MS. GREENBERG: Good afternoon and welcome to the University of Virginia Medical Center. We are delighted to have you all here. We appreciate your joining us.
I'm Marjorie Greenberg from the National Center for Health Statistics Centers for Disease Control and Prevention. I'm the Executive Secretary to the National Committee on Vital and Health Statistics, which is a federal advisory Committee to the Department of Health and Human Services for health data statistics and national health information policy.
The Committee is observing its 60th anniversary. And as part of that observance and celebration, we decided we would convene the current and some former chairs of the Committee, to talk with us about the Committee's history, the Committee currently and the Committee in the future. So can we start with you, Jim?
MR. SCANLON: Good afternoon, everyone. Let's see, first of all, let me introduce myself fully. I'm the Executive Staff Director for the Committee. I'm Deputy Assistant Secretary for Planning and Evaluation at HHS, and I'm currently the Executive Staff Director for the full Committee, probably since 1995. But I was associated with the Committee before then, actually probably at least a decade or two.
The Committee is probably viewed as one of the most productive and useful Committees at HHS. I think it's viewed very positively in the sense of giving the Department very practical recommendations.
Many of the Committee's recommendations, some of them were technical and can be implemented quite readily, particularly the HIPAA recommendations. Others always get a consideration and a hearing. There may be reasons why a recommendation can or can't be implemented under a number of other factors.
But in many cases the Committee has kind of sort of focused as a group thought leader in the sense that there's some collective expertise practicality in actually working in the health sector and in public health and giving us views of again what the future could look like, an integrated view. The Committee is an expertise-based Committee. So it's not made up of members of various organizations because of the organizations.
So again the Committee at various times, has provided very specific help with the Department's very grateful for and at other times has given us more of an overall view or a concept of what the future could look like. And sometimes the Committee was the only car in the lane on the highway and other times as of now there are probably two or three other Committees and other forces acting as well. And the Committee has always been able to navigate very successfully.
And the Committee has been the one that survived
MR. DETMER: You know, it seems like the personality that's over us here today is Kerr White.
[Photo montage of Dr. Kerr White here]
MS. GREENBERG: Yes.
MR. DETMER: And I just feel like I've got to make a comment or two about Kerr White who's a friend of everybody, I think, at one level has touched our lives. But Kerr, you know, moved to Charlottesville and made it his home. And if I'm not mistaken, that's actually why we came because of UVA, although as much as I'd like to think you came to see me in UVA.
Kerr was such a classic gentleman and scholar, as they'd say. I think my first recollection was his article in Scientific American that had the wonderful illustration that still people relate to today talking about primary care and really where most people get care. And then there's only this little box in the corner is academic health centers which I think gave a sense of reality to all of us of the importance of public health and primary care.
But I think he's still very vital and wanted to be with us. I think he's disappointed that he couldn't be, and you could say more about that if you wish. But at any rate, I do need to really thank him for all that he did including actually from the University of Virginia perspective. He gave his collection of all of his writings and books to the University, and they're in the library. And I don't know, I think you plan to film a little of that tomorrow.
MS. GREENBERG: Yes, we want to. Actually, it's in the Don E. Detmer Reading Room. [Photo of Reading Room here]. So we have quite a connection here to the University and to the Medical School. And as Don said and I just want to expand on that a little bit, it really is Kerr who has inspired me throughout my entire career and long before I ever met him.
But his commitment to population health, to health data, to the National Center for Health Statistics, where I have made most of my career is just remarkable. And we did visit with him about a year ago, and we got the idea of coming down here. And as I said, he's not actually physically able to join us today, but he has very much inspired our get together.
DR. DETMER: Yes, he's here.
MS. GREENBERG: He's here. I mean he's so much here that it's amazing, and I do thank him. And you know while I'm recognizing him, I also just want to recognize Ed Sondik who is the current director of the National Center for Health Statistics and would have loved to have been here, too.
I guess I just wanted to say that for me working with this Committee has obviously been more than a job. It has been a life's work, a passion. I started with the Committee in 1982. I was a junior staff member and then lead staff to a subcommittee, et cetera. And it's really been a tremendous learning experience because I really do feel that in our field of health information policy we've had the opportunity to have many of the best and the brightest of which you as the chairs, really represent the crème de la crème. And with that, I am going to turn it over to you, Harry.
MR. REYNOLDS: Thank you very much, and Marjorie asked me to make a few comments just kind of on the current state of the committee. So as you make your comments and we build on this today, you can one, understand the things that we're facing, and we'd love your input. Second, you can see the directions that we're trying to take and also just help you which, if you have a TV, a blackberry, a phone, you're getting instant messages on the fact that we are in a midst of an ecosystem in dramatic change. No matter what your technology that you use, whether you turn the TV on or what, it's there, it is front page, and it's going to be there a while.
The other thing that we're facing is that a number of the things that are already set in motion whether it be the stimulus package, the ARRA, the HIPAA, some of the HIPAA changes or 5010 ICD 10, electronic health records, personal health records, health information exchange, meaningful use, which we were lucky enough to actually chair and run the hearings along with Dr. Blumenthal on meaningful use right after it came out and worked on that.
And then the whole thing about administrative simplification, and I call it administrative simplification really because a lot of the initial HIPAA stuff that came out was a nice set of packages, but it didn't necessarily have operating rules and other things around it that allowed it to truly make a difference.
So that's what we're facing right now. Some of the things that excite me about what's going on right now if you look in most of the bills that are going through both the House and Senate, the NCVHS is clearly denoted regardless of which side of the House you see the bill on or side of the environment.
Whatever we tend to be doing, we're trying to do it and you taught us to do it in a pragmatic way so that most of it is being picked up by the industry and used by people in many ways. And for example, and Susan helped us do this, we just finalized and we'll be publishing a primer on data stewardship. We did a lot of work on secondary uses of health information and other things, you know, towards the end of Simon's tenure with us and do that. But now we've actually turned it into a primer. And the exciting thing is, Don, you mentioned the University here. More and more, as you look at the Stimulus and you just look at everything that's coming out in health, putting things out there so that people coming into the industry as well as those of us that are leading the industry, are able to pick it up and use it as a structured template –- not as the answer in your own entity, not as an answer in your own environment, but a structured template that people can use to think about the right things to take care of people's data because the richness of that is going to be extremely important.
DR. LUMPKIN: With all the other attention now going on to health care informatics particularly around trying to improve the effectiveness and efficiency of health care, I think the challenge of the Committee is to go back to its roots and to look at ways to integrate across the different areas, the areas that we described in 2001 with the Information for Health Report.
The personal space and the report that you had on privacy and personal health records is an important issue. But also moving the data in and out of personal health records, the space where the population health occurs as well as where clinical care occurs. And it's the interfaces between those different spaces which I believe no one else is really paying attention to and the Committee can.
DR. COHN: John, and just to follow up on your comment, I think what you're describing and, Harry, you mentioned the word competition. And certainly as I thought about sort of really the NCVHS future in preparation for coming here, I sort of see much less competition for sort of an almost natural way things happen in the government and elsewhere.
I mean the role of the NCVHS, and John, I think you're beginning to position this a little bit is cross-cutting, it's expert based, it's visionary. Yet we are not a political body that has the power to sort of make things happen. Now we can provide thought leadership. But it really is to others and other groups to really do a lot of that heavy lifting generally.
And so I think very rightly as this has become a bigger -- health information technology's become a bigger issue, certainly the Secretary and now Congress has come up with what they almost describe as heavier tools to try to push through the implementation.
JUDITH MILLER JONES: When I was at HHS, it was HEW, social security, education, welfare and health, were all together. So we took Social Security off and the welfare side, the income side, of the elderly was a separate agency. Education was separated. And yet, all the work that RWJ, IOM, Kellogg, are doing now on determinants of health we want to say how do we improve health and functioning? Medicine's a strong part of it, but population health, public health, even housing policy, transportation policy, all of these things pertain.
The sad thing is that meaningful use has been developed with an electronic health record in mind, a medical record, because it's going to be the way in which you allocate dollars to physicians' offices and others, when meaningful use really is how is information used in a meaningful way to improve health and functioning.
And so this committee in some ways –- Simon, I think I disagree, we are political. Any advisory committee has a political concern. It operates in a political environment. That's why the FACA laws that you have to be open. It's a conscience. It's a reminder to say, you know, you're caught up in the issues of the moment facing all your agencies within CMS, you know, trying to restructure and do things in a new way. CDC, all of these agencies are trying to meet the matter of the moment. But above it all, how does it fit together. Because I think there is this recognition that health is much broader than just medical care.
And that's where I think it goes back to what John said. What is the focus of this committee as opposed to other committees which will be looking at the purely medical concerns that CMS is facing in how it uses its medical care, clinical data and administrative data.
This is an interesting time. We are talking about health reform. To some people, it is health insurance reform and some people it is health delivery reform. And yet, I think what we are talking about here is even broader than the two. And we're saying, how do we look at the way this country is spending its money through mixed public and private insurance systems and other services to improve health and functioning?
Within the health insurance domain, we worry an awful lot about adverse selection, the notion that we want to have everybody pay in so that everybody's covered and especially so that we can hold institutions accountable.
RON BLANKENBAKER: We could reform an awful lot of health care and not change the health of the public at all, and I think there's a good chance that that will happen.
A friend of mine, Leland Kaiser, I don't know whether you know him or not, he's not related to Kaiser-Permanente. But he says you can shut all the hospitals, and the health status won't change. He's probably correct.
Health is different from health care. And if we want to improve the health of the public of the United States, we've got to think much broader than is currently being thought of of health care reform. And I don't know how the committee ties into that. But the committee ought to play an important part in that.
DR. DETMER: And I think generating an outcomes model of where we're willing to go and it really should be anchored on health and determinants of health as well as obviously the care itself. And I think some thinking through what that model might look like really would I think position NVCHS to really offer a huge benefit. I mean the IOM can do chunks of this. A lot of players can do chunks of this, and obviously these other groups.
MS. KANAAN: It raises for me the whole question of customers which was mentioned earlier, and that's a very dynamic question –- the whole issue of customers. And I think the committee, it seems to me that the committee has worked very hard in recent years to be very clear about who its customer is and not to just do things because they seem like a good idea at the time.
DR. LUMPKIN: To me, the number one customer for this committee is the Secretary and the Department.
And so in many ways I think where the committee has been most successful has been when they've been able to frame the issue in a way that creates an aha moment. And Don and I were there.
MS. GREENBERG: Yes, I wondered if you would just tell us about that moment.
DR. LUMPKIN: So we published the report on Information for Health in November of 2001, and I worked with Jim and Marjorie, trying to set up a meeting with somebody, you know, with ASPE, with ASH, the Deputy Secretary, just about anybody to say, hey, we've got this report, you ought to pay attention to it. Nothing.
And then about six or seven months later, the Secretary had commissioned a report from the Institute of Medicine on rapid advances in health care, and the IOM came in with four areas of recommendations and they sponsored a meeting. And the Secretary was there the evening before the meeting, and he was there the entire day when there were reports. And there was a table just actually right before lunch, and sitting at the table was Don, myself, Molly Coye and the Secretary.
DR. DETMER: There were a lot of people sitting around.
DR. LUMPKIN: Talking about HIT, and the lights went on, and it was just like one of those aha moments. That's where I finally felt that we reached our customer.
DR. DETMER: Yeah, when he turned around and said to Scully who was at CMS and said, "Is that right?" I made the comment that, well, with all due respect, sir, you had a set of standard recommendations on the Department or you said it for months that Don had developed a long time ago. And he turned around, he says, "Is that right, Scully. If you don't move those things by the end of this week, you're fired." Then he turned around to us and said, "Can you come to my office in the morning, and we can start working on it." It really was quite an astonishing thing. I'd never seen anything quite like it before or since actually.
MR. SCANLON: We did some work. We had several summits, you'll remember. Many of you were present, and everything looked very promising. It led to the creation of ONC. It led to the Executive Order. It led to a succession of ONC coordinators, and now we have the full office and high tech as well.
MR. REYNOLDS: But I think the one thing, Simon, that you helped us towards the end of your tenure on the committee and we're trying to do more of it is that we take more of our full committee meetings to educate the committee on an upcoming subject that we might have recommendations on. So although we're taking it into a particular committee that has, you know, the expertise, we're bringing the committee along because we've always had a great thing in the committee is that when whoever of us around this room signed a letter, we knew it was agreed, we knew everybody was in, and we knew that the public was in because everybody had a chance in the room and they show up when it's a subject that's got an issue. They show up, and that's been consistent. I see every head nodding. They show up when the game's on.
And we hear you loud and clear. You mentioned the word political. It's about the relationships, and we are working those relationships all day every day on a regular basis.
SUSAN KANAAN: we've ranged back 60 years and probably ahead nearly as much, and brought in people who were not here but kind of invoked them. So in a way it feels appropriate to finish up talking right about sort of the present moment and what we're doing right now. I'll turn it over to Marjorie now to conclude for us.
MS. GREENBERG: I think it would be actually impossible for me to really summarize this rich conversation. But it certainly met my goals, although as has often been said, 80 percent of life is showing up. And so you all showed up, and I really appreciate that, but you did so much more than showed up.
I wish we could talk into the night, and it's such a privilege and pleasure to have you all here with us. But I think you've given us, as I said, a lot to think about. I think we value that. We value all of you as colleagues, as friends, as advisers. So with that, we will close our get together.
Director, Health Plan Transformation
Global Healthcare & Life Sciences Industry
Durham, North Carolina
Associate Executive Director
The Permanente Federation
Kaiser Permanente
Oakland, California
Senior Vice President and Director
Health Care Group
Robert Wood Johnson Foundation
Princeton, New Jersey
Professor Emeritus and Professor of Medical Education
Department of Public Health Sciences, School of Medicine
University of Virginia
Charlottesville, VA
Director, National Health Policy Forum
Washington, D.C.
Retired
Chattanooga, TN
NCVHS Executive Secretary
National Center for Health Statistics, CDC
Hyattsville, Maryland
NCVHS Executive Staff Director
Office of the Assistant Secretary
Department of Health and Human Services
Washington, D.C.
NCVHS Writer