2009 NCVHS Accomplishments

As advisory committee to the Secretary of the Department of Health and Human Services, the NCVHS accomplishments in FY 2009 include:

  • Instrumental in laying the strategic groundwork for transition to ICD-10-CM and ICD-10-PCS to replace the current ICD-9-CM volumes 1, 2, and 3, which have limited ability to accommodate new diagnoses and procedures within the established hierarchy of the coding system. After commissioning a cost-benefit analysis and outlining the issues and background information in a letter to the Secretary (2003), the Committee followed up with briefings on international classification activities (2007), and an update on ICD-10 revision plans (2008). All of these efforts contributed to the Department’s milestone release of a Final Rule to adopt the replacement code sets.
  • Producing and distributing a Privacy Report “Recommendations on Privacy and Confidentiality, 2006- 2008) distributed in Spring 2009. The report highlighted three letter-reports to the Secretary, proposing ways to enhance public trust in, and public benefit from, the electronic exchange of personal health information. The recommendations directly informed and influenced formulation of the official HHS FERPA/HIPAA Guidance (December 2008) helping to clarify particularly confusing and sometimes contentious issues concerning minimum necessary, outliers from the Privacy Rule, and application of privacy rules on student health records.
  • Continuing to make e-prescribing recommendations and, specifically, to foster adoption of appropriate NCPDC Script Standard Versions in acute and long-term care settings, most recently recommending 10.6 for use in Medicare Part D eprescribing.
  • Helping to clarify and define a crucial aspect of HIT in preparation for electronic health records development and support, “Meaningful Use of Health Information Technology.” The definition is pivotal with respect to the American Recovery and Reinvestment Act (ARRA) of 2009 directives for “Medicare incentives for adoption and meaningful use of certified EHR technology.” In one of the largest hearings in its history, the Committee heard from stakeholders, constituent organizations, as well as receiving public testimony obtained via federal register request, and organized a report of major themes, as directly requested by the Office of the National Coordinator on Health Information Policy (ONC), (submitted May 2009).
  • Providing further analysis of “Meaningful Use” by preparing Observations based on the major themes heard at the hearing and submitting to the Secretary, to help clarify key issues to achieve adoption and meaningful use of certified EHR technology (June 2009).
  • Encouraging support for the Nation’s Health Statistics Enterprise by submitting a letter to the Secretary recommending that adequate funding and resources be made available to assure a robust vital statistics and population health information infrastructure that can provide rigorous, unbiased, statistical metrics of the nation’s health and health care (March 2009).
  • Preparing a Primer on Health Data Stewardship. The topic is cited prominently in the NCVHS Report “Enhanced Protections for Uses of Health Data: A Stewardship Framework for ‘Secondary Use’ of Electronically Collected and Transmitted Health Data. The primer will provide an entry point for people in the field unfamiliar with the important concept and serve as a concise summary and resource for the field.
  • Holding three days of hearings on Personal Health Records and their privacy challenges and implications. A report with recommendations is under development.
  • Staying abreast on the federal health IT enterprise through briefings by executive officers and liaisons from ONC, as well as the National e-Health Collaborative and the new Federal advisory committees.. Current and former NCVHS Committee members are engaged in these new organizations.
  • Obtaining other targeted updates on health information technology via briefings and ongoing communication with leaders in the field. The Committee heard from a vendor company about its experience setting up and using the technology for Personal Health Records, (September 2008) which provided insight about the success and challenges of companies providing online access to health management tools including a personal health record (PHR) while offering providers an electronic health record (EHR). The Committee was also briefed on current HIT realities in the States, how state public entities are using health information technology, legislative updates and future projections.
  • Receiving a briefing by an official from the Clinical and Translational Science Awards program at NIH about a new approach to funding biomedical research to facilitate and encourage multidisciplinary scientific applications. The Committee will continue analysis of this issue because the health research enterprise directly effects the acquisition, study, and use of vital and health statistics.
  • Conducting a Strategy session via the Executive Subcommittee (October 14-15) with particular attention to de-identification of health data and cross-cutting concepts in person-centered health. The members reviewed and fine-tuned their Charges to more effectively represent their targeted goals and current strategic plans. This was the first strategic session since several of the Subcommittee names were altered and adjusted to more effectively reflect and represent each Subcommittee’s focus. The Committee’s executive leadership reinforced its commitment to help “prepare the landscape for data-driven reform,” and develop an Information Framework for Health Care Improvement.
  • Receiving a briefing from the Executive Secretary on the latest developments in international classifications and public health informatics from the 2008 WHO-FIC Network meeting in India and the conference that followed, as well as the proposed harmonization activities between WHO and the International Health Terminology Standards Development Organization (IHTSDO). At an earlier meeting, the Committee was briefed by NLM on coding and classification issues, and at the February 2009 meeting, the Committee was briefed by Professor Martin Severs from the U.K. and IHTSDO Chair on emerging international health information terminology and technology issues.
  • Receiving a briefing on Measuring and Reporting Functional Status “Are the Stars Aligning for ICF” from Dr. Lisa Iezzoni, a national expert in the field, and former Committee member. Dr. Iezzoni chaired the Subcommittee that developed the NCVHS report on “Classifying and Reporting Functional Status.”
  • Focusing for much of Fall 2008 on developing a Standards Initiative with plans for panels and testifiers for future hearings on the processes for developing, selecting, coordinating, and implementing health care information business rules and standards to further the adoption of these standards nationally. Although these developments were curtailed after the first hearing by the more burgeoning developments in defining “Meaningful Use of Health Information,” the background analysis provided valuable information to pursue at a future date.
  • Exploring aspects of Federal health data capacity to support health policy in areas of access to care, insurance coverage, and costs, via a ½ day hearing organized by the Populations Subcommittee, with support from ASPE. Departmental staff were essential in contacting, coordinating, and securing speakers to examine data capacity and gaps for measuring the extent of under-insurance, length of time uninsured, and the availability of coverage data to support state-level policy estimates. Testifiers represented the Treasury, CBO and GAO as data producers, and data users, and the information has already been recognized as a pivotal reference point.
  • Continuing examination of health data capacity in the Federal sector, a subsequent hearing examined capacity of simulation models for estimating the impact of policy changes on insurance coverage at national and state levels.
  • Reiterating its concern from previous letters and reports to the Secretary that the inability to electronically prescribe controlled substances is a major barrier to overall e-prescribing adoption by providers. The letter on “Electronic Prescriptions of Controlled Substances” contain comments relative to the Department of Justice (DOJ) notice of proposed rule making (NPRM) regarding its Drug Enforcement Administration’s (DEA) intent to revise its regulations to provide practitioners with the option of writing prescriptions electronically for controlled substances. (September 2008).
  • Continuing to analyze the themes from the hearing on the Patient-Centered Medical Home (PCMH) organized by the Population Subcommittee with the purpose to gather information from key stakeholders of the PCMH and to answer questions about the potential of the PCMH to improve the quality and lower the cost of health care in the U.S. A special summary document was developed and the information continues to be a valuable resource for the Committee while the Subcommittee stays abreast of the topic’s continuing evolution.
  • Organizing a hearing on the strengths and shortcomings in defining and addressing how “meaningful measures” of quality are created, introduced to the field, adopted and sustained. In addition, the hearing will seek to gain input and recommendations on the state of measure development and adoption in select national priority areas, especially using emerging data sources.
  • Continuing to collaborate with the NCHS Board of Scientific Counselors (BSC), building on the cooperation fostered by their joint session (September 2006). Since then, the BSC Chair consults routinely with the Populations Subcommittee Chair in developing and orchestrating agenda items, strategic plans and projects. Both groups recognize the impact of tightened revenue funding streams and privacy regulations and policies on collection and analysis of health data. The members from both groups took advantage of their contiguous September 2008 meeting schedules with coordinated agenda planning.
  • Continuing to make use of the information gathered from the Workshop organized by the Subcommittee on Populations–Using Administrative Data to Improve Statistics on Health Outcomes, to identify data linkages within and among federal government agencies with a view to promoting best practices. Department officials frequently refer to the gathering and the report which helped to identify baseline issues in using administrative data. The Committee continues to seek ways to promote data linkages that can improve health information for Americans and identify factors that influence disparities in health care and health status. The session continues to be recognized for providing a rare opportunity for representatives from a range of agencies to discuss these issues, share lessons and observations and dialog about data linkages.
  • Remaining very engaged in and committed to updating the 21st Century Vision for Health Statistics report. The Vision report, published in 2002, pre-dates much of the electronic information technology advances of recent years, which will be addressed in Phase I of the project. Consultants Drs. Dan Friedman and Gib Parrish prioritized the report recommendations based on the Committee’s feedback, and interviewed key leaders in the field for input and observations. Next steps will entail actual workshops or hearings to explore the issues and provide more extensive input. The plan includes development of a preliminary updated Vision report by summer 2010 in time for the NCVHS 60th Anniversary Celebration.
  • Designing a poster of “NCVHS: 60 Years of Making a Difference” for display at the 2008 WHO-FIC Network meeting in India.
  • Preparing a 2010 report which will reflect the extensive activities that have occurred since publication of the 50-year history in 2000. The report will highlight activities since the 2005-2006 report. In addition to a new administration, the four years between biennial reports have witnessed extensive strides in electronic health information technology, an intensive exploration and interest in electronic health records, and an unprecedented influx of funding provided in the ARRA to accomplish many HIT goals.
  • Preparing to celebrate its 60th anniversary, including an oral history project in Charlottesville, VA in September 2009, which will recognize the legacy of past NCVHS chair persons.

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