. FRIEDMAN: I think it is very important you brought it up, John, so it stays on the radar screen. I had frankly forgotten myself that it is a time-limited provision. As I think through its interaction with other components of HITECH, I think it interacts positively with those, so we should definitely revisit that and be sure we keep that expiration date on our radar screen. So thanks for bringing that up.
Here is a slight modification of the figure that was published in David Blumenthal's article from January of this year called Launching HITECH. I don't know if all of you have seen this figure, but it is very, very useful to keep score and map the playing field, in addition to giving an overall sense of what the entire strategy comprises.
I described it in the ONC CMS program, with CMS playing a critical role in that yellow box relating to the incentives and penalties, but there are many agencies involved in this on the federal side in addition to advisory committees and others. So just calling it an ONC CMS program does not give full credit to the parties involved.
Just to give you a quick sense of where things are, what I would like to do this morning is just give you a quick overview, and then dwell on three aspects of this that I hope you will find interesting, and one especially.
Regional extension centers. We have now funded 60 regional extension centers. We funded them in two separate groups, 36 and then 24 more. Of the two billion dollars that was appropriated to us in HITECH, I don't recall the exact amount, but something in excess of $600 million is invested in the regional extension centers.
I am going to speak more about the workforce training program in a little bit of detail. We have awarded four grants -- we have completed awards in four grant programs to address the absolute critical need to expand the health IT workforce. Karen has spoken of the progress relating to the definition of meaningful use, and the soon to occur issuance of the 2011 meaningful use stage one rule that will be the foundation for the implementation of that program.
We have awarded grants to 56 states and territories to assist them in the role states and territories must play in moving toward a national program supporting health information exchange of the $2.564 billion that are invested in the state HIE program. We are working diligently. The interim final rule relating to standards is a piece of this on a more comprehensive standards and certification framework, which is an essential underpinning of a system of health information exchange and the target of interoperability, and we are also working actively on a privacy and security framework. There will be more to be announced about that soon.
Underlaying those programs which target themselves specifically at adoption and exchange as denoted by the diagram, are two what I call transcendent programs. One of these is the program called SHARP. It is a program of research to enhance health IT, and I am going to speak a little more about that. Then in addition, another transcendent program is the Beacon Community program, where we recently awarded 15 grants, actually cooperative agreements, to communities for the purpose of demonstrating what is possible as a result of meaningful use of health IT and of course other supporting activities, and driving improvements in the quality and efficiency and safety of care. We have a funding opportunity announcement on the street to award a small number of additional cooperative agreements to create some additional Beacon communities.
I am going to talk a little bit more about workforce training, about SHARP. I am going to talk about a nascent program which we have code named element three. I think I made references to this in previous presentations, but I am prepared to say a lot more about this now.
It is specifically directed at the end goal of the program articulated in David's diagram as improved ability to study and improve health care delivery, in other words, creating a learning health care system, which has been widely articulated as a result that could be realized in part through interoperable health IT and the programs of the HITECH Act.
Let me stop here before I do a bit of a dive into workforce, SHARP and element three, and ask if you have any questions about the program as a whole.
MR. REYNOLDS: You mentioned 60 regional extension centers. Some of these numbers are more than the numbers of states. Are states breaking into pieces?
DR. FRIEDMAN: Yes. The regional extension centers program did not follow a state logic.
MR. REYNOLDS: It can, but it doesn't have to.
DR. FRIEDMAN: It can. Some of the extension centers have a statewide scope, others do not. They come under these catchment areas.
MR. REYNOLDS: But are you requiring each of them to follow the same standards, so that within an environment you don't have one educating the doctors and others on one set of standards and another in the same state doing something different, as they try to work together in a state.
DR. FRIEDMAN: I think a good summary answer to that question would be yes, Harry. We don't want every extension center, regardless of where it is and which practices and hospitals it happens to be serving at that moment, to be following the exact same procedures. But I think at an appropriate level of generalization, the activities of the extension centers are being standardized, so they all work in pursuit of the same goals.
MR. REYNOLDS: I was interested more in outcomes than structures and process.
DR. SUAREZ: Every time I think about where we were even a year ago, it is amazing that the amount of work that has been done in building all the infrastructure components that we will see over the next ten, 20 years, will put us where we want to be.
One aspect that I wanted to ask you about is the standards and certification framework. Each of these boxes are just gigantic in terms of the scope and the size, but the standards and certification framework, there has been a lot of work being done to reposition perhaps or to re-engineer, restructure, the concept of harmonization, use cases and selection of interoperable standards.
Out there, there is about 11 task orders that have been issued to address 11 different elements in this standards and certification framework. I wanted to ask you if there is any -- or if you could share with us the status of those, have there been any finalization of that process and the work in each of those major task orders is about to start, or are we still in the process of selection? Can you talk a little bit more about that particular part of the standards and certification?
DR. FRIEDMAN: I am tempted to go back to my film still in the cutting room slide, because that is where profoundly where this is. Frankly it changes from day to day in terms of what is on the street, what is being reviewed, what has been awarded. Even if I had it in my head, I'm not sure today's breakdown of where the horses are in the race would be helpful.
But let me say as a generality that we are making progress, and also to say that there are some very key initiatives developing out of this. One I would like to call out, you all may have heard of it, is NHIN Direct. Am I saying something you all have heard about? Okay.
So I would call out NHIN Direct, without going into too much detail about it, as one consolidated theme relating to the standards and certification of the framework. NIHN Direct represents an attempt to insure that some of the very basic information exchange capabilities that are required by what is anticipated to be in the 2011 meaningful use criteria, can be implemented by eligible providers and hospitals that seek to be meaningful users in the near term. So we really are focusing the program on immediate needs and aligning our priority structure with meaningful use as best we can surmise the final representation of it will be.
MS. FRANCIS: Could you comment a little bit more on the development of the privacy and security framework time line and the role of what I gather is called the tiger team in working on that?
DR. FRIEDMAN: I don't have too much more detail I can share, Leslie. I can tell you, I think everybody on this committee knows that we have appointed a chief privacy officer, Joy Pritts. Joy is taking an increasingly important leadership role in this domain. Some specifics about this will be forthcoming soon, but I am really not at liberty to give any more details at this point, I'm sorry.
DR. FERRER: Chuck, your first graphic depicted the adoption, dismal rates, because they are very low. In five years from now, after all you funded, what do you think will be an acceptable adoption rate in numbers? That is the first question.
The second one would be, usability tends to be a relatively troublesome issue for electronic health record adoption rates. How are you addressing that?
DR. FRIEDMAN: Point one. The President has articulated a goal that every American should have care supported by an electronic health record by 2014. We are aiming toward that goal. We are seeking to attain it. Any fractional attainment of that goal will be a fractional measure of success.
At the same time, forward progress is forward progress, and to the extent that there is more meaningful use of health IT driving quality of care, that is progress. But we have a goal and that is what we are seeking to achieve.
Regarding usability, we hear that point. We are working with NIST and with AHRQ and with other agencies to develop a coherent program focused on usability. To that end, there is going to be a major usability meeting, some have called it a usability summit, at NIST on July 13. You might think about this as a formal startup of this program as a collaboration with national import.
DR. FERRER: So you are having a meeting on usability. You funded already the research. You have already funded for people to adopt the tools, but now we are going back and re-looking, because usability tends to be a problem, is that correct?
DR. FRIEDMAN: Well, we are moving things along in parallel. I think a major priority of this particular focus on usability is going to be an exploration of ways usability can be measured. Usability is a construct.
DR. FERRER: Usability is not a construct. Usability is how you are affecting the clinicians at the point of care using the tools. So if you are asking clinicians to change how they practice medicine, that is not a construct, that is how people practice medicine.
So I am trying to get it from the abstract into people using them so your adoption rates go higher.
DR. FRIEDMAN: I think we are going in the same direction. But unless we can measure usability, if you can't measure it, I don't think you can improve it. So I think a focus of this initial meeting, I'm not 100 percent certain of this, but it is very likely that a focus of this initial meeting will be to identify the steps that are necessary, so we can measure usability. Once we can measure usability, we can see where we are and figure out how to improve it.
I take every point you have made about the centrality of this concept.
MR. REYNOLDS: So Chuck, why don't you continue?
DR. FRIEDMAN: Okay. So seeing what time we are at, let me just go quickly into workforce. I think this is -- one of the reasons I am emphasizing this in my presentation is that this is a critical but possibly easy to overlook aspect of the need and what consequently may need to be done to address the need.
The HITECH Act did specify that we would have a workforce program. I applaud that. We set in motion the development of one. A key initial step we took in developing a workforce program was to articulate 12 key workforce roles, all of which one could surmise, if they weren't underpopulated at the moment, once HITECH took hold and adoption began to increase, would be flagrantly underpopulated if nothing were done to increase the training capacity in the nation.
HITECH required us to look at those kinds of training programs and those kinds of roles for which six months preparation for people with appropriate backgrounds might be appropriate. So we articulated six goals, very much aligned with support of the EHR adoption process, and the ongoing support in practices and hospitals of the technology that is supported there. We believe that these six roles could all be trained for with a six month program if someone brought to that training either some significant background as a health care practitioner or some significant background in information technology, with the idea that the program would give them that piece of it that they didn't have.
We also articulated six roles, equally important, possibly less needy in terms of numbers. These roles would require a one to two year preparation, training even of that longer duration would assume that the trainees came into the program with some relatively background. An exemplary role in this group is the role of chief clinical information officers, chief medical information officers, chief nursing profession officers and chief public health information officers, but also software developers who specialize around the needs of health IT applications, and also researchers and specialists in the fields such as security of systems.
We have put in place for integrated programs. All of these were announced in November and December, and funded in April. We have created five community college consortia, pretty much covering the nation, operating in five regions. There are approximately 80 community colleges who are participants in these five regional consortia. We have funded a set of culture development centers to help fast track and educational programs being brought up in these community colleges by producing high quality instructional materials for them. We are also developing a competency examination to assess individuals skilled in the competency areas addressed by that first set of six roles, for which six months of training could be seen as adequate.
We funded a separate program. We funded nine cooperative agreements. It is more than nine institutions, because some of them are consortial, to provide training, one to two years in duration, going at those other six roles for which a more lengthy and more in-depth training might be required.
So all of this work is off and running. The community colleges are to stand up their training programs no later than September 30 of this year. There will be a major event in Oregon in August to train community college faculty in the use of the materials being produced by the culture development centers, and all of the training sites for the university based training will be recruiting trainees into their programs starting in the fall semester.
So the gun has gone off, and the race to produce the workforce has begun at full capacity. The community college training program is designed to produce a minimum of 10,500 trainees per year to address a need that has been estimated to be at least a shortfall of 50,000 as the program takes hold.
Any questions about the workforce program?
DR. HORNBROOK: Chuck, I don't see anything here unless I a misreading it about training champions inside the current medical care system, that is, people who are clinicians who want to learn something about health IT. Are they supposed to be folded into some of these pathways?
DR. FRIEDMAN: The chief clinical information officer program, while it is advertised and focused on training CMIOs and CMIOs, is going to provide training very appropriate for that champion role. This is for someone with a medical degree, for example. This would be a year of training in health IT and health informatics and leadership and other topics. That would be a preparation for that role as well.
DR. HORNBROOK: We have a CMIO who is in that job pretty much full time. Then we have a series of physicians who elected to change their certain careers, went back and got masters degrees in informatics, have come back and now work as the champions inside, in order to not be totally controlled by the systems programmers at Epic.
DR. FRIEDMAN: We hear you. This is very much in line with the intent of that program. Anything else on workforce?
MR. REYNOLDS: Please continue.
DR. FRIEDMAN: Okay. In the interest of time, I am just going to go very quickly through the SHARP program.
This goes to Jorge's comment about usability. One of the things that we are doing as we think about HITECH and how to roll it out is to skate to where the puck is going to be. We are contemplating improvements in the technology itself that are going to be necessary to efficiently support the more sophisticated aspects of meaningful use that everybody anticipates will be part of stages two and three as those take shape.
We have identified four areas in which it was felt that research that we have audaciously described as breakthrough research will be necessary to insure that the technology itself is as good as it needs to be to support these more sophisticated aspects of meaningful use that are clearly coming down the chute.
The four themes were first, patient centered cognitive support. For those of you who saw last year's study that came out of the National Academies of Science on challenges for health IT, the need for patient centered cognitive support is a component of health IT. So as more and more data become available to clinicians, we actually make their jobs easier rather than forcing them to drink from a fire hose, and how we create decision support that is compatible with the way people think as opposed to the way machines are programmed, is the crux of this theme.
A second theme is security. I don't believe I have to elaborate very much on the need for advancements in security, from a technological perspective, to help build the necessary thrust in information stored and processed in electronic form.
Secondary use or enhanced use of information in EHRs, a topic near and dear to this committee, and one I am going to return to in a moment, is the third theme.
The fourth theme is extremely interesting. It looks at whether there are different technical models, different platforms than the ones currently in use today that might be bases for, that grease the innovation skids as health IT develops and matures.
So we organized four separate competitions, intending to make one award of a cooperative agreement of about $15 million in each one. The applications were multiple and extremely high in quality. We funded after competitive review the University of Texas at Houston, University of Illinois at Champaign-Urbana, Mayo Clinic and Harvard to be our four SHARPs. Since SHARP has the P word in it for projects, saying SHARP projects would be redundant.
I would just encourage you to check our website if you want to see more detail about these projects. I will particularly point out the Harvard work being done by Zack Ohaney and Ken Mandel and their team as being particularly innovative and forward leaning. They are looking to see if something analogous to an iPhone type of platform into which substitutable applications can be plugged, unplugged and replaced, could evolve as a platform architecture supporting health IT in the future with all of the appeal and flexibility that we see in the iPhone then being manifested in future health IT systems. If you didn't like the user interface that you were using, and you wanted a different user interface, you could swap the use interface you had out and put the user interface you want in, to cite one very crude but I think illustrative example.
MR. REYNOLDS: Before you continue, Leslie, I don't think I let you ask your question earlier, did I?
MS. FRANCIS: You did.
DR. SCANLON: I was wondering if there are any plans to fund more institutions along these themes, particularly in the area of secondary use. Secondary use involves a broad range of things, and I can imagine that a clinical perspective is one perspective to it from, but there are other perspectives as well. It is not quite a thousand flowers that you want to bloom, but you want multiple flowers.
DR. FRIEDMAN: Right. It is a great point. We are obviously hoping that that will be the case. My printing press however does not print money, I wish it did. I would have loved to have funded several of the applications that we got, but what we had was funding for one in each of the categories. We are obviously hoping that something can be done to enhance the magnitude of the program in the future.
Let me move now to element three. I think in my last presentation to this group, I suggested that we could think about the HITECH program -- and this aligns with that playing field diagram I showed you earlier -- as consisting of two elements. Element one, which is promoting adoption of health IT systems, and element two, establishing a trusted pathway for health information exchange.
I think I made the point in my previous presentation that if you superimpose the two elements thus described and add a very direct extension on health information exchange, that is, the ability for a report out to some entity that would receive quality measures, then in elements one and two we had all of the statutory bases for meaningful use, adoption, exchange and quality reporting. You see that here. What is on the top of the diagram I showed you earlier is element one, the programs leading to adoption. What is toward the bottom are the constellation of programs that comprise element two.
Just to tell a little bit of a story, about six or seven months ago, I was asked to give a talk at the Institute of Medicine. They were having a meeting on developing a learning health system for cancer. I was asked to give a talk on how ONC's HITECH program would establish a learning health system for cancer.
As you can see here, we even articulated as a goal of our program words that could be equated with the establishment of a learning health system.
So I scratched my head for awhile, thought about what I had to say on this topic that I had agreed to speak on, and suddenly realized that the only honest answer I could give is that it won't. The programs we had in place, elements one and elements two, and even the transcendent programs, were not going to in and of themselves be sufficient, although they would take us part of the way there, to create an environment where the kinds of entities you see depicted on this slide, research institutes, public health agencies, practices, federal health agencies, health center networks, IDS's, Beacon communities, could efficiently exchange information for the purposes of carrying out all kinds of research, the activities of public health writ large, and to envision the kind of closed loop learning system where quality of care data could be aggregated, studied, and the result of those studies fed back to drive quality improvement.
Yes, the standards would help. The adoption would certainly help. Health information exchange would certainly help. But the admixture of all of those was not sufficient to get us to an end goal that we had articulated.
I gave my talk, and this slide is right from that talk that I gave, and I have used it ever since. I basically said, we need something else. We have element one, we have element two, we need an element three. I have yet to come up with a better name for it, because element three in words is those components of an infrastructure, including technology and policy, that are necessary above and beyond meaningful use to support public health, research, and create a learning health care system.
Since I have yet to be able to come up with any way to say that in fewer words, we have just agreed to persist for awhile with the code name of element three. I took some comfort in hearing the story about how Part D of Medicare became the official name for that program, so maybe element three can become the official name for this program, although I think everybody is hoping that I will come up with something better.
So what is this? It is all well and good to draw pictures, but in a little bit more detail, we have articulated and are now developing as a major component of ONC's coordinated program to work in collaboration with many others, this element three as a major feature of why we are going forward. We have articulated for now the highest level goal that by 2015 we would create a federated integrated learning system for health care quality improvement and population health.
It is at this point that I would say another value of calling this element three is that people think I need a dose of it. But I think this is a fair goal to articulate.
Yes, Mark?
DR. HORNBROOK: Somewhat tongue in cheek and somewhat seriously, I think there is one word missing, and that is affordable.
DR. FRIEDMAN: Yes, and that is a great point. One of the things that makes it affordable is meaningful use will take us a significant amount of the way there, if we do this right. We can build this on the shoulders of meaningful use.
So if you meant affordable for the country, that is one point I would want to make. We are not talking about doing this as a separate effort which will start in its own swim lane at the starting line. This will work on the shoulders of meaningful use, and other projects that I will get to in a moment.
DR. SCANLON: I was going to interpret affordable in a very different way. You are talking about whether the learning system is affordable. I am worried more about the issue of the affordability of health care.
One of the key things for me around element three is that we contribute to understanding the provision of health care so much better that we can achieve Jim's second objective from the Secretary, reduce health care costs by promoting high value effective care.
So I think efficiency, value, et cetera is part of what we need to be talking about in terms of a goal.
DR. FRIEDMAN: Yes, thank you. I don't think we can get there without something like this.
DR. SCANLON: I agree with you completely on that.
DR. SUAREZ: In this day and age of sensitivity to privacy issues, as one reads this statement of a federated integrated learning system, I can think of people that would think we are building a gigantic database in the sky, integrated and federated, but still a gigantic database.
DR. FRIEDMAN: And that is exactly what we are not doing.
DR. SUAREZ: Exactly. So I think it would be very important to somehow incorporate into the statement, because everything is in short statements, and that is what people remember, something about privacy and security, the concept that it is a private secure protected federated integrated learning system.
DR. FRIEDMAN: That is a great point. I think you might have also heard, as I said, this is as much about policy as it is about technology. Obviously the security aspects would be central to that policy structure.
Harry, maybe we will take Jeff's comments, and then can I go on for a few minutes?
MR. REYNOLDS: Yes, and then Larry and Marjorie will be the first --
DR. FRIEDMAN: We are going to run out of time.
MR. BLAIR: Chuck, element three is exciting. When I listen to you, I am mapping it a little bit against stage one, stage two, stage three of meaningful use. So I am thinking that on stage three, when we get to the point where we have adoption of the clinically specific terminologies, that that would be very supportive for element three.
But I don't know if I am reading in something that is not there or not. Do you see a relationship like that, or is there a different way that you are looking at it?
DR. FRIEDMAN: No, it is exactly how I am looking at it. I think element three -- any interoperability exercise requires standards. I think element three will inherit the standards needed for public health, quality studies and research, a lot of them, but not all of them, from the stages of meaningful use and the larger sets of standards that will be required to support those stages of meaningful use. So I am right with you.
Let me just move on very quickly. Here is the kind of element three scenario which I hope makes it clear that we are really talking about a federation or a grid, not anybody building a centralized database.
The element three scenario is that any authorized person, where what authorizes you would have to be based o a solid policy foundation, could broadcast to other members of this learning system a question, and have that question applied; I want to modify automatically, maybe in some cases automatically, but maybe in other cases not, to relevant data distributed at these various sites across the nation.
The idea here is that if the question is a simple question requesting a numerator-denominator answer, the answer could come back, out of 137 X's, we have 42 who have Y. That could come back as a rolled-up answer. For a more complicated question, what would be necessary would be the sites returning fully deidentified data in the form of a local data matrix, which based on the standards in place could be superimposed with comparable data from other sites aggregated, analyzed and then probably disposed of. So there would be no persistent store the way I am viewing it, and nothing like a centralized database that would be part of this.
Just some very quick observations. As we have said, meaningful use is necessary but not sufficient for element three. I have discussed persistent databases already after Walter cued me, but I would have done it anyway.
The ONC interoperability framework service being built into the NHIN will also be technical bases which will be expanded to support element three.
Then another point I would like to make. It is not like we are starting from scratch here. There are islands of element three all over the country already, and we have to leverage those as well. C.A. Bigg is an island development three. The wonderful things Kaiser Permanente has done is another island of excellence in element three, and there are many others. We really need to leverage those.
We were developing an element three plan. It has got four components. First of all, building generalized recognition of the need. That is possibly harder with some groups than others. We need a signal technological architecture to do this. Probably at the end of the day we can't have 13 architectures for this competing with each other. We can't have different federal agencies, even though they might all be doing it, doing differently, using different technology what in effect could be done once. We obviously need explicit data definitions and standards, and above all we need a policy and governance structure to resolve consent issues, privacy issues, data ownership issues, governance issues such as how can you be authorized to ask questions, and so on and so forth.
My final slide is to let you all know we have contracted with the Institute of Medicine to hold a series of element three multi stakeholder workshops. They are not calling it that. They are using the longer language of an infrastructure to create a learning health care system in support of population health.
You will be hearing more about this, but there is going to be a -- they are holding a sequence of three workshops, one in late July, one in early September that is likely to be an event completely open to the public, and a smaller event in October, to distill what has been heard into a set of findings that will be conveyed in a report issued by the IOM, at least a short version of it, no later than the end of this calendar year. So there will be an element three manifesto on the street from the IOM by the end of the year clarifying a lot of the issues that admittedly were muddy in this presentation, in part because they are still a little bit muddy in my own mind. We are going to need the thinking of a lot of very smart people who come from a diversity of backgrounds to clarify the muddiness that currently exists in some key areas.
So let me stop here, take a few more questions. Thank you for your interest in this. I think this concept goes to a lot of what this committee is about and has historically been focused on.
DR. GREEN: Chuck, I completely agree that what you have been talking about here in the last few minutes goes right to the heart of the committee.
I am sensing that we lost momentum by missing our February meeting, and are ever going to regain it at this meeting. So I am reluctant to make too sweeping a change. I'll just speak for myself here.
I love this report. This is a fantastic report from my perspective. This is movement in a direction for reasons. It is action oriented. It is not sitting around talking about a lot of stuff. What you have laid out here today is absolutely inspiring to me, and I want to express appreciation for the work that you are doing.
I want to flag two things. One is related to the ONC and the other is related to the NCVHS.
For the ONC, I would flag one opportunity to deal with what you presented as a key rate limiting step to achievement, which was the lack of adoption in physician offices. Dr. Ferrer brought this back up again.
Maintenance and certification is not a theoretical construct anymore, it is an implementation strategy by ABMS. It touches every board certified physician in the United States. The American Board of Family Medicine has every board certified family physician in that process as of January 1, 2010. There has to be an opportunity to put a serious dent in that adoption problem by working with the physician certifying boards.
What I would flag for NCVHS is element three. It is out there. I am from Colorado. I love to fly fish in streams, particularly in August. For you guys that don't know about this, when you have a high floating drive fly about three inches off the bank in a stream in Colorado in August, trout find it irresistible. They just can't help themselves. And element three for this committee is like a dry fly floating four inches from the bank right now, and we ought to get going on this sucker.
This is about -- the NCVHS' purchase in my view is the epistemology of it, the ontology of it, the classification and ordering principles that can lead to quality improvement and improving population health, and knowing the population's health improved. That is our territory, as I understand it, and we ought to get going. But we should try to have our pace, not yours.
DR. FRIEDMAN: Thank you, Larry. This is why I thought it was so important to have the extra time to talk to you about this in morning.
MR. REYNOLDS: As they would say in Parliament, hear, hear.
MS. GREENBERG: I think Larry and I are a bit of a tag team here, because I will follow up on what Larry said.
Yes, we did lose momentum but no, not as much as we could have, because as I think everyone knows, we have been straining the resources of AT&T or whoever else controls the phone resources in this country, for the last six months or so, in lieu of having been able to meet in person.
So I think we are coming on a parallel path here. So it is great that you have presented this. When you said element three, I said to Judy, that is our paper for tomorrow, partly at least, to enhance information capacities for health.
I have to understand a little bit more what you have in mind, but I think this idea of integrating this meaningful use and leveraging the opportunities brought forward by the HITECH and meaningful use to improve health and health care, and to leverage those information capacities, is what we were attempting to talk about. If we were just going to call this element three, we could have saved ourselves a lot of time, because it was an incredible amount of time, but well spent, I think.
So I think we are with you. What I think we need to talk about with you and among ourselves, but really with you as well, is how we can as Larry said really bring these things together. I think that is not only the territory of the National Committee, but this idea of population health research and health care, the integrated view, is clearly what we are trying to talk about and think about in this 60th anniversary.
Is this something that one of your two FACAs embracing or responsible for? Or is there some -- how do you see us not just agreeing with you, but actually being a part of it? Like, I had not heard about any of these workshops at IOM, but maybe others here had.
DR. FRIEDMAN: This all just developed in the last like four to six weeks.
MS. GREENBERG: So can we be involved with those? Can we have participation in them? Can we engage with you about how we can make this document and what we are wanting to take forward and integrate it? I'm not saying we wouldn't have other things as well, because this group has to decide, but have this all work together.
DR. FRIEDMAN: Well, thank you for that, Marjorie. I will take all the sentiments that have been expressed here right into a planning committee called at the IOM at one o'clock today. So I think it is very important that NCVHS and several of its members be engaged in this as quickly as possible.
As the fog clears, I am starting to see things that have to be done to move this forward in more detail. One of them I would just hang out there is the fact that element three is going to need standards. For example, how do you standardize questions that are not being contemplated by the meaningful use process? Why would meaningful use require a standard for asking a question?
One of the things that I see that is going to require the kind of work that this committee has done in the past, just to pick up an example is this whole area of what is a question, how do you standardize a question.
Just one idea. I think there are several others. As we navigate and the fog clears, I think lots of ideas and ways to work together will emerge.
MS. GREENBERG: Obviously this requires more discussion. You are just here this morning?
DR. FRIEDMAN: I am here this morning. I hope to be here tomorrow morning.
MS. GREENBERG: And then tomorrow afternoon?
DR. FRIEDMAN: I am hoping to be here tomorrow afternoon. It depends on factors beyond my control. But my plan is to be here tomorrow morning if I possibly can.
DR. WARREN: Marjorie pointed out some of my stuff. I was going to ask about the workshops and about some of the work that we have done on our various committees and being involved in that, because I think it will enhance some of the things.
Then have you started coming up with criteria for invitations of people? You have got multi stakeholder there, so I think that is going to be a critical factor, that we get the right assortment of folks there, and not have them predominantly in one area that usually are people that show up to a lot of these things.
DR. FRIEDMAN: Right, multi stakeholder is absolutely key to this. We have identified a range of stakeholder groups. I do have to say that the way the IOM operates, they have put together a planning committee for these events. We from ONC participate in the meetings, but we are not the members of the planning committee. Ultimately once we have contracted with IOM to do this work and put its imprimatur on it, our role in the actual planning of the activities is limited. But we certainly have input into the process.
DR. WARREN: So given that, because that helps a lot, to know where ONC's role is with IOM, how would you see then us participating? Would that be a request that ONC would make as part of its agreement with IOM, that there be representatives from NCVHS?
DR. FRIEDMAN: I will fold that into the planning process. What I am trying to say is, I can't control the outcome of it, but I can certainly raise the idea as a good one.
DR. MILLETT: In addition to the areas that Larry identified for intersection with NCVHS in element three, privacy and security is very rich. There is a lot of interesting application.
When you think about deidentification, states' organizations approach it differently based on a variety of allowable factors within HIPAA, based on organization and risk levels. So when we think about storing that sort of information in a common deidentified manner, it would be helpful to have privacy and security standards that everybody would play to at that level with respect to what they need to do internally.
DR. FRIEDMAN: Yes, and that will clearly need to be part of the policy structure that supports that. Without that, the policy structure will be too brittle and the system won't work.
MR. REYNOLDS: Jorge, last question, and then I've got one comment.
DR. FERRER: You mentioned NHANES a few times. What about the Connect initiative?
DR. FRIEDMAN: The Connect initiative is an implementation of the NHIN standards and services that was initiated by a consortium of federal agencies, but in fact is an open source piece of software that anybody can use.
Connect is alive and well. Agencies are using it. What they are using it for is the information exchange use cases which we are now calling NHIN exchange, which are the use cases like patient lookup, exchange of a summary record, that were the focus of the NHIN demonstrations that took place in late 2008. So that cooperative of entities that participated in those 2008 demonstrations and others, because the group is growing, continue to participate around a set of use cases we are now calling NHIN exchange, contrasted to the simpler use cases we are calling NHIN direct, which are mostly push scenarios.
The Connect software is an implementation of the exchange, NHIN exchange centers and specifications. That is one way to skin the cat, but not the only way.
MR. REYNOLDS: Chuck, one comment. This is real exciting, but to the overall stakeholders that are trying to drive the industry, that are around the room here, that are everywhere, the concept of chase the committee is a hard thing. So when you talk about ONC working with IOM and where is NCVHS, and NCVHS ought to chase that committee and somebody ought to do something and something else, it starts to be unclear to the entire ecosystem how to play.
So I think as you take that message back, making sure that as this comes up, if the IOM has workshops and what is going to follow that workshop and where is that going to go, otherwise there is so much exciting stuff going on that people are just chasing it. So I think it is going to be extremely important for NCVHS and ONC to be real crisp on which pieces are where and what are they doing, and what is the process, so that some of the people that are sitting around the edge of this room as well, whether it is hospitals, doctors' groups or anything else, don't have to attend 26 meetings to figure out which one is going to be the one that says now, now we are going to decide, no, I want to testify.
So the excitement is incredible, what is going on is real exciting. If we can stay in structure as all of us that are these committees that are making these decisions, so that that communication is clear, it is going to help people get behind it a lot faster. Nobody will be able to yell, I don't understand, I didn't know the process, you left me out, I didn't get there, you didn't include this, you didn't include that.
I think that is going to be extremely, extremely important as NCVHS and especially ONC works together to draw those lines in some kind of honorable way.
DR. FRIEDMAN: And that is the intent, Harry.
MR. REYNOLDS: I was not alluding that it wasn't, but if you just look at that one slide, then what would happen after December. Is December when it is over? Is December when it is just starting?
DR. FRIEDMAN: December, I would characterize, is when enough of the fog has cleared and the muddiness has disappeared that we have a path going forward.
MR. REYNOLDS: I wasn't pushing you for an answer. If you are sitting in this room, you want to lean forward and say, now what does that mean, so that you know whether to play between now and December or get involved in December, of what do you do.
So, great discussion. Is this your last slide?
DR. FRIEDMAN: Yes. But write to me. Harry, to your point, if you ever think we are falling into that pattern of chase the committee, write to me or pick up the phone and call me.
MR. REYNOLDS: No, I think that's great. You want everybody to support all of this, so do we, and I think we have got to help them with the structure.
DR. SUAREZ: On the NHANES side, we have NHANES Connect and Direct and NHANES exchange, which you can probably wrap all that around something called NHANES everywhere. I think that is truly what we want to see happen in reality, is that NHANES is everywhere.
But anyway, on that NHANES side too, I want to ask you very briefly about NHANES governance and the path towards forming some sort of a nationwide governance around NHANES. What comments can you make about that?
DR. FRIEDMAN: It is another work in progress, Walter. A proto governance exists around the cooperative that is doing NHANES exchange. NHANES exchange is actually live, and several members of that cooperative are exchanging data in real time, based on covenants that they all have signed and agreed to.
So in some sense there is governance for some NHANES functions already in place. One way this could go is, we could grow out of that, but the way it will go -- I'm not sure -- one thing that is certain is that we were charged in HITECH to set up a governance for the NHIN, and we will set up a governance for the NHIN.
DR. HORNBROOK: I just wondered whether the committee needs to add a focus on human engineering factors, human factors engineering, rather. Culture, sociology, psychology of informatics are very, very critical. You are ruining peoples' lives, you are causing them to escape or retire, leave the profession because of this revolution. So there are people who are die hard resistant because they don't want to change or can't accept change, physicians, nurses.
You are also changing things like, collecting more data electronically, make it more accessible, means there is a lot more inspection going on. I see a lot of resistance among practitioners to sharing data amongst themselves because people are seeing data that they have never had a chance to see before.
So even something as simple as oncologists recording performance status, Karnovsky performance scores. Our oncologists resist putting it in the electronic medical record system because they don't want somebody else seeing those performance scores and then seeing what they decide in the way of treatment for somebody who a higher level performance score. They are worried about people looking over their shoulders.
There is a whole social psychological impact of having data out there. Information is power.
Then the final area that I am worried about, that I am seeing things creating tensions in the health care system, is the fact that informatics can totally redefine what it means to practice team medicine. All of a sudden, the boundaries between medicine, nursing, pharmacy get blurred, because in order to practice medicine efficiently inside this environment, all of you have to have redundant functions inside the EMR to make it work. All of a sudden your work as a physician has got to be very well integrated with everybody else on your team.
You say that makes sense, but sometimes the reality of having that happen gets backlash. So we haven't thought about some of these issues, about what it means at the point of care for peoples' behavior, attitudes, sense of well-being, as providers, when you add all the rest for patients.
DR. CARR: I just want to underscore, I think that the human factors component to this implementation, this grand scheme, is the critical factor. You couldn't have said it better.
MR. REYNOLDS: Chuck, thank you. Obviously this afternoon in your breakout sessions we have a whole set of new things to think about. That is a perfect time to spend a little more time with the playing groups.
So we have done our document. We have heard the future here. We have heard what CMS is doing from Karen and we have heard Jim. So I think we have got a nice overview to go to our breakouts.
We are going to take 15 minutes, be back at 11:20, and then we will move on.
(Brief recess.)
MR. REYNOLDS: The thing we want to do before we get started with this section is, we want to recognize one of our extremely, extremely important colleagues. That would be Mr. Jeff Blair. I'll let Jim talk about that more, but as I have prepared my comments for dinner tonight, the theme of my comments is, be like Jeff. I don't care who you are, what age you are. There are some interns in the room. There are some young people. There are people that are aspiring to be different things. If you just spent your life being like Jeff, you will get to be whatever you want to be and probably more.
So Jim, let me turn it over to you.
MR. SCANLON: Well, Jeff, I am sorry to see you go after all this time. I realize now that you probably are our longest serving member. I think you had three full terms beginning in March of 1997. So I think Jeff is probably -- 1997, remember when we were in our 30s?
But at any rate, in recognition of your service and leadership, Jeff, the Secretary has issued a letter of appreciation and a certificate of appreciation for your service. I would like to read this.
MR. REYNOLDS: I want you to read it, absolutely.
MR. SCANLON: This is to Jeffrey Blair. Dear Mr. Blair, it gives me great pleasure to award you this certificate of appreciation for your 12 years of service to the Department of Health and Human Services as a member of the National Committee on Vital and Health Statistics.
The Committee is one of the oldest and most prestigious advisory groups serving the Department. Its recommendations have helped shape health statistics, health data standards, health information policy and public health for our nation. Your knowledge, expertise and experience have contributed greatly to the excellent work of the committee. We wish to comment you particularly for your kind leadership effort and advice you provided as a member of the Executive Committee, co-chairman of the Subcommittee on Standards, as well as a member of the NHI ad hoc work group as well as the full committee.
She concludes, only the very best are asked to serve, and we are proud to have had the opportunity to associate with you in this endeavor.
As always, she feels free to call on you for free if the need arises in the future. Thank you very much.
The certificate itself reads, For dedicated leadership, service and major contributions to the advancement of national health information policy as a member of the National Committee on Vital and Health Statistics, March 13, 1997 to May 7, 2010. So I think you do have the record for contributions and longevity.
MR. REYNOLDS: So Jeff, congratulations. You will hear a lot more from your friends tonight. Some of it might not be for public view. Some people contribute, some people are legends and some people are amazing, and I think you fall into all three of those.
MR. BLAIR: Thank you.
MR. REYNOLDS: Marjorie has something to say here, too.
MS. GREENBERG: The NCHS staff also is recognizing you with a plaque to Jeffrey S. Blair, MBA, for outstanding leadership and guidance of the National Committee on Vital and Health Statistics as co-chair of the Subcommittee on Standards, providing critical insights to address aspects of HIPAA, the Medicare Modernization and Improvement Act, and meaningful use of health information technology. June 2010.
MR. BLAIR: Very nice. Thank you so much.
MR. REYNOLDS: Jeff has to make a call. That is why we wanted to do this quickly. He is still acting important on us, and he has got an 11;30 call, so we will let him continue to do that. We will talk to you later, buddy. Thank you and congratulations.
MR. BLAIR: Thank you, Marjorie, thank you, Jim, thank you, Harry. I will be back this afternoon.
MR. SCANLON: Let's take a few more minutes to honor our Chair. Probably this will be your last meeting as Chair, Harry.
Harry again is one of our long-serving members, as a member and as Chair. In recognition of your service and leadership, Harry, the Secretary has written a letter for you as well, and a certificate. So let me read this as well.
This is to Harry Reynolds. It gives me great pleasure to award you this certificate of appreciation for your seven years of service to the Department of Health and Human Services as a member of the National Committee on Vital and Health Statistics.
The committee is one of the oldest and most prestigious advisory groups in the Department, and its recommendations have helped shaped health statistics, data standards, health information policy and public health information. Your knowledge, expertise and experience have contributed greatly to the excellent work of the committee.
We wish to commend you particularly for your leadership and counsel as -- and this is a long list of compliments -- chairman of the committee, obviously, co-chairman of the Subcommittee on Standards, member of the Executive Subcommittee, Subcommittee on Privacy, Confidentiality and Security, as well as a member of the NHI work group and the secondary use ad hoc work group. So that is a very long and distinguished set of accomplishments.
Only the very best are asked to serve, and we are proud to have had the opportunity to associate with you in this endeavor. Sincerely, Kathleen Sibelius, Secretary of Health and Human Services.
The certificate. To Harry Reynolds for outstanding leadership, service and major contributions to the advancement of national health information policy as a member of the National Committee on Vital and Health Statistics, November 1, 2003 to June 9, 2010.
MS. GREENBERG: Not to be outdone. I have to tell you, we have had cyclones, we have had volcanoes, we have had blizzards. This was due to some type of tornado. HIPAA got left out on both of these. So it will be mailed, the corrected version.
To Harry L. Reynolds, Jr. for outstanding leadership and guidance as Chairman of the National Committee on Vital and Health Statistics in advancing health information policy, promoting HIPAA standards and being a tireless advocate for health data stewardship. June 2010.
I guess you might want to officially announce who will be our next Chair.
MR. SCANLON: Yes. I think you know this already, but the Secretary has asked -- as Harry is leaving today, the Secretary has asked Justine Carr to serve as Chair. It is a two-year term obviously, and Justine in a moment of weakness has graciously accepted. So Justine, we welcome you.
DR. CARR: Mr. Chairman, may I speak? I want to say first that I was humbled to be asked. I am honored to serve, and I am hopeful that you are all going to help me. Thank you.
MS. GREENBERG: If you want to know just how much a moment of weakness this was, she was at the airport waiting to fly over to meet her new grandchild, her first grandchild, when I got her on her cell phone to ask her if she would consider this. So you can imagine, in her state of euphoria, she was not responsible for what she said, but we held her to it.
Agenda Item: Plans for the NCVHS 60th Anniversary Symposium
MR. REYNOLDS: The most exciting thing about the committee is, it gets better and better. So thank you. Let's move on now to the discussion about the 60th Anniversary Symposium.
Each of you have at your table the program for tomorrow. I would like all the staff that worked on this program, including our document, to stand up, please.
MS. GREENBERG: Anyone on the NCVHS team please stand up, because this is a team. Those of you who haven't yet stood up, please do.
MR. REYNOLDS: That is the amazing thing about this committee. A lot of us have worked on committees where you didn't have any kind of support like this. It is a magical thing, to have this kind of support from so many people that are true professionals, and in all cases peers on the committee. So thank you.
I am going to turn it over to Marjorie to give you the exact details so I don't get you lost as to where you are going. We will be presenting though the paper. I will be summarizing that and turning it over to the existing co-chairs of the subcommittees to talk about the past and the future of what is going on.
Having been a part of what Marjorie and the group that just stood up did at Charlottesville, Virginia, I think you will enjoy the comments from the past chairs, as we were all interviewed and had a roundtable and so on. So you will get a sense of what it means to be part of something for 60 years and what it means to be a part of something that is going to be ongoing and truly making a difference.
So Marjorie, let me turn it over to you.
MS. GREENBERG: As some of you know, I had to join Facebook when my grandchildren, particularly the second one, was born, because it was the only way I could see pictures of them. So I put on Facebook, I think it was on Monday night, that I was excited about this 60th anniversary of the National Committee this week.
I had been working with the National Committee since 1982. Then I put in parentheses, or is it 1949? Anyway, that is the way I feel. It is hard to believe that we have actually come to this moment, but as Harry said we have all come together holding hands across the telephone lines and across the ages.
So many people have contributed to this, but I will just briefly let you know what is happening. Tonight we are having the dinner, in which we will recognize Harry and Jeff. Can I just have a show of hands as to how many people will be coming to the dinner? That is going to be at Legal Seafood, so it should be fun. We can't promise everything we saw will be legal.
MR. REYNOLDS: It won't be on the record.
MS. GREENBERG: Off the record remarks, but it is Legal Seafood. Then tomorrow we are meeting. This afternoon you all will be working on finalizing your slides.
Then tomorrow we will be meeting from nine to 11:30; you have your agenda. Then there will be a shuttle bus or a bus or something that will take us all over to the Keck Center. I don't know if any of you are staying overnight here and then leaving after the event tomorrow afternoon, so you have to think about whether you want to take your suitcases or what have you.
We will convene at one. Do we know how many people we have signed up for the symposium tomorrow? Eighty? We will have all the former chairs who were in Charlottesville with us. We are expecting all of them, as well as, Bob Hungate is joining us. I don't know if there will be any other former members.
If you look at the agenda, there will be the welcomes, including from the Chair of the Committee on National Statistics, so that is nice, and Ed Sondik from the National Center will also be making some remarks. Then Harry is going to present some slides regarding -- I don't know if it is element three or more than element three, but it is towards the enhanced information capacities for health.
I really do have to recognize Bill Scanlon, for whom this was at least a part time job
DR. SCANLON: A moment of weakness.
MS. GREENBERG: And of course Susan Canaan, who has the patience of Job with our group. Everyone has this document. I think it is a nice high level concept paper that will hopefully be well received.
Then each of the subcommittees is going to present their current and future thinking about projects. The paper itself ends with something about each subcommittee, which Harry will not present, but we will go into the subcommittees' presentations. Then after that we will have a break. It is our understanding that the cafeteria is only open until three, so we have to get a cup of coffee or a soft drink.
Then we will have a discussion. We will open it up to whoever wants to comment. If you know anybody who is going to be there and you want to plant a question, you can do that. If there isn't that much comment from the audience, members can comment as well.
Then we are going to have the Charlottesville video, which I love. In many ways I had nothing to do with it, other than getting the idea. A huge amount of work went into pulling off the event, which was then video'd, including through our colleague Bob Phillips of the Robert Graham Center, Larry's support, et cetera, just getting this all together down in Charlottesville.
I am forgetting the oral histories which we also have on all the chairs. I was interviewed as well. We had about two and a half hours that we had to get down to about 20 minutes. I would have enjoyed watching all two and a half hours, but we didn't think anyone else would, at least not all 80 people. So Debby and Catherine worked with -- first of all, they did a bang-up job, the videographers at the University of Virginia, so let me recognize them.
But to try to work with them on editing it when they were down in Charlottesville and we were here was going to be complicated. So through our own information services folks, we worked with a group called --
MS. JACKSON: (Comments off mike.)
MS. GREENBERG: So we worked with this group. I say we; Debbie and Katherine, and they showed me a version, which I was thrilled, but we did a little more work on that then. Video Ed Productions worked with us, and now we have 22 minutes or something like that.
I think you will all enjoy it. We do plan to then post it on the website. Also, you can look at it during the reception. On the monitor there will be clips from the oral histories. We may put that on the website as well, we have to decide.
Then we will open it up, probably call on the former chairs, at which point Harry will almost be a former chair. It was rather clever of you. We don't have to keep saying the former chairs and the chair, we can just call you all former chairs, and open it up to them and anybody else who wants to make any comments. Harry will have the final word and we will adjourn, and then we will go to the reception.
We wanted to give you time today to finalize your slides, so those will be posted on the website, but nobody is going to get copies of them at the event tomorrow.
In this lovely booklet, I do call your attention to something called the National Committee on Vital and Health Statistics 60th Anniversary Documents and Events. As you know, I have suggested probably two years ago, that although we would be working towards this event at the National Academy, we should think in terms of a series of events and activities, et cetera. Several people took us up on that.
We have the history, we have this document, we have two presentations that Judy Warren made. We have the conference that we held in Salt Lake City. We have the talk about Lisa Iezzoni, everything in Charlottesville. I have perhaps overdone it, but I have done a poster and a few papers.
Then we will have three events after this week. Next week is the North American Collaborating Center Conference on enhancing our understanding of the international classification of functioning, disability and health. That is being cosponsored by NCVHS, your long work on supporting functional status data. At that point our new Chair, Justine, will be making a presentation to the folks. I think we are going to have 100 people there. But it is also going to be videocast. So we will make sure you all have the videocast URL in case you want to tune in on any of it, or your students or your friends or your mother or whoever to do so.
So we have that two-day meeting next week, the 23rd and 24th, also in celebration of the anniversary.
Then we are going to have a session at the National Conference on Health Statistics, which is what I used to call the data users conference. It is celebrating the 50th anniversary of the National Center for Health Statistics, which was established in 1960, although some of our programs predate that, certainly Vitals and even the National Health Interview Survey.
So we will have a session. I am going to give a paper on the 50-year partnership between the National Committee and the National Center. Don is going to present some version of this document.
DR. STEINWACHS: Once I hear Harry present it. Then I will know what to say.
MS. GREENBERG: And whatever the Populations Committee of the full committee wants him to say.
Then Wesley is also making a presentation on privacy and security in this new electronic age, and drawing I'm sure from tomorrow's remarks, as well as the conference. So that is on August 18th, the last day.
This conference is free. There is no registration, as is the ICF conference, since we are on the Internet here, is also free. In both cases you are asked to register so we know who is coming but there is no registration fee. If you look at some of the things that you get on your e-mail and you see what people are charging for registration for meetings, I think these are going to be real bargains. Not just that they are free, but there is going to be a huge amount of information.
There are going to be tutorials. The first day we will have a tutorial on ICD-10CF and ICF, and there will be tutorials on all of our systems, all of our NCHS data systems, in some cases hands on as well. So I really encourage you or your students or your colleagues to think in terms of that conference, which is August 16-18.
Then I am presenting a paper about national committees in Milan, Italy in November, at the 16th Congress of the International Federation of Health Records Organizations. This is something I have been interested in. As you know I am very involved with IFHRO, so I was going to go anyway, but as you know this committee came out of a recommendation of the World Health Organization in 1948, that countries should have committees on vital and health statistics, national committees.
In the '70s we know there were quite a few of them. Our history shows us that, but we really don't know what is going on currently. I am doing a little survey with the Pan American Health Organization as well to all my fellow center heads to find out what types of advisory committees are out there on national health information policy. So I would like you folks to fill out a survey. It shouldn't take very long. It is mostly multiple choice questions, a preliminary look at this on the two new FACA committees and on the National Committee, so that maybe we will identify some groups that we would want in the future to communicate with more.
DR. CARR: Healthy People. We had talked about that at the meaningful measurement hearings, a Healthy People advisory committee.
MS. GREENBERG: Yes. One of the areas that PAHO is very interested in is indicators, committees that are addressing indicators. So that maybe will enhance our international work in the future, but I will certainly share that paper with all of you.
At that point, by the end of the calendar year, we will officially call the 60th anniversary of the committee done, and starting off the next decade.
Are there questions about the rest of these two days or about any of the other things that we have done already or have planned? Okay, that is all I wanted to say, really.
MR. REYNOLDS: I gave a speech in Minnesota a couple of weeks ago to 600 people. They had somebody standing beside me for the hearing impaired. I want you to visualize tomorrow when I am presenting this. Justine and I worked closely on a lot of things here. Picture her beside me with a bullhorn, really saying what I am saying. So it will take a little longer to present tomorrow, because she is going to be editing everything I say as I say it. So it should be fun.
(Remarks off the record regarding breakout session locations.)
Unless there are any other comments, we will break for lunch, start again at one. Thank you very much.
(Whereupon, the plenary session was adjourned.)