[This Transcript]
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Room 405-A
Washington, D.C.
DR. LUMPKIN: Hear ye hear ye. Welcome all.
I guess we should start off with introductions. My name is John Lumpkin and I'm chair of the work group on the National Health Information Infrastructure and the outgoing director of the Illinois Department of Public Health.
DR. DEERING: We hope you don't go out too quickly and you are certainly not out-going from NCVHS. I'm Mary Jo Deering. I'm in the Office of Public Health and Science and I am lead staff to the NHII work group.
DR. COHN: I'm Simon Cohn. I'm the National Director for Health Information Policy for Kaiser Permanente.
DR. HUFF: I'm Stan Huff with Intermountain Health Care and the University of Utah in Salt Lake City, Utah, and participate mainly in standards, both vocabulary and message data exchange standards activities.
DR. ZUBELDIA: Kepa Zubeldia with Claredi Corporation, a member of the committee and subcommittee.
DR. FITZMAURICE: Michael Fitzmaurice, senior science advisor for information technology to the Agency for Health Care Research and Quality, a liaison to the national committee and staff to the Subcommittee on Standards and Security -- and maybe this committee, too. I've forgotten.
MR. BLAIR: Jeff Blair, Medical Records Institute and member of the committee and member of the work group.
DR. STEINDEL: Steve Steindel, Centers for Disease Control and Prevention, liaison to the full committee and staff to this work group.
MS. BOWER: Cynthia Bower, Office of Disease Prevention and Health Promotion and staff to the work group. DR. ORTIZ: Eduardo Ortiz from the Agency for Health Care Research and Quality and staff to the work group.
MR. HUNGATE: Bob Hungate, Physician-patient Partnerships for Health, a member of the committee and of the work group.
MS. WILLIAMSON: Michelle Williamson, CDC, National Center for Health Statistics and staff to the work group.
MS. HANDRICH: Peggy Handrich, new committee member, here observing.
MS. SQUIRES: Marietta Squires, CDC, NCHS.
MS. ROTH: Denetica Roth, NIH management intern.
MS. BICKFORD: Carol Bickford, American Nurses Association.
MR. RODIE: Dan Rodie, American Health Information Management Association.
DR. DEERING: I would like to raise a procedural question right away which is I noticed that we do have some people who are here sort of observing and I wonder whether you would like us to put you on all of the formal distribution lists for the work group from here on out or was this a one time dance with us?
We'd be happy certainly to make you part of our regular communications if you would like. Peggy?
MS. HANDRICH: I was told that it would be good for me to observe several of the subcommittees in action before I select the area I would work in so that's what I'm doing.
DR. DEERING: We'll court you very assiduously. Simon?
MR. SCANLON: There are other committees actively recruiting.
DR. DEERING: Stan?
DR. HUFF: Yes, I would like to become a member of the subcommittee with the caveat that I probably won't be able to make the meeting on the 18th.
DR. DEERING: You may be in luck. Is there anyone else who is here today who hasn't be getting our e-mail list announcements at least. We'll definitely add Stan and Simon will give Peggy a chance to signal for herself.
DR. LUMPKIN: The first item on our agenda which is not actually listed on our agenda is Jim who is going to talk about the upcoming conference on the NHII.
MR. SCANLON: Thank you, John. I mentioned this this morning to the full committee but let me go into a little more detail to the work group today.
Among the activities that HHS is planning to support and promote the NHII is a conference that is planned for June 30th through July 2nd here in Washington at the Renaissance Hotel. I believe we have a hotel.
The tentative name or theme is NHII-03: Developing Agenda for the National Health Information Infrastructure. What is envisioned here is a convening, an HHS convening kind of a role to get everyone involved with interest in the NHII.
The focus will be on identifying consensus and potentially an action agenda. Not just a federal action agenda but a national action agenda for moving forward with the NHII.
The plans would be for a fairly structured conference that would involve plenary sessions which would be begun by experts in areas and then breakout sessions in eight areas which I will mention in a minute.
The eight areas in the breakout sessions would be chaired by -- well, facilitated I guess, I would call it -- by experts in those areas and I think we've actually identified some folks now which I can tell you about.
And the hope would be that at the end of the two and a half days, we would have some understanding of where some consensus exists on goals and objectives, on specific action steps and the who as well, who does these things, that can be pulled together in kind of an overall action agenda for NHII moving forward.
Let me describe the eight areas first. Basically the breakout areas. The first area would be research and population health or public health.
The second is homeland security.
The third is consumer health.
Fourth is financial incentives. This would be how does one actually promote or incentivize some of the NHII progress.
Fifth area deals with safety and quality of health care.
The sixth area deals with standards and vocabulary.
The seventh area deals with architecture, systems and data architecture.
And the eighth area would be privacy and confidentiality issues.
I think there are tentative facilitators or discussion leaders that we've already identified and I think, let me mention some of you, let me mention who they are now.
And, again, this is sort of the overall structure. Plans are proceeding but I think we really will be consulting the full committee here. Some of you have already agreed to take on certain roles and we would certainly ask for your participation as this moves forward.
On the privacy and confidentiality area, I think John Fanning from my office has sort of agreed, was asked and agreed to serve as the leader.
On architecture, Mark Overhag -- I think many of you know Mark from the Regenstrief Institute.
On standards and vocabulary, Betsy Humphries from NLM.
Safety and quality, David Bates from Partners Health, many of you met him.
On financial incentives, we have an alumnus from the NCVHS, Don Detmer has been asked to come and kind of lead that discussion.
Again, this is not so much that the facilitators have the answers as you need someone to be designated as traffic cop and discussion leader.
On consumer health, Patty Brannon. Many of you know Patty. She worked with us on privacy as well.
On homeland security, Richard Morris. I don't think many of you know Richard. He's here with the department. He's at the National Institutes of Health and he spent some time at the Office of Public Health Emergency Preparedness. He's an informatic specialist as well.
In research and population health, it looks like Blackford Middleton has agreed to serve as the facilitator or discussion leader there.
Let me see if there's any more detail at the moment. No, let me stop there. That's the basic structure of the committee.
We'll be putting up a web site. We will have a contractor putting up a website for registration. I think we are probably expecting a thousand folks and I think we'll have discounts on the rooms available for participants at the hotel.
MR. BLAIR: I like the categories that you all have selected. They make a lot of sense. What I'm struggling with is mapping the categories to -- and I'm going to give an example here where we have a professional association, a trade association like HMSIS that seems very supportive and very anxious to step up to those responsibilities and provide leadership for provider sector and it's hard for me to see if we have similar groups in public health and in consumer affairs to see the mapping fitting nicely there.
Have you thought about this or am I bringing up an issue where we just simply have to figure out how we address that as we go along.
MR. SCANLON: To some extent, Jeff, it's just a practical issue. These are, some of these aren't mutually exclusive. In some of the areas, as you say, there are organizations and strong industry groups already moving along. In others, it's not so much and there's not that much of an organization.
Homeland security, for example, I mean, I don't know how that will actually shape up. I don't know that there are any associations, for example, though there clearly are a lot of interest in people sort of trying to understand hat requirements are and who's doing what to whom.
So I think each of them is a bit different. Some of them, as you say, are well-developed areas, well-organized, with the federal government and industry groups and there are others that are -- they are going to look quite a bit different.
Population health, public health, is another matter where it's probably going to be largely public sector groups that are represented there rather than what might be represented in architecture and other places.
So I think we'll just have to -- I mean, any suggestions you have, I think we are open here because to some extent, it's somewhat new territory, getting these diverse perspectives together.
The other thing, I think, the rule, Jeff is that we are not, if you start out -- this is not a track. If you start out in architecture and you decide, well, gee, I would like to learn a little bit more on the next breakout about patient safety and quality or homeland security, that's sort of allowed, too. This is not meant to be that highly structured.
But we really with open, again, as I say, this is sort of new territory and we are quite open to any suggestions about how to make it easier.
DR. DEERING: Jim, having seen how robust the action plan from the public health informatics effort was that you produced in a similar effort and I know that his process is usually draft preliminary materials and to go in with working, just straw man documents.
And I guess my question is, given the timing of this, is there any opportunity for the work group to play a role, for the NHII work group as a work group in anyway to play a role here?
I guess I'll just leave it at that. What role would the work group be maybe in helping prepare these draft materials or take a look at the agenda.
MR. SCANLON: Well, let me, -- that's a good question. Let me, when Bill gets book, let me see where we could -- timing, this is one of those issues where, to some extent, we are probably, you need a year to planning something like this, to be honest, but we shortened it to roughly half a year in the interest of getting everyone together.
So we had to condense the time frame but let me see if there's not a way that we could -- I know we've got a master schedule of when we expect any papers to be due and maybe we could clearly get them to the committee, circulate them as well, in their early draft stage.
DR. LUMPKIN: It may be that rather than being involved before the conference, one of the things that the committee can do is look at the work products and sort of vet those into a finished product.
MR. SCANLON: I guess the other thing I would say, while this goes in as a relatively highly structured meeting, that's not really the way the world operates and I think ultimately we are looking at the quality and sophistication of the recommendations that come out and the agenda items.
And again, this is not, I know people often have an analogy of building the NHII to a building and I don't really think it's a building. I think it's almost like city planning where there are a lot of people who play a lot of roles and there are a lot of people, there are a lot of forces at work and you can agree on certain things and people go off and do things there.
While it looks like it's highly structured, and to some extent it has to be, I think there will be a lot of interplay in terms of what the recommendations ultimately look like, what the agenda would look like.
DR. LUMPKIN: I think the only other discussion is I think it would be a mistake to put research in population slash public health in the same group. Issues are just so totally different.
DR. ORTIZ: The only thing I was going to say about this is this looks like a great meeting with just a lot of wonderful people.
The only thing I get concerned about is one, with so many people here at this type of meeting, you end up most of the time at these kind of meetings just being more informational, just because of practical considerations.
Just one of the things that we struggle with is it seems like there's so many people kind of pushing on this whole idea of the NHII but no one has quite figured out how to actually really get it to move forward and so I'm just going to -- I know that you think about this, but really kind of push that as you guys put this meeting to be, to really kind of push on that issue that talked to the facilitators and everything, that the output of this meeting as much as possible, you know, try and come up with some recommendations that are maybe actionable, something that can really move this forward.
Because otherwise you see this great informational meeting, a lot of kind of great recommendations but maybe the stuff that we kind of already kind of know and I'm just trying to think of how can, since you are going to have all these great people in the room and so much attention, how can we take this as a opportunity to really move something forward and make it really happen.
MR. SCANLON: I agree. We've all participated in summits before that were over, the day they ended.
MR. BLAIR: Jim, as I heard some of the other questions, I'm coming back to the fits and what I'm going back to is our report.
I remember that, for example, when we talked about the National Health Information Infrastructure, we said what it was and we said it was standards and applications. We included values in there.
We do have -- I'm almost wondering -- we have privacy and confidentiality. Maybe that could be subsumed within a broader category of values because privacy and confidentiality clearly are, would be among the values but maybe -- I would just hate to lose that. That was one thought.
The other one was that we also set forth in the report the different stakeholder groups -- towards the end of the report where we had the professional associations, then we had the representative or provider organizations, representatives of the states, representatives of -- and that was what was in my mind when I was thinking of how do you map.
I gave the example. HMSIS but you would have all of those other stakeholder groups that we felt with were essential target areas.
You know, one was, another one was vendor associations, another was -- is there some way we could make some effort to connect back to the stakeholders that we identified so that we could not lose, not lose that connection there somehow.
MR. SCANLON: Sure, I think any suggestions we can actually look at. I'm remembering those pages, Jeff, in the NHII report from the committee where there was actually a lot of stakeholders and, again, this is a fairly open meeting but I think you are saying we should actually make a special effort to invite certain of the stakeholders I think which is fine.
MR. BLAIR: Yes, what I would like to do is I'd like to go back to the report, some of our major recommendations -- we wound up saying these are the stakeholders that are needed to be able to go forward.
And make sure that when we have our meeting on June 30th and July 1st and 2nd, I think it's fine to have the framework that's been created because it's a very action-oriented framework and I like action-oriented frameworks.
But that we do something to cross-map that to the stakeholder groups that we wanted to engage and make sure that they fit and that they are part of it somehow, and the same thing is true with the way we defined what an information infrastructure is and the values is one that I didn't hear there.
DR. LUMPKIN: If I could just sort of branch off of what Jeff suggested, it looks like the structure is plenary, breakout, plenary and breakout but it's the same breakout groups roughly and we don't have to go back to the same ones.
The question is whether or not one of those breakouts might be by category as Jeff was describing so that if there are three or four breakouts, one of those breakouts would be, you know, the provider is getting together, maybe even breaking down between institutional and individual providers. States getting together, looking at many of the same issues but from their group of origin specific approach.
MR. SCANLON: That's a good idea.
DR. STEINDEL: I would like to pick up on that as well because when I look at this agenda, I see stovepipes and the NHII report was an attempt to break down those stovepipes and amalgamate different people who are in stovepipes today into one common direction.
I do not see the various groups coming together in the same sessions on this agenda and I don't see a way that they could be compelled to come together and this is sort of what John is saying and what Jeff is saying.
MR. SCANLON: Well, on the other hand, they are stovepipes of another kind so I think you are right, though, I think we have to plan some way structurally to get the like groups together.
DR. STEINDEL: But the point of the NHII report was that health care is a shared entity and that we have to bring the groups together to bring them into a sharing environment and the report stresses things like privacy and confidentiality is not a stovepipe. It's an inherent feature that needs to be presented across all the areas.
MS. BICKFORD: Carol Bickford from the American Nurses Association. I would like to share with you a strategy that we used in our nursing environment as we developed nursing's agenda for the future and that was to employ the Hoshen Conrey methodology.
DR. LUMPKIN: What's that?
MS. BICKFORD: Hoshen Conrey methodology where we had the desired future state and we actually worked in our work groups to come up with the key drivers that are going to make a success. We had the consensus building, the brainstorming and the final revision of the key action items that will take us forward.
It was a very successful amalgamation, conglomeration, coordination, consensus building initiative because we had our 60-plus specialty nursing organizations going off in opposite directions and as we brought our folks together to focus on the desired future state, and identifying what that looked like and what the strategies were to make that, we came up with a very viable partnering and group initiative coming forward to make that a success.
So I offer that as a methodology to get the consensus buy in and also key action items and identification by those experts of what are the primary three or four activities that are going to help move this forward so I offer that as a methodology.
MR. SCANLON: You can make that available to me?
MS. BICKFORD: I can give you information.
MS. GREENBERG: I realize that I came in in the middle of this, I was in data populations. So I don't know, but this discussion seems to be around something we've been talking about in the Public Health Data Standards Consortium which the community wide informatics.
I think that my reaction to this is the same as Steve's, that yes, we do need people looking at specific areas, but we really need to be looking at the integration across these areas and that's, I think, what we are thinking of in the sense of communitywide so that -- and I think that is the essence of the NHII report, too, the integration across the public health, the clinical medicine, the population, environmental, housing -- I mean, you name it but it's all the contributors to health so I this that this is something that we are going to be discussing, actually, at our steering committee meeting in a few weeks and the consortium would be glad to work with Bill on trying to get this community-wide informatics theme into the meeting. DR. LUMPKIN: I think we are going to have to move on. It's already 5:00.
MS. BICKFORD: This is Carol Bickford again from the American Nurses Association.
One group that you do not have included in this discussion is the health care consumer.
MR. SCANLON: Yes, it's one of the groups. The meeting, Carol, will have one.
MS. BICKFORD: But that's a key point, I think, about your structure.
MR. SCANLON: No, no, I think you are right and I think you are pointing out -- and all of you, I think we just need to find a way to do this. We have the general idea. The National Health Information Infrastructure supports all of the various aspects of health and all of the different communities and I think both in terms of the keynote and in terms of reinforcement and in terms of structuring, we have to keep focusing on that throughout.
We could certainly change some of those -- well, I mean, to some extent, you break out to focus on specific areas, then you have to integrate again and I think it will be a challenge but I think it's just something we have to do.
DR. LUMPKIN: Thank you. The next item on our agenda is to go through the hearings we had in January and see if there are steps that we want to take based upon those hearings.
One area, just sort of to get us started, we had, as you remember, hearings on the personal health record and the National Information Infrastructure and as I was listening to the presentations by the various groups within the federal government that are involved in moving forward the National Information Infrastructure agenda, it seemed to me that other additional HHS agencies ought to be involved in that networking and information technology research and development program and other kinds of things, including ARC and CMS and CDC, participating in some of the active research and development going on.
PARTICIPANT: ARC is a member and does present a research there. We could be more active, that's for sure.
DR. STEINDEL: I'm raising the issue with CDC.
MR. SCANLON: We're probably going to have departmental representatives as well.
DR. LUMPKIN: So it sounds to me that while the recommendation might be to do that, I'm not sure that it necessarily requires action by this committee. Is this something that we maybe might --
PARTICIPANT: It wouldn't hurt, John, to -- in the form of a letter recommendation to reinforce that DR. DEERING: And especially, I mean, HRSA isn't represented here and I think we all saw HRSA, again, certainly not from the R and D side, but that as we mentioned, sort of the consumer, potential consumer of some of this and so getting their perspective there.
I think one of the interesting things was the opportunity for sharing and input in a variety of ways. They have got different types of committees, they are not just bringing a research portfolio to the table so that could be the impact of a recommendation, is that it authorizes people then to go where we don't already have infiltrators at work.
MR. SCANLON: Well, it formally gives us some ammunition.
MR. BLAIR: It would be helpful to me if John, if you and Jim might be able to give us your view of the role that the NHII work group within NCVHS should be playing from this point forward, relative to the work that is, you know, starting to get scheduled for June, that HHS is assuming that leadership role.
And I just have a very fuzzy feeling for not knowing where the boundaries are in terms of us providing guidance and leadership which we did up to now. I sort of feel like the baton has been passed and yet not completely so.
Could you just clarify that a little bit for me?
MR. SCANLON: In terms of the June meeting itself, Jeff?
MR. BLAIR: Well, the role of the NCVHS-NHII work group from this point forward with respect to the NHII.
It's good, it is changing because we now have HHS being able to assume leadership and getting some funding to do so and, you know, what role should we play now? DR. LUMPKIN: I think I can start, based upon our discussions of at least the last two meetings that we've had of the work group.
First and foremost, now that we've passed the baton with our recommendations to the department, I think our responsibility is to monitor that progress and to help them define that so in regards to the meeting in June, I think if that meeting -- there's a work product that comes from the meeting that belongs to the meeting and it's not a federal government document.
By being a FACA committee, we can take that work product, and massage it, make a recommendation to the Federal Government, to the department which then becomes an actionable set of recommendations so it gives it, it sort of refines that product and I think that would be our continued role in monitoring the activities of the department.
The second area that I think we play an important role is now that we've sort of defined the general area is to clarify areas where the report or the activity isn't fully fleshed out.
One is the integration with the National Information Infrastructure which we've done and I think we've identified some areas which, based upon our hearing and other pushes, the department is now moving forward and I think we should come up with recommendations on.
Another area would be in the personal health record which, where there are fewer market forces that are engaged in addressing those issues right now and while there are some -- and I do have to make a disclaimer because I'm one of the executive vice chairs of Connecting for Health but the Connecting for Health work group on the personal health record of the Markle Foundation is going to be coming out with some recommendations which they are going to toss out to the world that I think will be complementary to what we've already done in regards to looking at the personal health record.
There may be other aspects of the NHI which we think there isn't appropriate space for the committee, particularly looking in the area of population health.
We've had some ongoing interest to concerns about meds and med specifications being fully specified, how those are going to interface with the other aspects. So I think that's something for us to look at.
When you start putting all those pieces together, I see a pretty full agenda for this work group in regards to moving it forward, but to the extent that the department is taking up the baton, I don't think we -- I think it's a great thing and something that we just need to play a role monitor.
MR. SCANLON: And let me just continue, Jeff. I think that in a way, many of the things the department is doing are arising out of the committee's work anyway, plus some of the fine work of the agencies over the years that's sort of getting some recognition and has put into place the foundation on which we can actually talk about moving forward but there's a lot more to do and I don't envision that the meeting in June is really -- I mean, I'm certainly looking forward to how it all works out but there are a lot of things to do.
There's much more specific -- your own report on the NHII I think you would all agree had a couple of very specific recommendations of an organizational nature but otherwise, it was at the 20,000 foot level and I think there's a lot to be filled in and I anticipate a lot of back and forth between the department and the committee in terms of specifics and directions.
In addition, I think we were, when Jerrod was here this morning, in terms of the whole clinical data standards and vocabulary area, we are planning to use the committee as you have agreed, whenever we want collective advice, this committee has agreed to serve as the advisory committee for that so we'll be coming back -- I guess I view the NHII as encompassing all of these things, including HIPAA, including PMRI standards, including privacy and confidentiality, including R and D and including these convening activities as well.
So I view the June meeting assort of the step along the way. I view it as arising out of the intellectual work of the committee and some of our agencies as well but I think there'll be a lot of both framework and specific areas that we will come to the committee, again, for hearings, for sorting things out.
In fact, my guess is that when we, actually we have the June meeting, there will be more questions than answers, to be honest, in terms of what strategies does one use, how does one prioritize, what's the best way to sort of maximize the integration across.
So I don't think the committee has the baton at all. We've entered a new stage which I think we can all be happy with because we have actually generated a lot of interest now in moving forward. Now the more difficult questions and distinctions will have to be dealt with.
MR. HUNGATE: I'm coming in a little late to the process but --
MR. SCANLON: But there's so much work to do I would say that you are not coming in late, you are not coming quite --
MR. HUNGATE: Well, let's put it this way. I remember participating 15 years ago in the computerized patient record institute discussion, you know, where you could visualize the National Health Information Infrastructure. You didn't need to talk about a lot.
Among those who are interested, you kind of knew those things. You kind of knew that was where you were going and so I asked myself -- how is what we've got here going to change what's going to happen and I don't have good enough answers for myself because I don't have a sense of what are the tipping points of this thing, and I don't hear the discussion that focuses on what are the critical things that have to happen for this to occur, that there's kind of an assumption, well, if we make it a big enough deal, to make enough noise, everybody will get interested and they will sign up.
Well, I'm not sure whether they will sign up or get frustrate and so I want to get a sense of that. I'm on the frustrated side. And I've wasted a lot of time talking about it so far and so I don't want to do that anymore.
MR. SCANLON: Here at our committee or before we leave the table?
MR. HUNGATE: Well, I'm expressing my expectations for my participation in the process. I'm setting my own standard of what I think I ought to talk about and try to identify.
Let me give an example. My personal opinion is that emotional health status is a critical parameter for measurement of health, and I know that this committee has gone forward and said that's important. But, what's go to make it happen?
I think that unless we say something about well, it's got to be part of the personal health record, we've got to stimulate venture capital and begin to invest in personal health records, then I don't see what's going to change the hospital industry's reluctance to invest in these tools that improve their ability to control process.
DR. FITZMAURICE: This isn't the first table that Bob and I have sat across from each other. We've even sat side by side probably 15 years ago. We were at the same meetings. I'm sure that we were.
And at that time, there were a few of us who could give the vision and, by and large we were talking to ourselves and we got tired of exchanging the vision.
Today, there are a lot for people who have this vision and so the people who have the vision say, well, it's a nice thing to have, what can I do to make it happen.
Of my own personal activities, I jump down into the bottom into standards and push standards and standard development and processes and an awareness of standards so people would know what was going on and why things weren't being done.
Now, what I've seen and what I've seen NCVHS do and I think NCVHS is one of the most important focal points, I've seen standards begin to become reality. I've seen the Secretary, considering what NCVHS is saying, that, Secretary, you ought to adopt these standards.
I see other groups like CHI also being listened to and that eventually the Secretary may adopt these standards and say these are for use in the department. Well, that's a signal to those hospitals out there that there is some basis for this and there's some longevity. Whether it's actual, we'll have to see.
I see also back then we were talking about, well, we need standards for protecting this data. We need confidentiality and privacy. Darned if we don't have a privacy rule and now we've got a security rule. Who would have ever thunk it 15 years ago?
We've got the national committee working on things like vocabulary, patient medical record information standards, to get common agreement. This is not a smaller HL-7 discussion that was held 15 years ago. We have a large HL-7, we have a large X-12 and thing are happening.
There are political powers and regulatory processes that say to save money, somebody has got to take a stand and say, now is the time to do it and here's what you have to do.
The industry got what it wanted and now we'll see if the industry can implement it within a reasonable length of the time but there's been tremendous moves forward, it has moved forward by having public hearings where we find out what the glitches are and then advise the leaders to say this is what you ought to say, this is what you ought to do and here's our basis.
They say, well what do the insurance companies say, what do the hospitals say, we bring them to the table, we get their advice and that forms our recommendations.
So I think John put it on the line with the National Health Information Infrastructure that yes, we said here's what ought to be done, our job is done.
No, it's not done. We have to monitor the follow-up. I would strongly recommend a recommendation coming out and saying, the HC shall play a better part in NIT R and D. My agency has been a member for over ten years, should play a larger part in it so there are many things to be done and it's worth our effort.
DR. LUMPKIN: Let me just add a little bit more to that because I think historically we'll look back and not that the report is necessarily what will be the tipping point but I think our report will be viewed as the tipping point.
Last November I spent an hour sitting at a round table with three or four other people and the Secretary of the Department of Health and Human Services talking about data standards and what's turned a paperless health record in a conference sponsored by the institute of medicine. That wouldn't have happened even two years ago. It wouldn't have happened a year ago.
So we are really seeing a dramatic sea change in the commitment of the lead health organization in the nation to the kinds of issues that we've been talking about and addressing within the NHII.
So when you tailor that and then you look at some of the private sector ventures that are pulling together, some of which may or may not survive or have one, but the Connecting for Health just has an overwhelming support from the vendor community as well as the hospital communities and their projects with the Marconi projects.
The American Academy of Family physicians is pushing forward a product to develop an electronic medical record for individual and small physician offices and small group practices.
There's just so many things that are happening that have been what we've talked about for so long that in looking back, we can see that some of the work of the committee may have helped precipitate this in that it's given everybody a common cry.
They are talking about the NHII. They may not all mean the same thing, but at least they know it's good.
MR. HUNGATE: The thing I guess I feel I would be made more comfortable by would be to have an understanding of the list, if you will, of these critical pieces and some assessment by others of where we are today. Are we 80 percent of the way there, are we still at the 10 percent?
I'm a measurement person. I believe in measurement and so I would like to say, well, we are here today and we expect to be here in two years or whatever that is because then the place where the gaps are the biggest is where we need to put the most work.
DR. LUMPKIN: I think you just defined a hearing. MR. FITZMAURICE: Today we are only ten percent of the way but look at the drivers we have. We've gotten patient safety as a driving force. Quality of care is a driving force.
On the other side we have economics. Prove to me that it can save me money or give me more customers. There are things to be worked out.
MR. HUNGATE: Yes, but if I look at the approach to the quality of the care, I see a quality assessment approach and not a quality improvement approach. I see a punitive approach, not an improvement approach. I don't see a methodology of measuring health so I say I see some stumbling blocks. I see some things happening but I'm not sure I like them all.
MR. FITZMAURICE: And we have to look at that and see how can we bring about a culture change that doesn't make more money out of me having errors done to me.
MR. HUNGATE: I agree.
MS. GREENBERG: You are mentioning the meeting that you went to and then talking about wanting to see some concrete examples of this really being rolled out, if not nationally, at least in a particular areas.
What makes me wonder is what is happening with the fostering rapid advances report and the recommendations for demonstration projects, etc., because I think that that would be, really would provide an opportunity to be put the different pieces together and have some concrete models that people can then, you know, try to implement themselves or show what works and what doesn't work.
Do we know? Has there been any response? Were any of the 2004 budget initiatives related to some of the recommendations in that sponsoring recommendation?
DR. COHN: I saw some legislation on patient safety going by in the last week or two that was actually earmarking money for demonstration projects related to NHII type activity.
Now, the problem was that I think we are only talking 25 million. It seemed like a very small amount.
DR. SCANLON: There are some versions of the patient safety bill that would provide for some demos and there are some matching programs.
I think Bob actually raises a fundamental point which I -- I was at that CPRI summit as well. I was a young man back then. And you were a young man and I remember, and I've also been at the CHIMS summits and everything else where this was the answer.
If people just understood how much the IOM knew and told everybody, it would be no problem.
What it teaches you, among other things is that first of all, timing is a big issue. The country was not ready, the health system was not ready and it was sort of the vision that everyone resonated with but there were almost no practical steps that meant anything to anyone or that had a business case or that had a clinical case or that had a public health case and actually at that CPRI summit, there were about half a dozen things that were viewed as necessary prerequisites, privacy legislation or regulation, security, nobody wanted to worry about security back then.
The unique ID which -- we'll see whatever happens there. Standards, both administrative simplification and clinical standards and things like that and then R and D and other things in support.
But there was no -- very little happened, you are quite right, Bob. Very little happened. The CPRI institute basically folded, everyone went on to the next thing.
So timing, among other things. The country has to be ready, the health system has to be ready. A lot of other things have to be ready, and you never know, when all of the work you have done on standards or whatever else is going to be ready for that timing to move forward.
We actually now have at least three or four of those, half a dozen prerequisites that were raised then but it's necessary, it's not sufficient and I don't think we are really going to see a whole lot more progress until there -- there's a lot of interest, let me put it this way.
There's a lot of interest. There's a lot of recognition of the potential, of the NHII. There's a lot of interest in how computer-based patient records and information technology could support patient safety and public health but there are still not that many specifics except for the standards which I think are viewed by the IOM and others as a tipping point but adopting standards alone won't really, it won't create a single system, for that matter and it won't help a single hospital unless the whole community and the vendor community and others actually make this move forward.
So I don't think there is that much understanding of what the specifics are, of what to do next and that's what I think we thought we would have to have some sort of a conference.
I remember when Dr. Lumpkin presented at the NHII report to our data council. Everyone resonated with the vision and people said, what are the one or two or three specific things that we could do or anyone could do, to kind of actually make this move forward.
And it was very difficult today decide what exactly those were. We started about three or four of them now with standards and privacy and other things but I don't think it is that clear.
I don't think there is a consensus on what the specific things are next. Should you focus on general capability, should you focus on a few technologies, prove some benefits?
I don't think people know and I think the committee would help out.
DR. HUNGATE: Well, it that's where we are, then it's hard for venture capital to fund investments that might solve part of the cost problem or institutional pieces of the system that it hasn't facilitated yet the other part of the world in terms of change.
MR. SCANLON: And that's why you haven't seen in the health area, you haven't seen the Microsofts, you haven't seen the big companies putting money at the health applications that go anywhere.
DR. HUNGATE: But it's a lot bigger problem. It's got a lot more money washing around in it. It ought to be a golden opportunity.
MR. SCANLON: It is, but you have to know what it is that would help.
MR. BLAIR: I think that that's why you see at this point, if I may interject, that a lot of these proposals are calling for the demonstration projects because there have been a number of the developments in academic medical centers, some vendors have been putting forth together systems, but for the most part, the provider sector has become much more mature and much more knowledgeable about these systems.
I mean, in the early 1990's, the provider sector and vendors were euphoric and then there was disillusionment in the mid-1990's and I think we've now reached a stage of realism that, yes, we've got a lot of the component pieces but we are not sure how they fit together.
We've got a lot of the concepts, got a lot of the technologies, a lot of the standards but we've got to be able to pull them all together and do it with cultural change and do it with interoperability and do it with having all the sectors starting to work together so that is what I think is reflected in the agenda that Jim has presented to us for June the 9th and July the 1st and 2nd.
MR. HUNGATE: One last comment and then I'll shut up again.
Because I think they are answers, the thing that I wish maybe we could do in the work group is say what demonstrations would we like to see?
In other words, if we understand this better than anybody else, we ought to be trying to say what demonstrations will best articulate. We are trying to affect the thinking of a broad and fairly skeptical audience that is very change-resistant and I think that the group that comes will be more skeptic then enthusiastic and how we present the motion is part of what the challenge is and I think that's -- it's -- I've exhausted my line of thinking. DR. LUMPKIN: I think, though, that one of the advantages of serving on a committee as this that we don't necessarily have to be the brightest lightbulb in the box because we have the opportunity to invite many of those folks to make their suggestions and then we just have to pick which one of those bulbs seems to be burning the brightest and then take credit for it.
MS. GREENBERG: If you aren't the brightest lightbulb, I'm sorry. When I had you appointed, I thought you were.
DR. LUMPKIN: But I think that what we have done, to the extent that we may want to look at the particular issue of what would make a good demonstration project that rather than trying to start that off here in the committee, the best way is to bring in people from various venues to talk about that issue and then to sensitize that.
We have the wonderful opportunity on the committee, and you haven't had the experience, is that we have a tremendous staff support and because of that, we get the chance to sort of take the reality of what's inside the agency, in our own experience and synthesize that into a letter, a recommendation, a document, or a report that sort of pushes the envelope and I think that that's a very good suggestion and one we ought to put on the agenda.
DR. HUNGATE: Count me among the pushers.
DR. DEERING: I just wanted to add -- interrupt my colleague who had her hand up first -- but just to, from a process point of view, it sounds to me that I was also taken by one of the things that you talked about is a visual graph about where you are on certain issues and being also someone who is concerned about the communication of what this is to the public as well.
It does seem to me that coming up with a simple, a very simple presentation like that is almost a prerequisite to these hearings on why do we need the best demonstrations. Because it helps inform.
At least it can be put out there as one more piece of the puzzle and shared in them so I see them as very complementary and I would encourage us to consider whether we do have a role in trying to come up with almost like a, the famous single sheet of paper that says, you know, by each of these categories, here's about where we are and where a few of the best opportunities appear to be.
MS. BOWER: I was going to say, I mean, from everything we know, from what Secretary Thompson likes, I mean, he certainly likes clear measures and actionable suggestions. I think that's accurate.
But what I wanted to comment on is while you are -- to this idea of what the next letters to the Secretary say is that while you are patting the department on the back for paying attention and for convening, I still think there's plenty of room to challenge the department on the nature of the leadership role because I don't know that convening and paying attention actually do constitute leadership in the sense that it was described by Bob.
And so to the extent that there is plenty of room, I think that given the fact that we've heard from people that this office, the specific suggestion around an office wasn't going to happen, that there's still lots of opportunity to elucidate what the leadership role the might entail and how HHS might work with other parts to sort of share those leadership responsibilities.
Because I think that -- I brought up in other venues -- I don't think the discussion is happening internally in the department yet about all the different ways that the department can sort of step up and play the leadership role.
DR. STEINDEL: Almost to a certain extent, Cynthia raised better what I was going to say because I think -- and I'm going to use her language -- that there are a lot of demonstration projects naturally forming. There have been a coalescence around the development of computerized patient record systems in institution for various reasons.
The department is coalescing around patient safety as a reason to put those systems into place in more and more institutions and as we see that, and Jeff's surveys with MRI show that naturally there is an increasing rate in computerized patient record systems.
We are seeing at CDC the development of public health communication infrastructures on their own in various states and we are trying to instantiate our own systems to promote that even faster.
So I think that the movement to create an NHII is out there. It needs the leadership, it needs the philosophy to put it together. It's going to come together, but it has to come together in an organized fashion, that it exchanges information on a national basis and not on a local basis that cascades up and this only comes from leadership. DR. SCANLON: Well, again, I think part of it is, as I said, I think when these NHII report that everyone I think -- the vision resonates with everyone. Now it's time for that. It's time for the really hard work.
I mean, as hard as it was to get the vision of what the potential is, how this was viewed as a common infrastructure supporting all of these, now I think now, what's the next step? How do you make this happen in public health? How do you make it happen in all of these other areas and how do you do it -- and what is the agreement about what the steps are?
So it's not an easy thing at all, it's quite difficult.
MR. BLAIR: The only piece that I would like to add and this gets back to my earlier comments, is that the report did a little bit more than just a vision. It also set forth a framework and it set forth a road map. Both of those at a high level, but it did and I just didn't want to see us ignore those parts of the report as we start to step forward because I think they are useful.
MS. GREENBERG: On this whole issue of where are we, how far do we have to go, whatever, at the meeting that Bill hosted in December, we did an exercise which people -- it was kind of a brainstorming thing, but of where would we have to be to know that we have achieved it and there would be people, you know, 80 percent of the emergency rooms would be able to do that -- you remember that exercise.
Is that meeting going to be written up? DR. SCANLON: No, we didn't really write it up. We have testimony on overheads from everyone, but I think that procedure, Marjorie, may, it sort of forces you to thinking about how would you know if you had it.
MS. GREENBERG: I mean, I think it would be good if we could look at what came out of -- somebody was taking that down at least. I remember it was being put up on -- DR. LUMPKIN: We taped that up, although I don't think we saved that. Let me see what we have on it.
DR. LUMPKIN: Let me perhaps suggest that we've been doing this agenda backwards which is okay. We've had discussions we need to have.
It seems to me that based upon the discussion that got us launched into this, we want to look at developing a letter to the Secretary regarding more involvement in the NITRD and similar NII activities at the federal level by HHS agencies.
Are there any other recommendations we want to make, based upon our hearing that we did on the NII that people may have taken notes about? Since we report to the Secretary or advise the Secretary.
MR. BLAIR: Certainly we support the conference that is coming up out of the Secretary's office.
DR. LUMPKIN: NII, not the NHII. Because I think the areas that we were concerned about was the fact that there were all these developments happening on the next generation internet and so forth and we were concerned that the health dimension was not building adequately being addressed exactly and what I think -- my take away from the hearing was that there are things that are being developed.
There are some agencies that are HHS agencies that are involved but others probably need to be more intimately involved in these developments and it seems to me that the way this game is played is by bringing money to the table, not necessarily to toss into the pot but by bringing the money to the table and doing it in sort of a concerted way, the R and D activities for the National Information Infrastructure is moved forward and so to the extent that there are HHS agencies that are expending funds that adding this to the health dimension of the National Information Infrastructure will assure that whatever is being developed will address the needs of health.
MR. BLAIR: Well, that's the question. I don't know, have we answered that question? Do we feel as if health is being adequately represented in the National Information Infrastructure and do you feel as if the conference that is being set up is going to meet that need or is there some other representation that we have to make sure happens?
DR. LUMPKIN: The conference -- we are going to compartmentalize our discussion because the conference I think we've pretty much beat to death.
The issue is --
MR. BLAIR: The issue is national information -- not health.
DR. LUMPKIN: Not health, right.
MR. BLAIR: So the question is, is the health industry adequately represented or is the National Health Information Infrastructure adequately represented in the national information infrastructure and I don't know if we've answered that question.
DR. FITZMAURICE: Some of the issues that come up are the need for secure systems and the need for software that doesn't fail or software that can repair itself.
They think in terms of these as moonshots as high speed NSA encryption or decryption of things that, whatever NSA looks at, it may be the words coming out of the microphone so they look at it from a high level science development point of view and they don't see that if health care gets its act together, we are going to need software that doesn't fail or that rebuilds itself because we are operating a lot of the functions that our body fails as we get older.
On the secure stuff, we send patient records all over the place. We need to make sure that the information is contained and secure and that the systems that pass it through can account for it. They have a lot of uses but they don't think of the health uses that people around this payable can think of.
DR. STEINDEL: My comment in response to Jeff's comment is that going into our hearing session, I was aware of what the NIII was doing and the research involved with it. I really felt CDC did not have adequate representation at the table and I'll go one step further.
I didn't feel CDC needed to be at the table. I left the meeting feeling that health did not have an adequate representation at the table and CDC needed to be at that table.
So I think a letter to the Secretary is very important because I think there's a lot of agencies within HHS that don't realize this, that we do have a place in this basic research structure and it can benefit, as Mike just enumerated some very good points that I heard during that presentation that I need to take back, I took back to my agency. Now I have to spend some time convincing that.
DR. LUMPKIN: Maybe if Mary Jo and Steve and Ted could work on the first draft.
DR. STEINDEL: John, you asked if there was some -- John, you asked if there was some other issues. We run into to many meeting with too many different chairs but -- DR. LUMPKIN: But on the new committee now, you can use the word John and usually, you have a high percent of being right.
DR. STEINDEL: I heard a lot at the other session that needed to be raised to the awareness of the work group but I don't think they are ready to be brought to the Secretary and we probably need some time to discuss them and discuss what we should be promoting with regard to that.
Because I heard that there was some abortive starts in various areas with the personal health record and probably some good statements from this group about where work needs to be done would be very helpful but that is not necessarily a letter to the to the Secretary.
DR. LUMPKIN: I think that sounds like we need to make, we will work on a recommendation to the NII, that perhaps we need to do more work on the personal health record and question is when, when is it due.
Is that something that we should look at to have the ready for our June meeting or is that something that we should start after our June meeting?
MS. GREENBERG: What type of work do you want to do?
DR. LUMPKIN: I think we, obviously we don't want to get involved in setting standards, but I think our role is identifying gaps and recommending that these gaps be filled.
MS. GREENBERG: Let me only raise an issue of timing that might suggest one approach or another.
The NCVHS meeting is the 25th and 26th, I believe, of June. The NHII meeting is at the end of June.
The Markle Connecting for Health Initiative is having its big meeting on June 5th where it will announce a lot of findings and one item on the e-mailed agenda that wasn't in the initial agenda, but it was on your e-mailed agenda, if you read that was the thought of holding a hearing on June 4th on some topic that, I mean, to be determined, that would enable us, those members who would have liked to come to the Markle and hear it.
We could do it either the day before or the afternoon of and I, for one, have some suggestions to offer as to what we could begin to do around the personal health record that would make a very legitimate hearing so in terms of identifying what it is we do, we have a certain, we have several calendar opportunities on which to hang them.
DR. STEINDEL: I see the need for us to get together around that time frame.
Now, my question is, do we need a hearing or do we need some committee time to discuss what we've been seeing. I'm concerned that we've had very, very limited committee time since we released the report and I think we need some good, solid committee time to discuss what is going on, what's involved with monitoring, what we have heard but at that time it might be two hearings, that the committee needs to come together and get some consensus and get some statements that we can start articulating in public and I would be in favor of coming together on June 4th not for a hearing but for a committee meeting.
DR. LUMPKIN: I think every everybody is agreeing with that. If that's the issue, do we need -- what do we need to prepare for that meeting so that we can get the most utility out of that. I think timing-wise, even though the announcement is going to be on the fourth, we'll have most of the materials from Markle, we have a few people that have inside tracks on those materials related to the personal health record.
I think that we would probably want to have some discussion on demonstration projects, either to better define what it is and develop the questions that we would want to have addressed at a hearing and some discussion related to that.
MS. GREENBERG: How about asking the department to engage with the work group on what demonstration projects are being considered in response to the IOM reports? DR. LUMPKIN: I think hopefully by then we should be able to have at least not only from the department but also from ARC because my assumption is if it's in the President's budget at least they are beginning to think how they are going to spend the money.
MR. BLAIR: Why did we choose to have our meeting prior to the EHI meeting? I would think that the EHI meeting would be giving us information we would want to talk about and deliberate about. Why don't we hold it the day after instead of the day before?
DR. ORTIZ: It's kind of a procedural question. Relating to what Steve was bringing up, I agree that that would be a very useful gathering. The concern I have is that, you know, sometimes if you get just the committee together, then it's good for us to discuss things and flesh things out, but we may not necessarily have the expertise sometimes to come up with some of the things that we think we should do.
Sometimes when we have these hearings, you have people kind of present, you ask them questions, and that's it.
Are there opportunities within our framework that you can actually have kind of a committee hearing -- committee meeting, but bring outsiders in more in terms of just discussion. You know, where you spend a day --
MS. GREENBERG: Like a round table
DR. ORTIZ: I mean round table, expert panel because I think that would be more productive at this point but I still think that we may need more input and that would hip us, but I just didn't know if we were allowed to do that or not. I don't know what the rules are but it just seems like that might be useful, for us to get together plus bring in some experts on personal health record and then have a one-day expert panel where we try and come up with some items based on that meeting.
MS. WILLIAMSON: I think that's an excellent idea. I also think that we should do, like Jeff is saying, follow up and have this meeting after the Markle meeting. We will have fuel from what they have provided along with a round table discussion.
DR. STEINDEL: I was sighing a bit not because of the format or anything, but just because of the specific statement that we should have some experts around the personal --
DR. ORTIZ: Some additional experts, sorry about that.
DR. STEINDEL: We just had a day and a half of hearings where we heard from the experts around the personal health record and what I took home as a message was that there were no experts with regard to the personal health record and that's one reason why I would like to get some committee time to bounce that feeling off of the committee, to see if that's something that other people came away with and if there are some experts out there, to identify them and bring them in in either a hearing format or a round table format or even not, even in the NCVHS format, but throw those names out into another format so the personal health record could start to be fleshed out.
DR. DEERING: That makes another good argument for holding it after because, in fact, I would say that the collection of people who are working with Markle on the personal health record would probably be brighter lightbulbs, at least they would have received more juice on that topic and considered it more deeply and in detail.
So I think that hearing what they had to report at that time would possibly bring together at least the state of both knowledge and ignorance on the issue.
DR. ZUBELDIA: There is a brand new initiative started by David Keating(?) Of the American College of Pathologists on the open electronic health record and it's starting to pick up some steam and the intention there is to have some sort of open source that can be distributed to the masses as the basis of their personal health record. It's brand new, started about a month ago.
DR. LUMPKIN: Well, how about if we try some modification of that, that we would look at the time on the 6th, that perhaps we would spend the mornings on the personal health record, the afternoon talking about demonstration projects and I'm going to say that the afternoon is not going to be a long afternoon because it is a Friday.
MS. GREENBERG: I think it's a Thursday. Oh, what is the Markle, forth and fifth?
DR. DEERING: No, it's only one day and it's only 9:30 to 2:00 so we do also have an opportunity if people have come in there for it to have a few days to talk in the afternoon of the fifth because it ends at 2:30 at the National Press Club.
We could even see about reserving space over in that direction for that afternoon and then continue the next day. We could have three hours' worth of discussions, well, not quite, 2:30 to 5:30, but anyway, I'm just mentioning this.
DR. LUMPKIN: I think the next day.
DR. DEERING: Oh, including it, but you said you needed to break early so I'm just saying that you could jump start the process by having a few hours.
DR. LUMPKIN: We can look at the logistics later. I'm thinking of basically spending committee time on two issues -- the personal health record and demonstration projects and we would sort of modify the agenda if we've identified a few experts that we might invite to participate in sort of a round table kind of discussion, including some who may be at the meeting on the 6th.
DR. STEINDEL: That's what I was going to ask. It sounds like the brighter lights are going to be at that meeting on the 5th and either extending -- having a session with them on the 5th or if they are available on the 6th sounds like a very good idea to me.
MR. SCANLON: And we would ask, John, I think, when we discuss -- I think we could have the, there are several agencies within HHS talk about what they -- they could view it more from a collective demo program -- ARC and NOM.
DR. LUMPKIN: And actually some of the discussions on the 5th will also address the issue of demos because Marconi will be rolled out so it will be a nice segue into the two issues that we want to discuss. There will be some massage materials as well as some other things that we would want to pull in.
I don't think we would want to be or presented as a committee reaction to the Markle presentation but I think it gives us an opportunity to have some of the people we want to talk to be available and brought in on somebody else's nickel.
MS. GREENBERG: Is the Markle an open meeting? DR. DEERING: I believe so. It's at the National Press Club.
MS. GREENBERG: And any registration fee? DR. DEERING: I don't believe so, but we can certainly verify that.
DR. LUMPKIN: Okay. That takes care of personal health dimension, demonstration projects.
The only thing that I see that we absolutely have to talk about is the hearing on the 18th which we are proposing that that be moved to a different day. And the problem being is that all the people that we want to get, which are many of the folks at CDC who are involved in that and the leadership, it appears that very few of them are available that day.
And so the thought was that there's also a session here on open source electronic medical record which some people my want to attend so if we looked for a day later on, do we have a candidate?
DR. DEERING: I think there's no doubt we would have to circularize, canvass the whole work group but one suggestion from Steve was on May 12th because this is the day before a big meeting at CDC on the public health information network -- is that correct -- and so some of the cast of characters might or might not at least plan to be in town at that point.
So May 12 will certainly be one of the candidate dates that we will propose and we, of course, always check with this great lightbulb here to check his availability. DR. LUMPKIN: Well, I can tell you right now my best guess, unless we are still at war or we are at war that day is the people we want to reach at CDC won't be available. That's the week of top-off. Top official drill. It's a Congressionally mandated every two year drill that involved top officials in the federal and state agencies and it's going to be scheduled that week in Chicago, Seattle and Toronto.
MS. GREENBERG: We'll look elsewhere then. To be continued. But March 18th is not going to happen. DR. LUMPKIN: That is correct.
MS. WILLIAMSON: I did make a few preliminary contacts but I can contact them. One, in particular, had mentioned that the date was a problem for him anyway and he was trying to see if he could juggle so that he could attend but I'll get back to the other two.
DR. LUMPKIN: That gives us a little time. Attached to the e-mail that everybody received was a proposal for the panels. If I could ask you all to take a look at that, given the hour right now and get feedback to Mary Jo within the next week so we can confirm the panels that we've established.
Do we have a list of the questions?
MS. GREENBERG: I think the documents that you got has some questions up at the top of it.
DR. LUMPKIN: So we want feedback on both the questions and the panels so that we can get that finalized for the dates coming up sometime in May.
DR. STEINDEL: So we are looking at -- definitely going to be looking at a May date.
DR. DEERING: We actually did e-mail out almost the same list of panelists I believe
MR. BLAIR: Mary Jo?
DR. DEERING: Yes.
MR. BLAIR: The Subcommittee on Standards and Security will be meeting on May 21st and 22nd. You could tack it on before or after that, that would be convenient for some of us.
MS. GREENBERG: That's going to be in Atlanta and that meeting is going to be here.
DR. LUMPKIN: And the other problem is, again, we are starting to bump up onto June 6th when we've got another meeting scheduled so we may want to look and see if we can do it earlier in May. Or April. I was suggesting that we shouldn't be hard on May if we are not going to do it May 12th.
DR. DEERING: We did canvass you all for early in April. And didn't get a very nice rate of responses but we can look later in April and early in May.
DR. LUMPKIN: Okay. Anything else we need to cover? For those of you who are going to dinner, we'll see you in half an hour. Otherwise we'll see the rest of you tomorrow.
(Whereupon, the meeting was adjourned at 6:00 p.m.)