[This Transcript is Unedited]
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington , DC 20201
Agenda Item: Introductions - Dr. Lumpkin
DR. LUMPKIN: I'd like to encourage our new members to join us at the table, take an empty slot.
MS. GREENBERG: -- if the old time members aren't here then take their spots.
DR. LUMPKIN: Basically what I thought we would do today are three things, the first is to just recap what we did at our retreat, when was the retreat, last year, our last meeting, an update on some developments in Connecting for Health, then finally an overview discussion and status of where we're moving in the conference in early summer, late spring, or whenever.
DR. YASNOFF: It won't be late spring, early summer would be the earliest.
DR. LUMPKIN: Okay, because spring is June 22.
DR. STEINDEL: Yeah, that means it's after June 22.
DR. LUMPKIN: In summer. Any other items that we want to --
MS. GREENBERG: Maybe what your plans are for the February 18th meeting.
DR. LUMPKIN: And then our plans for the February 18th meeting which would be like number four. Okay, 3.5.
DR. YASNOFF: Are we live on the internet?
MS. GREENBERG: We're being taped, we'll have a transcript, but we're not on the internet.
DR. LUMPKIN: So we're going to start off going around the room for introductions so everyone gets to know each other. My name is John Lumpkin and I'm senior vice president of Robert Wood Johnson and chairing the workgroup. And why don't we go this way.
DR. DEERING: Mary Jo Deering, Office of Disease Prevention and Health Promotion and lead staff to the workgroup.
MS. WILLIAMSON: Michelle Williamson, CDC, NCHS, and staff to the workgroup.
DR. WARREN: Judy Warren, University of Kansas.
DR. STEINDEL: Steve Steindel, Centers for Disease Control and Prevention, staff to the workgroup and liaison to the full committee.
MR. HOUSTON: John Houston, University of Pittsburgh Medical Center, member of the full committee and member of the subcommittee, NHII Subcommittee.
DR. LUMPKIN: Well, we're a workgroup.
MR. HOUSTON: Workgroup.
MR. HUNGATE: Bob Hungate, Physician Patient Partnerships for Health, member of the workgroup.
DR. VIGILANTE: Kevin Vigilante, new member, Brown University.
DR. YASNOFF: Bill Yasnoff, senior advisor NHII, and Office of the Secretary, and liaison to the workgroup.
DR. ORTIZ: Eduardo Ortiz, Agency for Healthcare Research and Quality and staff to the working group.
DR. CARR: Justine Carr, new member, Beth Israel Deaconess Medical Center in Boston.
DR. HARDING: Richard Harding, Department of Neuropsychiatry, University of South Carolina.
DR. FERRER: Jorge Ferrer, staff to the workgroup, CMS.
DR. LUMPKIN: Why don't you have a seat at the table?
DR. FERRER: I didn't see my name --
DR. HUFF: Stan Huff, Intermountain Health Care, Salt Lake City.
MS. GREENBERG: Marjorie Greenberg --
DR. LUMPKIN: Actually I'm going to suggest we go around the room quickly one more time. John Lumpkin.
DR. DEERING: Mary Jo Deering.
MS. WILLIAMSON: Michelle Williamson.
MR. HOUSTON: John Houston.
DR. WARREN: Judy Warren.
DR. STEINDEL: Steve Steindel.
MR. BLAIR: Jeff Blair.
DR. COHN: Simon Cohn.
MR. HUNGATE: Bob Hungate.
DR. VIGILANTE: Kevin Vigilante.
DR. YASNOFF: Bill Yasnoff.
DR. ORTIZ: Eduardo Ortiz.
DR. CARR: Justine Carr.
DR. FERRER: Jorge Ferrer.
DR. HARDING: Richard Harding.
DR. HUFF: Stan Huff.
MS. GREENBERG: And since I never got a chance to officially introduce myself, Marjorie Greenberg, National Center for Health Statistics, CDC, and executive secretary to the committee.
DR. LUMPKIN: As I mentioned before as we're getting started we're going to try to cover in a very quick order four items. The first item is a quick overview of our last meeting, second item is a quick update on Connecting for Health and how that fits in with our strategy. Third item is the upcoming meeting in summer, and then the fourth item is our meeting on the 18th of February.
Agenda Item: Overview of Last Meeting - Dr. Lumpkin
We had at our last meeting just to sort of recap, we looked at what we would want to do over the next year or two what we, we're looking to do is develop a seven to ten year vision and approach to what the NHII should look like as a long term vision. That we would look at developing metrics for progress towards the vision, look at some of the financial models and incentives and how we can align those models and incentives with the vision. Look at fleshing out perhaps as we, and just to remind, those of us who were there when we developed the report remember but we struggled with what we should call those things that we ended up calling dimensions, one of them were views, and it really is how does the NHII look to certain groups of people and we felt that it needed to look for patient, providers, and for the population health dimension, it needed to work there if it was going to be successful. One of the thoughts was to flesh out other dimensions, such as the payer/purchaser, research and public policy. We also thought we needed to as part of our report to look at the business case in NHII and go through the pieces, the legal, the policy, the standards, and architecture as part of developing a seven to ten year roadmap.
That's kind of the vision, as we worked through that we thought that it would, as our work plan move forward, the upcoming conference that the NHII Office in ASPE was planning might be a very good vehicle to sort of kick off and focus on discussion and help us accelerate the process of developing this vision.
MR. BLAIR: When we had our NHII report November 2001 I think in the report we put forth what I think of as a vision, so at least in my mind I was thinking that what Bill is developing and what we would be sharing with the industry is more a series of models going a little bit past the vision. I was just thinking of it to distinguish it from what was in the report, it's not quite to the level of an architecture but it's at least a series of models. Do you, am I going too far, am I not in sync?
DR. LUMPKIN: I think that's consistent with our discussion. Bill?
DR. YASNOFF: I believe the word roadmap was used and I think that's exactly consistent with the discussion. Certainly I didn't hear anything at that meeting indicating a desire to go back over what the report that was already done but rather fill in more detail in terms of how it's going to look and how we're going to get there.
DR. LUMPKIN: Any other comments? Is that how we remember our work plan and thoughts from our full day meeting?
DR. YASNOFF: I think I was asked, or I volunteered, or both, to provide discussion documents on as many of these areas as possible and I intend to do that for the February 18th meeting so that we don't have to start, I mean you can accept them or not but at least you have something to discuss.
DR. DEERING: I had a couple notes that certainly as you said the conference is sort of the middle piece chronologically in this year and a good kick off point and to, my notes say to assist in the planning and see what it can and what the gaps are when it's over and map out hearings in the second half of the year to fill the gaps, and then have those concluded either by the end of the calendar year or by January of '05 and write the report in '05, and then possibly present a draft of the report at the '05 NHII Conference.
You may have mentioned it amongst the discussions that came out and again, pardon me if you did mention it, it was this notion of focusing more on the interfaces among them, did you --
DR. LUMPKIN: Yes, my eyes went over that line but the words did not come out of my mouth. But I did say flesh out, because we wanted to look at the overlap areas.
Agenda Item: Connecting for Health - Dr. Lumpkin
Okay, that review over, the next item on the agenda is Connecting for Health and some potential for work for us as a workgroup, I assume most of the people here are familiar with Connecting for Health, which is an initiative that started out with the Markle Foundation, a public/ private partnership looking at intercedes or what can be done to accelerate the process of improving health informatics connectivity and it has a fairly broad steering committee representing many areas and I've been the co-chair. And one of the concerns that we've had is how does this fit with everything else that's going on and with what we're doing. Simon has worked with the standards workgroup a little bit.
After we had our meeting the leadership of Connecting for Health sort of looked at the NCVHS, our activity as being the long range perspective and what they're tending to do over the next nine months is to develop a short term roadmap for what are the tasks that need to be done within the short timeframe of a couple years in order to assure that the vision moves forward.
The leadership of Connecting for Health in the sense of full disclosure, my organization is now a grantee to the Connecting for Health process.
MS. GREENBERG: You're getting a grant from them or they're getting a grant from you?
DR. LUMPKIN: We're giving them a grant. We don't get grants. They are our grantees, from the Robert Wood Johnson Foundation in order to assist in this particular process. The intent and I think the interest would be is that to the extent that they develop a short term roadmap, which would be defined as anywhere from four to six things that ought to be done in the near term, that that would then come to our workgroup as a presentation and should we decide to make any recommendations to the department along the lines of this public/private partnership recommendation then that would be brought through the department through the auspices of the NCVHS as a recommendation, which is we agree with it, we disagree with it, well, obviously if we disagree with it we probably just wouldn't say anything, but if we agreed with it recommendations for modification along the lines of some of the work that we've done for CHI.
The department is a participant as amongst any other parties in the Connecting for Health Initiative and there is no easy way for them to look at these recommendations without going through a back up committee.
DR. COHN: Cause for hearings in other words.
DR. LUMPKIN: Right. I think it would be a hearing where we would use the hearing basically as saying do these things that make sense as the short term roadmap and then do they sort of fit in with where we're going in our long term.
DR. COHN: What is the timeframe of their recommendations, is something spring where that information would feed into a longer term roadmap?
DR. LUMPKIN: I think they're actually looking for a shorter timeframe, maybe the fall.
DR. COHN: A longer timeframe.
R. LUMPKIN: Fall of '04.
DR. COHN: Okay, okay.
MR. BLAIR: So then they would have the benefit of what Bill is able to develop as the longer term set of models first so that they could be heading towards the seven to ten year, they could be within that longer term goal.
DR. LUMPKIN: I think the level of detail and perspective are different, I think our perspective is going to be the 30,000 view. I think they're looking to say, I don't know what would be a good example of something that needs to be done in the short term, maybe there needs to be some consensus on the architecture like we had as a discussion at our table last night for those who weren't at our table, saying somehow we have to decide is this vision going to be a peer to peer or is it going to be a spoken hub, some of those decisions need to be made in a relatively short period of time. That I don't think is going to be something in a seven to ten year vision the horse will already be out of the barn, but that may be something and I'm not saying that that will be but that would be an example of the kinds of things that may come out. Something looking in two to three years time that the industry and providers, the government and the public/ private partnership should say these are things we should do.
MR. BLAIR: May be the point I was trying to make was that it is going to be very helpful to have somebody who's going to say what should we do for the next two to three years, and I think that if they're going to wind up presenting that to us in the fall that would be very helpful because that means that in June we would wind up at least having some flesh on the bones for where we're trying to head seven to ten years from now and they could be on the same path, working in the same context and that's what I was trying to say.
DR. STEINDEL: I'm having a little bit of confusion on dates. We're having a meeting this, NHII is having a meeting this June, right Bill?
DR. YASNOFF: July.
DR. STEINDEL: Summer. And so Jeff are you talking about using the results from this meeting to fulfill the short term Connecting for Health?
DR. LUMPKIN: No, actually I think what Jeff is saying, you've got the June meeting, I'm sorry, the summer meeting, after June 22nd meeting, the presentation in the fall by Connecting for Health, and then the following year we do our vision so there's synergy and alignment that can occur as part of that interface, by the time we will have had enough time to process the summer meeting in the fall to be able to evaluate the recommendations that will be coming to us.
DR. STEINDEL: Now for putting my Mary Jo staff timeframe hat, if we want to send a letter to the Secretary concerning the Connecting for Health roadmap that means we have to put it before the full committee, which means that we have to have our committee meeting either, for this hearing, either before the September meeting or before the November meeting.
DR. LUMPKIN: Or, I don't think, let's suppose they get done in September/October because I just don't remember the timeframe, but we would probably want to do a hearing and my guess would be that we would then be talking about our winter meeting rather then our late fall meeting.
DR. STEINDEL: That fits in with their timeframe then, okay, that's what I was trying to get on the schedule.
DR. COHN: And doing a letter in the middle of elections is not going to be a very productive activity.
DR. STEINDEL: That's fine, I just wanted to get the timeframe down.
MR. HUNGATE: There's a window --
DR. LUMPKIN: Then they'll be a whole transition period and making recommendation in that period of time and I think we need to, first of all we need to as the process goes through is make sure that that's something we still want to do --
DR. DEERING: Speaking of details of deliverables, I'm hearing a couple of different things that are not necessarily mutually exclusive but I just wanted to get them both on the table. We know that we will hold one or more hearings sometime in the fall that would encompass not only Connecting for Health I would assume but perhaps some other things that we've determined based on the work that we already know they're doing, in advance of hearing from them and Bill's conference and the HHS conference, so we'll see some things already knowing that we're going to have at least one set of hearings and at least more then one set of speakers. And then we immediately jump to talking about making recommendations to the Secretary, on the other hand we also talked about not writing our report, a full report, until into the calendar year of '05. So I just want to be sure that what we have on the table is perhaps a preliminary letter with recommendations that are more specific to one or two short term action items that would be followed by a lengthier report.
DR. LUMPKIN: And I think we need to look at what they are because to the extent that there are those processes outside and there have been a number of independent efforts to try to look at what are the short term steps and how to move forward. My impression is within the federal government, which is beyond HHS, there is an initiative by the White House to kind of pull that all together so that there is more convergence and not moving in different directions. It appears that the partnerships that are involved in trying to also move forward this agenda are looking to say that that can be the role of the NCVHS to also pull together the public/private so it all goes through one channel and therefore is more likely to be aligned. So that the work product, the two products would be some recommendations for short term actions and then the second work product would be the long term vision and the refinement.
DR. DEERING: It occurs to me that another set of inputs that we need to put in is the HL7 EHR effort that would have been balloted and completed, and regardless of the outcome it's certainly engaging an awful lot of energy in the industry and so simply to sort of take, get a briefing on exactly what happened, what's the impact, what does it mean for all of these activities, because I think one way or the other to ignore it would be --
DR. COHN: I actually think it's an important effort, obviously now in its second version, but that may be actually something that we want to get a briefing on at the next full committee. The timing would be good only because it's coming up on the ballot at that time.
MS. GREENBERG: -- March 4th, 5th, could be a little premature on that. When is the voting --
DR. DEERING: The go to ballot on the 15th of March --
DR. YASNOFF: There will not be a decision whether they're going to go forward on the ballot until March 10th, so although by the 4th or 5th probably it'll be clear which way it's going to go but there won't be an actual decision.
DR. LUMPKIN: And I think that part of this, and we'll have to make the decision as we look at how things are developing, we may look at the sort term roadmap and say it's all standards and security stuff, in which case we may want to punt.
DR. COHN: Do you think that the short term roadmap results, I mean I think there's some architecture pieces that, now of course that could be standards but let's begin to bound the role of standards --
DR. LUMPKIN: My only point is that we're going to have to, to the extent that there are folks in the outside world who want us to play that role we need to figure out internally how we're going to do that. And while we have a strong representation in standards and security on this workgroup there may be pieces that may seem more appropriate to be handled by our committee that certainly is much stronger on standards issues.
DR. YASNOFF: I think along the same lines Mary Jo was talking about, there are, as these various road mapping, planning, thinking, recommendation processes move along, as you might imagine there are activities that actually have to occur immediately, so the activities are not all by any means put on hold while those things are going on and so I think that the HL7 process is just one example of a number of short term things that I hope the workgroup would be willing to take a look at. And I think depending on how events move along, I can't necessarily predict exactly what things are.
DR. LUMPKIN: Right. So it really describes a long term vision activity, which is a roughly two year initiative to produce a document, some short term activities by the committee to address some of the pieces that are beginning to fall into place. Are we in agreement with that sort of our plan? Okay. That takes care of the first two items.
Agenda Item: Summer Meeting Planning - Dr. Lumpkin
DR. LUMPKIN: The third item is the upcoming meeting in the summer.
DR. YASNOFF: In the summer, yes. The upcoming meeting, we are currently soliciting for a contractor to help with that meeting and it looks like it, best guess it will be in July. We have internally had some considerations about postponing it but I think that would be a mistake and I'd be interested in other people's thoughts. I hope to have a relatively detailed proposal for you on February 18th, I do not have that today, but I can tell you that there are two major objectives from the department's perspective we'd like to accomplish at the meeting.
One is we would like to update, we want to present the summary of the recommendations from the last meeting and engage the attendees at this meeting in some kind of process to comment on, expand on, clarify, review, update those recommendations. So we want to take advantage bringing together all the stakeholders to further refine the recommendations that came from the last meeting. Essentially the consensus building agenda setting part of the meeting.
The second objective is to present activities that are occurring in building the NHII, so as to begin the process of sharing lessons learned, people can see what other people are doing, providing people with an outlet for NHII specific activities.
There's some question as to whether both those objectives can be met in what amounts to a 48 hour meeting, and we're pondering that and we'll be interested in your additional input.
MS. GREENBERG: I can just mention, if you're looking at July, the NCHS Data Users Conference, which generally attracts like over 1500 people is the week of July 12th, so I would encourage you not to have it that week.
DR. YASNOFF: Thank you. We are wanting not to overlap any related meetings.
MR. BLAIR: Could I ask a question? In the July session will Bill, will you be presenting some straw models, your initials ideas of what the NHII would be looking like seven to ten years from now to begin to get feedback and critique?
DR. YASNOFF: Well, I think that's a good idea but I'm not, I think that information should be presented and I would think that the workgroup would want that kind of information presented. I don't think I will be presenting anything personally. One of the things I've learned from doing these meetings is that when you organize the meeting it is a mistake to put yourself on the agenda in any form. But I think that those are the kinds of things that do need to be presented and could logically be part of this refining the vision, refining the consensus agenda. For example there were specific, there were architecture recommendations that came out of the last meeting that actually were not very specific and so logically one could present those recommendations and a straw man architecture and then have some kind of breakout group to get comments, that's one strategy.
DR. COHN: I know that you're putting a lot of energy into planning the session and I would obviously defer to you on what you think are the pertinent items. I guess having been reflecting over the work we've been doing and our discussion of models and roadmaps and all of this other stuff, I guess I was reflecting back to our last discussion where we were I think observing that the payers may or may not be engaged and that they're still sort of looking on at the business case around all of this, and I don't mean to be sort of obvious about this but you're not going to get much of an NHII if the payers aren't convinced that this is a good idea because they're going to be likely paying for most of this. So this is I think something we talked about in terms of model development but it probably is something that has a little greater urgency then some of the high level models that you may create and it really may need to be something that's frankly discussed around the business case engaging the payers and other pieces like that. And once again, this may have a little more urgency, I see you're nodding your head, you're agreeing also.
DR. VIGILANTE: Yeah, we've been talked about this as well, I mean the payer issue is really, incentives in line is a key part of this.
DR. YASNOFF: Yes, and I agree, and that is urgent and in fact we've been holding stakeholder specific meetings as you know, and we did have a payer stakeholder meeting. We have since had an employer stakeholder meeting which was quite interesting. I think if anything the employers are more enthusiastic about this then the payers because ultimately it's the employers who are really paying. Of course it's the consumers that are ultimately paying but at the moment they're not well organized and it's difficult to, they don't really control the process at the moment, I'm not commenting as to whether that's good or bad, but that's a fact. And in fact at the employer stakeholder meeting several of the employer groups not only were supportive but were imploring us to move faster, emphasizing the urgency of the problems, of the need for solutions of the problems that an NHII addresses. So I think that we certainly are going to make serious efforts, and I think we will be much more successful this year engaging that community and bringing them to this meeting and actually my expectation is that the meeting will be quite a bit larger because we will have better representation from more stakeholder groups.
DR. LUMPKIN: If I could sort of give a little feedback conceptually how this might fit into what we're looking at. I think that when you think about a meeting like that you think about the plenary sessions and then the breakouts. One of the areas for discussion could be trying to flesh out alternative models for financial incentives. My guess is is that we don't want to come out of this conference with one model, that's going to be a political disaster. But if there are multiple models for incentives that then allows researchers, foundations, AHRQ, to commission research to do some financial modeling and determine what would be the cost, what would be the expected outcomes of these models in preparation for really short to medium term decision making.
The second would be on architecture models, and again with the goal not to develop a single model and reach “consensus” but rather flesh out a few alternative models which then could be also evaluated as to how this would move forward, what were the barriers and obstacles.
The third is to perhaps look at breakouts that may focus in on the new dimensions that we want to describe, a payer/purchaser breakout of what does NHII need to, what down the stream should it look like in seven to ten years. One for research, which has two aspects of it that we may or may not want to address, one being health care clinical research, that sort of thing, and the second is health services research, which are two components but two separate components. And then the third being the public policy implications, which would be a separate thing. So I think that kind of may be one of the frameworks that's consistent with what we have put in our agenda but that would I think present some very interesting and useful work product.
MR. BLAIR: The only thing I guess maybe I was reacting to because I wasn't able to exactly tell, we have a situation here where we're forming one seventh of our economy, it's huge and it's complex, and it's going to take time. And maybe part of what I was trying to put forth before, it's swimming upstream, it's a struggle, how do you put a sense of urgency into where we're going when it's going to take some time to identify where we're going. But maybe the point of what I'm trying to get to here is I would like the series of models to be as high a priority as we can because we're going to have a lot of folks like Connecting for Health coming to us and saying we've got an interim plan, we got a two to three year plan, and they're going to say is it good. And how are we going to say whether it's right or not if we don't have at least if not a solid vision of where we're going seven to ten years from now, at least the beginnings of a converging vision of what the architecture, the finances, the standards, the legal issues, the ethical issues, so I was trying to see if there's something we could do to try to get that series of models in place as soon as possible to help us make decisions for the next two to three years. If it's going to take two years to get to it maybe we have to accept that, it just can't realistically be done before then, but if there's any way for us to accelerate and put that as a real high priority I think we should.
DR. YASNOFF: I share your concern and I think that the way we need to approach this is in an incremental fashion where we don't attempt to put together an architectural document that specifies every aspect of this down to the last connector, that's just not realistic and I think we need to start at the top and move gradually to a more and more detailed level. Your point I think demonstrates why it's so important at this meeting to have reports from if you will the explorers in the new territory, the people who are building these systems in their communities, we need to hear about that and I can tell you that there's a tremendous amount of interest in building community health information exchanges around the country and I don't know that we're going to have results form those efforts by the summer, in fact I suspect not, the new efforts are not going to have a chance to get very far by then, but I think we will be able to for example compare and contrast a number of approaches the different communities are taking in terms of how they assemble the stakeholders, how they're doing the governance, how they're planning to pay for the systems and distribute the financial benefits, I mean these are all going to be plans but I think that the different communities will give us a range of ideas as to how people are really doing this. Because people --
MR. BLAIR: Know what the problems are that we might not have anticipated when we start looking long term.
DR. YASNOFF: Correct, and I think the people in communities are not waiting for this recommendation document.
DR. LUMPKIN: I'm going to have to put a bookmark here. The fourth item on our agenda is what we're going to do on the 18th.
MS. GREENBERG: I would like my opportunity just to say one thing. Since I had my hand raised and Jeff started talking.
Well, I know it's not at the top of everybody's agenda, it may relate to the health services research, it certainly I think relates to community health information exchange, but I just want us not to forget that as you mentioned in the beginning, one of the dimensions of the NHII was the population dimensions. It wasn't a major focus at last year's meeting, part of that dimension was the 21st Century Vision for Health Statistics, the NCHS Board of Scientific Counselors is very interested in kind of staying on top of that and coordinating with the NCVHS on that, and I've told them about the session we're having in March. But I'd like us to think about how the June/July summer whatever meeting, and our overall process, still keeps that as a piece of it because I think the population part tends to kind of fall off our agenda.
DR. LUMPKIN: Let me put my bookmark in right here.
Agenda Item: February 18th Meeting Planning - Dr. Lumpkin
DR. LUMPKIN: We will be meeting in three weeks and I think we have pretty much framed the discussion we will be having in three weeks.
DR. YASNOFF: Can I ask one very quick question? Is there a desire on the part of the workgroup to schedule formal hearings as part of this conference? If there's no quick answer then I'll ask that question again on the 18th.
DR. LUMPKIN: To tell you the truth the thought hadn't even crossed my mind and so we would, it may be good to explore what would be the value of actually having formal meetings, formal hearings, because that's intriguing.
DR. DEERING: And we could rephrase that also to say the way I would like to interpret that is an invitation to the workgroup to think about what we need to get out of it, I mean hearings is just one mechanism for getting something out of the conference.
DR. YASNOFF: And actually that's a good point and could I ask in order to help expedite the process if people have ideas about what they would like to get out of the meeting, if those could be fed to me in the next three weeks so that I can at least try to incorporate those into this draft plan that would be very much appreciated.
DR. STEINDEL: I would not like to hold hearings at the meeting but I would like to hold hearings around the meeting.
DR. LUMPKIN: Well, let me just toss this out because Bill raised it and it just sort of clicked something in my brain. What if the last session, which was the report back from the workgroup, was a hearing of the subcommittee? An open hearing --
MS. GREENBERG: People would have to be able to come whether they paid the registration for the meeting or not.
DR. COHN: 1500 attendees, that could be interesting.
DR. LUMPKIN: My point being is we look at our timeframe, that then makes the work product of this meeting a work product of the workgroup, which means it can be almost immediately published.
MR. HUNGATE: Much more direct input.
DR. YASNOFF: I think that's something that needs to be considered and again, I'm not committing either way to what needs to be done but obviously would like to hear from the workgroup as to what the desires are. Clearly, I suspect most of the people that the workgroup would want to hear from are going to be attending this meeting.
DR. DEERING: It also enables us to identify what we want to go into the hearing, I'm sorry, into the meeting, so that by the time we report out we know who's going to be there. And just to pick up on a couple of points that you all have talked about, fleshing out the models, to get to even the point where you have draft models for discussion at the conference I'm sure you would be using the process that you set up before, which was a very robust preparatory process where you got that kind of input. And picking up on Jeff's sense of urgency, there would be a lot that needed to be done before that meeting ever occurred so that you could be sort of doing the polishing and the refining even if it weren't final --
DR. YASNOFF: That hasn't escaped my attention.
DR. DEERING: So I'm just observing that if indeed that was something that we were quite strong on hoping to see come out of that meeting then we have an opportunity to work with Bill in making sure that those things are drafted --
DR. LUMPKIN: Solicitation of papers, those kind of things that could be then as the workgroups within the conference met those would be part of the preparatory --. I think that there's a lot of potential there.
What we had hoped to do today was to get our thought juices flowing about the meeting on the 18th. I think we've kind of outlined pretty much the broad areas that we want to talk about, we want to talk about what models we want to see, how we may produce those models as part of the conference, we also need to give some thought to once we've produced the models, or have some fleshing out of those at the conference what do we do with them after that as part of our work plan in developing the final document.
I think that we would want to kind of review the timelines for getting that work done, and to look at other aspects of the working on the three new dimensions and to flesh out the overlaps between the three old dimensions. And to make sure that some dimensions that may not have been fleshed out as well as we would have liked since our report, such as the population dimensions, gets some attention.
DR. COHN: I agree absolutely with all things that you're saying. I think the one other thing that I think I had heard from our last meeting, and I apologize, it's early in the morning and it's really early California time --
DR. LUMPKIN: But you've been here all week.
DR. COHN: But I've been here, I can't use that as an excuse. I had thought that there was also an opportunity on the list to hear from, I wouldn't say you're quite the holder of the vision or the actuator of the vision at this point. My sense is that you've taken really that NHII vision and moved it in different directions and have a number of sort of world views about it, and these aren't roadmaps, these aren't models, these aren't frameworks, these are sort of fundamental beliefs around all of this that, I mean I personally need to understand it, I think maybe the rest of the workgroup needs to talk about it to make sure that we're all in agreement with them, just because I think it would be useful to help us understand sort of the, I mean it helps us understand the strategy and the actions of HHS --
DR. LUMPKIN: So we probably would want to start the meeting off with that. Yes? I think we have a plan, we've worked through our agenda, we're running about five minutes late so we need to have a ten minute interlude before we, after we end this meeting to get the equipment upstairs.
Okay, we're going to --
DR. YASNOFF: Can I just add one more point, I would like in as we develop the formal agenda for the 18th I want to be sure we don't spend, the thing from my perspective that has to get done on the 18th is whatever input into the conference planning the workgroup wants to have has to be completed on the 18th. So I would like to suggest that while obviously the workgroup is very anxious to get into specifics of various issues, that if we get distracted in those then the conference is going to have to be planned regardless of whether the workgroup has any input or not. So I just want to make that --
DR. LUMPKIN: So we want to talk about what models we want, we don't want to get into the models themselves.
DR. STEINDEL: May I request that whatever planning documents Bill was planning to give out at that session reach us in an expeditious fashion between now and the meeting?
DR. YASNOFF: I will do my best to get them to you a week in advance, that's probably the best I can do.
MS. GREENBERG: I'm a little concerned and that's why I just want to kind of check with people about the fact that I realize that this was the only time the meeting could be scheduled, the 18th, but the Subcommittee on Privacy and Confidentiality is hold a meeting on the 18th and the 19th and they're working on a number of panels, going to have a lot of testifiers, right now that subcommittee with two retiring members is made up of Mark Rothstein, Simon Cohn, Richard Harding, and John Houston. So everyone but Mark is also on this NHII Workgroup and I don't want to be bringing in lots of outside testifiers and have Mark sitting there by himself. So we have to think through, I don't know and I don't see staff, they must be upstairs, whether both meetings are going to be in the Humphrey Building, which would certainly be helpful if that's the case, but I just alert you to that as, with our new rules --
DR. COHN: Don't look at me, look at Richard. Richard, what do you think? If Mark were here we'd ask him.
DR. HARDING: I think that if we do have the quality and caliber and number of testifiers that we had in the last hearings that it is very important that members be there.
MS. GREENBERG: We don't have the same quorum, we don't have quorum requirements explicitly for subcommittees but you hear me.
DR. LUMPKIN: Right, we need to have a division of labor.
MS. GREENBERG: Need to be some decisions among you.
MR. HOUSTON: I intend to go to privacy, I think it's important if you're having people come in that clearly we show our support and attendance of that, so I am concerned about how we try and share time.
MS. GREENBERG: The other thing is that the Subcommittee on Privacy and Security hopes to have a letter based on that hearing and the previous hearing, and obviously, by March 4th, there's not going to be time to wait and get the transcript and all that. So some people are going to have to have been there to contribute, to have heard what the testimony was and contribute. So I know that you probably don't want to hear this but I think it's important that we think that through so we have a division of labor. Of course the new members are encouraged to go to one or the other.
MR. HOUSTON: Or both.
MS. GREENBERG: Or both as the case may be.
DR. LUMPKIN: Both is going to be hard but we do want to point out that we need to make sure we have an adequate division of labor.
DR. YASNOFF: Is it too late to move one of them one day?
MS. GREENBERG: We can't move the Privacy.
DR. YASNOFF: But the NHII Workgroup, we're not having any testifiers, so would it be possible to have that the day before?
DR. LUMPKIN: No.
DR. YASNOFF: Or the day after.
DR. LUMPKIN: We've been looking for, we've been through about five different things and trying to pull schedules together it's just --
DR. DEERING: Is it possible to at least plan the agendas and the lunch breaks, squeeze out any little bit of --
DR. LUMPKIN: I think we're going to have to pretty much have, I'm not sure that all the members, the current members of Privacy will be there but we want to have the vast majority of the members of Privacy at the Privacy hearing.
MS. GREENBERG: Now maybe like the Privacy starting at 9:00, we could even start at 8:00, vary our lunch hours, let's try to be creative here so that people can, hopefully both will be in the same --
DR. COHN: Sounds like cloning may be an option.
MS. GREENBERG: But I preferred to bring this up here then upstairs.
DR. DEERING: If we're starting out with a discussion of the conference and Bill has been able to share any documents in advance, and if we have given him feedback in advance, then members who have to miss the morning will have already in some senses both gotten a little bit of input and given a little bit of input themselves, so that might be also what we have to do.
MS. GREENBERG: We'll work it out but I just wanted to make you all sensitive to that.
DR. LUMPKIN: Okay, back upstairs.
[Whereupon at 9:03 a.m. the meeting was adjourned.]