Public Health Service
November 15, 1996
Washington, D.C.
- Meeting Minutes -
The Subcommittee on Data Needs, Standards and Security of the National Committee on Vital and Health Statistics was convened on Friday, November 15 in the Hubert H. Humphrey Building in Washington, D.C. The meeting was open to the public. Present:
Subcommittee members
Barbara Starfield, M.D., Chair
Simon P. Cohn, M.D., M.P.H., F.A.C.P.
Kathryn L. Coltin, M.P.H.
Don Detmer, M.D.
Lisa Iezzoni, M.D., M.S.
Thomas A. LaVeist, Ph.D.
John R. Lumpkin, M.D., M.P.H.
Clem McDonald, M.D.
Vincent Mor, Ph.D.
George H. Van Amburg
Staff and liaisons
Marjorie Greenberg, National Center for Health Statistics (NCHS)
Lynnette Araki, NCHS
Bob Moore, Health Care Financing Administration liaison
James Scanlon, HHS Executive Staff Director
Bill Braithwaite, ASPE
Harvey Schwartz, Ph.D., AHCPR
Summary: The Subcommittee on Data Needs, Standards and Security met at the close of a two-day session of the National Committee on Vital and Health Statistics. The purpose of this meeting was to decide on a charge, establish work groups and assign members to them, and lay out the work plan for the immediate future and mechanisms for longer- range planning. Members established two work groups: 1) Work Group on Population- Based Data; and 2) Work Group on Administrative and Clinical Data. The latter deals with transaction-based data and has primary responsibility for the mandates of the Kassebaum-Kennedy bill (P.L. 104-191), nicknamed "K2" by the Committee. The work groups will make recommendations for the Subcommittee's work plan in their respective areas. Dr. Starfield, the Subcommittee Chair, and Ms. Coltin, Chair of the Planning and Implementation Subcommittee, will watch for subjects that should be addressed by the full Subcommittee.
· Mr. Moore will supply the members of the K2 Work Group with the draft recommendations on provider and payer ID regulations.
· The K2 Work Group will hold a conference call, consult with Dr. Starfield and Dr. Detmer, and recommend a work plan including meeting plans.
· Mr. Scanlon will supply the members of the Work Group on Population-Based Data with materials on the survey integration plan. Like the other Work Group, they plan to meet early in 1997.
· Dr. Cohn will provide fellow members with copies of his publications regarding the research agenda for code sets.
· Mr. Van Amburg circulated draft recommendations of the former Subcommittee on State and Community Health Statistics regarding community health assessment, which stem from a series of hearings held by the Subcommittee. He asked members to review the document and offer suggestions and comments at the next Subcommittee meeting.
As the Subcommittee began discussion of its charge, Dr. McDonald suggesting getting a sense of where within the huge administrative simplification effort the Committee can make the greatest contribution.
The group characterized its purview in terms of both survey integration and administrative and clinical data. They discussed the place of clinical data in respect to administrative data, and agreed that the two are inextricably linked. In response to a question, Dr. Van Amburg said that the concerns of the former Subcommittee on State and Community Health Statistics are well reflected in the draft charge of this group.
Dr. McDonald suggested including a statement about doing the immediate work on administrative simplification with an eye toward facilitating electronic medical records and the next phase of the legislation. Members agreed that the charge's preamble would include a statement to this effect, along with mention of surveys and population-based data issues. The Subcommittee authorized Dr. Starfield to redraft the charge reflecting the foregoing discussion.
They then discussed an internal structure for the Subcommittee, starting with a suggestion of three work groups, on 1) the administrative tasks mandated by K2; 2) clinical data in a broader context, including core data project follow-up; and 3) population data. Ultimately, two Work Groups were established, one on Administrative and Clinical Data and one on Population-Based Data. Members felt that three sub-groups would spread the energies of the Subcommittee too thin and make operations difficult. It was noted that core data element recommendations can be pursued in the contexts of both K2 and surveys. In general, members felt that even though K2 envisions work on the electronic medical record as a future stage, it should be phased in gradually, and administrative and clinical issues should be addressed together.
A recurring theme of the meeting was maximizing the synergy between the two sub- groups and bringing broader, less technical perspectives and skills to bear on the standards work. Much of the discussion represented an effort to develop a common understanding of the terms and the task at hand. Dr. Cohn and others pointed out that in the future, population- based studies and data will depend on the standards. Dr. McDonald added that at the heart of the standards development effort lie conceptual and relational matters that are critical to clinical information and surveys. Dr. Iezzoni commented on the need for genuine dialogue between people in the standards organizations and NCVHS members with a population-based orientation, with a common language and genuine listening. This has not always been the case in the recent past. She observed that the Committee faces a challenge to be productive and stay on the same page. Dr. Mor stressed the need for those interested in population-based issues to help the other work group "see the forest."
Having agreed to establish two work groups, Subcommittee members then volunteered for one or the other, as follows:
Work Group on Administrative and Clinical Data
Dr. Cohn
Ms. Coltin
Ms. Frawley (assigned in absentia)
Dr. Lumpkin (later appointed Work Group Chair)
Dr. McDonald
Dr. Mor
Work Group on Population-Based Data
Dr. Iezzoni
Dr. LaVeist (contact person)
Mr. Van Amburg
Dr. Starfield said the entire Subcommittee would deal with coding and classification issues as they are of interest to both groups. Ms. Coltin observed that there may be several cross-cutting issues for the entire Subcommittee to address, such as the various kinds of identifiers.
Dr. Starfield expressed concern that K2 tasks would consume the Subcommittee, to the neglect of other aspects of clinical data. In response, Dr. McDonald explained that his reason for longstanding participation in the standards development effort is precisely "to build medical information, clinical information, research information to a common place" with a common form and language. He stressed that all data activities have a single framework, and everyone has a stake in standards development. Dr. Starfield commented in this vein that it is not the Committee's charge to come up with standards, but to look at the mass of them and recommend what should be done with them. Mr. Moore and others pointed out, however, that this still requires attention to the details by at least some Subcommittee members.
The group discussed process issues at length, and reached the general conclusion that the work groups would propose work plans after learning more about the Department's expectations and other aspects of their responsibilities.
Mr. Moore outlined the Department's plans over the coming months, one facet of which is to issue draft regulations on payer/provider ID in February. The group struggled with how to synchronize the work plans and timetables of the Department and the Committee, given the extreme time pressures imposed by legislation. Some attention was given to the underlying question of the Department's accountability to its advisory body. Mr. Moore said the Department would inform the Committee of its actions and recommendations, and would make sure to stay in regular contact with the K2 Work Group. He will supply the members of that group with the current recommendations on payer and provider ID, and they will hold a conference call soon to discuss them. He suggested that the Subcommittee may wish to comment on the Department's categorization of payers, which the Committee has already taken exception to. In respect to the forthcoming draft regulations, the sense was that the Work Group may be able to have some input prior to their issuance in February, after which the Committee can respond during the public comment period.
Another question that arose in this context was the extent to which the Work Group can act autonomously and/or represent the Subcommittee to the Department. The implicit tension is between consultation and timeliness. Members agreed that the Work Group could make decisions about procedure without having to consult the Subcommittee, and that it would serve as the Department's point of contact to the Subcommittee in regard to K2. However, the work group will not take formal positions but rather make recommendations to the Subcommittee. Dr. Starfield was encouraged to participate in all Work Group conference calls to help identify subjects on which the entire Subcommittee should confer.
Dr. McDonald said it is possible to predict some of the issues that will arise in these discussions with the Department, and he outlined a few for the group. Mr. Moore predicted that the Committee would be especially interested in the content of enrollment records, claims and encounters, and less interested in matters that only affect payers and providers. Dr. Mor pointed out that although in the short term these decisions only apply to people with insurance, ultimately they also may have to work for broader public health purposes. Mr. Moore reminded the group that the goal of the legislation is administrative simplification, which can free dollars to go back into patient care in the community.
There was some speculation about next steps, with Dr. Cohn and Dr. McDonald urging that the work groups first be allowed to investigate what they can and should be doing and to develop a work plan on that basis. The general feeling was that the six people on K2, in dialogue with the Department, could do that more efficiently than the current large group. Dr. Detmer asked Dr. Lumpkin to coordinate the K2 group, and Dr. Lumpkin accepted the appointment. Dr. Braithwaite and Mr. Moore will staff the Work Group.
Dr. Lumpkin pointed out that the Committee has an obligation not just to work with the Department but also to represent the perspectives of all those who will be impacted by the standards.
Dr. Iezzoni remarked that the Work Group on Population-based Data needs a staff person who is knowledgeable about survey integration issues. Mr. Scanlon offered to supply members with materials on the survey integration plan. Mr. Van Amburg pointed out there is more to population-based statistics than integrated surveys -- for example, many CDC activities. Dr. Lumpkin agreed, noting that while survey integration is on a fast track and needs prompt attention, a host of other population-based issues also need addressing. Dr. Iezzoni offered to serve as the contact person for the Population-Based group.
Dr. Starfield asked for a discussion of hearings, and several possible topics were suggested:
· states already dealing with standards, from whom the federal government might learn something (e.g., MN, MA, MD, NJ, TX, UT, per Mark Epstein)
· CDC activities such as on communicable disease transmission using immunization data through formal standards, getting cancer data from base lab data, and work on birth certificates
· eliciting the views of operations people in organizations such as the AMA regarding their experiential measures of successful administrative simplification (i.e., how it would feel to them)
· testimony from the ANSI-accredited SDOs not yet heard by the full Committee, and possibly SDOs
· identifiers other than personal ID (provider, location, payer, health plan), with an eye to commenting on the forthcoming HHS draft regulations
Dr. Cohn urged that the Subcommittee clarify its objectives and develop its work plans before thinking further about hearings. Members recognized the need to decide quickly, in order to give adequate advance notice of hearings. Dr. McDonald suggested that the K2 Work Group propose specific hearings as soon as it has clarified what the Subcommittee needs to accomplish in this area. He encouraged the Subcommittee to steer clear of the most contentious and intractable issues, and to put its energies where it is most likely to make a contribution.
Dr. Mor mentioned code sets and their interrelationship as an important area, and Dr. Cohn responded that there is a specific research agenda in this area and the Subcommittee must be careful not to suggest changes that could have a broad impact without benefit of a significant research demonstration. He offered to provide copies of his publications on this topic.
Regarding future meetings, Subcommittee members expressed a preference for informality and other conditions that promote give-and-take and consensus. It was stressed that Work Group meetings, like Subcommittee meetings, are open to the public and will be staffed.
Finally, Mr. Van Amburg circulated draft recommendations of the former Subcommittee on State and Community Health Statistics on community health assessment, stemming from a series of hearings held by the Subcommittee. He asked members to review the document and offer suggestions and comments at the next Subcommittee meeting.
Dr. Starfield then adjourned the meeting.
I hereby certify that, to the best of my knowledge, the foregoing summary of minutes is accurate and complete.
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Chair Date