[This Transcript is Unedited]
Hubert H. Humphrey Building
Room 443E
200 Independence Avenue, NW
Washington, D.C.
Call to Order and Introductions - Dr. Lumpkin
Update on Plans for NHII Conference - Dr. Rippen
Update on CAHIT - Ms. Cronin
Update on Connecting for Health - Dr. Lumpkin
Agenda Item: Call to Order and Introductions - Dr. Lumpkin
DR. LUMPKIN: -- so we're going to play around with our schedule and I guess we need to do introductions. I'm John Lumpkin with the Robert Wood Johnson Foundation and chair of the workgroup as well as the full committee. Why don't we go with Simon?
DR. COHN: I'm a member of the NHII Workgroup and the full committee.
MR. HUNGATE: Bob Hungate, member of the NHII Workgroup and the full committee.
DR. HARDING: Richard Harding, University of South Carolina, member of the subcommittee and the full committee.
MR. BLAIR: Jeff Blair, member of the workgroup on National Health Information Infrastructure and member of the committee.
MS. BEBEE: Suzie Bebee, ASPE.
DR. RIPPEN: Helga Rippen, ASPE and ONCHIT, I didn't want to do the pronunciation.
DR. STEINDEL: Steve Steindel, Centers for Disease Control and Prevention, staff to the workgroup and liaison to the full committee.
MS. POKER: Anna Poker from AHRQ and I'm going to be staff to the quality subcommittee and a staff member here at NHII.
MS. WILLIAMSON: Michelle Williamson, CDC, NCHS, and staff to the NHII Workgroup.
MR. HOUSTON: John Houston, University of Pittsburg Medical Center, and member of the NHII Workgroup.
DR. DEERING: Mary Jo Deering, National Cancer Institute and lead staff to the workgroup.
MS. SERTZ(?): I'm Katherine Sertz on behalf of the Association of American Physicians and Surgeons.
MS. BOWER: Cynthia Bower from that other unknown office, Office of Disease Prevention and Health Promotion.
MR. LARSON: Ed Larson, I'm a business strategy consultant.
MR. DAVIS: Lynell(?) Davis, Blue Cross/Blue Shield Association, also a member of the Electronic Health Record Task Group of HL7.
MS. CARVELL(?): Jennie Carvell with ASPE on detail to David Brailor's Office.
DR. LUMPKIN: Which is called?
MS. CARVELL: ONCHIT.
DR. LUMPKIN: Somebody's got to pronounce it.
MS. CARR: Justine Carr from --
DR. BICKFORD: Carol Bickford, American Nurses Association.
MR. RODY: Dan Rody, American Health Information Management Association.
DR. WARREN: Judy Warren, University of Kansas and a member of the full committee.
DR. LUMPKIN: So we're going to postpone Kelly's spot and then move on to --
DR. HUFF: John --
DR. LUMPKIN: Oh, there's somebody on the phone.
DR. HUFF: The thing said there are a couple of us but this is Stan Huff with Intermountain Health Care and University of Utah in Salt Lake City.
DR. LUMPKIN: Great, Stan, anybody else on the phone? There's supposed to be somebody else, Stan, could you introduce yourself again maybe as a different person?
DR. HUFF: I don't have that much imagination.
DR. DEERING: Amy Patterson of NIH had intended to join, I know that she was by phone on one of the previous calls.
DR. LUMPKIN: Okay, take it away.
Agenda Item: Update on Plans for NHII Conference Ms. Cronin and Dr. Rippen
MS. CRONIN: Well all of you will be getting more paperwork of course that you can actually help use if you would like to follow, well, you're just going to have to take it by faith. But I will be going through it in a verbal way. As you know we are planning for that wonderful conference in July and we are actually looking forward for all of you to participate so I hope that you have registered and we have ways of following up on that as a first thing because we really do need your input and we do need your support.
As you know Dr. Brailer did join recently and he will be giving I guess some comments tomorrow at one of the larger, the entire meeting, and what we have done is given him the first morning of the first day on Wednesday to actually provide a kind of a status report on the strategic plan. And so I'm not going to be going into detail on the specifics of the morning session but let you know that it will be called the Secretarial Health Information Technology Summit II, it's a follow-on to the May 6th meeting that occurred, and it will be very exciting and that's part of the larger meeting. So that was going to be happening then from 9:00 until 2:00 in the afternoon on Wednesday.
Does this make sense with regards to process check? Okay, just want to make sure.
Then from 2:30 to 4:00 we had I guess previously had several discussions with regards to the breakout groups and to whether or not topic focus versus stakeholder focus and we are continuing with the topic focus and then a reconfiguration with stakeholders to have some ability to do stakeholder concerns. And so in that vein then the first breakout is going to be based on the topic tracks, as you know there are eight topic tracks, we have four of the eight papers already drafted by various co-chairs, and we are hoping to get the next four by the end of this week, early next week. Once we review them and make sure that they're in a consistent format what we're going to do is send them out and post them so that everyone will have a chance to see where they are. There is a standard format, the first part is really kind of an overview of the scope of what the topic is and what's going to be covered under the topic. The second then is what the recommendations if any were made from the NHII '03 meeting but actually more importantly then is what have the, what were the advances between that meeting and today so that we're all up to speed and we're not reinventing the wheel.
And then the final section of that would be then what are the recommendations. And that will be presented in the first breakout session by the people that were co-chairs and co-leads and co-authors of that paper. And then there will be a time for the group to discuss that in light of the morning summit and the strategic framework.
And then based on deliberations for that they're going to make recommendations, then they're going to have a little because we do believe in a little coffee and tea, and then coming back then from 4:30 to 6:00 to really define then an action agenda based on those recommendations of moving it forward.
Then the evening from 6:00 to 8:30 we have a reception and the posters of the endorsers, and that will be a very nice event. Then we're going to start then Thursday morning from 8:00 to 9:00 with a preliminary presentation of the drafts recommendation and action items of the eight topic groups.
Following that then we'll have our first plenary because now as you know our meeting was cut in half, we're going to have implementation, community buy-in and business case, and that will be followed then by a stakeholder breakout group where now the stakeholder groups are able to respond to each of the recommendations in the topic areas and voice any concerns because again they may have a different perspective based on stakeholder interest. And that will continue through a working lunch and then we will have a plenary session that talks about what are the private sector initiatives and that includes LeapFrog, eHealth Initiative, NAHIT, WEDI, HIMSS, Connecting for Health. And then 2:30 people are going to reconvene in the topic groups to talk about how to incorporate the stakeholder responses and advices to topic area action plans. And then the final stakeholder or I should say not stakeholder but this topic track, so there's a correction there, from 4:30 to 6:00 is to then prepare for the NCVHS meeting the following morning on Friday.
There will be a special interest group session on community of practice in the evening on Thursday and on Friday we're going to be doing the report outs with then a closing by Dr. Brailer and Dr. Yasnoff, kind of next steps. And then NCVHS will continue on with regards to any questions, follow-up questions, other information. So that's really the agenda with regards to the NHII '04 meeting and the health summit.
MR. BLAIR: What time on Friday?
MS. CRONIN: We have slated for NCVHS 4:15, I don't know if you need that time but we have you from 1:00 to 4:15 to continue deliberations, ask questions, have a break, that sort of thing so depending on what your agenda is you can have a shorter meeting.
Just to kind of get you up to speed because we do want your help as always with the NHII '04 we have also a handout, it's about three pages long, of all the entities that are endorsing this meeting so if you have any recommendations of who else should be asked to attend that would be wonderful, we'd really appreciate it. And Susie, want to talk about them?
MS. BEBEE: We're asking that the endorsers also participate in the poster session and out of the 61 endorsers that we have so far about half of those have confirmed with the poster session. And we're also asking them to disseminate information about the meeting, that's been very successful and they're doing it in many different ways, journals, newsletters which are even weekly, website URLs, list serves, so we've been real happy with getting the information out about the meeting.
As you can imagine with Dr. Brailer's addition to this activity and now our new office there's been a heightened interest and we've been fielding all those calls and emails as well. And that includes people wanting to come on board and endorse the meeting so that's been a pleasant piece of work that we've been dealing with.
There's another piece of paper too that is a handout that shows the number of individuals that have registered, we're down to 34 days and counting so we're expecting in the last 30 days that we're going to have a rush for registration if it's true to form, that's the way it was last year. And you can see in this handout the breakdown as to the interests of the people that are registering. And so the breakdown for instance registration category is about an 80/20 split for the private industry being actually 75 percent, federal government is at 19 percent, state six percent and local government one percent. And the highest registration for a topic area is standards and architecture, over 40 percent. Stakeholder affiliation is running about three of them close system developer, health care organizations which are actually institutions, and then the health care provider such as physicians, those are all running in the 20 percent.
MS. CRONIN: And so again I think it's important, I mean I'm pretty impressed with the kind of mix of people, they're less from the government and more from the private sector and there's a significant number in the health care provider domain. The other thing is that many are requesting for the tutorial so it implies that many of these are new to the whole concept of the NHII and that's very important, and that many, almost 70 percent, are interested in actually participating in the community of practice, also kind of giving a sense of where they may be with regards to the actions and where they may want to be starting to perhaps think about implementation. So again, it's interesting with regards to looking at these numbers and what that might mean.
But what it also means though is that we would like your help and actually all the attendees that are also sitting here to make recommendations with regards to how to target certain groups that are under represented here and to be effective and making sure that it really truly is a diverse stakeholder meeting so we can really get the most out of it and we can get everyone perspective incorporated in the things that get reported out to all of you.
MS. GREENBERG: I'm sorry I was a little late, I was up at Populations, but I know there's been some concern expressed about the, I guess there were about what, about 45 people from public health which is actually better then I anticipated so maybe it's picked up a little but with this very small number from local and government and a pretty small number from state too. To the extent that the registration and travel are a barrier for folks like that any thought or any of the sponsors willing to contribute, I mean is there any thought about waiving registration or lowering registration fees for those groups, or getting any of these sponsoring organizations to maybe sponsor some scholarships or something?
MS. RIPPEN: Well actually, that's actually a good point and I will turn it around to many of you who have maybe opportunities to help facilitate that. As you know we have a very tight budget and for us to actually carry on, to actually do the conference and to pay for the food alone and for the facilitators and the planners it's a half a million dollars and that's all of the money that we have. And so we are looking to have organizations that may be able to provide scholarships to do so. If there's any recommendations with regards to who those organizations may be because I think we have had requests from certain entities, especially from the public health sector, and consumer groups actually with regards to being able to not only pay for their tuition but also their travel. So again, I think it's really important, we welcome any ability to do that and if you have any recommendations as far as how to accomplish that we would love to hear it.
DR. DEERING: I was only going to share your pain as a government office that's put on national conferences and that question always comes up to those around the room who are not in the government it is virtually impossible, it's a non-starter for the government to almost ever be able to even make a dent in that issue and certainly can't directly touch it at all. And I know of almost no circumstances unless it's a direct sponsorship effort of one particular sponsor who says I really want to pay to bring these people in but otherwise, CDC has sometimes in the past decided that they would be able to bring in X number of people from the states but otherwise there aren't any other options.
PARTICIPANT: We have been seeing a lot of contact from LeapFrog group and LeapFrog is GE, Wal-Mart, Microsoft, why don't we ask them to put their money where their mouth is? If they are so concerned about improving the quality of care, if NHII is one of the key fundamentals for improving quality of care let's reach out and touch them, they can afford to do this.
MR. HOUSTON: It's a little late for this year to try and go solicit funds like that.
DR. RIPPEN: Unless somebody has it, they don't have to get approval, that line budget $50,000 kind of --
MR. HOUSTON: What was the attendance last year?
DR. RIPPEN: About 600 or 700.
MR. HOUSTON: We would expect we're going to be above that for this year, correct? Does that help the budget situation knowing that --
DR. RIPPEN: We budgeted for up to 1,000 people.
MS. BEBEE: We did it in chunks of 600, 800, and 1,000, and even discussion of having 2,000 people --
MR. HOUSTON: But the economics still are pretty tight. How about the Robert Wood Johnson Foundation?
DR. LUMPKIN: A couple of quick ideas, we can talk, some organizations that aren't on the list that probably ought to consider, National Medical Association, the Asian and Pacific Islander Americans Health Forum, and I can't remember Jane Delgado's group, they're based here in D.C. --
DR. DEERING: COSSHMO, C O S S H M O --
DR. LUMPKIN: No, they changed their name to Alliance for Expanding Health or something like that. If you send --
DR. DEERING: If you search on Jane Delgado you'll find it.
DR. LUMPKIN: Those are ones that just come to mind, and my guess is they will also have suggestions, there's the Association of Black Cardiologists, there's a whole list of minority health groups that I think ought to be approached.
DR. DEERING: Has Markle been able to suggest any consumer oriented groups? I know they tried to find people from time to time and I don't know what the status is of their success in tapping into any consumer groups. Are you aware of any?
DR. LUMPKIN: But mentioning that, AARP --
MS. RIPPEN: They are actually sponsors.
DR. LUMPKIN: I didn't see them on here, but maybe I just, maybe because you spelled out their name.
DR. COHN: Helga, just a question about the make-up of the whole, probably the issue of your trying to provide resources for under represented, it's so hard to know who's represented. Obviously I can tell consumers, health care providers has a number of different meanings --
DR. RIPPEN: Yes, it does.
DR. COHN: It can mean hospitals or it can mean physicians or it can mean neither, and health care organizations overlaps with all of that. Do you have any insight? A different way to do this where when you have a better sense of whether --
DR. RIPPEN: We have the organizations so we'll take a look at that.
DR. LUMPKIN: Following up on that there's the Association of Community American Primary Care Association or something like that, the community health centers.
DR. DEERING: Oh, the community health centers, that'd be a good one.
DR. LUMPKIN: There's the American Public Welfare Association, you can check with Peggy Hamburg about, there's the American Public Welfare Association and then there's the State Medicaid Directors Association.
DR. DEERING: I notice that you have IHS as having been asked about a month ago but given the fact that they are moving forward on their electronic health record with VA it might be worth really prodding them some more, not even so much about their being a sponsor as helping to promote it to the people who are working out in the field.
MS. BEBEE: We're trying to also, David Brailer was meeting with all the federal agency heads so we'll be getting those --
DR. DEERING: And certainly the same for VA which is rolling out its care in the community projects, their VISNs, I don't know what it standards for.
MS. BEBEE: [Inaudible.]
DR. LUMPKIN: AHPA, I don't see them on there.
DR. RIPPEN: There are other non-physician providers they did not tap into, I could take a look at --
DR. LUMPKIN: And you may want to also look at the membership, particular consumer membership, of the NQF.
DR. BICKFORD: If you're looking at the CAM providers, a whole new venue, they should be partners in this discussion.
DR. DEERING: National Health Council is an umbrella for a lot of consumer voluntary organizations, National Health Council.
Helga, I have a question about the papers that are being written. Would you mind going over for us who, I take it the facilitators are the authors or are those different people?
DR. RIPPEN: No, they're different. Okay, the facilitators are hired professional facilitators that are not involved in the topic area. We have the co-leads who are writing the paper and they're not actually only writing the paper, they're coordinating writing the paper with a team of experts, six experts that are working with them so that makes eight, and they're the ones that are going to be giving the presentations to the groups, to the topic groups. They are also responsible for selecting a reporter, the reporter cannot participate at all in the discussions and evolution of the paper but they're identified as an expert and their role then is to participate in the meeting and to work with the facilitators in capturing the discussions and the recommendations of the group.
This was done to prevent any appearances of conflict with regards to having a vested interest in the original paper which was a concern during last year where some people thought that opinions were already formed and that it was just being moved forward. We have the professional facilitators because we know that it's important that everyone kind of feels that they're part of the discussion and many times leaders in the field are not necessarily known to be the best in facilitating discussions and so this would allow everyone to be at an equal footing. So again, that's really the structure.
There is no additional vetting for the materials, these are the works of the leads and the team that was assembled and the vetting will occur at the meeting where there will be discussions, obviously we'll take a look to make sure nothing's inflammatory or obviously wrong or anything like that because again, this is not our, it's not our material, it is the communities and it's up for discussion.
DR. DEERING: Do you have the names of the paper authors that you could --
DR. RIPPEN: Yeah, we do, I think that they were actually listed, they're listed on the site so if you want the website has all of them, and so I have a copy of them here, we can go through them or you can just take a look at them, there's a lot of names. There's a listing of topic leaders but then also who has participated in writing, so the experts. And also topic reports so everybody's name, affiliation, so people can see where the bias may or may not be.
DR. DEERING: I was also thinking and I'm sure we'll get back to this after we take on Kelly and her ONCHIT, but depending on how much time the workgroup thinks it wants for the open hearing afterward I mean the issue will be do we go back only to those people and give them more time now to talk to us or if we think we're going to try and have an open hearing and sometimes we go out and we solicit even additional participation, we certainly then don't want to overlap there so from a staffing point of view of the folks who will be helping the workgroup decide who it wants to hear from in the afternoon it would help us to get a feel for what the universe is.
DR. RIPPEN: There actually may be an additional consideration given that these papers will be posted in a very short amount of time and there will be an opportunity for people to review them, that again depending on what kind of public comment period you want or how you want to use your meeting, people that may or may not be attending the meeting or have comments, it might be an opportunity to provide them. So I just throw that out that there will be something to react to even before the meeting.
Now what is presented versus what is finally presented to NCVHS may have, it might be significant, it might be something that you don't even recognize, and that actually happened last meeting too where some people, what people came up with was totally ignored and then people just went on. So again, there's no prediction but there's more food for fodder.
DR. LUMPKIN: Why don't we take this sort of slight lull and use it to have Kelly give us an update on her new location, and if you could just tell us how to pronounce that acronym.
MS. CRONIN: There's already been many variations, the one that seems to be sticking is ONCHIT, it doesn't really roll off the tongue.
Agenda Item: Update on CAHIT - Ms. Cronin
MS. CRONIN: Well, as you all know we've had only about a month or so to try to get somewhat organized, and after talking with Dr. Brailer yesterday to figure out what the scope of the conversation should be today we thought it would be a good idea just to focus on what was in the executive order given that he's presenting to the entire committee tomorrow and will give you a much better idea on perhaps where we're going in terms of principles for the strategic plan and some of the early thinking around the framework.
But just to get back to the executive order, as everybody probably knows it was established, or it went out on April 27th, and it not only established this new position for the National Coordinator for HIT but it also established this new office that we've been working very diligently on to try and get organized which has been quite challenging. But specifically the executive order does spell out that the coordinator has responsibility for directing HHS HIT programs and I think in interpreting that one realizes that an office of say between ten to I don't know what the upper limit would be, FTEs, you would not be able to actually directly have hands on involvement in managing any of these programs but we would like to think that we'll be working to coordinate and get involved as needed to make sure that from a design and implementation perspective that things are in line with the overall strategic direction. And there will be some link, formal link to the budget process too in terms of evaluation and how it fits with the strategic plan.
There's also a specific charge that says that the new office will coordinate outreach and consultation by executive branch agencies with interested public and private parties. So what we're thinking in interpreting that right now is that our primary agencies outside of HHS that we'll be most involved with will be the Veteran's Administration, DOD, and the Office of Personal Management, and all three of those had very specific charges within the executive order too. VA and DOD are working now to figure out how they can use their know-how and their technology to improve reach to rural providers and OPM is now considering various options for incentives to accelerate adoption of HIT as a major purchaser for the government.
We're also supposed to be providing comments and advice regarding these various programs, not just HHS programs but programs across the government, and while I think there's already a structure to the coordinating function in place for bio surveillance at the White House and elsewhere it's likely that we'll want to make sure that we're involved to the extent that we can ensure that any kind of future architecture discussions or planning, especially through the federal health architecture, allows for sort of everyone operating in a uniform direction so that if DHS has a major program along with CDC that everyone is sort of mapping to where we're going as we move forward and that we're not creating a lot of stovepipes essentially.
There's some specific details in the executive order that we have to report to the Secretary within 90 days with progress on the development and the implementation of the strategic plan. Now we're already to the point where we do have a preliminary outline that we've vetted with agency heads as of yesterday but we really have not gotten to the point where we have anything that's sharable with the public. But it specifically requires us by basically July 21st for the summit that we're going to be reporting on this progress. Now given that that's only a month away it's not likely we're going to have our final, final plan on how we're going to make this happen in ten years but our preliminary thinking and certainly a framework will be presented at that time along with specific actions that the agencies and the private sector can take that they feel comfortable and ready to talk about.
The executive order also specifies that we need to ensure that key technical, scientific, and economic issues effecting public and private adoption of HIT are addressed. Obviously we'll be considering a lot of these issues as we move forward, it's not likely we're going to have any sophisticated new cost effectiveness or cost benefit analysis done before anything is released on the 21st but obviously this is something that we've been supporting through AHRQ and ASPE through various research projects and will continue to do within this new office. We also need to be addressing privacy and security issues as this committee has in the past and we're actively trying to seek input from OTC and OCR to make sure that our own internal expertise is being used appropriately. And we need to include measurable outcome goals obviously which we've actually done quite a bit of thinking on in just the recent week.
And we're specifically not to rely upon additional federal resources to accomplish this program and that obviously presents us with some challenge but one that we're willing to take on at this point. Helga's already talked about the summit so that was covered, everyone probably also is familiar with the goal that was set by the President which is a nationwide interoperable health information infrastructure and electronic health records available to most Americans within ten years. Of course people would like to think that we're going to be able to do it before then but that's our definitive goal.
The specific agencies that we plan to be working with I mentioned outside of HHS, DOD, VA, and OPM, there could be others, right now that's our focus. Internally it's still the agencies that we've already been working with under CAHIT, which include CMS, AHRQ, Indian Health Service, NIH, CDC, FDA, HRSA, and SAMHSA, so we will be reaching out continuously to all of them to make sure they're included in the development of the strategic plan and that it's representing everyone's collective ideas.
I think it's probably premature again to get into principles, David is going to be covering those tomorrow, but one decision that has been made recently is to have a link with the federal health architecture since there's going to be a lot of emphasis on that in the next couple of years. And it was actually sort of informally done with the NHII group in previous months, we're now going to move forward and make sure that that effort is closely coordinated with all of the HHS operating divisions but also the other departments that we'll be reaching out to. And it will also provide a link with CHI and the standards that have been adopted through that effort.
We still haven't figured out exactly how CAHIT and some of the other coordinating functions will be institutionalized but we have an intention to figure that out in the short term, we just have so many things on our plate right now, one of the many. And I think I mentioned also before that they'll be a definitive link to the '06 budget process and the strategic plan will inform that as well.
So that's sort of the very general overview and if anyone has any questions I can attempt to answer them.
DR. DEERING: How about a link to the '05 budget?
MS. CRONIN: That's a good question, I mean you know the $50 million of additional funds is already in the budget, it's likely that that will go through, it's not, obviously we don't have a crystal ball but no decisions have been made about exactly how that would be distributed. But in terms of informing other decisions made within ASBTF that has yet to be determined.
MR. DAVIS: Lynell Davis, Blue Cross/Blue Shield Association, in getting that plan ready for the July timeframe you talked about the private sector, what process are you vetting that plan through the private sector to ensure their comfort and coordination with that, whatever you're laying out?
MS. CRONIN: That's a good question, we have been seeking in put from organizations but there also are public/private collaboratives as was covered in the last NHII Workgroup meeting, Connecting for Health, which represents a lot of different stakeholders, is working on an integrated roadmap and that process and the content that is coming out of that is informing in part what we're doing. And we have been as inclusive as our schedule will allow to try to meet and talk with anyone who does have ideas that they'd like to introduce.
DR. RIPPEN: The other is the meeting itself will provide an opportunity to provide direct feedback into the process and through NCVHS so that's why it's important to get as many stakeholders together.
MS. CRONIN: And I think you're also aware that there's been a series of stakeholder meetings that ASPE has held over the last year and that gives us sort of a basis from which to work as well.
DR. RIPPEN: In the end the private sector has to decide what they're going to agree to do obviously.
MR. DAVIS: And I guess the reason I bring that up is I guess representing the payer community I've worked within Blue and quite surprised it's just Blue and I'm a little concerned that a lot of the other payers haven't quite gotten on this train yet and I'm not sure if they've been at some of those meetings, and I know we haven't because within the association we are getting on board with this but I'm concerned where's the rest of the payer community because there's a lot of financial incentives we already do and those really ought to be integrated closely with some of the incentives you're working on. It's not clear to be that coordinating is happening and that coordination could probably be very powerful.
DR. RIPPEN: And I do know that from OPM's perspective they are actually reaching out obviously to the payer community given their charge too.
MS. CRONIN: I think moving forward NCVHS will obviously be another place where we'll continue to get input, in fact the meeting right after the meeting in July will provide another sounding board so to speak.
DR. LUMPKIN: Let's perhaps massage the agenda a little bit and suggest that, what I can do is a very quick update on where Connecting for Health is and then let's have a discussion about that Friday, the agenda for the Friday workgroup meeting because I think we can bring a lot of these pieces together.
Agenda Item: Update on Connecting for Health - Dr. Lumpkin
DR. LUMPKIN: Actually Kelly has told you all the relevant factors that we discussed at our last meeting, Connecting for Health is developing that short term roadmap and have made significant steps in that direction. We had a presentation from Carol Diamond at our last meeting, what they're attempting to do is go through those forks in the road that she talked about and to identify which ones it appears that the broad based public/private partnership that Connecting for Health will recommend, and again the roadmap, the forks in the road were presented as a do this or do that and that doesn't mean that the choice will be to pick one of those two because there may be another choice in between.
At the June 30th, just a few weeks away, steering committee they hope to have a rough draft, high level version of that roadmap which will then be submitted as part of the development process for the conference and there will be reports at least I think from the architecture workgroup that has been working on trying to develop some sort of consensus architecture addressing many of the issues that we came up with of how LHIIs, other kinds of connectivity work in a new environment as well as some other work products that will be submitted for some of the breakout sessions.
The intent will be then in the fall to have the more fleshed out work plan, roadmap, adopted, which would then, I think we have a meeting in November, it should come to us in November, so that's sort of the plan there.
MR. HUNGATE: Does that plan have contingency points in it, what are the hurdles, when it has a branch is there something there that's an obstacle to be overcome that determines which of the branches just in a content of that work plan?
DR. LUMPKIN: Well, right, that's what the roadmap is really to look at, where there are those forks in the road, do we go with completely the group architecture, do we go with the highly structured, there's obviously neither one of those is going to work out so there needs to be some sort of thought on that, issues related to Stark(?), how are we going to approach that because that creates a barrier to hospitals and physicians working together to develop information systems. So those are the kinds of issues that were brought up and having not seen it yet but we hope to have it fleshed. So thinking about this we really have three things that will be on the table at the time of our meeting, we will have a Connecting for Health high level, sort of this is what we're thinking about moving towards the roadmap --
MS. GREENBERG: Are we talking about the meeting next week?
DR. LUMPKIN: No, this is our meeting, our Friday meeting, the July 23rd meeting --
DR. STEINDEL: When you say our next meeting you mean the July meeting.
DR. LUMPKIN: The July 23rd of this group. We have the reports from the workgroup which we will hear the various work sessions that we'll hear in the morning and then we'll have the ONCHIT strategic plan. So it's the conference work, it's ONCHIT and Connecting for Health.
So my thought on that is that we may want to, we will have heard presentations from all three of the groups, we will not formally have heard a report, and again just not knowing the overlap because I won't be there except for the last day, our board of directors is meeting, they pay my paycheck, I think I'll need to be in Princeton, and again so I'm not sure if there's overlaps. My thought would be is that we could have two presentations in the afternoon and then proceed to kind of walk our way through the work groups, so the two presentations would be from the Office of the National Coordinator for Health Information Technology on the plan, presentation from Connecting from Health, and then we would walk through the eight reports that we just received to identify those areas that we think we may want to bring together into what we're calling NHII-2, so I would see that really more as a planning meeting trying to synthesize what we heard and re-crafting our agenda as we move forward towards trying to develop our report in sort of a methodical fashion. The afternoon session, we have approximately three hours.
MR. BLAIR: Will there be any discussion or description about the fact that up until now we've referred to this initiative as the National Health Information Infrastructure but the office is National Health Information Technology Coordinator and why it's different? And I'm not opposing it's different, actually I think there's certain reasons why that might be a good choice but now we have two different, well, we have an initiative which isn't totally congruent with the name of the office.
DR. LUMPKIN: I don't think that that needs to be, in fact that probably would be more confusing if it were because in a sense my guess is, and correct me if I'm wrong, what I'm hearing on the focus, the initial focus for the ONCHIT will be on the provider, the health care provider dimension, that's going to be the initial focus. I'm not saying that they're going to ignore the population base dimension and they may or may not have time to focus in on the personal health dimension, but my guess is that's going to be their focus. Is that a fair statement?
DR. RIPPEN: So I guess I want to clarify what the question is, the question is really that you have a National Health Information Infrastructure activity and you have something called --
MR. BLAIR: Office of National Health Information Technology, and why is it that the names are not the same?
DR. RIPPEN: Well actually I think I can, even from a before perspective there is an effort that really needs to occur within the federal government with regards to the coordination of all activities and funding and research and actually that was one of the issues with the federal health architecture with regards to their internal things and they have to somehow be interfaced with the external. Per Bill Yasnoff his kind of conceptualization of what that was was really the private sector and that it was a more facilitating discussions amongst the private sector with regards to how to move this forward. And so actually with regards to that then ONCHIT is then in a very nice position to then be able to interface a private kind of sector push as far as activity and then marry it with the internal activities so that then there's a seamless approach.
Now with regards to what does that mean for a complex topic such as health information technology and diffusion and yet another acronym, yes, from a marketing perspective, there's some significant issues. But with regards to the concepts that I think we're talking about it's not I don't think, it makes okay sense from my perspective. But I don't know if that answers your question.
MR. BLAIR: That's fine, it just --
MS. CRONIN: I think also it's important to keep in mind with new leadership comes new ways of thinking and with that will come new terminology as well. So I would just be patient and wait to see how the next couple of months fall out.
DR. RIPPEN: And actually because again the NHII was not a government created term, it's actually a term created by NCVHS, the question is then from your perspective even in recommending here what does that mean.
DR. LUMPKIN: I think where I was trying to go in a very fumbling fashion was that what I think we're looking at in our vision is broader --
MR. BLAIR: Yes, and it included legal issues and ethical issues and cultural acceptance --
DR. LUMPKIN: Which the more ONCHIT does the better but there still needs to be that marrying of the private sector and other forces and other issues that we may identify as being important address. So I think the fact that there is such an office, which as I mentioned earlier was partially our fault, certainly is I think an encouragement for us to continue our efforts rather then to be a distraction.
Conceptual model thoughts, that's just a straw model I'm throwing up for what we want to do on that Friday. We could spend all the time looking at the reports of the workgroups, we could --
DR. DEERING: We are in the morning, tentatively we have two specific sessions to hear the reports in the morning.
DR. LUMPKIN: But it's all them talking to us and so at some point, and what we've kind of learned in our process is to the extent that we can spend some time talking to each other and synthesizing what we've heard before we all leave and forget and lose the essence of it what I'm proposing is is that we kind of do it in a structured way to try to figure out what we've heard and how that has impact upon what it is that we want to do in preparing our report.
DR. COHN: John, I'm still trying to think of what this is all going to look like, there will be a 1,000 people at this meeting and presuming they'll be a 1,000 people at this Friday morning activity --
DR. LUMPKIN: Friday morning, yes.
DR. COHN: I'm presuming that there won't be 1,000 in the afternoon but we might have 300 or 400 people out there and we're going to need to figure out some way, I don't know that it's going to work with us just all talking around the table with 400 people down there --
DR. LUMPKIN: You don't think we can put on a good show?
DR. COHN: We could, I think we can actually put on a show, the question is is how we may want to involve them or not, or whether we want to do something more structured, and I just bring that issue up.
DR. LUMPKIN: Well I can't ask you to be on this committee because you already are, like we did with the other troublemaker down the table.
DR. COHN: Well, these are just sort of things we need to think about.
DR. LUMPKIN: No, I think it's a good point, I'm not sure I have, okay, now Simon, you've got a solution for this?
DR. COHN: No, I wasn't hearing the solution, I just realized there was sort of --
DR. STEINDEL: Picking up on what Simon is saying, I think sometime in the afternoon session we should have an open period for the audience to contribute thoughts to us.
DR. DEERING: Maybe they may need to sign up in advance as happens in the case with many other advisory committees, that they have X days and sometimes it's one week in advance or two days in advance or whatever the guidelines are, but they actually need to register --
MS. GREENBERG: I think that probably wouldn't work because --
DR. STEINDEL: I think we want them to react to what's being presented and we're not going to know that until --
MS. GREENBERG: They can tell, the only thing is if there are 300, I mean it's never been a problem in the past when we say okay, everyone, we'll talk public comment and three minutes per person and maybe if ten sign up, I don't know, ten have never signed up, you'd only have 30 minutes. But let's say 100 sign up, well three minutes is still more time then we have.
DR. STEINDEL: Maybe it would be a good idea to pick some reactor people or groups and sort of seed the discussion and say immediately after lunch we'd like two minutes or three minutes from your groups on your reactions to what you heard this morning.
MR. BLAIR: Would it be possible since we can't control how many people would sign up or would not sign up that we have a limited amount of time and maybe we could hear 30 some odd folks, and if more then 30 sign up then we indicate to those folks that we didn't have time for to invite them to please send us an email with their comments --
MS. GREENBERG: First come, first served.
DR. LUMPKIN: But I think the question is what we are asking them to react to, the panel reports in the morning are going to be them telling us what they're thinking. The only two things that I don't think that they've had an opportunity to react to, and the first one is going to be, I think isn't going to be our call, I think that's going to be the ONCHIT call, whatever, CHIT call, and that is at that particular point given how fresh this is do you want in a public forum to get responses to this newly rolled out plan, and is it going to be far enough evolved. The second thing that I don't think the audience will have necessarily had an opportunity in that structure to talk about will be the roadmap. So if we think about it that way as having audience participant, if we've got three hours, we could open the mic and let people comment on those two ideas and then spend the last hour talking about next steps for us as a workgroup.
DR. STEINDEL: I'm assuming that in the breakout sessions that there will be discussion of the strategic plan, so we probably will get comments on the strategic plan in the reporting out from the breakout groups as it relates to their areas. Now whether the meeting planners are planning for that to happen or not I'm not certain --
DR. LUMPKIN: I think they will come but not necessarily in a structured way --
DR. STEINDEL: No, I don't think they'll be structured.
DR. LUMPKIN: There will be imbedded in the reports from the workgroups and I think there'd be some benefit of getting structured feedback. My guess would be is that as this plan is being implemented, assuming that HHS wants to get feedback, it will be our responsibility to help participate in structuring that feedback and that may be one of the ways to do that.
MR. DAVIS: As one of the folks that's going to be in that audience and have gotten several plans to come, let me support Steve's idea and also add to that, I'm a member of National Uniform Billing Committee, the committee where we go out of our way to make sure there is a broad representation of the various stakeholders. I think it's incredibly important that you make sure key stakeholders, and I would urge you to look at your sponsor group to make sure some of those actual sponsors know in advance you're going to get a chance to talk because as you said you want to be able to get real feedback and talk while it's fresh, I would encourage you to get some fresh feedback from some of the key stakeholders, like the providers, like the plans, some of the folks that are interested in this because trust me, I know I will be polling my group and we will get in a little caucus group and throw ideas back and forth and I guarantee you you'll hear something that's got a Blue perspective and I got to imagine the providers and other groups would do the same thing if they knew in advance we were going to get a chance to get some fresh feedback into this group. Trust me, they'll work together to give you some really good feedback.
DR. LUMPKIN: Let me push back on that though, we're going to have a couple of hundred people here, whether we ask you to do it or not I know we're going to get written comments from WEDI, and they'll be structured and if we wait a couple of days they'll be even better then if we ask somebody to come to the microphone that afternoon. That's going to be true of the Blues, that's going to be true of the AMA, that's going to be true of the hospital association and a bunch of other groups. So the question is we have this time, how can we best us it to hear from folks that we may never hear from otherwise in the way we do it.
MR. HOUSTON: Assuming that the reports from the workgroups do accurately reflect the discussions at the workgroup sessions themselves, the breakout sessions, I would think that everybody's interests should be reflected or at least the discussion should be reflected in those reports. I would hope that there isn't a lot of new discussion that arises at these meetings or these particular sessions.
MS. GREENBERG: Well, that's the role of the facilitator, to make sure that all viewpoints get --
MR. HOUSTON: So is it extraneous or are we just going to hear rambling, I mean I hate to say it that way but are we going to hear things that are already being considered in the workgroup reports, are we already going to hear things that --
DR. LUMPKIN: The question I have, and I don't think we know but I don't know to what extent the facilitators are going to be, I mean they're going to be instructed to try to get something out of that group and it may not be to respond to the new plan.
MS. GREENBERG: It may not be what?
DR. LUMPKIN: To respond to the strategic plan, and so I don't know to what extent that feedback that we're going to hear in the morning is going to actually give us insight into how this broad group that's there at the conference view on first blush because my guess, I don't even know if it's going to be even printed up as much as presented orally this new concept that's being put out.
MS. CRONIN: I think it will be certainly disseminated on the 21st but there will be no lead time to review it, or process it or get any kind of consensus amongst individual stakeholders. My sense is there might be a lot of very good discussion the first day too given that they'll be four reactor panels. So there might be some very interesting comments that you would get but my sense is that it may not be as structured as you would like if you're really looking for something that would formally represent most of organized medicine or the large part of the payer community.
PARTICIPANT: One of the things we've already planned for in our organization is to meet afterwards to discuss the impact and how it faces what we've been dealing with for the last five years. You all have been dealing with NHII as a concept for well over five years and I think what would be helpful to us as an organization and others is I'd like to hear your reflections and your questions after that morning session and I'd like to hear your questions that we might respond to as we get a chance to let this soak in and reflect back to you in writing, it will make it a little easier then another hearing, but to give you some feedback but since you've dealt with it for so long, you've had various integration with this whole process, I think it would be helpful to hear your thoughts and then be able to reflect both on what we pick up from the meeting and yourself.
MR. HOUSTON: If we want to get meaningful feedback, if we limit the length of the responses, we ask for short, something that's manageable, then we can take that back and review after the fact in some type of structured fashion, all the different comments and try to incorporate them into --
MS. GREENBERG: May I just ask a question that was stimulated by what Kelly just said about the reactor panels? There's a federal agency reaction panel, right, private industry and then a legislation, but there's nothing from state, local, community --
MS. CRONIN: The federal is intending to represent public health as a whole but we have not branched out beyond that.
DR. LUMPKIN: I'm sorry, Jeff asked if you could repeat what those three panels were, the reactor panels --
MS. GREENBERG: Federal agency, private industry, and then legislative, it said Congressional staff --
MS. CRONIN: Not staff members --
MS. GREENBERG: Congress.
MR. LARSON: Can I ask what the role of NCVHS is on an ongoing basis with NHII and the strategic plan, one of the things of excitement in the industry is with Dr. Brailer's appointment that things will move forward, obviously there has to be consideration with the proposals. But you talked about a fall meeting, what will NCVHS do based on the input from the NHII conference and these three sources, what will your deliverable and contribution then be?
DR. LUMPKIN: Whatever the department wants it to be.
MS. GREENBERG: I won't accept that answer.
DR. LUMPKIN: No, I think it has to be put within the context, we are in the process, we've begun the process of developing a follow-up report to our original information for health and what we will do is look at what the department, the directions they're going and make suggestions, support the directions we think are good, make suggestions in areas that we think they may have overlooked, and other new areas that we think ought to be explored. So really that really has been our role, the role, and I just go back to my roots in Illinois, if you've ever been out in a soybean field you see these, every now and then you see these little stalks of corn, they call it volunteer corn because no one asked it go out and do that, it just volunteered. And we just volunteered on the NHII. Our charge is to advise the Secretary in relationship to health information policy and we choose to do that in regards to the overall concept and implementation of the National Health Information Infrastructure.
MR. HOUSTON: So therefore there would likely be a recommendation letter out of NCVHS to the Secretary regarding NHII direction or --
DR. LUMPKIN: Well, I think that there are any number of things depending upon what we hear. First of all as a FACA committee what comes out of the conference can go directly to the Secretary in a way that the department can act on, FACA, Federal Advisory Committee Act, and so that gives it a certain weight, additional weight, as it moves through the process, it moves directly to the Secretary, so that's a really important role that we play in listening to that, and we then synthesize what we hear at the report and then they make take in addition to the specific text of those say here are our recommendations based upon what we heard. That really is our role.
DR. STEINDEL: I was going to suggest that what I'm hearing is a need for a meeting in the early October timeframe to put this all together.
DR. LUMPKIN: See I'm not necessarily hearing that, because there's a conversation we need to have with Dr. Brailer and that is October may not be soon enough.
DR. STEINDEL: Oh, if you want to do it sooner, I was --
DR. COHN: Were you thinking of a September letter?
DR. LUMPKIN: I think we need to understand the timeframes better which we don't right at this moment and I don't know why, the guy's only been there for 30 days, I mean been there for all of 30 days already, he should have all these pieces together. But no, I think that we need to figure that out as time goes on and we get closer to the meeting what our timeframes are for helping him and the office provide meaningful input onto this plan. So it could be that we may need to look at doing something even much sooner and trying to come up with something by September --
MR. HOUSTON: -- start laying in the dates if you're going to get written document --
DR. DEERING: I think it depends on what the document is, if it's a letter, I mean the NCVHS has done both short letters that are highly --
MR. HOUSTON: I understand that, my point is that if you want, if the structure or the process we're going to go through is that we are going to ask questions and elicit input, written feedback, then we need to have deadlines established that are reasonable for people to then provide feedback based upon the questions we ask. And then we have to have a chance to review those and then take those and distill them down into these recommendations that we're going to make. I mean that's, that could take some time and we have to then to get buy-in from Brailer and whatever --
DR. LUMPKIN: Let me see if I understand, if I understand the direction you're going in you're kind of leaning towards what we would do in the afternoon is sort of synthesize and begin to construct questions based upon what we heard from those three sources.
MR. HOUSTON: I just sort of sense that there might be, that might be a direction we take where we do have, need more information or like to get more information and put those questions out for written comment or written, I mean I think Dan was sort of, I don't know, that was what I sort of heard, I'm open, rather then trying to get people to stand up and say something in front of a microphone, an open mic for however long, which chances are we're not going to get a lot of really valuable feedback in that forum because we will not have had an opportunity to really distill down what they heard at the conference. If we sort of throw some things on the table which we see as immediately being issues that warrant some type of feedback a lot of people who go away and then provide written feedback based upon those questions, then we need time to look at that and then use that to formulate our recommendations. Again, that's how I thought the way it was sort of proceeding.
DR. STEINDEL: And I think we have to allow reasonable time for that, for the feedback to come in.
DR. BICKFORD: As you were talking about what should the NCVHS be doing in that afternoon it seemed to me that this would be a perfect opportunity to showcase the think tank, the advisory capacity this group is engaged in that people who have no concept of what NCVHS is about who may be staying can maybe hear the discussion. I have a concern that this is an opportunity for NCVHS to do its work in public --
And as they do that you're synthesizing the questions that people are going to have to respond to or they choose to respond to, that would be a powerful experience for students who may be participating in this, who've not seen the committee working, it allows the consumers to appreciate it, it's sort of like you're on the hot spot.
DR. DEERING: I was first thinking in terms of the structuring and helping to guide the input that we wanted to receive just to make it easier for people to give us meaningful feedback, but I think the same thing I was thinking might apply also to the committee itself which is it would be possible to come up right now with a generic structure of how we want people to address the issues, what were the things that you've heard that you really, really think are top priority, what were the things that you heard that jump out at you as problematic, what are your priorities, I mean if you gave people a little, if you told people to be thinking actively and again, trying to anticipate what would be most useful to the Secretary, because some people would perhaps appreciate being told what would be most useful as opposed to just standing up and going off on a little factoid that might or might not be helpful. In the spirit of an open hearing of course you don't want to guide things but I'm just putting on the table whether there could be value --
DR. LUMPKIN: Well, when we think about what we're going to hear and the kind of recommendations that will be coming forth we have a series of breakout groups and I don't have the list of the stakeholders but --
MS. GREENBERG: I'm a little confused, who's going to be reporting back, not the stakeholder groups but the --
DR. LUMPKIN: The topic groups.
MS. GREENBERG: The topic groups who are supposed to have incorporated into their, the stakeholder, then what's this last one here, breakout five, stakeholder tracks?
MS. BEBEE: That's supposed to be topics, that's a typo, it's still a topic.
MS. GREENBERG: Oh, that shouldn't be stakeholder.
MS. BEBEE: Back to topic.
MS. GREENBERG: This is a topic, thanks.
DR. LUMPKIN: So the reports will be in four, in the eight topical areas that are listed here.
MR. BLAIR: For my benefit, would you mind reading --
DR. LUMPKIN: Yes, I will. Personal health, governance, incentives, standards and architecture, confidentiality, ethic, privacy and access, measuring progress, population health and clinical research. My guess would be that given what we've done the issues that would be ours in a sense would be to talk about, four of those come to mind as kind of rising to the top. Personal health we've always had an interest in, governance, incentives, standards and architecture, measuring progress, and I don't want to slight confidentiality, ethics, privacy and access but I think that we probably just want to mention that, discuss what we've heard, and flip those off to the Privacy Subcommittee.
DR. STEINDEL: When you mean by us you mean this workgroup.
DR. LUMPKIN: This workgroup, yes that is the us.
MS. GREENBERG: I think in light of what we're seeing I think this, this could be a lot of people and they're not going to understand the nuances of this as the NHII Workgroup, one workgroup of the whole national committee. So although that's what you are there I think it would be important to articulate that you've got the national committee addresses all of these so population health, research, privacy, all of these, I mean otherwise if you tried to circumscribe it it would come through that's what the national committee --
DR. STEINDEL: I think we have to receive information on all eight but when we're synthesizing we're going to look at those areas that are from the workgroup domain.
MS. GREENBERG: You're doing this for the full committee.
DR. LUMPKIN: No, we've got three hours and if it's going to be a meaningful exercise for us and for the audience to see how we work and identify what are the key issues that we want to hear feedback on I'm not sure that spending two hours for would that be 15 minutes apiece would do that justice.
MS. GREENBERG: Yeah, but population health is one of your dimensions too, I don't know you would pick personal health and not population health.
DR. LUMPKIN: Now you're getting into details, I think let's decide on the concept and then we can pick out of those I would think we probably would want to pick four --
PARTICIPANT: You mean to discuss in detail, is that what you mean?
DR. LUMPKIN: To spend some time and identify questions on, or not because I'm hearing some --
MR. HUNGATE: Let me come from a different corner and try another cut at the same thing. This is a big deal, this meeting, I'm not going to be there this time unfortunately because I'm going to be off salmon fishing in British Columbia and I'm not coming home. That said, there are these eight topic area feedbacks and there's two customers for that, one is the new office that really is doing this and they're going to take that information and react to it and NCVHS has had ongoing agendas that relate to all this and our agenda may shift a little bit based on what occurs. And so I'm wondering whether what we should be talking about is how does this change what we do, where are we now, what does it change about what our mission work and its maybe broader then just NHII, it maybe is the whole, and so that took me back to wondering whether this was an NCVHS hearing or a workgroup hearing. It's a two level discussion because the momentum has changed from where it was when I came on the committee, the situation is different, and I don't know how much, what that changes.
DR. LUMPKIN: Let me try it again a different way. We're going to have the strategic plan, could we use that as the structure that we would take what we've heard in the morning and then try to work our way through the strategic plan in trying to frame questions that will tease out what we've heard in the morning in a more structured way to fit within the plan. My guess is the plan will probably have some structure and we can pull it, we pull it apart into maybe four different areas that will allow us to then synthesize what we heard in the morning and trying to develop appropriate questions to ask.
MS. CRONIN: I think you can map the domains to the strategic framework pretty easily.
MS. GREENBERG: I just would think that your questions should be cross cutting in a sense across all of these rather then focusing on four of the eight or something.
DR. LUMPKIN: Right, and I think that's the way we get around that by using a different kind of structure for that two and a half, three hours that we have. So I see a lot of people nodding their heads --
MS. GREENBERG: And where does Connecting for Health fit in?
DR. LUMPKIN: We'll have to figure that out.
DR. COHN: Are they presenting their roadmap during the meeting?
DR. LUMPKIN: I don't know if they're presenting it at the meeting or --
MS. CRONIN: I think they just have to fit it in a time slot.
DR. COHN: Kelly, help me with this one, I don't know what not independent of time slot means, is it a topic that is going to be considered and you just don't know where it's on the agenda, or is this something that we really actually need to talk about on Friday afternoon after the conference is over as something that wasn't discussed.
MS. CRONIN: It's likely that a lot of the people participating in the meeting will be very familiar with what's in the roadmap if they haven't been directly involved, so it will be a lot discussion about it but I don't think that there's a time on the agenda, and Susie correct me if I'm wrong, that actually allows Carol Diamond or anyone else who could speak on behalf of the effort to give an overall summary of what's been accomplished. So it's probably something you may want to consider as part of your agenda.
DR. BICKFORD: Is that part of the workgroup's discussions? Is it background material that goes into participants at that level and they need to be referencing it?
MS. BEBEE: It's not prepped into the background material, no --
MS. CRONIN: But it will be available.
MS. BEBEE: As Kelly's just described it there will be people in the audience that will be very familiar with it and will be part of the topic discussions and stakeholder discussions so I'm sure it will be folded in.
DR. COHN: I was just going to comment, I will apologize, as the day goes on my thought process gets more disordered. But I guess I'm sort of struggling since, I mean we obviously have an opportunity here and I think we're having trouble figuring out how to structure the session, but part of the formation that I think is happening is is that maybe there needs to be some discussions that do deal with sort of longer range how can we help as a workgroup, what is the government need and what timeframe, I mean if there's really some sort of an expectation that we need to do the hurry up offense and have a letter in September, that I think really changes how we may work this versus something a really much more long term planning exercise. And it seems like, John, maybe you have an occasion to have some conversations with staff and others to sort of figure out really what would be helpful and then we can sort of devise an agenda and process to meet it.
DR. DEERING: I was just think as a staff who helps --
MS. POKER: I was just going to segue what Simon said, if you use the strategic plan and you're going to map into it whatever the breakout groups say would you want to go from there where the role of NCVHS could be pivotal for the different breakouts? In other words kind of like emphasize, I don't know, population, this is what we're doing and this is what our goals are, or this is the current ongoing activity and kind of get feedback for the individual subcommittees. In other words kind of use the synthesis that you get from there and see this is what we're doing, is this the direction, kind of put it out there for them. I mean this is just a thought.
DR. LUMPKIN: Here's kind of where I think I'm getting at after this discussion. First of all I think the issue that you're raising says to me in just looking at the schedule we need to open this hearing on Friday morning with an explanation of who we are, why this hearing is happening, and why we're doing it and what the NCVHS hopes to get out of this. And then the morning session flows into the afternoon session and so again realizing the morning session is we're actually hearing from broad groups of folks, at that point we may want to look at how this fits into the time schedule for the strategic plan and including getting something from Connecting for Health, then this afternoon, the afternoon, where it's going to be us discussion whatever, my suggestion on process is that we try to set up a conference call for as many of the committees as we can pull together having benefited from this discussion, by the time we do the conference call somewhere a week or two before the meeting we should be able to have the bare bones, what Connecting for Health will have, that will have come out of the steering committee, that should be available after the 30th of June, that will give me an opportunity to touch base with David or have ONCHIT an opportunity to kind of decide, have an internal discussion on what it is and how they see our role. So then we can have a conference call to further structure that based upon those two important bits of information that we don't have at this time.
MR. BLAIR: Kind of building on what you've said and paraphrasing it a little bit, the role of the NCVHS as an advisory body to Health and Human Services has been to mostly gather information from the private sector, not exclusively, and try to pull together some thoughtful recommendations that could assist health information policy. Now the thing that is a little different about this situation we're heading into is that the principle recommendations that we've made on the NHII have essentially been adopted and now this meeting in July Health and Human Services is hosting a group of people to gather reactions and information, in other words a lot of the functions that the NCVHS might be doing this meeting is doing in the two days before we meet, which is actually good because it's being done now on a scale that is far beyond what we would be able to do and that scale is important to do so it's doing something that we didn't have the resources to do and so I think that that is something where we don't want to duplicate it, we don't want to be redundant with it, and they're going to be getting feedback on these eight different groups as well. If it turns out that your suggestion that the area we focus on, something that would be appropriate for the time that we have and appropriate for the make-up of the NCVHS in terms of the skills we have to be able to contribute, is strategy, for us to give feedback on the strategy, and if we give feedback on the strategy in a manner that tends to be a little bit consistent with the things we've done well in the past where maybe we have a reiteration of the strategy and we have a targeted selected group, either a folks or ways or framework to get public feedback, not just our own but public feedback on the strategy, followed by our questions to the people that are reacting and then maybe a little bit of a discussion on our own as to how we feel about the strategy, then that becomes consistent with what we do well, it might be a piece that is reasonable to bite off where it's not too big or not too small, and I don't know, Kelly and Helga and Susie, do you think that that's a good fit where we're complementing what you folks are doing?
PARTICIPANT: I think that sounds perfectly in sync, this is Jennie, I think when you see the strategic plan I think there will be parts of it that will be easy to identify that will be kind of bitable chunks, pieces that you could clearly focus on, and then as you're suggesting, or at least what I'm hearing, think I'm hearing you ask for, is some feedback on those large bitable chunks at the time of your meeting in July as well as some additional feedback from other folks as time goes forward and then being able to synthesize that and then provide back to David Brailer's office, I think that would be very, very helpful.
MS. CRONIN: I think it would also be very helpful though to have a follow-up meeting when you've had more time to think about your future scope and how it's going to fit because this is really evolving week by week and conceptually it does seem to have a really good, a good idea to have some strategic feedback and based on structured input from the various stakeholders and your interpretation. But I think it probably warrants more consideration then what we can give it right now.
MS. BEBEE: I have a question, some of the answers to what the opportunity or role of NCVHS was in this meeting, there was mention of a letter but also you've been talking about a new report so my question to you is how does this fit into that bigger role that Kelly just referred to, the scope that you have and the new report that you'll be working on.
DR. LUMPKIN: Well, I think I see the role of the committee is to serve, and if we don't get the report out within our timeframe and a little bit longer because we expended a little bit of time doing something more focused and quicker that has impact on the strategic plan which will have a very long range impact, I would see that as being a better choice in that within that context the environment is totally different then even when we started working on the second phase. So I'm comfortable with the fact that we may change our agenda and our schedule and our work plan to try to produce something within the timeframe that's going to be meaningful with the new office. Marjorie?
MS. GREENBERG: I had a question but first I wanted to make a comment about, I think the executive subcommittee retreat, which will be August 6th I think, is also an opportunity to try to have some discussion about this in that that's already scheduled. I mean Bob, well you won't be there --
MR. HUNGATE: I'll be there the 6th.
MS. GREENBERG: But you'll be at the retreat right? And you'll bring some salmon and all that, Simon will be there, of course you'll be there, and it's even possible that if we wanted to bring in some of the other members of this workgroup by conference call we could, or bring them even to the meeting but we can't devote the entire, but I mean this is, we've had discussions in the past, in particular I remember we've had discussions like with Susan Canaan when we were writing the reports, is the NHII part of, almost like a sum of all the committees, or is it smaller then the committees, is it bigger then the committees, but in some ways as we looked at these topics it does cut across all the foci of the committee. So it would seem for the executive subcommittee to, this would be an opportunity of a meeting that's already scheduled.
DR. LUMPKIN: I think we really need to get a feel for the timeframe which we don't have. If it's a choice of putting off and saying moving the executive subcommittee to the rest of the agenda items and have another retreat meeting in November/December, somewhere around there, versus kind of upserting that meeting in August, which many of us already have on our calendar, I'm saying having the meeting in August but we may change the focus.
MS. GREENBERG: It's just an already scheduled meeting with a number of --
DR. LUMPKIN: So we need to remember that meeting because the day after that I'm going to be gone for three weeks so trying to find the time when we can come together, that may be a time that's already kind of sitting there. Steve.
DR. STEINDEL: Those were somewhat magic words because the executive committee retreat is about what, two weeks or one week after the NHII Conference and if you're gone for three weeks and we're actually getting together again in early September just about the time you come back --
DR. DEERING: I like the thought that I'm sure you will get additional feedback in prior to the 23rd from David and from staff and everything to think through exactly what we need and will be very focused. And the reality is I'm sure that you will indeed get input from some of the other subcommittees on some of the more technical aspects here, that's a foregone conclusion probably that the Privacy Subcommittee is one that you're going to turn to and you're going to say, you're going to task them to do that, and you'll turn to Simon in his dual role, so I think that that's a reality. And then I started to say thinking of the kinds of letter reports and things that have been given back I'm just imagining that this is going to be fairly concise, it's probably going to be focused on really key issues, this is not going to be a general oh we love it, this is fine, it's going to really be focused on what are the key strengths, weaknesses, gaps, concerns, that you see in the report. It's going to be really straightforward and so there again, I think to the extent that people are tasked with listening with those ears so that by the time we get to August 6th people should have done some homework maybe in those two weeks along those two questions or whatever those questions, what are the questions you want answered, tell us, and then we can have something --
DR. STEINDEL: Just from a practical point of view during that two weeks period Simon Legree(?) over there is bringing together the Standards and Security Subcommittee for three days to accelerate the e-prescribing letter, and we're repeating that in mid-August.
MR. BLAIR: While our fearless leader is having this vacation we're having another e-prescribing standards meeting in later August.
DR. LUMPKIN: I'm actually doing work for two of those weeks, out of the country.
MS. CRONIN: I think there will be a level of detail in the report that will require a lot of technical expertise and a lot of thought and it could have something that's way beyond what was specified in the report a couple years ago so I think that alone would make you want to have a little more time for consideration. I also think that this is going to be a living document and like any good strategic plan it should not be something that sits on the shelf never to be looked at but something that really is going to be an implementation tool and react to needs as they arise over time. So they'll be plenty of opportunity is my sense right now for you to contribute to that as things develop. But it's probably best to circle back with David.
MS. GREENBERG: Can I just ask a question because I realize I came in late but I'm trying to understand how all this fits together and for the topic breakout sessions it says presentations of submitted topic track draft recommendations, are these being, these are the things that are being developed by the facilitators?
MS. BEBEE: Where is this Marjorie?
MS. GREENBERG: I'm sorry, I'm on, right after the legislative panels and when the breakout sessions start. People are going to be discussing, each track is going to have some kind of a paper, right?
MS. BEBEE: Yes.
MS. GREENBERG: And those are being developed by --
MS. BEBEE: The people leading those groups.
MS. GREENBERG: The facilitators --
MS. BEBEE: The facilitators are paid --
MS. GREENBERG: Right, they don't know, so the technical leads, they're developing these and how --
MR. HOUSTON: There's a group of leaders and subject matter experts.
MS. GREENBERG: And then how do these connect with the strategic plan that's being developed.
DR. LUMPKIN: Parallel tracks.
MS. GREENBERG: They're doing their papers here on these topics, they're doing the strategic plan here, okay, so they're not --
MS. CRONIN: There's likely going to be very similar concepts and ideas but there's not a parallel process in terms of, I mean there's not a lot of communication between those processes.
MS. GREENBERG: Okay, so there will be a need to integrate --
DR. LUMPKIN: And as was discussed as happened last year, what goes into those breakout sessions, which are the papers, and what comes out, may be two different things. And very likely will be.
MS. BEBEE: These papers are only five pages long, the papers are only five pages long.
MS. GREENBERG: And those are going to be distributed prior to the meeting?
MS. BEBEE: They're going to be posted prior.
DR. LUMPKIN: As I understand it the goals of the papers are to encourage the breakout groups not to rehash old territory but to move into new territory with brand new issues.
MS. BEBEE: And catch anything that wasn't caught already.
MS. GREENBERG: Okay, thanks.
DR. LUMPKIN: Okay, so I think if I can summarize where I think we are with our plan, that over the next two weeks or three weeks we're going to try to have a conference call sometime mid-July or so. The purpose of the conference call is to sort of, by then everyone will have a chance to see the roadmap from Connecting for Health and I will have had an opportunity to have a conversation or conversations with David Brailer about where we see the role of the workgroup and the committee in the livingness of this strategic plan. That will give us the scope of what we need to accomplish in the timeframes. Based upon that we'll have a conference call and we'll structure the day actually, the workgroup reports are kind of fixed but there's the introduction and then the afternoon session. That will also determine and we'll discuss in the conference call what we do on the already set August 6th meeting and whether or not we need to plan on doing something for our September meeting.
DR. DEERING: The conference call will be of the workgroup only?
DR. LUMPKIN: Workgroup.
DR. DEERING: Because the workgroup, are there any members here who are not on the executive committee who may not have it on their calendars, so the point is that the August 6th will be just of the executive committee right?
DR. LUMPKIN: Well, I think that anybody who is on the workgroup who is not on the executive subcommittee I would ask that you would at least try to hold the 6th until our conference call, just in the event that there, at the very least it will be a short conference, there will be a conference call with the executive subcommittee and at the most there would be more extensive involvement of the workgroup with the executive subcommittee.
MS. BEBEE: John, is there a possibility that, I understand you have a meeting in September, there would be further activity, hearing, or something along those lines depending on these other two issues?
MS. GREENBERG: But this workgroup doesn't have a meeting, the full committee has a meeting, 1st and 2nd.
MR. HOUSTON: The reports are going out, the reports are being done on Thursday, correct, in the morning? From the different workgroups?
MS. BEBEE: I don't know, when is it?
DR. LUMPKIN: I'm sorry, which reports?
MR. HOUSTON: Two levels.
MS. BEBEE: The reporting out of the eight topics --
DR. LUMPKIN: Friday the 23rd.
MR. HOUSTON: On Thursday they have preliminary session, never mind, because I was thinking we also have, not to make work for people the night, we have Wednesday night and Thursday night if we, we could spend a half hour or an hour just following the sessions if we needed to convene to decide to finalize what we're going to get on Friday based upon, I'm just, I'll shut up.
DR. LUMPKIN: I'm getting in some time that evening.
MS. BEBEE: The purpose of that summary is because we're then getting ready to have the breakouts for stakeholders so it's trying to get everybody on the same page before they, about the topic issues, before they go into the stakeholders.
DR. DEERING: Can I ask a question for Jackie and Marjorie's sake? This has to do with the physical logistics to get back to the very mundane, what I've heard us confirm is that, and I know Jackie I think you've already been over there and I think you're already working with them about space on Friday, I think we just need to be sure that what we've heard is that we may not know until after our conference call whether we need a physical set up that accommodates open mics, that we have not yet made that decision or have we in fact decided against it? Or will we wait until our conference call to make that decision?
DR. LUMPKIN: I can't think of a scenario that would not involve some open mic time with the workgroup so I don't know what the balance is going to be but I think we need to have the capability to do open mics. And a limited number of open mics, I'm thinking two, so people can line up in front of the mics if we're going to do that but if we have too many mics it's just the control factor gets lost.
DR. DEERING: But also I don't know, I haven't seen this room, have you seen the room where we're going to be Jackie? Are we like up on a stage? Or is it a huge room and we're --
MS. ADLER: Low risers.
DR. DEERING: Just on risers.
DR. LUMPKIN: And the accommodation, how many people can the room accommodate?
MS. BEBEE: 1200.
DR. LUMPKIN: For the afternoon?
MS. BEBEE: Yes.
DR. LUMPKIN: So we'll stay in the same room and --
MS. BEBEE: Actually the room, there are three rooms and it's laid out in a rectangle and it's going to be horizontal, not vertical, so actually it is theater but actually we could close off two of the rooms, so I mean that's logistically the capability.
DR. COHN: Well, it depends on who's there though.
MS. BEBEE: Exactly, it's set up for the whole 1200 capacity in three rooms.
DR. LUMPKIN: I'm just thinking and hoping that it being a Friday afternoon that when that session closes at noon that people are going to be --
DR. STEINDEL: I think that's a safe assumption.
MS. GREENBERG: It's another reason to give some background on the committee at the beginning.
DR. LUMPKIN: Well, of course, of course --
DR. COHN: We know Dan's going to be there.
DR. DEERING: You know by definition those who are there would really like to participate.
DR. LUMPKIN: Right. Okay, I think we have a plan and we've run out of time but I think this has been --
DR. COHN: I guess we'll figure out the dimensions later on.
DR. LUMPKIN: Yes, we may have time to think about that as our agenda seems to be getting upserted by the conference.
[Whereupon at 6:03 p.m. the meeting was adjourned.]