2011 NCVHS Accomplishments
Accomplishments of the NCVHS in FY 2011
As advisory committee to the Secretary of the Department of Health and Human Services, the NCVHS accomplishments in FY 2011 include:
- Achieved its full membership complement of eighteen members, including congressional appointees, the first time in almost ten years. Provided thorough orientation for all eight incoming new members, nearly one-half of the membership, with a conference call to provide a basic overview of the Committee’s mission, recent tasks and accomplishments, as well as meeting logistics, and a follow-up session conducted directly after the Full Committee meeting June 16th. Both sessions included participation from an OGC official for Ethics training for Advisory Committee members. The six Executive-appointed members and two Congressional appointments represent a range of interests including state health departments, statistical and economic agencies, universities and privacy expertise.
- Through two Subcommittees — Population Health and Privacy, Confidentiality and Security — conducted two NCVHS workshops on: “The Community as a Learning System for Health: Using Local Data to Improve Community Health.”
- At the February 8th session, participants shared information on using local data and other information resources to improve community health and provided insight about using available resources, dealing with the local realities and overcoming barriers. Workshop was attended by Todd Parks, HHS Information Officer, who offered comments, and invited the participants to attend the 2nd Annual DHHS Health Data Initiative Forum conducted June 9th. (The Subcommittee Co-chairs and Executive Secretary participated in the Forum.)
- The second Community Health Data Workshop (conducted May 12th) provided insights about privacy and security within the framework of a model community highlighting enablers and barriers to data use for community health.
- Developing a report based on information from the workshops, preliminary environmental scans, and interviews with key participants. The report will discuss how successful community health efforts seem to have certain elements in common: trust, collaboration, access to useful data, agreement on priorities, support, and ways to translate information into action, including evaluating the results. The report also will suggest how the federal government and others can help communities join the national momentum toward better community health. Once the report is reviewed and accepted, plans will be underway for subsequent hearings including a model community to obtain more in depth information for further improvements.
- By special request, the Executive Secretary briefed Dr. Seth Foldy, Director, Public Health Informatics and Technology Program Office, OSELS, on health information technology issues under discussion and review by NCVHS and interactions of the Committee with the Office of the National Coordinator. Also, per the Executive Secretary’s suggestion, Dr. Foldy has been named as the new CDC liaison.
- Submitted a letter, developed by the Quality Subcommittee, on a quality measurement roadmap, based on information from the October 2010 hearing, and which reflected the interactions of the Population health, Quality, Standards and Privacy Subcommittees in addressing mutual and overlapping issues. The letter’s findings and recommendations emphasize a focus on the consumer perspective, health care value, and accountability and care coordination. As in previous letters, the Committee recommends that quality measurement stakeholders should be convened to formulate a strategy to coordinate development of measures.
- Submitted a series of letters prepared by the Standards Subcommittee in line with implementing part of the Affordable Care Act, recommending a standard for Health Care Electronic Funds Transfers and soliciting Operating Rules for Electronic Funds Transfers (EFT) and Electronic Remittance Advice (ERA) (February 2011)
- Submitted a letter prepared by the Standards Subcommittee as part of implementing aspects of the Affordable Care Act, recommending CAQH CORE in collaboration with NACHA as the candidate authoring entity for operating rules for all health care EFT and ERA transactions (March 2011). NCVHS was charged with this crucial assignment because of trust in the Committee’s effectiveness, fairness, and deliberative process.
- Submitting a letter prepared by the Standards Subcommittee (based on a hearing conducted June 17th) on the status of industry implementation of updated and new HIPAA regulations and ICD-10 code sets. The hearing included input from federal agencies, health plans, clearinghouses and vendors, providers and an assortment of other stakeholders for a robust and inclusive session.
- Was briefed by Executive Staff from the National Library of Medicine (NLM) about bridging SNOMED CT and International Classifications, (February 2011); NLM clarified the status and usage of various code sets and the limited resources to carry out the necessary mappings.
- Submitted a letter developed by the Executive Subcommittee which reviewed and commented on aspects of the recent report on Health Information Technology from PCAST, the President’s Council on Advisors of Science and Technology, in light of the Committee’s own vision for an interoperable health information system and the adoption of electronic health records. The Committee’s response to the report clarified the foundation needed to achieve basic interoperability and referenced previous NCVHS letters and reports already in the record.
- The response to the PCAST report also acknowledged the recently published Announcement of Notice of Proposed Rule Making (ANPRM) issued by the Office of the National Coordinator regarding metadata standards to support electronic health information exchange. The Committee noted that while technical development has been occurring, corresponding policy framework guiding the implementation of this technology has not developed in parallel, and also noted the need for synchronous policy development. Comments will be submitted on this ANPRM.
- The Committee is also responding to another ANPRM – Human Subjects Research Protections – which is intended to extend protections to a larger number of participants while simultaneously streamlining the oversight and paperwork for scientists. This topic has a broad impact across all of the Subcommittees, involving the Common Rule, FERPA, and HIPAA. As the proposed changes would be the first in two decades to the “Common Rule” that governs nearly all publically-supported human-subject research, this is pertinent to NCVHS activities and projects. As such, the Committee plans to develop a series of comments pointing to past NCVHS work and current positions, providing insight based on its extensive coverage of these issues throughout the years.
- Reviewed the preliminary summary of concepts in the IOM Learning Health System in light of future planning and NCVHS activities and projects.
- Received a briefing from the Executive Secretary on the 15th North American Collaborating Center Conference on ICF: “Enhancing our Understanding of the ICF June 23-24, 2010) at NIH in Bethesda. The objectives of the conference were to provide basic information about ICF coding including the ICF conceptual framework, and to enable enhanced sharing of resources about ICF applications between and among American and Canadian scientists and government agencies. NCVHS had been one of the conference sponsors.
- Received a briefing from Executive Staff from ASPE on the Multi-Payer Claims Database for Comparative Effectiveness Research (June 2011), with the goal to enable research on priority populations, interventions, and conditions for both clinical and delivery system research, with analytic tools for greater functionality. The ultimate aim of this public-private partnership is to lay the foundation for future enhancements with clinical data. Incorporating public and private data into a single source is expected to enhance the value of claims data for comparative effectiveness research.
- At the same June 2011 meeting, received a briefing from the Executive Director of the National Association of Health Data Organizations (NAHDO) on how NAHDO is collaborating with the All Payer Claims Databases Council (APCD) in working with states and the insurance industry to develop consensus data collection standards to promote the uniformity and comparability of APCD data across states, as well as the availability of these data sets for health services research, public health, and market applications.
- Approved a letter prepared by the Privacy Subcommittee on Sensitive Health Information in Electronic Health Records. Based on input from several hearings, the Committee recommended that HHS explore the use of technology that can assist with the management of sensitive health information, specifically by investing in research to enhance the capabilities of electronic health records and health information exchanges to identify and manage sensitive information, including the development of standards, if appropriate. The deliberations required the Committee successfully to find the right balance between privacy and confidentiality concerns of patients with the need for information by the treating physician.
- Through the efforts of the Quality Subcommittee, NCVHS organized and conducted a session at NCHS headquarters on “Developing a Quality Measurement Roadmap, Considering Future Information needs and Data Sources.” Speakers noted information needs for the public and consumers, what providers need to improve quality, the role of professional organizations in assessing clinical performance, and payer and group purchaser needs. Major themes involved the need for a patient-centered approach throughout the health care spectrum, the need for a collaborative team approach to care, and quality as a decision support tool. The members also reiterated the need for an educated workforce as stated in previous communication, reviewed an environmental scan that had been conducted, and cited key items in its previous December 2009 letter, “Meaningful Measurement of Quality Health Care using Electronic Health Records” for reference.
- Routinely receive briefings from executive staff of the Office of the National Coordinator (ONC), including the ONC Privacy Officer, who helped clarify issues pertaining to sensitive information in the medical record, and Dr. Charles Friedman who introduced the concept of “Element 3,” creating a rapid learning system through use of electronic health records databases, an item of interest for IOM.
- Was briefed on governance of the NCHS Health Indicator Warehouse (HIW), an instrumental component of the Department’s well- received Health Data Initiative. A challenging aspect of the project involves implications about data on federal sites – data being amassed from all kinds of sources, with concerns about federal oversight and responsibility for the data.
- Developing an enhanced tenth HIPAA Report that reflects the constantly evolving electronic information exchange environment and conditions that directly impact all aspects of health insurance portability, the core framework for HIPAA implementation. The report will serve as a much needed reference to help organize and clarify the numerous sets of HIPAA recommendations, and to understand the context of HIPAA’s mandates for consistent and timely implementation in the electronic media in an era of health reform and the Patient Protection and Affordable Care Act (PPACA).
- Following up on requests for information about the “Colloquium of Former NCVHS Chairs” at the University of Virginia in Charlottesville, VA with highlights from the individual interviews now included on the NCVHS Homepage as part of the Committee’s oral history, celebrating 60 years.
- The NCVHS Executive Leadership meets periodically in conference calls and in “retreat” for appropriate strategic planning, review of processes and operations to assure the Committee’s effectiveness. The extensive cadre of new members will be settling into their subcommittee assignments through the end of the year. Accordingly, a new liaison representative to the NCHS Board of Scientific Counselors is being identified to continue as an active participant in the Center’s program review efforts and activities.
- The NCVHS Leadership also coordinates with the Office of the National Coordinator and its two HIT Advisory Committees to assure complementary and synergistic work products. The Committee continues to reinforce its commitment to help “prepare the landscape for data-driven reform,” and develop an Information Framework for Health and Health Care Improvement.
- Planning to receive a briefing from the HHS Leadership, on The HHS Action Plan to Reduce Racial and Ethnic Health Disparities, outlining goals and actions HHS will take to reduce health disparities among racial and ethnic minorities (September 2011). With the HHS Disparities Action Plan, the Department commits to continuously assessing the impact of all policies and programs on racial and ethnic health disparities. It will promote integrated approaches, evidence-based programs and best practices to reduce these disparities.