[This Transcript is Unedited]
Quality Hotel Courthouse Plaza
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DR. LUMPKIN: The first item on our agenda is the hearing in San Francisco.
DR. DEERING: Would you like us to talk you through what is proposed? I think NHII comes first, so I will take you from the top. It's now NHII in the morning, and then the vision, and then the combined. Our first panel is labled "Financial Barriers and Recommendations for Federal Action."
The three proposed speakers on there are Peter Juhn, who is with the Kaiser Foundation Health Plan. He is specifically within Kaiser, their CEO of what they call Care Soft, which is their whole consumer-oriented online interactive activity. And we have a couple of voice messages into him. I have no idea whether we will get him at his level or not.
Reed Gardner, who is both a professor of medical informatics and co-director of informatics at the LDS Hospital has accepted, and he will be on that panel.
We had proposed a couple of alternatives in the provider community for the third slot, both of whom would have been from Blue Cross/Blue Shield. It looks like we are not going to be able to get either of them, and we are just beginning to pursue a back-up in a provider organization up in Oregon. I don't have the details with me, but we have a couple of names from that plan, because although they are smaller and perhaps less well known, they are implementing informatics.
The second panel was labeled I think, "Technical and Other Barriers to Action, and Recommendations for Action." One of the people recommended there was Linda Neuhouser(?), who is the executive director of -- she is at UC-Berkeley in the School of Public Health, and she heads a collaborative activity co-funded I believe by other universities and a couple of the California health care foundations that is looking at e-health for the underserved.
So while I know we are not specifically looking for more details about the underserved, I think she represents the community-based level approach of what community organizations would be struggling with to implement that. So she has accepted.
Let me look at my own list here, because I didn't bring it all with me. Mark Smith was also on one of those lists. He has not returned phone calls, and I was thinking we might need to get in a bigger gun for him.
Mary Kane, who is the director of the Health Care Horizons part of the Institute for the Future out there, we have messages into her. Last year at least, they did a lot of work looking at information evolution and its impact on the health care system. And they have written a lot about that, so we hope we'll get her.
I'm going to jump ahead, if you don't mind, to the combined panel, because I contacted all those people, and I think things are looking very good. Phil Lee has accepted. He is delighted to come. And we have Molly Coye, a voice message into Molly Coye, and hope that she'll be able to come. And Rita Moya(?), who the vision people were specifically interested, and I knew of her more consumer health information activities as well. She has also accepted. So two of the three on the combined panel have accepted.
DR. HENDERSHOT: And the first two sessions in the afternoon would be on vision for health statistics for the 21 century. I have to apologize, I have been out of the office for four days. When I got back my computer -- brand new computer, which was good -- was not working, so I wasn't able to check the status of this, but I can tell you a couple of things.
The two sessions, one is on national, state, and local issues. That is, breaching the different levels of aggregation that are needed in a health statistics system. And one of the persons on the list for that session was Rick Brown. I know Paul may have some comments on that choice, and I can't tell you for sure who the other two of our first three on that list were. Maybe Paul will remember.
The second session is on issues of public and private cooperation. I did talk with Kathy McCaffrey, vice president of the health care data and operations of the California Association of Health Plans, who told me that she helped organize a meeting in San Francisco a few years ago. She was very interested. She had to clear it with her bosses before she could accept, but she said she would get back to me early this week.
I also had a call into the Washington office of the Kaiser Family Foundation for somebody from the Kaiser Foundation, and they were going to be checking around and getting back to me. And I had a call into the Packard Foundation, asking about their interest.
That's about I can tell you right now. I did send out a list of proposed names for each of those sessions, and that's what we are working from. After I sent that out, Paul came back with a suggestion that we put David Batista from UCLA back on the list, which I did.
DR. NEWACHECK: Back on the list? He was off for a while?
DR. HENDERSHOT: He was for a while. We reviewed a long list, and I got some feedback. I sent out a version of the draft agenda in which I plugged in some names, and sent that out. And then you reacted to that. Batista was not on what I sent out, and you suggested he be put back in.
DR. NEWACHECK: I guess I didn't see that initial list, but I think he would be an excellent speaker in terms of representing the Latino health issues, and that larger community.
DR. STARFIELD: He would be excellent, but he almost never makes it.
DR. NEWACHECK: He has been coming to some of the meetings I've been going to.
DR. HENDERSHOT: Which of the two should we try to slot in for the national, state, local kinds of things, or the public/private?
DR. STARFIELD: Neither.
DR. NEWACHECK: Probably national, state, local. I think it's hard to guess about either one.
DR. STARFIELD: He'll talk about national.
DR. NEWACHECK: He does a lot of California stuff too.
DR. FRIEDMAN: Gerry, we had talked about the possibility of Jonathan Fielding.
DR. HENDERSHOT: He is on that list, yes.
DR. STARFIELD: He would be good.
DR. HENDERSHOT: And which of the two sessions was that?
DR. FRIEDMAN: I think for the state and local.
MS. GREENBERG: When you're talking to these public health people, see if they would also like to serve on the committee.
DR. STARFIELD: Well, Hayes Batista has been on the committee, has he not?
MS. GREENBERG: He has?
DR. STARFIELD: I thought so.
MS. GREENBERG: Not in the last 20 years. I think he's maybe testified.
DR. NEWACHECK: So, Gerry, is anybody confirmed?
DR. HENDERSHOT: As I said, I've been away for four days. I just got back in the office this morning. There were no voice mail messages.
DR. NEWACHECK: So do we have like a back-up strategy?
DR. HENDERSHOT: Always. We have more names than we are currently working on. And anybody who declines an invitation, we will ask for suggestions about people.
DR. STARFIELD: What about somebody like Joyce Lashook(?).
DR. LUMPKIN: Former state health official in a wonderful state.
DR. STARFIELD: That's right, she laid the groundwork pretty well, didn't she?
DR. NEWACHECK: I don't know how active she is now. I don't really see her around the campus. I see her walking around the Berkeley Hills exercising. But she would be a good person if she is still active.
DR. LUMPKIN: Anything else on San Francisco? November 20 in Raleigh. This is the one that used to be scheduled elsewhere.
DR. DEERING: We had about three speakers specifically that I think I circulated in the initial list. I'm not going to remember all of their names. I do know that Dave Cochrane(?), who is at Duke Medical School will work -- Duke has instituted for itself, an online system. And he has played a lead role there, and is certainly interested in the consumer/patient sides of things, as well the clinical/administrative side of things. So he is one recommendation.
Another is a gentlemen whose name I got off the Massachusetts data list serve about a consortium of states who have funding to try to implement the public key technology around health care delivery. So he, in North Carolina, is one of the six in that consortium, so I thought that he was a good person.
And the third I think was a Healtion WebMD, because their administrative offices are actually in the South, even though the technology offices are on the West Coast. And regardless of what one might think of the dot-com, it might be interesting to get someone from that organization to testify if we could.
DR. FRIEDMAN: Certainly in terms of the health statistics part, we had talked about having a section primarily devoted to privacy, et cetera.
MS. GREENBERG: Devoted to what?
DR. FRIEDMAN: Privacy. Do you remember that?
MS. GREENBERG: Yes, I do remember that.
DR. FRIEDMAN: And we sort of left open whether or not it would be Raleigh or Washington. There were advantages to each.
MS. GREENBERG: I know we had talked about technology issues in Raleigh, and I don't know if it's a good -- if there are many people who would be interested in speaking on privacy.
DR. LUMPKIN: It would be harder to try to get the privacy folks to travel outside of DC.
MR. BLAIR: I know that Simon is planning on having some folks testify on digital signatures, electronic signatures, PKI within the Subcommittee on Standards and Security. If we separately are having people that can testify on PKI for NHII, is there overlap, or is it that we are looking for a different focus or different issues? Or should we coordinate?
MS. GREENBERG: What is PKI?
MR. BLAIR: Public key infrastructure.
DR. DEERING: I mentioned this one consortium that has the grant. California was another state, I think Nevada was. I've forgotten who the others were, and North Carolina was. So that's certainly a very good point. And I don't know how many aspects of it there are, or what would be different about this group.
For example, it could be that one group could look more at the technical issues associated with PKI, and someone else could look at maybe the institutional issues of implementing it, and the operational issues of implementing it. I don't know how broad the field is.
DR. LUMPKIN: I suspect that we may not want to overlap. I still think that the issues for us on the NHII side is again, focusing on barriers and recommendations. They are really closely tied in, but I think that's probably what we want to look at.
One of the issues it might be good to deal with in North Carolina, it's a fairly rural state, and we may want to talk about barriers, particularly to more rural and isolated communities. Because if it's anything like Illinois, and I'm assuming it is, when you start talking about Internet connection in areas outside of the --
DR. NEWACHECK: No DSL.
DR. LUMPKIN: No DSL; T1s are extremely expensive.
DR. STARFIELD: I suppose the privacy issues would come up in a rural state.
DR. LUMPKIN: That doesn't mean enough though we may want to focus the Washington one in a little more detail, but we may want to see if there is some --
DR. DEERING: Could I just have you repeat for the record my understanding that when you ask for recommendations, you are really looking for recommendations for federal action.
DR. LUMPKIN: Right.
MR. BLAIR: If we were to try to pick different issues with respect to PKI, the piece that I find extremely confusing, which I think might be a little bit of a separate issue than the technical requirements for PKI, which maybe SSS would focus on, is do we need to have a national certification authority, a coordination for certification.
PKI kind of tends to drag along some of the existing medical certification procedures, but it seems to be done, from what I have been able to hear, on either a state basis or a regional basis. And it appears as if the things they have come up with are in competition with each other. So anyway, I think we should consider that maybe if we focus on certification, and separate that from the technical requirements for PKI interoperability, that maybe that's a possible way to divide the issues between the subcommittee and the NHII.
DR. LUMPKIN: I think that may be a little bit more technical than we want to get into. Particularly as we look as a 10 or 15 year projected out, I suspect many of those issues may be resolved. What your comment brought to my mind, and what I thought would maybe be beneficial is to ask people what kind of infrastructure needs to be in place at the national level?
MR. BLAIR: Can I back up a second, just for clarification, because I didn't think of certification as technical. The piece that I was thinking of for certification is whether a physician is board certified, and whether they are certified in a particular hospital or state. So I was thinking of certification from the standpoint of non-technical. Maybe you understood that. I just wanted to make sure that we are still talking about the same thing.
DR. LUMPKIN: I didn't, but let me get back to that. I'm not I understood what you said then. But the thought I had about the standards and the PKI is an example of -- our conceptual model of the NHII has to do with data being kept in all these little buckets, the way it normally is. But there needs to be some sort of infrastructure in place, which can be local and built upon local information sharing systems, and local networks with electronic medical records, and that kind of stuff.
But there needs to be some sort of national infrastructure to make it all happen. How do I share data from one place to another? Well, part of that is going to be standards, and we can identify those pieces. But does there need to be, like with PKI, a national certificate authority?
MR. BLAIR: Yes.
DR. LUMPKIN: Those kind of things where for PKI, we may be a little bit clearer on what the choices are. Whether there are other pieces for which we haven't really conceptualized what the national infrastructure needs to be in place, technical infrastructure in order to enable local flux analogies.
DR. DEERING: Well, one thing I was thinking is I can certainly try to find out more about this consortium, because it may well be that it's not the PKI hook that we are interested in. But the mere fact that they are working collaboratively on it may have other implications for the exchange of information or standardization, et cetera, et cetera, that may suggest something.
So maybe I'll just dig around a little bit more, and see if I can find another angle where it seems like a representative of this group would in fact have something to say. Hearing you say, and I think everybody agrees that our focus again is on two things. What are the practical barriers? What are the real barriers to doing this? And then secondly, what are the national recommendations in this area? So maybe we could find things that don't in fact overlap with Simon's at all, and that aren't technical.
DR. COHEN: The people here who will be drafting some of the questions for the digital signature, we really haven't had a chance to talk about it as a subcommittee, or the full committee for any additional issues. Obviously, I think that there is a fair amount of overlap, but I think it's actually fine in the relationship around PKI and digital signature, because I think for all of us it's a critical issue.
First of all, you have the business case for what the country needs. And I think it's one thing to do two days of hearings in Washington to try to get that answer, but I think it will be very useful to go out regionally and ask as part of the overall vision of the health information infrastructure, from your local view, what is it that you need there.
The only thing that you're really concerned about is that you can data from San Francisco to Oakland, or Raleigh-Durham to Charlotte, or do you have a bigger view of what your needs are? And I think as we begin to all together, understand what the business issues are, then we can use that to help us determine what really needs to be happening, both hopefully from the standards view, as well as the other aspects of quality here. So I think it actually works together pretty well.
DR. MC DONALD: But if we're short on time, why don't we just combine those hearings, and have one big hearing. Is that what we are talking about?
MR. BLAIR: Actually, I have been kind of groping with PKI. I have sat through several sessions where they have four or six people speak to us about PKI, and I'm still somewhat confused. Clem, maybe you know this issue better than I do. But many times when they present, and Kaiser has been one that has presented, and Connecticut has presented, and this organization out of California has presented, and the AMA group has presented.
And it seems if the technical issue doesn't to be the big issues. They all wind up saying that they have adopted ASTM standards, but the thing that they struggle with is the certification procedures. And that does not seem to be a technical issue. It's a matter of -- and this gets to this piece here -- who is going to be the authority, the certification authority, not only for providers, whether they are board certified to operate in a hospital or board certified in a particular domain.
Forgive me, because I may not use the correct phrases here, or authorized to operate in a particular hospital or a particular health plan. But also authorization of patients, authorization of administrators, authorization -- that whole spectrum. It's like a whole new area that nobody has thought out, and it's all ad hoc. And that seems to me to be more an NHII set of issues, which may get to recommendations for legislation or regulation, than it is standards. I'm trying to do a clarification here.
DR. MC DONALD: I agree with you that there are some problems, and they are everywhere. So the different certificate systems don't communicate with each other. Being certified as Clem McDonald doesn't make it me. Anybody can sign up to get a certificate under almost any name. And the best you can do is show your driver's license. So it may get to biometric connections. So it gets tricky.
And then you have the issue about how secure the certifications were, wherever they are sitting. So do you have to type in a password every time you go in and do a transaction, and make it more secure. That's horrible if you have thousands of transactions an hour.
So when Microsoft certificates run out, people can steal your certificates and use them, if they can tell what they are, for what they are. So we have to work through all this, and it's tricky. Right now in both the popular products and health environment there is a thing called secure ID, which is a hardware product.
DR. LUMPKIN: I think what we are trying to do is define the hearing that we are going to have in North Carolina. And while one small piece of the question is to what extent should the NHII address those kinds of pieces of the infrastructure that need to be in place, when the recommendation is in place that we either should have a central authority or not have a central authority, that's just one piece.
But are there other things that we need to envision for the NHII to happen? Obviously, there needs to be a national system to assure that what is going through is appropriate, protected. It's authentic, can't be repeated, all that stuff we are talking about. But if that happens, will we have the NHII? My guess is the answer is no.
And so we need to be able to develop that laundry list of things like that, that need to be developed, because that's where I think we want to try to get some testimony to help us in our thought process of trying to, when we have the final report, the list of things for which a national infrastructure needs to be in place.
MR. BLAIR: Let me suggest one other thought here, because it's so hard sometimes to get very highly qualified people. And they may have experience which covers both NHII interests and SSS interests. And maybe we could make sure that if somebody is going to come to SSI and testify -- I'm sorry, SSS -- that maybe in terms of coordination, that we do include a few NHII questions, so that we don't lose the value of their input. And that may be another way to do that.
DR. LUMPKIN: I like that. I think I like that structure of trying to get, when you are doing the hearing on PKI, you ask NHII questions, whether than trying to ask PKI questions at our hearings, because our time is going to be much more restricted.
DR. FRIEDMAN: I want to briefly return to the privacy issue. I'm just thinking about, and I had not thought about it quite in this way before. I'm a little bit concerned about leaving that hearing both for the last, as well -- because I think it does have the potential, and we really haven't tested out this sensitivity or initial reactions to either of those documents.
We have done it more for the 21st century than for the NHII, but I do think it does have the potential for being disruptive, let's put it that way. And I also think that it might be worth testing it out at a more neutral site, a local site, rather than just having it aired in Washington.
DR. LUMPKIN: I'm easy.
DR. DEERING: We should probably be able to find someone in California too. I'm thinking Mark Smith could certainly -- his foundation put out a big report on Internet privacy. I don't know to what extent they are also immersed in the broader aspects of privacy, but maybe if we asked them to address that as one of the other barriers. In other words, we still do have two or three slots in play there.
DR. COHEN: The CIO from that organization is actually pretty articulate in this.
DR. DEERING: From the California Health Care Foundation?
DR. STARFIELD: He might be better than Mark Smith actually.
DR. DEERING: Could I just stick with that for one moment, because Mark Smith was clearly the name that we were going for, and all we recognize that he might not want to take the time, and might want to send someone. In the spirit of shortcircuiting it, would you strongly recommend Katz as a CIO? Is he also too high to probably take the time to come? I'm just thinking the closer we can get to someone who is really good in the organization, who also has the likelihood of accepting, the easier it might be.
DR. COHEN: Either of them would be excellent. I have heard both of them speak, and I think that they would both be excellent people. They speak in public on somewhat different items. So I think Katz would probably be a little bit closer to the technical issues or the requirements around NHII. Smith might speak from a higher view of the business requirements, and less technical. So I don't know at this stage of the workgroup deliberations, which --
DR. MC DONALD: I'm thinking on these things we have these magical promises that are going to be out there to take care of everything. And the people who have done something with them can often reveal the truth. So Katz is actually the guy that --
DR. COHEN: He might be a good choice.
DR. NEWACHECK: I also might be worthwhile looking at Ports(?) and which project officer was in charge of the Internet one.
DR. LUMPKIN: Is that enough direction or beginning for North Carolina? We may want to -- do we have a local host?
DR. HENDERSHOT: I have the name of somebody to contact.
DR. FRIEDMAN: Just in terms of the health statistics component of it, I think since we're there, it's always worth again -- may be worth again having a panel focusing on the state and local integration, integration of the national.
And the second thing that really does overlap greatly with privacy that I think would be worth trying to get some folks to address is that in that health statistics report we do spend a little bit of time talking about the importance of ultimately trying to move towards single data collection and multiple use. And it would be nice to get some feedback on that, as well as that and its relationships to privacy and confidentiality issues. That clearly overlaps with NHII.
DR. LUMPKIN: I agree with that. I was also thinking we may want to involve Bill Roper, because this would be in his neck of the woods, issues related to quality. And I know some of the things that have been doing at Chapel Hill around public health practice, he may be a good resource of identifying local speakers and that sort of thing.
DR. NEWACHECK: How about the more generic issue of rural health statistics needs? You talked more, John, from the perspective of access to the Internet, and access to resources, but there is also health statistic needs that are different in rural areas. Most of our national surveys don't really do well in rural areas. We have very small samples. So we are really getting urban samples that we generalize to rural areas. It might be interesting to have a speaker or a panel that would focus on what are the rural health statistics needs, and how well are they being addressed?
DR. DEERING: That would make a good combined panel, since we were also sharing that, what are the issues in a rural state.
DR. COHEN: Not that it's in Raleigh, but it's in Atlanta, it's in that neck of the woods. You might want to ask Claire Bruton(?) to come up and talk about, certainly from a statistics, public health view, some of what she sees has been the whatever coming out from the CDC perspective.
MS. GREENBERG: Well, I know you are talking about the 21st century meeting later in the week in Atlanta where is going to be, right?
DR. LUMPKIN: She will be the reactor.
MS. GREENBERG: And also we're talking about doing something in addition down in CDC.
DR. LUMPKIN: In October.
MS. GREENBERG: Oh, you -- and the two of you are briefing the senior staff, Dr. Copeland and his senior staff on these two reports, and getting feedback. That's on October 17, Tuesday, the day after Yom Kippur.
DR. STARFIELD: What is doing the briefing?
MS. GREENBERG: Dan and John.
MR. BLAIR: Barbara, are you here?
DR. STARFIELD: Yes.
MR. BLAIR: With a suggestion about trying to get better rural health care data, it reminded me of your article which was in the briefing book. And you came down to three points which may be very helpful for improving health care, really getting at the real issues in the US. And my thought was are we beginning to bridge off, or make sure we are including those as part of the agenda of the testifiers that we want, to be able to flesh those out a little bit more?
I would think that there should be some benefits to correlating or focusing on those three areas within how we move forward with the NHII. Because if the NHII could help us address those three areas, it could really make dramatic improvements in health care.
DR. LUMPKIN: But Jeff, if I look at those three points, it seems that it might be more appropriate to look at those in the context of the health statistics, because they really are more measurement rather than infrastructure and implementation.
MR. BLAIR: Okay.
DR. LUMPKIN: But we could ask the expert, since she wrote it.
DR. STARFIELD: I think what I was getting at in that article emerged in a very confrontational way this morning, and that is the difference between health, the national health being the sum of the individuals, versus the population.
And we as a committee, haven't really confronted that. And we haven't even confronted in the NHII vision statement, what implications does the difference make. All of those three things have to do with population health that's not a sum of individual health, the health care system effects, the adverse effects, and the disparities one in spades.
Clearly, that's the main reason why population health isn't individual health. It's because population health is subgroup health aggregated, not individuals aggregate. Not every individual is equal. It's a really hard concept, but I think it's causing us problems in the committee.
DR. LUMPKIN: I think there is always that tension, but for instance with the NHII, my vision of having a system that allows you to push knowledge to the point of service in many ways would either highlight or eliminate bias, because the factors that the individual delivering the service takes into account in making the decision, do we a coronary artery bypass graft on this individual? Well, they ought not to be taking ethnicity and race into it, and clearly they do.
But to the extent that the system now has taken the same set of inputs, and those that are relevant, and versus those that aren't, and the knowledge base in there says this should be the outcome, it really puts the onus upon the provider to explain why a different choice was made.
And anyone who engages in that activity on a regular basis, you are going to want to do some oversight on what they are doing, because if they are continuously disagreeing with standard practice and the protocols, then something is wrong here, whether it be for bias reasons, or just because they don't agree, or they are dealing with a very small subpopulation that is all different.
So there is a whole number of reasons why there are variances. But it gives us some ability to measure the fairness. So I'm not sure that we haven't addressed it implicitly, but we definitely haven't addressed it explicitly.
DR. FRIEDMAN: I do think generally we spoke of trying to hit the health statistics and the NHII more closely together, and make them more obviously congruent. That is some sort of -- it's not a population health model. It's some sort of an explicit population health focus. It's really going to be an essential part of that.
We had a little session in August before the Executive Subcommittee meeting in Boston where we focused on models of the determination of population health. We were really just trying to come up with some sort of essentially a template. Not really even a model, a template that we could use in assessing what the information we have, that's the information we don't have, what do we need?
And I found both the session very instructive, and very helpful in terms of what we don't have, and what we don't think of in terms -- I'm sorry, I'm digressing here -- I found the session very helpful in terms of what we don't think of, and what we don't take into account.
But I also found -- I have been doing a lot of reading recently on population health information models, particularly WHO models and Canadian models. It's fascinating the extent to which particularly in Canada and a couple of the European countries, population health information models have really become part and parcel of everyday discussion of health policy. And it's just something that seems to really have alluded us entirely.
DR. STARFIELD: You can take the same model and determine if it has an impact on health at the individual level or the population level. The population level you can't do with the individual level is look at distribution of health of the population. You can average the DALY or whatever it is, but can't get anything about distribution unless you take a population focus.
DR. LUMPKIN: You know, I'm sitting here listening to the discussion, and one of the things that we have to do is we need to have some time as the two workgroups, and we need to really think through a lot of these issues. I'm thinking we need at least a day, if not more to sit down. Let's talk through these issues. How do we balance population with the medical? What are the obstacles? What are the sort of things that we want to get out? How do we integrate the two documents and the two work plans?
I'm thinking that we probably need to look for some time that we can pull a day together someplace. If we want to do it in a central location, if we want to do it in Chicago, I can find a spot to do it. If we want to do it here, that's fine too.
DR. MC DONALD: There were a lot of pronouns in that sentence. Are we talking about the integration of exactly the what and the what? Let me respond here. I think the sense I had in the energetic discussion was that this committee is not supposed to be only public health. We all ought to re-read the charter. And I think if you read the charter, I think we are doing pretty close to what the charter says.
DR. LUMPKIN: I think the conceptual model that we have been working on with NHII is a health model of which population health is a piece of that. Health care is a piece. And we are looking at how we can integrate that into a system that really maximizes health within the country. And that is really the NHII model.
The health statistics for the 21st century is a subset of that. How do we get a better handle on the data that we are getting in surveys, through population-based data collection, sampling all these sort of things, and try to meld that into a vision. But putting those two pieces in their appropriate perspective is going to be -- those two pieces is really what the challenge is, and what I'm proposing that we try to find some time in January or February, some time around there between the meetings to have a chance for the members and the staff to get together and work through these issues.
MR. BLAIR: To make a semi-serious suggestion, I really think it is in the winter time, probably the most central location and the easiest to get to from all parts of the country probably would be Dallas/Fort Worth.
DR. LUMPKIN: I think we can look at some locations.
DR. COHEN: All joking aside, actually I think Chicago is a very good place to the meeting. Even though we don't have a Kaiser Permanente region there, we frequently hold meetings in Chicago year round for the exact reasons you are describing.
MS. GREENBERG: I just wanted to mention one thing about Raleigh. NCHS has sponsored in the last few years, centers of excellence to work on methodologic and other issues related to health statistics. One of them is at UNC. So that might be a resource also.
DR. LUMPKIN: If we're giving them money, they might as well help us out.
Do we have anything else we need to cover.
MS. REILLY: To get back on Raleigh, so that is confirmed, it's a one day meeting. You are comfortable with setting up the agenda in the same format we had the last two hearings. It seemed to kind of fit well with the people assigned to accomplish. One group in the morning, and another group in the afternoon, and then a joint at the end, the same kind that we have been doing?
DR. LUMPKIN: Yes, until we leave this meeting, and we'll start talking about a day and a half suggestion.
MS. REILLY: Was the demarcation that we had for the various working groups, we can keep the same theme? You're still exploring that, it looks like, in November as well for Raleigh.
MR. BLAIR: You have it starting at nine or something? Are you assuming that the East Coast folks would fly in the night before?
MS. REILLY: Yes.
DR. LUMPKIN: One of the things just to toss out on the Website, we have had some discussion in e-mail about the name for the NHII. Better information for better health is the one that sort of got the last play. So I just want to toss it out. We need to maybe think about it. I'm not quite sold on it.
DR. DEERING: What we have actually done thanks to Leslie Shue(?), we have actually mocked up a website. And it isn't even online, but I'm giving you the printouts in case you want to fly home and write all over them, and do some editing about it. It currently has a cartoon on the front that you don't have to approve of course, but we are trying to add a little bit of levity to this subject.
So I'm just going to hand these around. So if you will take a copy. And all comments and suggestions are most welcome. You will see the URL up there in the upper left-hand corner, so you can also go online and play with it. We do let you know that we have not kept the Web links on the resource page. That's the same resource page that we up almost a year ago. And certainly before this goes live, we will check it out.
DR. LUMPKIN: It's a great cartoon.
DR. DEERING: We have another one too that's more clinically oriented. And then we have one that is public health oriented. We could sort of a rotating cartoon.
[Whereupon, the meeting was adjourned at 2:00 p.m.]