[This Transcript is Unedited]
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DR. LUMPKIN: Good morning. The motion has been that we all do a stretch, it fails for lack of a second, so we can go on with our agenda. We have a few items on our agenda followed by the committee reports. Depending upon the debate that we have on our one action item, since the other action item has been deferred until our November meeting, my guess is if we are disciplined, we can get out of here by noon. What we don't want to be disciplined about -- I think I probably waited until she left the room to start. The first item on our agenda, and I do apologize, I waited until you left the room to get started, is a discussion on the Department of Health and Human Services strategic plan, so if you would introduce yourself.
Agenda Item: HHS Strategic Plan Briefing - Dr. Vijaya ChannahSorah, ASPE
DR. CHANNAHSORAH: Good morning, I'm Vijaya ChannahSorah with strategic planning at HHS. I've been directing the update of the strategic plan. Do you want me to just begin?
You have handouts, my name is not in the handouts, but if you need to contact our strategic planning box the web-site is on the display and it's on your handout and I have cards, if there are any questions left unanswered, there's ways you can contact us later.
As you probably know, we are in the middle of updating the strategic plan for the entire department. How many of you know about the Government Performance and Results Act of 1993? Some of you. Basically it's easiest to think about what's called GPRA, the Government Performance and Results Act, in terms of the products it legally requires, it requires a five year strategic plan, at least looking at five years, it can look at more, of all federal departments. It requires what's called annual performance plans and annual performance reports, reporting on annual performance measures.
So that is the brief 30-second course in GPRA. Anything else you want to know about it just feel free to ask. You can interrupt me in-between, I think we go until quarter of but this can be informal as we go through.
As I understand it, you'd like an overview of the strategic plan, I'll go a little more in depth into the objective you would be most interested in, information infrastructure, and then see if you have any questions or discussion. Does anybody want to do anything different than that? We tailor these things to meet your needs, we're the government.
Does everybody have a handout? This time around there are eight goals and 40 objectives. This is the first time ever we've had a management goal, Goal A, in the strategic plan of the department, based primarily on the President's management agenda, so I'll quickly run through what the eight goals are, you can read them.
The first has to do with prevention, preventive health care, reducing the major threats to health and well being of Americans, big priority of Secretary Thompson. Second is bio-terrorism, primarily has to do with bio-terrorism. Increasing access to health care, enhancing the capacity and productivity of health science research enterprise, which primarily has to do with the mechanics of research; training, recruitment and such.
Improving the quality of health care services and Goal 6 and 7 have to do with the human services side of Department of Health and Human Services, economic and social well-being of individuals and families, especially those most in need, and improving the stability and development of our nation's children and youth. There is a lot of emphasis in this Administration on families and children.
Our eighth goal is improving management excellence and the President's management agenda figures prominently in that goal as well as the whole idea that runs throughout the strategic plan of one HHS, consolidated, coordinating, communicating more among entities within HHS.
What I'd like to try to do is, I went through those very quickly, go in depth, a little more in depth through some examples of each of the strategic goals and then I tossed in a couple of examples and then we'll get to what's objective 5.5, the information infrastructure, which you may want to dwell on a little bit more.
The first goal as mentioned is reducing the major threats to the health and well being of Americans, our behaviors, our diet, what we eat, what we do or do not do in terms of habits, smoking and such. Reducing risky behaviors, under here is really what is a summary of what the strategic objectives are. If you want to see the whole strategic plan on draft, you have the web-site and it's up there.
Reducing risky behaviors, unintended pregnancies and so forth, tobacco use, injuries and violence, and by the way, we're about to receive a rather in-depth extensive report from Mathematical(?) on injuries and violence and diet and physical activity. They did an extensive logic model over the past year and a half for us, an evaluation synthesis, to look at it in as extreme depth as possible without doing original research to see what we know right now at this point about the affect of our interventions, what we do as a department or sponsor or pay for and so forth, how effective that really is. I just awarded a contract to do another one of those pilots, kind of still in pilot stage, to do this sort of in-depth well digging onto other new objectives in the strategic plan, I haven't picked them yet, anybody has ideas about that they are welcome, because we will be starting that soon.
Research and looking at data is a very important part of the strategic plan and there are a lot of requirements in GPRA concerning data quality, and I just met with OMB and GAO over the last few days and the emphasis really is on data quality, on measurement, on showing trend lines, our draft right now if you look at it on the web, we don't have base-line information in our measures and such.
In any event, there's a lot, as you look at these goals and these objectives there's probably some valuable input and advice, especially since this is still draft, and I'm glad to be here with you today, if not today than later, share with me whatever advice or counsel or thoughts you may have with respect to research and data quality and so forth. It's really welcome and the time is now because it is still draft and we'll be doing another draft and going final in the late winter.
These are examples of some strategies for the first objective, 1.1, and I'm not going to read them to you. If you want me to go back to anything I will.
The second goal has to do with bio-terrorism. We moved it up to Goal 2 because of what's happening in the nation right now. Increasing the capacity to respond to any public health threats is the first objective in this goal and the safety of foods and drugs and biological products and we're just now, there are studies underway by us and many research entities and the inspector general's offices launching and so forth about the effectiveness of the efforts, of all this money going out there now for bio-terrorism preparedness. I don't know how many results we will have in the near future but we certainly planted a lot of seed.
DR. LUMPKIN: It is being well spent.
DR. CHANNAHSORAH: It's being well spent, right.
DR. LUMPKIN: At least in Illinois.
DR. CHANNAHSORAH: Are you spending some of it?
DR. LUMPKIN: Yes.
DR. CHANNAHSORAH: I thought so, good. Okay, the third goal has to do with access to health care and our objectives in that goal. By the way I'm presuming everybody is familiar with the nomenclature overall, there's an overall mission, health and well being of people in America. Goals are broad statements of what we want to achieve, strategic objectives are designed to help us reach the goals and they're more detailed, supposed to be outcome oriented and measurable to reach the goals. The strategies are the action steps that we're intending to take to reach the objectives.
Medicare+Choice and affordable health insurance options are part of the objectives in the access goal. Strengthening and improving Medicare disparities and there's a lot that our data council -- is Jim Scanlon here? Jim and I have shared, talked about a lot, and he's taken part in writing parts of the strategic plan on eliminating disparities, but to eliminate disparities you need to be able to measure what the extent of the disparities are, in what sub-groups they are, we don't know what's happening, so that's a big important part of being able to accomplish something, you need to be able to know what's going on in that arena. American Indians and Alaska Natives is an objective in the access goal too, that has a whole history to it.
Objective 3.5 said special populations and I thought I'd just kind of blow that up and point out to you what sub-areas, because they are really big and important ones to this Administration. Organ and tissue transplantations, HIV AIDS, mental health services and Title 5 children, children with special health care needs, are subcategories within this special population objective.
The fourth goal is health science research enterprise, improving research, the nuts and bolts of research. The way that we have arranged the strategic plan is that strategies that have to do with conducting research that will lead to improved diet, for example, those strategies having to do with research will find its way in the goal having to do with diet and physical activity. This goal has to do with mechanics of research, so if it's really programmatic related research to improve physical activity, or health, what strategies work to do that, those strategies will be found in the body of the strategic plan, not in this goal. Does that make sense? Okay.
DR. SHORTLIFFE: Does the report attempt to delve into a definition of what constitutes biomedical science?
DR. CHANNAHSORAH: No, well maybe in the lead-in a little bit, biomedical science. We went back and forth about even what to call some of these objectives and goals. If you have suggestions on that score, if you want to look at the draft and you have suggestions, I'll be pleased to hear them.
DR. SHORTLIFFE: There have been several reports submitted to HHS recently that have talked about the perhaps overly narrow definition of biomedical science from the perspective of the activities in support of biomedical research in this country. We need to think more broadly about what it means to do biomedical science. I just wondered if this report, since it's a strategic plan, had tried to address any of those recommendations in its definitions?
DR. CHANNAHSORAH: Well, now this does not report on any goals or objectives, really, it generally talks about what we've done, it is a plan that looks in the future so we won't be -- technically the reporting on success happens in the annual performance plans but in the plan --
DR. SHORTLIFFE: The plan could address the definitions, however.
DR. CHANNAHSORAH: Right, right. Does NIH, Robin Palazo(?) and Lana Scorbol(?) I worked with mostly from NIH, do they have copies of the report?
DR. SHORTLIFFE: Of those reports? Well, of course they have copies.
DR. CHANNAHSORAH: They are primarily involved in helping me craft the wording in the strategies and so forth, and will be continuing to review it, so there's still time to, if you can take a look at it on the web, because this won't tell us, I have it here but we'll use up too much time, maybe a little bit afterwards, tell me if you have suggestions on that and I will put it on the table in the next draft. The timing is perfect for that. Be sure to send me something.
The coordination and application of research is in this goal as is research integrity and protection of human subjects, is the last objective.
Improving quality of health care services is the fifth goal and reducing medical errors is really a big part of that. Use of actual quality information, there's a big attempt by CMS to put a lot for Medicare and Medicaid beneficiaries, to put a lot of information up on the web, and a massive effort to measure the extent to which that information is helpful, is useful, that people do access it, that they understand it. Or is it too much information overload? That's one of the things that strategic plan, by the way, needs to consider. External factors, what things in the environment might hinder our ability to accomplish the ends that we seek. In this case we're attempting to inform people but too much information overload could actually cause a positive harm and we need to address what all things might happen to get in the way of us achieving the goals and objectives and how we might mitigate them, it's a legal requirement. Actually there's a lot of pieces in the strategic plan that because of time I haven't gone over that I'll be happy to share at some time.
MS. COLTIN: I'm curious on Goal 5 whether any of the sub-objectives, particularly those that I assume would relate to appropriate use of health services, address any of the problems with current payment policies around the incentives that they do or don't create to support where we're trying to head. I'm thinking of things like group visits for patients with chronic diseases that have been shown to be extremely effective.
DR. CHANNAHSORAH: That one is not in there. There are strategies that have to do with payment policy and there's an entire objective in Goal 8 having to do with financial integrity and payment and so forth. Again, what you can do is look over the entire draft and if there's a key important strategy that you know we have under way that we didn't put in there that should be reflected in the plan, bring it to my attention. When you write in, I have a stack that my team has put together, I'm not exaggerating, literally like this of comments, send it in and flag it as the committee's comments and I will have my team members check that mail box and bring it to my attention so that I don't blow by it.
What I especially wanted to talk, to give you time to talk a little bit more about if you'd like and I really wish Jim were here because Jim and I, we really worked on this objective together, is a new, now first time ever objective to accelerate the development and use of the National Health Information Infrastructure and HHS's role in facilitating that. This was a very delicate balance because we couldn't say, create it, or create an electronic medical record, or so forth, our role is one of encouraging and assisting and maybe some funding and so forth.
In any event, the strategies for that objective are promoting rapid development of technology necessary for an electronic health record. We went around several blocks with several different verbs in all of these that would be clear and that would not understate or overstate what it is that we intend to do, what HHS intends to do. Promoting the voluntary adoption of national data standards as the building blocks of the information infrastructure, and conducting research on practical applications of National Health Information Infrastructure to serve the consumers of the information infrastructure.
Those are the only three strategies that we have underway right now for this objective. Are there any questions about this at this point? Suggestions?
MR. BLAIR: I gave some input a couple of weeks ago where I just wanted to encourage there be an additional perspective with respect to the role of the National Health Information Infrastructure plays because as you read down many of the other goals and objectives in the overall plan, there are many of them that will be severely impaired without a National Health Information Infrastructure to enable them. So I was wondering if the input was observed and noticed and considered.
DR. CHANNAHSORAH: You sent input on the strategic plan? Okay, we're going through those now. You sent written comments?
MR. BLAIR: There was a solicitation that was sent out and I think it was, I'm sorry I don't remember the name of the individual, it might have been yourself, asking for e-mail responses. You also had a meeting on August 29th, which I wasn't able to be at because we had our subcommittee on standards and security meeting, but then I, Mary Joe Deering(?) I think is working with you on this as well? Yes? She encouraged me to go ahead to submit them again to make sure that they were observed, so I was just simply checking to find out if that perspective is being considered. Because right now you're kind of looking at things in terms of goals and objectives, that is a very appropriate construct to consider the plan. My thought was that if you have items that are infrastructure elements that support many other goals than maybe you want to break that out as a separate goal so that it could achieve the focus and the priority because it enables so many other objectives.
DR. CHANNAHSORAH: In fact, the Department of Transportation calls all of those types of objectives enabling, that's their enabling goal, they use that word. I thought of doing that, too, we did that with the management goal, it's an enabling goal, it's Goal 8, it's the kind of infrastructure which, it's like the blood running through the whole thing as is this in great respect -- actually that objective was to change addresses a couple of times because of this reason we were trying to find the most effective place for it. Now it actually might lose attention and emphasis being put in Goal 8, the management goal. I have an IT objective in there because it's in the President's management agenda.
Now there's a couple ways of handling it. We could articulate the lead-in into the discussion of that goal which contains the information infrastructure objective to make it clearer and discussion in other places throughout the plan that talk about, there's many other places in the plan that we can do this effectively and I will welcome input on that. I think in our Appendix A, coordination, B external factors, measurement, C I suppose. Certainly, definitely in our data challenges chapter Appendix, there are a lot of places we can refer again and again to the fact that this permeates what we do in HHS. There's a lot of different alternative ways to make that clear. When you really think about it there's a lot of things that we do that are not directly program related that support everything we do, enable everything we do at HHS and there's different schools of thought on how to deal with it. I don't have a fixed opinion about that personally.
Now with respect to your specific comments, we're in the middle of going, we are literally in the middle of going through massive amounts of about 400 comments, through faxes, e-mails, letters and comments from the big meeting, the stack is this high, so they are in there somewhere. If you give me your name and so forth I will specifically kind of go back and look for it. I'll be sure to.
MR. BLAIR: I'll be happy to, I can give you my business card, or do you want my name right now?
DR. CHANNAHSORAH: Afterwards. Be sure to flag me down or send me a note.
MR. BLAIR: I won't be able to scoot around to get you so maybe if you could just come around to me.
DR. SHORTLIFFE: I'd like to restate in a way another way of thinking about the comment Jeff just made, which I agree with and that is a committee like this made up of people have this perspective, reads this report and sees --.
DR. CHANNAHSORAH: It's a strategic plan, it's not a report.
DR. SHORTLIFFE: I'm sorry, strategic plan, and sees the information infrastructure in every bullet. And yet, when you really look at the way things are phrased and everything, it has one single sub-bullet under this goal. In a way the emphasis --
DR. CHANNAHSORAH: That is an objective --
DR. SHORTLIFFE: Goal 5 had one, I think it was Goal 5 that had one mention --
DR. CHANNAHSORAH: That is an entire objective, that's at the objective level.
DR. SHORTLIFFE: The detail isn't that important. The real point is that somehow or another the role of the information infrastructure in facilitating all, almost everything that you are talking about here, didn't seem to come through in the strategic plan. In the plan, we were sent the plan, that's how Jeff got the plan with a request for comments, is because this committee received early information on the plan, and as I looked at it I said it's funny, all of this is so dependent upon getting the information infrastructure right and yet the actual mention of the information infrastructure explicitly was sort of relegated to one bullet and some how or another I think what Jeff is saying, how can we make it more clear how important it is?
DR. CHANNAHSORAH: Absolutely, I will welcome thoughts on that. I will tell you this much. People clamor big time to have an entire objective, I just have a little bullet there, it's not a bullet, it's a strategic objective, one of only 40 in the entire Department of Health and Human Services that contains over 300 programs. This is at an extremely high level, it's the first time we've had, created an objective for this. It's a new objective that we created so, we could relegate it to discussion as strategies throughout all the strategic objectives but it would really lose vigor. It's at a very high level. We can talk about both.
DR. LUMPKIN: I think that just trying to look at clearly the NHI goals throughout, a lot of the work goals throughout, I think that there are very few if any advisory committees that would place an objective into the strategic plan. That is big. And I think that to the extent that we can make some encouragement that maybe the wording is wrong, for instance under Section 7, there's a discussion on electronic disease surveillance in those categories, and anyone who knows NHI knows that's part of it. Obviously that there are other ways that we will need to constantly work with the department, but I think the fact that we have a bookmark for our important work is certainly much appreciated and particularly since it's in a programmatic area rather than in a management area. I think that would have been the big mistake is to put it under management because NHII is about the whole country and not about the department and it's management.
DR. SHORTLIFFE: What I was saying was not meant to suggest that we elevate this to an entire goal or something like that but really rather that in the discussion throughout, although this needs to stay as it's own item, but that recognition. When you talk about your immunization goals, well, the only way to achieve them is better information infrastructure for --, creating registries and so forth and just making that a little more clear I think might be totally addressing the point I was trying to make.
DR. CHANNAHSORAH: Okay, thank you, point taken. Actually there are other points in the plan at which, let me go through quickly, there's the electronic commerce, these are strategic objectives in Goal 8, but other sections, other chapters of the strategic plan in the data challenges, which Jim Scanlon helped write and actually authored a great deal of that, we address the extent to which that information infrastructure needs to be the lifeblood of everything that we do. It's an entire, I was going to bring that entire chapter to you but my attaché was already like this, and I think it's not loaded on the web, I can get it to you. I will e-mail it to the whole committee if you want.
DR. LUMPKIN: I think that would be useful because that's obviously the area that we want to focus on.
R. ROTHSTEIN: I'd like to raise a question about privacy. In your document, privacy is in the Appendix under data challenges, it seems to me that is a very narrow conception of privacy and it certainly is part of data, but it's a part of a more central aspect of the health care system. I was wondering if any thought had been given to having that in Goal 5 under Patient Protections as opposed to a purely a data challenge issue.
DR. CHANNAHSORAH: I think in the last plan and John Fanning, our privacy advocate, is here, we had some strategies that made mention of privacy of information within the context of strategies in other parts of the strategies plan and can consider doing that this time as well. You're right, it relegates it the discussion in that Appendix, I will tell you, there actually needs to be a lot more in the whole strategic plan of cross fertilization of concepts, it's too silo oriented, this is one example, I agree.
MR. ROTHSTEIN: It's not just that it's sort of isolated there, by putting it there it sort of represents a very narrow view of privacy and it's only records as opposed to the interactions of people and systems.
DR. CHANNAHSORAH: Jim, John and I will talk about it some more.
MR. BLAIR: Could I make one other suggestion? I'm groping for, here it is, for those of you on the internet you can now hear me. You might consider representing the strategy in three dimensions instead of two because that way the additional dimension could be enablers, facilitators, and infrastructure, items that cross-cut all of the other goals and objectives. That may be very helpful to you in allocating resources and setting priorities rather than just doing it in a two dimensional manner.
DR. CHANNAHSORAH: How do we get that third dimension?
MR. BLAIR: Well, I'll tell you what, let's talk about it afterwards. I think that there are folks here on the subcommittee that could also give you good ideas on the tools and techniques to do that, otherwise you're going to be led by a blind guy. I can conceptually represent it, I know that information system tools exist to be able to do that, but some folks here may be able to tell you the exact tools that they use, either in excel or access or relational databases or others to be able to do that.
DR. CHANNAHSORAH: Thank you. I don't want to chew into your time. Yes?
DR. MAYS: I have a question and then a comment, comments more for the committee. Throughout I saw that the recommendations for research on this, research on that, so I'm assuming that if that got picked up, is there also some sense of additional budget? For some of these things they are budget issues and I'm just trying to figure out in terms of recommendations if there's also some plan about budget.
DR. CHANNAHSORAH: Recommendations from the committee --.
DR. MAYS: No, no, no, in the strategic plan --.
DR. CHANNAHSORAH: Strategies for research, ok, very good question. I'll give you a short answer. I go around with OMB about this, this is not technically a budget request, this strategic plan. We have the Congressional justification, the President's budget, which is the budget request each year, we have to be very careful not to make this sound like it's committing financial or other resources that we do not yet have. There are certain language OMB will not clear, will not let us use in a strategic plan, however, it is a strategic plan. If it does nothing more than say what we can do right now constricted with today's resources, it is useless as a strategic plan. So this is an implication without blatantly saying so in the strategic plan that resources will be required to carry out the strategies and to conduct research on the effectiveness of the strategies, measure the effectiveness of such, gather data, we just can't articulate it that way, because it's not the place to do it. This is at 30,000 feet, it's the strategic plan for an entire department. But there are not necessarily resources already committed and in place, by definition there can't be if this is a five, six-year strategic plan for everything that we say in here. And acknowledging that, a requirement of the law and a section in the strategic plan is an articulation of resources, human, technological, financial and otherwise expertise, knowledge, training, to accomplish the ends that we seek, the strategic objectives and goals. Does that answer?
DR. MAYS: Well, it gives me a sense. The other is I guess John maybe at the end of this I would probably make a suggestion that the committee should consider sending a letter commenting as a group. I know that we had it on our agenda and I thought Barbara Starfield was going to be here, Barbara sent comments that she wanted to see us comment on this. Given that it seems like at least from the population subcommittee, there are issues that we would comment on, and it seems like there are in other places. It might be useful to think of whether or not there's a process we can get some comments in as a group to get them flagged.
DR. CHANNAHSORAH: The comment period is technically closed but, however, since you're now my friend -- were on the internet, public --
PARTICIPANT: And being recorded.
DR. CHANNAHSORAH: Thank you. Write to me in jail send me a file and cookies, and lots of coffee.
(Laughter.)
DR. LUMPKIN: Let me see if I can understand this that of course during the process of developing a strategic plan you review all the documents and relevant actions of departmental organizations and advisory committees that may have some impact on your decisions related to the strategic plan. So if we were to create such a document it would of course be part of your scan of the environment.
DR. CHANNAHSORAH: Right, exactly. I'm still going through the documents, you can still send in comments, but please make it within the next couple business days, quickly. People who have commented, as the gentleman over here has said, he sent me in comments, and other people attending the big open meeting, but the 9th of September was the close of the comment period, technically. I haven't closed off the draft though. I'll still be redrafting for the next few days, but actually fairly quickly, if by Monday or so. I mean key points that you have, that you really want me to focus on, you can, as you review it, send me, that will be helpful.
DR. LUMPKIN: I think probably the best thing would be to send all those to Marjorie, we'll just send a collected set of comments rather than an official comment from the agency, rather from the committee.
DR. CHANNAHSORAH: You'll just do it informally, and again, flag it, say send it to Vijaya because I do not check the strategic plan box, that e-mail that's in your packet, my assistant Juanita Neconie does that, and so she will, when she sees it and you flag it from the committee, and I'll tell her to look for anything from the committee, or you can even say, please flag for Vijaya, I'll get it.
MS. GREENBERG: So even people who have already submitted comments, if you would send those to me, the ones you've already submitted, then we can bring them all together and forward them.
DR. CHANNAHSORAH: Can you do one thing? If it's something you've already submitted just make a notation so we don't, with a stack like that we'd be going through things twice.
MS. GREENBERG: Just indicate the date it was submitted. It is possible if there were two or three or four main points you wanted to agree in the cover letter during this meeting right now, we could do that. Obviously we don't have time to develop a detailed letter, but if you wanted to emphasize issues related to the NHII, to populations, to privacy, that could be done in a cover letter. You want this by Tuesday? People will be back in the office hopefully tomorrow; they can send me whatever.
DR. CHANNAHSORAH: This is Thursday, yes, that'd be fine, not close of business.
MS. GREENBERG: If there's anything you want the cover letter to emphasize a few points then it can be decided upon today.
MR. ROTHSTEIN: Do you want just sort of a summary of what we are proposing or the rationale, as well?
DR. CHANNAHSORAH: Are you asking me? You can, as we've talked about here today, you can put a little bit of rationale, actually in cases that's helpful, in some cases, then I'll understand. You're not just saying change this word and I don't know enough about your expertise to know why and I might dismiss it in error. I don't know. MR. ROTHSTEIN: Just a brief couple of sentences as to why.
DR. CHANNAHSORAH: You could, unless it's just on the face of it eminently clear and you think even I could understand it. Use your judgement on that, you don't have to take extra time for justifications if it's really pretty clear on the face of it what it is that you're saying.
I am technically out of time. Do you want me to wrap up, end?
DR. LUMPKIN: I think you've hit the points that are certainly of concern to us and I think that -- I'd like to thank you first of all because this is actually timely and very helpful and then see if there is perhaps a motion to submit a cover letter to comments that would emphasize the committee's concern about the cross-cutting character of issues related to the NHII, privacy and populations?
DR. CHANNAHSORAH: I think it's more population, at the level of population.
DR. LUMPKIN: Well, it has been moved by Brady, and seconded by Mark that we send such a cover letter and attach to it the comments of individual committee members that would be supportive of those concepts, that we would, I assume that the motion also included that I could do that without the approval of the executive committee or other body so that it can be done by Tuesday.
MS. GREENBERG: I think that it's clear that NHII and privacy protection et cetera, are kind of enablers for a lot of the rest, I need a little bit clearer what we'd want to say about populations?
DR. MAYS: I have to get, Barbara has a whole set of comments, I don't have them with me.
MS. GREENBERG: I mean in the cover letter, what is the key point we want to make about population health.
DR. CHANNAHSORAH: In the strategic plan some of the levels of the planning process is at the level of individuals as opposed to overall population, so it puts the onus on individual behaviors as opposed to broader infrastructure, community based and contextual types of strategies for changing their health.
MR. ORTIZ: Eduardo Ortiz from AHRQ. I'd also like to recommend if you could that you also add to that list the whole issue of research that I was concerned about because when I see this I feel that research is very narrowly defined as the biomedical research that's done by NIH, cancer research, drug studies, and I think from a perspective of quality, cost-effectiveness, safety, et cetera, we really need to expand the definition of research to health services research, informatics research, all those areas that I think they view these as more services and not as research and I think that's very important.
DR. LUMPKIN: Ted's original point. So that would be four items, if that's okay with Brady, the maker of the motion.
MS. COLTIN: One other would be to encourage that payment policies be reviewed to the extent to which they support these various objectives. It's already there in some of the objectives, it will say look at the payment policies, but I think it isn't necessarily always there when it could be and among the strategies that could be used to support some of these objectives are a reexamination of some of the payment policies.
DR. LUMPKIN: Okay. Vickie?
DR. MAYS: I just want to be a little cautious about this research issue. I am in agreement about kind of the macro issue of its definition, but I don't want to start getting too specific and part of that has to do with my concern about when there is no budget there and this thing gets put into agencies on top of what they already have. Because some of the things they are talking about I don't think are research agendas, they're really evaluation agendas, they're monitoring agendas, I don't think everything there was really necessarily a "research" agenda. It could be put into different categories. I just want to be a little cautious about, stick to our comments about research but I get a little nervous when we start getting into the specifics of the research because I don't think all that has to be a research agenda.
DR. LUMPKIN: I think the character of the comment would be is that the definition of research should not be narrowly defined to bench research or something along those lines.
DR. SHORTLIFFE: I think this is equally generic, but there is one under Objective 5.5 that we looked at, that's the one about accelerating a National Health Information Infrastructure, that's going to harken back to our discussion yesterday. The third point says conduct research on practical applications of the NHII that serves consumers, professionals, et cetera. That's under a heading of “accelerate the development and use”. That doesn't accelerate the development. That accelerates the use and the understanding of the use, and I would argue that there's a missing bullet there about the kinds of research that in fact are necessary to accelerate the development of an NHII that meets the needs of the health care community and public health. So it comes in under the notion of how we define research and how the spectrum between the more basic investigative side of new methodology development and new technique development as opposed to doing practical applications. I'm worried that this reads right now as saying the role of HHS is to a whole bunch more demonstration projects and no research, even in this non wet bench area.
MS. MALINA: Cynthia Malina, CEO, Alternative Link. It seems like both of the objectives that are being discussed could be achieved by just going under each goal and having the first line item under the goal be measure and characterize whatever that goal is. For example, Goal 1 is reduce the major threats to health and well being of Americans. If you made the first bullet point under that instead of reduce risky behaviors, to measure and characterize the major threats to health and well being of Americans, then you'd have the infrastructure built in and you'd have the research element built in. If you did that on each and every major goal you'd have infrastructure and research throughout.
DR. LUMPKIN: As I understand the motion, and I think what we want to do again is to try to put some input, it's going to be tinkering around the edges of what's already fairly well developed. I think we've made some comments that can be taken into account but the focus of the letter will be on the issue of the NHII privacy, populations and research. Then we will include some additional comments and supporting materials from each of the members who choose to write in comments by?
MS. GREENBERG: I'm going to work on this letter this afternoon and I think I've been authorized to finalize it with John, emphasizing these different points. But I need to get your input to back-up by Monday.
DR. SHORTLIFFE: Is this an official letter that goes up on our web-site, et cetera.?
MS. GREENBERG: Yes.
DR. SHORTLIFFE: But the comments, the individual comments will be attributed to individual members as an addendum to the letter.
DR. LUMPKIN: Okay, all those in favor of that motion say aye, opposed say nay. It carries. Thank you very much.
DR. CHANNAHSORAH: Thanks so much, thank you for your thoughts and your comments.
DR. LUMPKIN: We don't envy you your job.
DR. CHANNAHSORAH: People think I'm crazy, I thrive on this, I love it.
DR. LUMPKIN: Okay, we're going to work through the reports from subcommittees and workgroups. We're going to start of with the workgroup on quality.
Agenda Item: Reports from Subcommittees and Workgroups - Workgroup on Quality - Ms. Coltin
MS. COLTIN: We had a meeting this morning and focused our attention in two areas. One was the development of the draft set of recommendations to AHRQ on the proposed measures and framework on the National Health Care Quality Report. AHRQ is in the process of compiling recommendations and comments that they've received through their web-site and will be making that information available to us within about a week, and we will be taking the information we received through the public testimony at our July 25th workgroup meeting in Chicago along with these comments and developing a draft set of recommendations that we would like to bring back to this committee at the November meeting. So that will be an action item we hope for November.
The other part of our meeting time was spent reviewing the list of common issues and themes that we heard throughout the testimony that's been taken during the course of many panels that have been conducted on quality issues at the full committee meetings over the past five years. We are in the process of synthesizing those, combining some of them which relate to highly related areas, prioritizing them and identifying potential options for recommendations that we might make related to each of the major issues that have been identified and we will be reviewing those options for recommendations at our November meeting with intent to present a draft report that will contain these recommendations as well as background information and summaries of the issues for review at our meeting, I guess the first meeting in 2003. That's where we're headed.
DR. LUMPKIN: Thank you, any questions on the quality workgroup? Ok, let's move to the privacy, action item.
MR. ROTHSTEIN: The subcommittee met this morning and approved an amended version of the letter we discussed yesterday to try to take into account the comments that were made at the full committee meeting. You should have a copy of the document in front of you. At the top it says full committee, updated version. That's the latest version and the only changes were, well let's put it this way, the changes begin on the second page with the paragraph that begins - It is not the intent.
DR. LUMPKIN: Can you read that paragraph?
MR. ROTHSTEIN: Yes.
It is not the intent of the NCVHS to be alarmist or critical of OCR or the Department. The implementation of the privacy rule is undoubtedly more difficult than with typical regulations and it will require concerted efforts by more than just OCR or even the HHS. Nevertheless, we believe that the Department's HIPAA implementation assistance efforts needs be increased by several orders of magnitude and quickly. A substantial increase in resources and personnel is necessary. A massive public education program, including public service announcements, is needed to inform the public about HIPAA and the notices, acknowledgements, and authorizations with which they will soon be confronted. Providers and other covered entities need targeted education programs in various formats and media. OCR needs to produce and disseminate sample forms, including notices, acknowledgements and authorizations with simple wording and in multiple languages. It also needs to provide prompt technical assistance, including responding to the thousands of requests for explanation and clarification sent by covered entities. OCR also needs to forge active partnerships with professional associations, industry organizations, state agencies and other affected parties to leverage and reinforce activities already underway.
MR. BLAIR: Are there individuals that have a strong desire to keep the word alarmist in there? That's the only thing that I would delete. Just simply say we don't mean to be critical.
MR. ROTHSTEIN: Well, one could read this letter as being sort of alarmist, we don't --.
MR. BLAIR: I sort of feel like it puts us right on the defensive right away and I don't feel like it's necessary for us to be on the defensive, anyway, that's my thought.
MR. ROTHSTEIN: So you would propose it just read, “It is not the intent of the NCVHS to be critical of the OCR”?
MR. BLAIR: That would be my suggestion.
DR. LUMPKIN: Any comments on that?
DR. ZUBELDIA: I think it is the intent to be alarmist. To bring them alarm.
MR. BLAIR: Yes, it is to set an alarm. We don't want to be critical but we do want to get their attention.
MR. ROTHSTEIN: We could make it, “It is our intention to be alarmist.”
[Laughter.]
DR. FRIEDMAN: I'd suggest that Mark consider just deleting that initial sentence in the paragraph because in fact we are being critical, certainly of the department, and I think the sentence, the sentence that starts - The implementation of the privacy rule is undoubtedly more difficult - as well as the following paragraph about Director Campanelli, both accomplish the purpose of demonstrating that we are aware of and appreciate what the department has already done, so I would suggest deleting that sentence.
DR. LUMPKIN: I see nods of agreement around.
MR. ROTHSTEIN: I have no problem with that.
DR. LUMPKIN: Ok, it's gone. Dan?
DR. FRIEDMAN: I have one additional suggestion for that paragraph which is the final sentence which begins - OCR also needs to forge active partnerships - and I would suggest either adding expand and forge or changing forge to expand because as is this implies that there are no active partnerships.
DR. LUMPKIN: I think expand would probably work better.
MR. ROTHSTEIN: To expand?
DR. LUMPKIN: Yes.
DR. SHORTLIFFE: I don't think you need the word active because we are certainly not going to expand inactive partnerships.
MR. ROTHSTEIN: Okay, so forge active has been replaced by expand.
DR. LUMPKIN: Okay, I think we're done with that paragraph.
MR ROTHSTEIN: Okay, the next paragraph is a new one.
The NCVHS very much appreciates OCR Director Campanelli's appearance at our meeting on September 25, 2002. We think that new initiatives being developed by OCR in education and technical assistance are steps in the right direction. However, there must be a dramatic increase in the breadth, depth, and scale of implementation activities, and there must be a greater sense of urgency to the department's efforts. Unless prompt, vigorous action is taken to ensure that the implementation goes smoothly, the public acceptance and viability of the entire privacy rule with be threatened.
DR. LUMPKIN: Okay, you didn't change that last sentence, like I asked.
MR. ROTHSTEIN: Actually we made a slight change but that won't satisfy you. You might want to add a P.S. in there. Mark Rothstein, Chair of the Subcommittee on Privacy and Confidentiality and I, would be pleased to discuss these matters, including specific suggestions with you or your staff at your convenience. We appreciate the opportunity to offer these comments and recommendations.
DR. LUMPKIN: Moved by Mark Rothstein, seconded by Jeff that we send the letter as amended. Is there further discussion on that motion? All those in favor signify by saying aye, opposed say nay, any abstentions? Ok, thank you. Anything else from your subcommittee?
MR. ROTHSTIEN: No, just a reminder that we have two more hearings coming up in late October and early November and another recommendation of a more specific nature based o our hearings will be on the agenda for our November meeting.
DR. LUMPKING: Great, thank you. We've already heard the report from the executive subcommittee yesterday and did discuss that, Health Statistics for the 21st Century?
DR. FRIEDMAN: There has been two activities going on relating to the report, the first of which is Susan Kanaan has been working on drafting the executive summary and the policy maker summary. We've had a number of iterations, they're both in very good shape and now Susan is waiting for what are hopefully final consolidated comments from Ed Hunter, Gib Parrish, and myself.
And the second activity has been again, Ed and Gib, Gib who recently retired from CDC, but still has this load stone around his neck, and I have been working on doing the final wrap-up work on the report itself. We've incorporated the comments, the few comments from the data council, we've incorporated the committee's comments, and frankly, we have been spending what is truly an inordinate amount of time on copyediting and word processing. If I ever volunteer to write a report for the committee again, please remind me not to do it, even though it's been, having said that, it's been a valuable process, but it's, the final wrap-up work which really is trivial stuff, is taking much more time than any of us had anticipated and we certainly hope that we will have the ultimate version to the executive subcommittee for final review and approval within a matter of weeks.
Then once it's approved we will schedule a time for the final presentation of the recommendations to the data council. I really haven't had the energy to move on with forging the agenda for the workgroup for the coming year until we have finished the, until we have absolutely put the report to bed. That's where we are and if there is anybody on the committee who is especially skilled in Word, especially in Word 2000 auto footnotes, we could really use your help, because it's something that Gib in particular has spent I think literally two or three days on it. It's brutal.
DR. LUMPKIN: Any questions on this? Certainly a note of appreciation, Dan has put a lot and lot of work into this.
DR. FRIEDMAN: And also for Gib, who as I said is now studying, this has driven him to studying astronomy --.
DR. LUMPKIN: Well, he's always been a star so that's appropriate. Okay, we're going to try to telescope this discussion down a little bit. We'll move on then to the NHII workgroup.
Agenda Item: Reports from Subcommittees and Workgroups - NHII Workgroup - Dr. Lumpkin
DR. LUMPKIN: At our meeting yesterday, we began to discuss further work about adding items to our agenda looking at the cross-cutting issues that don't seem to fall into any of the other workgroups or subcommittees. We've identified four items that we will be holding hearings on, and I'll prioritize those. The first set of hearings will be two days and will address two topics. The two topics are the National Electronic Disease Surveillance System, Bio-Terrorism, and Syndromic Surveillance, which will be one day of hearing.
The second hearing has to do with in relationship to future directions of the National Information Infrastructure, particularly newer directions such as the next generation internet, those kinds of activities, particularly interested in the involvement of health in those developments. And so we're looking at a two-part approach. One is to look at where that development is going, what kind of input needs to be there from the health table, what kind of input is actually there.
The second thing then would be to look at on the health side what kind of involvement is going on, what is planned, and how those resources can be utilized in order to impact and make sure that the future developments of this technology the technology takes into account the needs and special concerns related to health which is a major part of the nation's economy.
The other two items that are on the agenda for exploration have to do with the issue of looking at registries as a particular item, how they are collecting data individually in their individual stovepipes and across registries as well as across states. Looking at those issues of compatibility and consistent standards.
The last item which we'll be working on also there's been a fair bit of interest after we raised this issue based upon our hearings in July from the Connecting for Health, by the Markle Foundation, and we look to working with that group on personal health records, looking at minimum data sets and other related issues, including taking a different approach at how an individual builds your personal health record, which means if I go to different physicians and see things, how do I then construct my record without having some sort of linkage variable. We're trying to stay away from terms like unique individual health identifier and really talk about how an individual can control and be a participant in their health care encounters by having their own medical record that they may construct and have available to them, so we're going to be delving into those related issues as well as the minimum data sets.
Those are the four items that we have in the schedule for our hearing and as we see through that various reports and letters and recommendations we will be coming forth to the full committee.
Yes.
MR. ORTIZ: Eduardo Ortiz from AHRQ. I don't know the format, if I can kind of make a comment on that at this point or not, or if it's appropriate but the comment I was going to make, I've been thinking a lot about what we discussed yesterday about the NII, the National Information Infrastructure and I thought that was an excellent idea and a very important thing for us to get involved in. But as I'm thinking about what is the best way to do this, I'm just wondering whether at this point in time whether holding hearings is the most effective and efficient means of accomplishing our objectives at this point.
It appears to me that most of the time we hold hearings when we're trying to gather information to try to make decisions and recommendations. It seems like at this point, at least early on in the game, we kind of know what we need to be doing, we need to have the National Health Information Infrastructure people sitting at the table with the National Information Infrastructure people, the Department of Justice, Department of Commerce, Department of Transportation, all those guys that do all that kind of stuff and we need to have them involved with some of the stuff that we're doing so that interaction takes place so that we can get involved in the next generation of the development of internet and other types of IT systems. At this point, I don't really see that that's the most effective way of doing that is by holding a hearing for a day or so or a couple of days where people come in and talk a lot when the bottom line is we still know that we have to do this.
It seems like it would make more sense to do the first step first and then as we move along, then perhaps we do some hearings as we start to get more of a feel of exactly what we want to get out of the hearings. So I know people may disagree, but that's just something I was thinking about.
DR. LUMPKIN: Actually that's not how the, in our experience, the process works. Frequently one of the roles of this committee is to, through the hearing process, point out to people that there are pieces that are missing and that won't happen unless you invite them to a meeting. Obviously this is not happened, it appears that it's kind of obvious that it should, it lays the basis for us in making recommendations that really would encourage people who are outside the committee that we have no control over it to sit down and talk to each other. So the hearing process can have some impact on that and has in the various other areas where action has been precipitated.
DR. SHORTLIFFE: I was just going to say, some of us believe this is a no-brainer, but I don't believe that's the overall perception and there is an educational process that goes on through the hearings and through the credibility that comes from recommendations that are generated by this body. I don't think, the point has been made for some years without it happening. This may be a mechanism for helping it to happen.
MS. GREENBERG: Well, I agree. I think we had talked about having this first set of hearings in Atlanta because of the focus on, the first day certainly, about terrorism, surveillance, etc. The second day might be a real opportunity to also hear from the public health community and others about what input they have had to the NII and how there receptivity to participating more, etc., because I think, to the extent that we want to then work in the future, meet with these different groups as Eduardo has suggested, that would best be done in Washington.
DR. SHORTLIFFE: I agree, Mary Jo Deering(?) and I were talking about this last night and we were both a little concerned that the key people that you'd want to have at such hearings are not in Atlanta, except possibly the CDC perspective.
MS. GREENBERG: I was thinking about that, too. I can see part of it being accomplished in Atlanta, but part of it would be up here.
DR. LUMPKIN: Well, we can work that out. Ok, any other questions, comments, on NIHH? Standards and Security. Jeff? Simon had to catch a plane and left early this morning.
MR. BLAIR: I didn't really take notes in the meeting so let me go ahead and give a summary of our activities with respect to PMRI, with our activities in our workgroup with respect to alternative medicine CAM codes, and DSM and then maybe Brady you could help me with ASCA(?) and Kepa you could help me with the ICD-10 issues.
With respect to the PMRI issues that we covered, we have an upcoming meeting on October 22 to focus on PMRI terminology, that's Patient Medical Record Information terminologies. There's a number of things that are happening at that time and we decided that we would do an abbreviated agenda on that at that time and defer some of the decisions we had expected to be able to make with respect to the scope and criteria of selection of PMRI standards until after we get some outside information which will happen after October 22nd.
We are in the process of compiling the plethora of wonderful information we gathered on August 22nd when we had people testify on scope and criteria of selection of PRMI terminology's and we will be harvesting that information to present to the committee for them to digest on October 22nd.
With respect to the issues related to the question of whether complementary and alternative medicine codes that Alternative Link has raised as a point for us to consider, some of that activity right now is, we're still awaiting information to be fed back to us from HICPICS and then we're looking at when we receive that information, that we're considering having hearings in the December timeframe with respect to these additional code sets. Is there anyone that wants to correct or tell the committee what I'm maybe missing on that subject?
MS. GREENBERG: I think it was from the point of view of timeline, it was agreed that the HICPICS panel would report back to the subcommittee at the December subcommittee meeting.
MR. BLAIR: It is going to be December, not November? I thought it was going to be November and then we would wind up trying to get additional hearings in December. Is that not correct?
MS. GREENBERG: It's my understanding that talking to Karen Trudel, she thought, there isn't a subcommittee meeting in November and the October meeting was too soon so it was a December meeting.
MR. BLAIR: Then I stand corrected. Brady could you give us a brief summary of the status of ASCA?
MR. AUGUSTINE: As far as ASCA is concerned we're going to, based on the new information from the submissions, going to update the sampling plan and then also have some conference calls with Karen and people at CMS about how to analyze, how we want to look at that data and cut and slice it. We talked about for the benchmarking best practices partnering that some people have experience implementing, we used SNIP and others, are getting some information from them that we can include in this document and that's all we really talked about unless you two can remember something else.
MR. BLAIR: Kepa maybe you could share with us the status of the ICD-10 issues.
DR. ZUBELDIA: I've already packed all my notes so I've asked Marjorie to see if she can give us a summary.
MS. GREENBERG: The subcommittee discussed the discussion at the full committee meeting and agreed that a background paper, which is actually already underway, would be prepared for the committees' consideration at the November meeting that would be related to the pros and cons and the issues on a replacement of ICD-9-CM Vols. 1, 2, and 3 with other newer code sets. I believe what was agreed was that at least a sort of outline, detailed outline of that paper would be discussed at the October 22nd or it might be the 23rd, the second day, October 23rd, meeting of the subcommittee and may also have some parallel work going on related to the components of a cost benefit and impact analysis that would facilitate the develop of that by the department. I think it was agreed that we would not have outside speakers for this presentation to the full committee in November, but this would basically be a presentation synthesis by the members of the subcommittee as to what they had heard and what the issues are that need to be resolved.
There was another issue that was related to that but it has escaped me. We also had talked about having a presentation I think at the October meeting on RX Norm(?) and probably hearing from and maybe more broadly about issues related to standard nomenclature for pharmaceuticals and medications and hearing from the VA, FDA and NLM on that. I think that was it.
MR. BLAIR: Does anybody else on the subcommittee, excuse me, on the full committee, have questions about the subcommittee's report?
MS. MALINA: I'm Cynthia Malina, CEO of Alternative Link. I just want to call attention to the full committee to an issue that may become a source of concern, potentially controversy, in the next several months, and that is in the subcommittee, the subcommittee has been presented with an entire code set for complementary and alternative medicine as well as for nursing. These are areas in dire need of measurement to support economic and health outcomes assessment. The American Medical Association is a physician trade association that has control over the assignment and management of coding and they have not adequately coded this area.
We were directed to the AMA by the subcommittee in May, actually in April of this year, and as a result of that direction, I mean as an immediate and direct result of that direction, the American Medical Association is now taking predatory action in compiling or gathering practitioners of alternative medicine and nursing and trying to re-create from scratch a code set that already exists and that was presented to this committee as an entire code set and has been under review under HIPAA for the entire length of HIPAA. This is a code set that was developed by purposes of meeting the objectives of HIPAA. It was submitted first to the DSMO's three years ago and these delays, such as the delay until December, are unfathomable given the sense of urgency about these codes. I just want to ensure the entire committee is aware of these delays and the predatory action that's being action and the lack of explanation or process or objective standards that have been put forth in evaluating this code set. Thank you.
DR. LUMPKIN: Thank you. Any other comments related to the report of the subcommittee? Subcommittee on Populations.
Agenda Item: Subcommittee on Populations
DR. MAYS: We met yesterday afternoon, and I think probably the best place to start is to do an update on the hearings we're going to have because we're all going to run out of here at the end of the meeting to Denver because our next hearing is actually focusing on the issue of data issues for American Indians and Alaskan Natives today, I'm sorry, tomorrow. We have I think a very interesting and rich hearing set up where we're hearing from tribal leaders, we're kind of piggy-backing on a meeting of the Office of Minority Health, so they have convened a very interesting group of individuals there that I think we'd have difficulty bringing in to the hearing so we expect them both as testifiers as well as individuals who are in the audience. That will be tomorrow.
Then we have a hearing which will be on November the 8th in which we're looking at these data collection actions for racial and ethnic minorities, particularly as they apply to looking at and determining health disparities from a state perspective. We're doing that in Philadelphia, again piggy-backing on the American Public Health Association meeting because a lot of the state people will attend that meeting.
In preparation for that November 8th hearing we had a presentation by Jim Weed, who is at CDC and is I think the deputy director for vital statistics, so I think we had a very good discussion yesterday about some of the vital statistics issues and some of the state issues relative to the collection, kind of the range of issues that states are in in terms of, for example, the status of the electronic birth certificate, where we are relative to the death statistics, death certificates, some of the issues that come up in misclassification, how the data is gotten, what's in the data files for tabulation, so it was pretty rich and I think will provide us with a set of very interesting questions to pose to the states as well as what we decided to do is ask the states that are going to be testifying at the hearing to actually share with us some of the forms that they are using and we'll see I think the range of differences that exist there.
In the future we will do a hearing on the Asian Pacific Islander group in terms of again, looking at this issue of determination of health disparities and whether or not we actually have the data that we need. We will do one on language and we haven't set the dates for those two hearings.
In addition, the committee has been asked, and I'll be the person to do it, to present at the IOM panel, is it a panel or committee?
DR. LUMPKIN: It is a committee that's holding the panel.
DR. MAYS: The committee, it's going to be on the West Coast, and we've been asked to share with that group which Don is a member of, the activities of the population subcommittee. This panel's focus is really looking at the issue of disparity, specifically for racial and ethnic minorities in terms of health care, access to care and I think a bit on the collection of data also, if I understand correctly. Their interest is really in what are some of the issues, what can we share with the group on recommendations and the kinds of things they might also think about talking about in the final report was my sense in talk with them so I think that's October 22nd that that will happen.
The other thing that we did which we actually spent a reasonable amount of time on is, we talked about the executive committee retreat on the issues of population and populations and tried to get, I felt it was important for the subcommittee to talk about it because we are the subcommittee on populations and to be able to think through what the proposals were and to think about how we could help the full committee in dealing with this issue and we actually came up with some suggestions.
I think one of the things that we thought might be helpful was as you talked about the meetings in September where we would actually do some presentations, it might be useful that as people put on the table what issues are, for the full committee to think about, if when they do that presentation, and as far as I'm concerned this can also come from people who are coming in from the outside to do presentations, if we could hear something about the implications of these issues for population health as well as to talk about its impact or concerns on particular populations. So if as you present this information you know that there are particular populations for whom there are specific issues, that would be great. In populations, from the populations perspective, that could be talked about. But at the same time we thought it would be useful for the full committee to begin to really practice this notion of once we've had this series of presentation on population health, if what we try to do was to have that as kind of a cross-cutting issue in our presentations so that we kind of practice what we're trying to achieve. We think that it from the point of view of education, it will be great after we have the presentations so we're going to kind of see if we can push people, we'll ask them, we'll be the group that says now what is the impact of that in terms from a population health perspective, so that's one of the things we wanted to bring to the full group and make that request.
The other thing we want to do to help this along is at the November meeting is to ask for an hour where we can meet with all of the chairs of the subcommittees and the lead staffs of the subcommittees to also work through some of these issues. One of the things we did was we had our writer, Sherre Crute, go through our history and really identify lots of issues that to some extent that may have fallen between the cracks, such as HIPAA. There have been raised in the past some issues about race and ethnicity relative to HIPAA. There have been in the past raised some issues in terms of code sets, and we realized that again, some of this cross-cutting interaction can really occur. What we'd like to do is really to meet with the chairs as a group as well as the lead staff and do some exchanges back and forth in terms of putting some things on their agenda as well as taking some things on our agenda, so we've made a request for an hour meeting in November as a way to, we're taking serious the things that came up at the retreat to try and make population everybody's issue so we talked about that. What that led is to also updating our work plan so I think after that meeting we'll be in a very good position to see what some of the exchanges will be and from that we will our update our work plan.
Was there anything else? Anything else I've forgotten? People feel free to chime in.
DR. LUMPKIN: Any questions?
MS. GREENBERG: I would actually interpret that last request as that maybe the executive subcommittee which is includes all of the chairs of the subcommittees and workgroups and usually the lead staff, what you're requesting that they meet for an hour that they meet during the November meeting.
DR. MAYS: Right.
MS. GREENBERG: I got a hint from Debbie that that was --.
DR. MAYS: As long as that's the group that has both the chairs and the lead staff because we also want to make sure we have the lead staff.
MS. GREENBERG: It does. They are always invited as well and that would also include the liaisons who I think would also would benefit from their involvement, the agency liaison. Of course anybody else is always welcome.
DR. MAYS: It's not a closed meeting, we're just trying to make it a focused meeting, it's not a full committee meeting, it's a focused meeting.
MR. AUGUSTINE: Is there anyway in the future when we have a full committee meeting maybe dedicating a whole day to subcommittee meetings so that those that overlap, I've liked to every one in a while attend a population subcommittee meeting and it always overlaps with the security and standards, is there a way we could maybe do that so we could attend different ones and hear about what they are doing in more detail?
DR. LUMPKIN: We can take a look at it, the issue is it's my guess and this was actually going to be part of my closing comments, as I was listening to the reports of the various workgroups and subcommittees, there is an incredible amount of stuff that we are doing, that's on our plates and the work at the full committee meetings are just a small portion of the work that's ongoing. Given that, the restriction that we have is we want to try to keep it to a two day meeting and that makes it somewhat problematic and generally when we have a two day meeting it means we finish up in time for people to catch their planes on the way out, so I think to the extent that we can look at that we will again look at that for upcoming meetings.
MS. GREENBERG: One thing that might come out of this discussion and review that Vickie mentioned is that having identified population issues that are really very relevant to the standards agenda and maybe vice versa, that if we have say a three hour subcommittee on an afternoon, and it might not happen in November, it might happen in February, then it could be two hours of the separate subcommittees and then an hour of the two subcommittees together, which would reinforce some of this.
MR. AUGUSTINE: I know there are some other ones, I know there's some talk about quality and standards and security having a meeting together as well.
DR. MAYS: I just want to make another suggestion and Mark and I were talking about something and something came up that I think is worth thinking about. And that is I think yesterday I said something about the fact that we have a lot of outside people presenting to us and sometimes some of the experts right here in the room. I'm surprised sometimes until I find out either at dinner or off line in some ways the expertise that we have among ourselves. And as we were talking we said it would be great if at some point we had just 15 or 20 minutes for each person to say a little bit about what they were working on and kind of what projects that they have in the hopper, because I think to some extent while we get slotted into certain things that we do as a function of the committee structure, we might be surprised at the expertise that actually exists in the room. We've been doing papers with each other, so we should think about, we always have an executive committee retreat, it might not be bad --.
MS. GREENBERG: We could consider a retreat of the entire committee.
DR. MAYS: It might be nice to have a day where part of what we also do is hear what we do --.
MS. GREENBERG: No, but I think and I will say that those of us who attended the dinner last night and it was a very good turn out. I really was delighted as sort of the mother hen of this group, that you all came to the dinner that I invited you to and ate healthy food and all of that, but I hope, in any event, we will be planning a dinner definitely at the November meeting and we may have a few members that that will be their last meeting, given that they have served most of their life and they want to move on, so anyway, I already saved that first night in November, and I think that is also a way particularly if we structure it a little different so that there is some time for exchange before we actually sit down to the dinner when we're kind of then sitting at a particular place, for more informal exchange as well. Though I like actually the idea of even a full committee retreat. I also say that, it's interesting, Rome obviously wasn't built in a day and when I think back on the retreat that we held, the executive subcommittee in Cambridge and then the last two years in Chicago, although things may not happen quite as quickly as we think, I see a progression here, I see some of the ideas really seeping in and taking hold and I'm really pleased with that and I think that we appreciate that this is a process and a journey. Any suggestion that you all have for ways to facilitate more exchange among the members, both informal, etc., both John and I really appreciate it.
Agenda Item: Future agendas for NCVHS Meetings - Dr. Lumpkin
DR. LUMPKIN: In our agenda book we have the listing of the upcoming meetings. November is getting tighter and tighter as time goes on.
MS. GREENBERG: Let me just tell you what, there are certain things that are definite, we're going to have this discussion, I would think we'd need two hours minimum on ICD and replacement of ICD-9-CM, I already mentioned that. We had hoped to have the directors of NIH, minority health at NIH as well as the Director of the Office of Minority Health actually at the last meeting and at this meeting, we keep being able to get one but not the other, but I think we've got both of them lined up for the November meeting, that's our goal at least. Debbie is on a first name basis with both of their secretaries and administrative assistants, etc., so that's our goal. We've already heard that we will need probably a good period of time for discussion of the findings and recommendations from the three sets of hearings of the privacy hearings on the privacy rule. So I think those are essentials. Jim Scanlon has mentioned in the past about the departmental gateway and even a demo of that and I think we will try to have that, I think he felt that would be ready for the November meeting.
The NCHS director is scheduled for the annual update then. We are talking now about having probably a meeting from 8:00 to 9:00 a.m. on the second day of the executive subcommittee as we just discussed. We've had other things suggested. It looks as if although we are eager to launch the presentations on determinants of health, I think we've concluded that the people that we really want are probably not available until the February meeting, is that correct Dan?
DR. FRIEDMAN: There are a couple ways, we had hoped that either Bob Evans from the University of British Columbia or Greg Stoddard from McMaster would be able to come. Greg is busy on the date in November and the only way we could get Bob Evans to come is if we could convince him to leave the beach in Australia and he didn't seem particularly interested in doing that and I don't think Marjorie will be particularly interested in writing the check. One possibility would be asking Barbara Starfield to do a presentation, both on her model and she could also reflect on Evans and Stoddard. Barbara and I have been editing a HAPH(?) forum on models of determinants of population health that will be coming out in March and we could also get, we could also ask, for example, either John Milar(?) from Canadian Institute for Health Information to reflect on the impact on the models on Canadian health policy or Illona Kickbush(?) from Yale, formerly of World Health Organization to discuss the use of the models in WHO policies and programs. Or we could wait until February and once again I don't know if I could do it again but maybe Debbie could beg Bob or Greg to come. I think that the first panel should focus on general models and then what we were talking about yesterday and then what I was talking about yesterday with Vickie was trying to have a second panel at another meeting because we want to leave plenty time for discussion to focus more specifically on some of the empirical research for example perhaps having -- from Harvard and some other folks come and present.
MS. GREENBERG: So something could be put together for the November timeframe.
DR. FRIEDMAN: If there were enough time, but at the same time maybe we should just wait until February and see if we can get --.
DR. LUMPKIN: I haven't found from the agenda that we're going to have time.
DR. FRIEDMAN: I'd hate to rush it. I hate to rush it, I'd hate to squeeze the time because one of the points of this is to leave enough time for the committee to really to discuss rather than -- through.
DR. MAYS: Even if we don't do anything other than ask Barbara, I think here again what you have is, Barbara knows what the committee's issues are, I think she can do a good presentation, she'll do an excellent presentation, but I think can also start us off in a way in which she can make it very specific. Given that I think that really is Barbara's last meeting I would hate to not --.
MS. GREENBERG: Of course we can always bring her back, even --.
DR. MAYS: You think you can always bring her back, Barbara is saying gone, we don't have her for this meeting, she has another agenda with another group that she is moving on to, we really, you can ask her now for example if whether she is even available in February.
MS. GREENBERG: We know she will be at the November meeting, we could at least --.
DR. MAYS: Just if it's no more than just her to start, that would be a good kick-off.
DR. FRIEDMAN: I think that would be a great kick-off and maybe we could just do it with Barbara and then see if we could get Barbara and Greg for February. My only caveat is I think even if the panel is Barbara, I would still ask for a couple of hours.
MS. GREENBERG: We'll see how the agenda works out and -- I don't think there is anything we can really bump, but we won't end it early in any event in November as we are this time. We might be able to work it out. I'm assuming the subcommittees do want to have maybe three hours, two or three hours again, I know I think the subcommittee on populations took about two and a half hours, not populations, standards and security, we used to have two hours and this time we had three hours, any feedback from chairs?
DR. MAYS: I was going to say for us we will by that time have had two hearings, we're planning what we want our report to look like, we kind of have a full agenda.
MS. GREENBERG: Okay, we'll work on it. I think we're back at the Humphrey Building in November. Let me just ask Debbie Jackson, is there anything I've forgotten?
DR. LUMPKIN: Okay, we will play with the agenda and we'll be sending it out as usual. Everyone have a safe trip home. If you happen to be travelling through Chicago on election date don't forget to vote like everybody else does, early and often.
[Whereupon the meeting was adjourned at 12:00 p.m.]