The NCVHS Executive Subcommittee met on Tuesday, December 7 in the Hubert H. Humphrey Building in Washington, D.C. The meeting was open to the public. Present:
Following a brief discussion and some minor wordsmithing, the Subcommittee passed a motion approving the report on Medicaid Managed Care, along with a cover letter for Dr. Lumpkin's signature, both prepared by the Subcommittee on Populations. The report and letter will be sent to the Secretary.
Ms. Greenberg introduced her NCHS colleague Debbie Jackson, who will be staffing many aspects of NCVHS. Among other things, Ms. Jackson will work on the Committee's work plans, which will be revised, updated, and reformatted.
Ms. Frawley summarized the highlights of a draft letter developed by the Subcommittee with comments on the Department's proposed privacy regulations. The full Committee will discuss the letter in a conference call on December 20. Both that meeting and the November 23 Subcommittee conference call are being announced in the Federal Register. It was noted that the Department has been asked to extend the public comment period for another 60 days. The Subcommittee agreed to try and get closure on the comments in the original time period, and to use the additional time if needed. They briefly discussed the issue of the access physicians should have to the records of non-patients, in the context of the issue of informed consent. The Subcommittee was asked to "flesh out" its comments in this area. Dr. Lumpkin also suggested that the full Committee receive a companion document characterizing the range and strength of opinions on various topics.
The group agreed that Ms. Frawley will revise the comments based on this discussion, recirculate it to the Subcommittee, and get the revised version to the full Committee by the following Monday. Members will be asked to send comments to Ms. Frawley and to Dr. Lumpkin in advance of the December 20 conference call meeting. They also agreed that the letter to the Department would outline areas of disagreement within the Committee.
(The discussion of work plans resumes below.)
Dr. Lumpkin noted the potential benefits of the Executive Subcommittee's spending a day doing long-range planning, possibly in the summer of 2000. The questions to be addressed include the optimal size of the Committee, how to coordinate the "right brain/left brain" facets of its mission and work plan; and priorities. A major issue is how the three major areas on which the Committee works can be cross-fertilized, given the demands on members' time.
The group discussed the merits of taking a broad view of the Committee's work and the extent to which single-issue people can contribute. One theme was how to reintegrate the standards theme and work load into the broader Committee mission; related to this were concerns about the differing emphases and interests of different Committee members. It was suggested that the Committee take more opportunities to talk informally across these boundaries, for example, in after-dinner meetings. Members supported the proposal that they develop an overall strategic plan.
Mr. Scanlon observed that this discussion mirrors ones taking place in HHS as well, and even in health care: specifically, how to more deeply connect the facets of standards, population-based priorities, and research. He noted that this is part of the Data Council's mandate.
There was support for Dr. Starfield's proposition that population should be the overarching view or context for all the Committee's work -- both special populations and issues affecting the population at large. Dr. Cohn noted that the NHII white paper provides a useful conceptual framework.
Dr. Lumpkin observed that both the NHII paper and the 21st century health statistics vision document will contribute to the Committee's strategic plan. He also suggested that the Committee have a regular annual meeting at which it addresses questions of priorities, direction, and so on. In addition, he proposed that the Executive Subcommittee function as an integrating body that takes a day periodically to pull the pieces together, making a first attempt at it this summer. Dr. Starfield noted that the 2010 objectives will also contribute to the prioritization process. Dr. Lumpkin agreed with Dr. Fitzmaurice's suggestion that the Subcommittee use an expert facilitator for this.
Turning to the question of new members, Mr. Scanlon said four or five positions will need filling. The group returned to the issue of single-issue people versus those with broader interests and expertise, agreeing on the proposition that even specialists need to be broad-minded and multi-faceted. They also discussed other desirable attributes for future members and the perennial issue of the time commitment required.
The Subcommittee is beginning to work on an implementation report to Congress on the HIPAA standards, for which it will probably want the support of a consultant. Dr. Cohn expressed concerns about the need for ongoing staffing support for implementation and enforcement, and whether HHS is adequately staffed. Dr. Lumpkin and Mr. Scanlon suggested formally asking the Department about its plans for implementation and, if the Committee has concerns, expressing them first to the Secretary.
The Subcommittee will probably review something on claims attachments at its February 1 meeting, and plans to prepare a letter for Committee review later that month. The Subcommittee will meet again in the Spring to look at the transition to new code sets and, in that regard, the issue of federally anointed monopolies (CPT and others). The unique individual identifier will also stay on the work plan, probably to revisit in 2001.
Dr. Cohn and Dr. Lumpkin agreed that the Subcommittee also should plan to address the question of what other transactions require standards. This may involve hearings.
The Workgroup on the Computer-based Patient Record is in the midst of a series of hearings. It has drafted a document on issues and recommendations for clinical data standards, and will have a draft for the full Committee to review for the February meeting. The deadline for final agreement on the report is the June meeting.
In addition to continuing its work on the comments on the privacy NPRM, the Subcommittee will hold a hearing in February on the use of the Internet for health information and its privacy implications.
Final plans were made for formally submitting the Subcommittee's reports on the U.S. territories and on Medicaid managed care. The Subcommittee is following the implications of the new OMB race and ethnicity categories. Its chief activity for the coming year is the functional status initiative, through which it hopes to determine the feasibility and practicality of adding a functional status element to standard code sets. She stressed that the Subcommittee has no foregone conclusion about this question. One possible outcome is the development of a research agenda. The Subcommittee will meet January 24-25 on this topic -- an important meeting. Dr. Iezzoni noted that there are staffing and issues to be worked out, largely owing to the fact that agency staffers are overextended. There are also decisions to be made about the contractor. Ms. Greenberg said she has asked Ms. Jackson to be a partner to the lead staff of every Subcommittee and Workgroup, to help ensure that things run smoothly.
The Workgroup will focus initially on medical errors. Noting the link between this work and that on the CPR, she proposed the possibility of joint sponsorship of panels. She welcomed people's ideas about this initiative. Dr. Starfield described her recent work on iatrogenesis and called attention to the errors and unintended reactions in ambulatory care as well as hospitals. She also noted the relevance of the core data recommendations, which could be expanded to look at iatrogenesis. Ms. Greenberg commented that there is increasing interest in these issues, and Dr. Cohn hailed the idea of a coordinated effort with the CPR Workgroup. One idea is to invite those who worked on the IOM report on medical errors to present on data and information system issues. Another IOM group that worked on information technology for improving quality may also be invited. Subcommittee members expressed interest in having one or both of these presentations made to the full Committee, probably in February. Ms. Greenberg said she would get copies of the recommendations from the errors report for the Committee.
This group has held the first of a series of planned meetings with state and local public health people, this one in Harrisburg, PA. It plans to present an interim report at the June symposium, with an edited volume to follow subsequently.
The Workgroup will meet on December 16. It also plans to present a draft report at the June symposium.
A document on the Committee's history will be updated. In addition, there will be papers from the Workgroups on NHII and 21st Century Health Statistics, and subsequently a symposium report.
The Subcommittee welcomed the idea of developing a brochure for distribution at the symposium, capturing themes in the history and highlighting major information about the Committee. Ms. Greenberg has an intern who is interested in doing this.
Ms. Greenberg and Mr. Scanlon asked for input from the Committee on new members. A call for nominations will be issued in the Federal Register in February. The group reviewed the areas of expertise that are especially needed on the Committee.
They then discussed the agenda for the February meeting, mentioning the following items:
I hereby certify that, to the best of my knowledge, the foregoing summary of minutes is accurate and complete.
/s/ John R. Lumpkin, M.D 7/17/00 ___________________________________________________
Chair Date