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The Public Advisory Body to the Secretary of Health and Human Services
 

 

NCVHS Accomplishments in 1998

This summary of NCVHS accomplishments during 1998 was prepared to meet reporting requirements under the Federal Advisory Committee Act. The recommendations referenced also can be found on this web site at http://www.ncvhs.hhs.gov/reptrecs.htm.

As advisory committee to the Secretary of the Department of Health and Human Services, the NCVHS’ accomplishments in 1998 include:

  • Restructured to streamline current activities and accommodate several new areas. The new infrastructure includes the following four subcommittees: Subcommittee on Privacy and Confidentiality; Subcommittee on Standards and Security; Subcommittee on Populations; and the Executive Subcommittee. There also are four workgroups: Workgroup on Computer-based Patient Records; Workgroup/Project on Health Statistics for the 21st Century; Workgroup on Quality; and Workgroup on National Health Information Infrastructure.
  • Maintained close liaison with the HHS Data Council and the HIPAA departmental implementation teams in developing and carrying out the Committee’s work plan.
  • Submitted the first annual report to Congress on Implementation of the Administrative Simplification Provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These annual reports by the Committee are required by the HIPAA legislation.
  • Sent two letters to the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, commenting on the Commission’s reports and noting a number of complementary activities being undertaken by the NCVHS. The first letter applauded the Commission’s Consumer Bill of Rights and Responsibilities and commented on standardization of quality measures, comprehensiveness of quality measurement sets, cost-effectiveness of data collection and reporting strategies, the importance of cultural competence of providers to a consumer empowerment strategy and the need for comprehensive confidentiality legislation.
  • The second letter congratulated the Commission on its excellent final report, Quality First: Better Health Care for all Americans and supported the report’s recommendations regarding investing in information systems; strengthening the evidence base for health practices; strengthening and coordinating quality measurement, reporting and oversight functions within and across the various sectors of the health care industry; stimulating quality improvement within health care organizations and professions; promoting accountability for performance throughout the health care industry at the community level; and empowering consumers to make informed choices about their health plan, providers and treatments.
  • The Subcommittee on Privacy and Confidentiality held two roundtable discussions on “Identifiability of Data” and “Health and Medical Registries” with a variety of participants from interest and advocacy groups, government, the private sector (for profit and non profit), the health care industry, the research community and academia. Following these discussions, the full Committee sent recommendations to the Secretary containing a number of observations and conclusions. Specifically, on the issue of records, the Committee believes that everyone who collects and uses health data must pay attention to and continually evaluate the likelihood that data once believed to be non-identifiable may no longer retain that status. In particular, Institutional Review Boards should be alerted to this issue. Concerning registries, the Committee believes that health data should be provided only to registries that conduct research, public health and related activities and that legislation should not undermine the flow of health information into or out of such registries.
  • Held a roundtable discussion with industry experts about the issue of confidentiality of health information and health care anti-fraud activities.
  • In the area of health data standards, the Subcommittee on Standards and Security held a hearing on claims attachment standards; under HIPAA, the Secretary is to adopt these standards by February 21, 1999. Testimony was received from payers, providers, state departments of health and vendors. The Subcommittee also met several times with members of the Claims Attachment Implementation Team. The full Committee has recommended to the Department that the standard for claims attachments should include only HL7 formatted text in an X12 envelope; however, a final recommendation on the claims attachment transaction awaits completion of testing by the Health Care Financing Administration and industry.
  • Transmitted to the Department comments on the HIPAA Notices of Proposed Rule- making for the National Standard Health Care Provider Identifier and for Standards for Electronic Transactions. The Committee was generally supportive of the content of the NPRMs and provided responses to a number of issues raised in the documents.
  • Also transmitted comments on the Proposed Rule for Security and Electronic Signature Standards, recognizing the proposal as a positive step toward requiring that all health care entities safeguard the integrity, confidentiality and availability of their electronic data. Supported the proposal’s recommendations for a technology-neutral standard that will promote interoperability among information systems, the accommodation of different sizes of health care entities and consideration of the cost of implementation.
  • Developed and approved a concept paper on “Assuring a Health Dimension for the National Information Infrastructure,” which is being forwarded to the Secretary and HHS Data Council. The paper describes opportunities and challenges for crafting a comprehensive approach to health information policy and guiding the optimal development of the nation’s information capacities. The NCVHS is committed to helping the Department address this important area.
  • Commissioned a white paper analysis of unique patient identifier options. The paper was accepted by the NCVHS. The full text of the report is posted on the NCVHS website.
  • Held a public hearing in Chicago, IL on adoption of a unique health identifier for individuals. The Health Insurance Portability and Accountability Act of 1996 directs the Secretary to adopt unique identifiers for health care providers, payers, employers and individuals. While broad-scale consensus exists for the other identifiers, there is no consensus on what identifier should be chosen for individuals, how it should be administered or even whether one should be adopted. Last year, the Committee recommended to the Secretary that it was premature to select a unique health identifier for individuals until provisions for security and confidentiality have been determined. It further stated that no such selection should be made without the opportunity for further public notice, hearings and comments. The Chicago hearing was the first of these hearings.
  • Continued to collaborate with the National Center for Health Statistics in an advisory capacity by participating in the development of a long range plan for health statistics in the U.S. Commissioned white papers on comparative descriptive studies of health data systems in nations outside the U.S., including a summary description of “models” for national health data systems; on case studies of the utility of the U.S. health data system in policy planning for health care reform and for the child health insurance program; and on one or more case studies of particular components of the national health data system that have performed successfully through periods of historical changes. In addition the Committee is contracting to obtain expert opinion through a process of facilitated discussions with representatives of a wide range of health data producers and consumers. These activities will be input to a workshop convened by the Committee on National Statistics.
  • The Subcommittee on Populations pursued its year-long review of Medicaid managed care, with hearings in Washington, D.C., Phoenix, AZ and Boston, MA, as well as contractual studies on Medicaid data requirements. The Subcommittee is identifying the questions about health and health services delivery raised by the move to Medicaid managed care and the data elements and types of information required to address these questions. A report with recommendations will be presented to the full Committee in early 1999.
  • Monitored the efforts by an Office of Management and Budget (OMB)-directed workgroup to develop federal guidelines for tabulation and presentation of multi-racial responses, as required by the new OMB Directive 15.
  • The Subcommittee on Populations held a two-day meeting on health data needs and issues in the U.S.- associated insular areas - - Puerto Rico, the Virgin Islands and the U.S. - associated Pacific Islands. Representatives from all of the jurisdictions participated and described their successes and challenges in obtaining and using health data for planning, grants proposals and public health programs. Representatives from HHS agencies and regional offices that work with the areas and from the Departments of Interior and Energy also participated in the information exchange. A report with recommendations will be developed and brought to the full Committee for approval.
  • The Subcommittee on Populations and Subcommittee on Standards and Security held a joint meeting at the Health Care Financing Administration (HCFA) to consider data requirements for “post-acute care.” Currently there are a number of different data collections in operation or planned to obtain information on medical or personal services provided in nursing homes, assisted living facilities, rehabilitation facilities and at home. The NCVHS is seeking to work with HCFA and the Department to develop a coherent data policy that focuses on patients’ attributes rather than specific features of existing settings of care.
  • Organized a panel discussion on the quality of data available for performance measurement. The Workgroup on Quality will be exploring this and related issues in the coming year, with an emphasis on data for the post-acute care environment.
  • Initiated the Committee’s work on recommending standards for computer-based patient records with a panel discussion on the current state-of-the art. A hearing will be held on this subject in early December. An Inventory of Clinical Information Standards, prepared by the ANSI Healthcare Informatics Standards Board and presented to the Committee, will provide valuable background information.
  • Approved a letter to the Secretary, recommending an appropriate adaptation and use of the State and Local Area Integrated Telephone Survey (SLAITS) for evaluating the performance of the State Children’s Health Insurance Programs at the State level. The Committee’s letter noted that the mix of State level programs now being designed and implemented provides an unusual opportunity for assessing the effectiveness of divergent approaches to insuring and delivering health care to children.
  • Will participate in a Workshop on Implications of the Administrative Simplification Provisions of HIPAA for Public Health and Health Services Research. The workshop is being sponsored by the National Center for Health Statistics and the Centers for Disease Control and Prevention in conjunction with the Agency for Health Care Policy and Research.
  • Received presentations on the process underway for developing objectives for Healthy People 2010. The Committee expressed strong support for the data development efforts underpinning the process, including linkages between socioeconomic status and health.
  • Were briefed on HCFA’s development of Guidelines for Documenting Evaluation and Management (E&M) Services and sent two representatives to a meeting sponsored by the American Medical Association on the subject. Implementation of the guidelines has been indefinitely postponed.
  • Received updates on the clinical modification of the tenth revision of the International Classification of Diseases (ICD-10-CM), under development by NCHS, and on ICD-10- PCS, the procedure coding system developed by HCFA under contract to replace Volume 3 of ICD-9-CM.

The full text of all of the Committee’s recommendations can be found on the NCVHS website at http://www.ncvhs.hhs.gov/reptrecs.htm

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