Fall, 2010, NCVHS Executive Subcommittee Meetings

―Highlights―

The Executive Subcommittee of the National Committee on Vital and Health Statistics held two sessions in Fall, 2010: a three-hour meeting on September 16 in Arlington, VA, following the full Committee meeting, and a day-long strategy session in Washington, D.C., on November 30 at the Marriott Washington Hotel. These notes briefly summarize both sessions.

September 16, 2010 meeting

A major purpose of the September meeting was to plan and prepare for the November strategy session. The themes of the meeting were:

1. Synergizing the Committee’s work with the ONC/IOM project on the Rapid Learning Health System (RLHS, also called the Learning Health System).

NCVHS members discussed the RLHS initiative with Dr. Friedman of ONC, who affirmed the Committee’s potential role in advising on the project in the context of its population health mission.

2. Early thinking about a workshop on local use of health data for community health

Drs. Steinwachs and Green reported that the Subcommittee on Population Health had agreed on the priority of holding a workshop on local use of health data. Dr. Friedman urged that the project be framed so it is congruent with the work toward the RLHS and meaningful use. Members agreed on importance of including privacy issues in the workshop.

3. Process improvements and structural questions

The group identified a number of process and structure issues to address at the November strategy session.

November 30, 2010, Strategy Session

The goal of the November 30 session was to determine NCVHS priorities for the next 12-18 months and decide how to organize the Committee to best carry them out.  (The meeting preceded a full Committee meeting, at which Dr. Carr reported on the session and the group delved further into topics addressed there. See the December 1 meeting summary and Dr. Carr’s slides for additional information on the strategy session.)

1. HHS Briefing: Mr. Scanlon

HHS plans to create a dashboard to monitor a few indicators for movement and impact. The Committee should be aware of the Department’s priorities as it does its own planning. Dr. Middleton noted the importance of measuring “systemness” and whether the system is working. Accountability and affordability were also mentioned. Members discussed with Mr. Scanlon the Committee’s potential role in developing the HHS agenda. He stressed the notions of convergence and marshalling data for broad purposes.

2. Digital Infrastructure for a Learning Health System: Claudia Grossman, Ph.D., Institute of Medicine (slides)

Dr. Friedman introduced Dr. Grossman, Program Officer for the IOM project on the Learning Health System (LHS) infrastructure. The IOM project involved three workshops, on the basis of which a report is being developed. Preliminary IOM documents define the LHS as one in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural by-product of the care experience, and seamlessly refine and deliver best practice for continuous improvement in health and health care.

Dr. Grossman outlined a dozen characteristics of the LHS and the aims of the three IOM workshops. The final report, which will identify priority action targets, is planned for Spring 2011. A major theme of the workshops was enabling an active knowledge-generation delivery loop, for which IOM specified the requirements. The biggest and hardest set of issues to arise concerned governance and oordination, and principles and priorities need to be identified in this area.

Participants discussed the presentation with Dr. Grossmann and Dr. Friedman, and raised the following major points:

• How are trust and buy-in enabled, to facilitate cooperation across stakeholder groups?


• What incentives will drive improvement? What is the value proposition? What motivates change? Where/how does accountability come in?


• How can NCVHS contribute to this initiative? Areas of interest include stewardship and “weaving the trust fabric,” governance, and education for patient/population engagement.


• A salient theme is the community as a learning system, and there is huge variability community to community. What steps are communities taking to become or be learning systems (called communities of solution in the Folsom Report)?


• How can coherence across systems be evaluated?


• People need to be educated about how to use and understand data.


• How adequate are the data for this enterprise? NCVHS should help build the reservoir of data on which all HHS priorities depend.

3. NCVHS priorities and themes, structure, and process

The Subcommittee spent the balance of the day working on 1) identifying priority topics and defining the large constructs and themes around which to organize, and 2) considering the structures and processes that will best enable efficient work in these areas. Dr. Middleton and Dr. Suarez created schemas to assist in this effort (see Dr. Carr’s 12/1/10 slides).

Regarding topics and themes, the group reviewed the Committee’s ongoing work and new assignments and outlined individual and collective priorities. Members enthusiastically endorsed the idea of an NCVHS workshop on local uses of health data for community health, co-hosted by the population health and privacy subcommittees. The Quality Subcommittee co-chairs proposed reframing/renaming their domain in terms of performance. Standardizing metadata emerged as a new interest, with encouragement from Dr. Friedman. He also urged NCVHS to “define itself as a forward-looking organization,” with clearly stated plans and areas of interest. Dr. Carr encouraged a thematic approach to NCVHS priorities in the next 12-18 months.

Regarding how to organize around priority themes, the group agreed on the need for a structure that is fluid enough to enable the Committee to address themes that cut across several subcommittee domains or represent an important new focus. Ms. Greenberg and others stressed the importance, as well, of retaining the traditional clusters, which group members by expertise and ongoing interest. Many liked the idea of using ad hoc SWAT teams that draw from multiple subcommittees to address emergent issues or assignments. For the time being, the Subcommittee agreed to assume the existing structure, with ad hoc teams used as needed.

Regarding process, the Subcommittee discussed the following topics:

• Making Subcommittee processes more efficient: subcommittees have the option of setting a standing time for calls. Subcommittee members who miss the calls have responsibility to find out what they missed. Staff will take notes and share them. There was some pushback against the idea of “layering on more meetings and calls.”


• Introducing new topics and projects: Members need to know in advance that a Subcommittee plans to write something, and what the scope is. Non-Subcommittee members on the Committee need a primer on an emergent topic so they know what they’re voting on. Environmental scans are needed in addition to briefing documents.


• Exercising better version control, and managing the review process: Every draft needs an accountable person and date. Comments will be inventoried, with a firm deadline for comments. Members need ongoing, systematic literature updates, and a template for letters. Letters, white papers, and “state of the state” documents need to be distinguished from each other. Clear timeframes for input and review and input should be announced.


• When is a product ready to go to the full Committee? This is at the discretion of the Subcommittee chair. Before going to the full Committee, all documents must be reviewed by the Executive Subcommittee. In the event of disagreement, the choice between going back to the Subcommittee and accepting a minority letter is also up to the Subcommittee chair, bearing in mind that the Department prefers consensus positions from advisory bodies. A general principle here is delegating authority to Chairs and supporting them.  


• Review process at full Committee meetings: Keep the focus on agreeing on the recommendations, and leave the framing language and wordsmithing to others.


• A master calendar for NCVHS would be helpful.


• For all of these areas, Ms. Greenberg reminded members to ask NCVHS staff for what they need, and staff will try to meet the needs.

As noted, discussion of these topics continued at the full Committee meeting the next day.

Attendees:

Members―Justine Carr, MD, Chair; Leslie Francis, Ph.D.; Larry Green, MD; Blackford Middleton, MD; Marc Overhage, MD, Ph.D.; William Scanlon, Ph.D.; Donald Steinwachs, Ph.D.; Walter Suarez, MD; Judith Warren, Ph.D.

Staff and liaisons―Marjorie Greenberg, Executive Secretary; Jim Scanlon, Executive Staff Director; Debbie Jackson, NCHS; Katherine Jones, NCHS; Ed Sondik, NCHS; Chuck Friedman, Ph.D., ONC; Michael Fitzmaurice, Ph.D., AHRQ; Marietta Squire, NCHS

Presenter―Claudia Grossman, Ph.D., IOM.