The NCVHS Executive Subcommittee met on May 9, 2000 in the Hubert H. Humphrey Building in Washington, D.C. The meeting was open to the public. Present:
Mr. Scanlon reported that Dr. Shalala will attend the Symposium. Ms. Jackson reported that all the speakers have been confirmed. Participants will receive Symposium materials by mail in advance of the meeting. Ms. Greenberg outlined the plans for reviewing the reports on NCVHS at 50, the NHII, and the vision for 21st century health statistics. The full Committee will be given a chance to review all three reports prior to publication.
The Subcommittee agreed that no further revisions would be made to the NHII and 21st century health statistics reports between the June Symposium and the July 10 hearing. Dr. Friedman suggested the possibility of creating iterative summaries of comments that would be updated following each meeting and attached to one or both reports. Dr. Lumpkin noted that the goal for both of these projects is to produce final reports, with recommendations, in early-to-mid-2001.
On another topic, the Subcommittee approved allowing Health Canada to reference draft four of the Committee's recommendations regarding PMRI standards, with appropriate caveats about its being a work in progress. Dr. Lumpkin suggested also asking Health Canada to comment on draft four.
Ms. Greenberg asked Chairs to inform her and Ms. Jackson of any errors or omissions in the draft NCVHS work plan.
The Subcommittee is looking at ways to streamline its structure. The reasons are the overlapping membership between the Subcommittee and the Workgroup and the need for the Subcommittee to be involved in PMRI issues and the development of recommendations once its report is submitted in August. The Workgroup will collect comments on its draft PMRI report in mid-May, produce another version, and then meet on June 1-2 to work on the final report.
Dr. Cohn raised questions about a communications plan for the PMRI report, to ensure its visibility during a time of transition in the administration. Dr. Lumpkin noted that the Committee's privacy recommendations to the Secretary had no separate form of circulation except for being posted on the Website. They were sent to the Secretary, "and that was the end of it." Dr. Cohn questioned whether the Secretary's permission was needed to move ahead with developing recommendations. Mr. Scanlon commented on the importance of getting the Committee's thinking before the senior HHS leadership, notably the Data Council. He noted that insofar as the Committee already has the authority to develop recommendations, it needn't ask permission. The group agreed to revisit this question at the August Executive Subcommittee meeting.
On the Subcommittee on Standards and Security, Dr. Cohn noted that all standards and maintenance organizations signed a memorandum of understanding at a recent Subcommittee meeting, a breakthrough for which HHS deserves credit. The Subcommittee will hold hearings in July and October, looking at HIPAA monitoring and implementation, recommendations about standards, and digital signature and PKI. (Dr. Lumpkin said the full Committee needs a briefing on PKI.) Codes will be a major focus in 2001, following on a panel on that topic at the September or November full Committee meeting. Dr. Cohn expressed interest in the pilot studies on ICD-10-CM.
Ms. Frawley raised the issue of ICD-10-PCS, and Dr. Lumpkin suggested having a presentation on that in 2001.
The Subcommittee is participating in the Populations Subcommittee's functional status project, at the request of Dr. Iezzoni. It will address this in June, contrary to earlier plans to talk about IRBs. Ms. Greenberg and Mr. Scanlon discussed the possibility of a briefing on an IOM workshop on IRBs at the June NCVHS meeting. The idea of a joint meeting on de-identified data with the Standards Subcommittee was suggested. Safeguards for the use of the Internet was noted as another fruitful topic for consideration by the two Subcommittees.
Ms. Greenberg noted that in early 2000, the Committee sent final reports to the Secretary and the Data Council on Medicaid managed care and on health data systems in the U.S. territories. To date, there has been no response on either report. She and Mr. Scanlon discussed the possibility of a presentation on one or both to the Data Council, maybe in June or July. Dr. Lumpkin suggested having the chair of the relevant Subcommittee make the presentation.
The major activities for the coming year will be four public hearings (Chicago [on July 10], California, Boston, and Washington), and preparation of the final report. A summary of the CNSTAT meeting is expected sometime in the next few months. An edited volume is still a possibility. The possibility of another meeting near Atlanta, possibly at Morehouse College, to focus on minority health information needs is being considered. The Website for this project is a very good resource that will be continually updated.
The Workgroup continues its practice of not holding separate meetings but conducting panels at full Committee meetings. A panel in September will discuss performance measurement and a pilot by the Performance Measures Coordinating Council. It was noted that more than one group is working on measurement using the individual practitioner as the unit of measurement. Another possible panel topic for November is a follow-up on activities that have come out of the IOM report on errors. A topic related to either or both of these is NCQA's draft information system standards and an IOM workshop on the potential impact of information technology on quality.
Ms. Coltin noted that the transcripts from all the panels on quality could be brought together into a report pulling together common themes and presenting the Committee's recommendations based on what it has heard.
Mr. Scanlon and Ms. Coltin commented on the Committee's role with respect to quality. This is addressed in the Workgroup's charge and in a letter to the Secretary about the President's Advisory Commission. One focus is quality issues with respect to vulnerable populations (broadly defined). Mr. Scanlon suggested using the aforementioned report to let the outside world know the intended role of NCVHS in this area.
The work of this group parallels the work on 21st century health statistics: the draft report will be discussed at the Symposium, and a final document will be developed after the hearings. A question for consideration at the August planning retreat is the longevity of these two Workgroups and the one on computer-based patient records. In the short run, the NHII Workgroup will be looking at how to market the concept of the NHII and to generate discussion and action.
Ms. Jackson reported that the retreat will take place at the Harvard Faculty Club, August 17-18. Participants will include both subcommittee and workgroup chairs and lead staff. Susan Jo Bumagin, a Boston consultant, will facilitate the strategic planning discussion on the first day. The second (shorter) day will be spent on Committee business. Ms. Greenberg suggested a conference call between Ms. Bumagin, Dr. Lumpkin, and staff prior to the meeting. She noted that Susan Kanaan will do whatever writing is needed related to the retreat. She will then be able to include strategic planning outcomes in the future-oriented portion of an expanded 50th anniversary report to be developed in September.
The group identified topics for discussion in August. Dr. Lumpkin noted that the Committee has been unable to do justice to minority health issues since the reorganization. Implementation of the new OMB race and ethnicity standards is one facet; state and local issues are another.
It was noted that Dr. Sondik is preparing a paper for the Committee on the advisory needs of NCHS. It will be discussed at the June meeting, and possibly again in August.
Dr. Cohn asked for discussion of whether it is really necessary to routinely hold subcommittee meetings in conjunction with full Committee meetings, and whether anything can be accomplished in these short meetings. Dr. Lumpkin asked everyone to think about these questions.
Ms. Frawley suggested taking another look at the organizational structure as well as questions of relative time commitment between subcommittees, workgroups, and the full Committee.
Ms. Coltin suggested that those involved with the NHII and 21st century health statistics visions talk to futurists about trends and their implications. Such a panel might be appropriate for a full Committee meeting. Dr. Lumpkin noted that this topic is emblematic of broader questions of 1) how to divide people's time between full Committee and Subcommittee meetings, and 2) how to use Committee meetings for panels on subjects of general significance that help cultivate particular perspectives on the Committee. These are questions for the August retreat.
Ms. Greenberg said she would find out about a relevant recent report from the Robert Wood Johnson Foundation on future projections and scenarios and try to get copies to members. Ms. Frawley mentioned a California Health Care Foundation report on the future of health care and the Internet.
Dr. Lumpkin asked members to suggest one or more "challenging" documents for everyone to read in advance of the retreat.
The Committee will meet in the morning on the 20th, participate in the Symposium in the afternoon, and reconvene for Committee business on the 21st. The Executive Subcommittee agreed not to meet on June 22nd as originally planned. Thus June 21 will be a very busy day, including breakout sessions, and all members will be encouraged to stay for the entire day.
The following topics were mentioned for the full Committee agenda:
Times were also blocked out for Subcommittee breakouts.
Topics for the agenda:
A conference call was scheduled for October 5 at 11 AM EST to discuss the November agenda. The Subcommittee may meet (in person) the afternoon of November 27.
The contractor will be polling members for 2001 dates.
A request for NCVHS nominations was circulated within HHS, and a general call for nominations was published in the Federal Register. Both had April deadlines. Some 40-50 nominations have been received. There is also a pool of 200 candidates from past nominations. It is likely that new members will be appointed in time for the September meeting. The terms of the two Congressionally appointed members expire in 2001.
The meeting was adjourned by Dr. Lumpkin.
I hereby certify that, to the best of my knowledge, the foregoing summary of minutes is accurate and complete.
/s/ John R. Lumpkin, M.D. 9-19-00
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Chair Date