MR. REYNOLDS: Do you have the letter? When we say we are going to edit it, are you passing something out?
MR. REYNOLDS: The NPI Letter.
MS. BENNING: No, I just got handed the version that Karen and Justine had recommended.
MS. GREENBERG: When did Justine have a chance to prepare a new version?
MR. REYNOLDS: No, she didn’t prepare a new version. They prepared it, I reviewed it, and then they had Justine look at it.
MS. GREENBERG: During this meeting?
MR. REYNOLDS: Yes, oh we were moving. Hey we got nothing to do here, we got to move. They were out there doing it, then they stopped me – so the point was, I think first thing in the morning won’t be any problem with having a revised letter. We were pretty much able to take one section out – I think they did a great job with that.
So, we have a number of things to cover. We want to cover the NPI letter, any NPI feedback, we will talk about the streamlining we just went through. We want to talk about the 5010 issues in preparation for the July meeting.
MR. REYNOLDS: Simon, we just give a quick update that we will have the NPI letter in the morning, we pretty ell have it done already. Karen and Denise worked on it, I’ve reviewed it, and Justine reviewed. We don’t have anything to pass out, but it was more pulling some stuff out, restructuring, not adding, anything. Is that a fair statement?
about the streamlining. Then we want to talk about the 5010 in preparation for the July hearing and we can talk about what we’ve done and what we’ve sent to WEDI what we’ve sent out to others and what we’re going to be sending, as far as them answering, covering different things.
Then I wanted to just spend a minute as to whether or not there were any things that we could hear from this committee that we would want to make sure that we consider as we do the secondary uses. And if there’s anything out of standards or anything like that that would be a subject or situation that anyone would want to consider, I’m not saying there is, but part our effort as we’re going forward is to at least see if there were any subjects or situations anybody wanted to talk about.
And then, just briefly talk about some things past the July hearings as we get there, we may have to take up claims attachments, ICD-10, whether or not after the way NPI occurred again, whether or not we need to do anything else on continuing to improve this process of implementation. You know we did the lessons learned out of HIPAA and the industry didn’t appear to learn a whole lot about grouping up because NPI, which may be the easiest of the ones we’re going to do didn’t really finish on time and we had to put a contingency in place, and then the next couple we are going to have, the next probably three we’re going to have are going to be bigger and tougher again and is there anything we need to do as far as anything there. I’m not recommending one way or the other; and then Simon you had mentioned today whether or not we needed to do anything extra with security for the NHIN.
DR. COHN: I’m still unclear on whether we need to do anything more in security period. Given that my understanding is that there may some changes coming up in NPRM, whether or not there is anything more we need to be doing around that.
MR. REYNOLDS: All right. We’ve talked about the NPI letter; let’s spend a minute just re-addressing the streamlining. We will be sending out to the Full Committee the proposal that came out. Bill Scanlon just stopped and talked to Judy and I, and he will be reviewing that intensely and he is going to recommend some wording for us on how to go about doing that. So that’ll be good. So as we work with him and hear any other input, we’ll start restructuring that – Jeff and I and Denise will take the ball on that – take what Bill has and try to get something back together that’s worthwhile from a discussion stand point.
DR. COHN: Will that be a topic where we come to finalization at the July hearing?
MR. REYNOLDS: That’s what we’d like to try to do, yes – for approval of Full Committee in September. We may have to work on it between July, in a call or something as part of anything else we’re doing.
5010. Denise, why don’t you go ahead and let’s walk through what we talked about as possible agenda and discussion items and everything for the 5010 please, if you would.
MS. BENNING: OK, we had gone through a number of issues that we thought WEDI could address at the upcoming subcommittee hearings on 5010 and some of those included what are the current issues and/or implementation barriers on 4010 and 4010A.1, which is the addenda. We wanted them to provide separate comments for providers and health plans since their issues might be different.
What was it about the current version that lead to the creation of the companion guide and what was missing from 4010 and 4010A.1 that necessitated the companion guides? One of the most significant improvements between 4010 and 5010 for providers, for health plans, for clearinghouses – one of the most significant improvements that have been made to 5010? Are those improvements technical? Do they enhance business processes and in what ways? Are there any timing implementation issues for adopting 5010?
MR. REYNOLDS: Back to our discussion again – is there any reason to consider sequencing? Is there any reason to consider any of this stuff? You know, right now we run everybody to the goal line at the same time – using a football analogy; everybody be ready May 23, 2007.
So basically, even the way its set up now, everybody could be ready at the same time but not ready together. So as a pair, we could be ready May 23, 2007 to do NPI. Provider could be ready May 23, 2007 to do NPI but not with each other. So as we think about 5010 and as we think about timing, and what it does – is there anything we feel – so that’s our timing so the testifiers will give us input on that.
MS. GREENBERG: When is that?
MR. REYNOLDS: July 30th or 31st – prior to one of our marathon weeks. It’s right before the ad hoc.
MR. REYNOLDS: OK, so go ahead.
MS. BENNING: Can we be sure any of the survey results after comments they’ve received on 5010 and also can they put together some industry panels to testify to 5010’s impact and all its different industry categories we talked about. And that’s pretty much the laundry list of what we’ve got.
MS. GREENBERG: Is that a half day on the 31st?
MR. REYNOLDS: Half day on the 30th and full on the 31st. The 30th is a Monday. Some people could come in Monday morning if necessary. I know Simon and some others from California can’t but at least we again would be back to looking at not bringing everyone in the night before.
PARTICIPANT: Are you starting at midday?
again WEDI will be a significant portion of the presentation plus we’ve asked people across the industry to come and discuss it – again with the goal of by the September meeting having a somewhat of a basic update as to what we see – and some of that may be just even reiterations of ok we’re going into the process again and its kind of like the primer – everybody’s has to do what they have to do so as the schedule’s put out, those are the things the Secretary and everybody else has to keep in mind.
MR. REYNOLDS: It may it depends upon how much people know about it and again I think the reason for a preliminary type letter would be to give CMS some kind of input along with the department some kind of input so if they are going to put out a proposed rule at least have had some input, we may not be done with it as a committee, but we may be able to share some early ideas before the actual proposed rule comes out which would allow all that to be considered in a proposed rule – so No, personally I don’t think the subject of 5010 is a one hearing completely. Another thing is I think a number of people in the room will become educated on 5010 from the industry and others, and I think that will create some discussion and also create further activity that we would need to do.
DR. COHN: Well I guess I was maybe _________ in a different way and reflecting back on all of course Karen knows so well as do I at this point – but I think we have to do more than just hear about it, I think we actually have to be sort of advising HHS to go forward with it.
MS. BENNING: And will they be able to do that for us?
MR. REYNOLDS: Yes, they say they will. That’s why we moved it to the end of July. In other words they didn’t feel they could have it by the middle of July and so we planed that they will have it then. And again I think another point is if we cant get as robust a discussion as we would want that also tells us a lot about the fact that it must be either bigger or different because its gone all the way through the SOS – so, the reason why I continue to be a little interested in the streamlining letter is if its gone all the way through the SDO process, we have struggled, in other words, to get honorable discussion. It took Karen and I 30 minutes, I made a few calls and it took Karen and I 30 minutes to put together the primer. We could not get the industry to do the primer. We tried to get the primer at the last hearing and we tried to get the primer for this. Because the SDO’s are over here in the very detail and nobody has thought about the raw impact nor do they want to even allude to what the impact is here. Remember, we got surprised at the last hearing we had, remember Denise?
DR. WARREN: Given what you just said, these are the same people who told us they want to streamline the process and yet it sounds like they are unable to follow the streamline process they proposed.
MR. REYNOLDS: I will temper my comments to say we could not get it from them – no, we could not get it from them, I’m not trying to expound on that – we asked them to give us a primer at our last hearing that we had.
DR. WARREN: An overview of changes.
DR. STEINDEL: I have a comment about this whole discussion which goes back to what we heard during the streamlining process, and one of the comments that was made during the discussion of the streamlining process was that the people who are sitting down at the SDO meetings are not necessarily the people who have the boots on the ground that are going to implement these things in the business offices.
DR. STEINDEL: Now what we’re asking is okay, 5010 is sitting there, its canned, its ready to go and what I’m concerned about is the only people that we’re going to get addressing the subject, because they’re the only ones who have really looked at it are the people who put together the standard.
DR. STEINDEL: Unless we can attract the other people and they are willing to openly discuss it, I’m wondering what the benefit is going to be.
DR. STEINDEL: Okay, people actually out running the business office.
remember, we clearly got a little concerned about this. At the last meeting remember the spreadsheet we got that said the SDO’s were done and they were handed at then to CVHS – remember the columns, and our column was checked off. OK, so process finished filled out our column and then the next columns were what does the industry and WEDI and others think about it? Our testimony is set up from WEDI and the industry to come and present this. Now, remember our hearing was a number of months ago and it was out and now people are realizing and we’ve invited people and made it clear we were having hearings and so I feel we are going to get people at the table.
DR. STEINDEL: Harry, it’s the cast of characters but also the cast of characters within the cast of characters. That we need to be talking to the people who are not the X-12 gurus who are going to say YES we changed this field to make it not optional anymore – you know that’s not what we really need to hear.
MR. REYNOLDS: No, we are not going to hear from them. I’m telling you that is not the hearing we need.
MS. GREENBERG: But you want some kind of matrix that tells you what changes have been made.
MR. REYNOLDS: WEDI has agreed to do that.
MS. GREENBERG: So we will be educating them if they aren’t already in the process.
MR. REYNOLDS: This is going to be both an informational as well as an educational to everybody, but once we hear it – and again the whole reason we want the three breakdowns – if there is a proposed rule coming out – in other words, we all have to remember is there is a lot of work being done on as to when THIS is done when ICD-10 done and so on, so at the same time when everyone says they are we going to do things at a certain time if we cant even get step one started and we cant get the industry to get serious about step one and they cant get a proposed rule without step one you sure know step two isn’t coming anywhere. So, there’s a whole process here that we are trying to deal with so, and its our duty to help – if we agree in streamlining then its our duty to move along and also I know CMS and the department want input from us before they would put out that rule with some kind of guidance so they can include some things in there. That’s where we are, now remember we’re one hearing late. Reason we were one hearing late is people wouldn’t come tell us the last time. I mean we had it all set. We were all set when we met the last time, it was set to go. We were going to hear from the SDO’s and we were going to hear from WEDI.
MS. GREENBERG: What was their explanation; they didn’t have time to do it?
MS. TRUDEL: I agree with all the comments about having the right people in the room to answer the right questions and I think part of what we need to do is from the business impact perspective make sure that as we invite people or as we discuss with WEDI we circle back to folks over the period of time before the hearing in July to make sure that everybody agrees to what the expectations are and that they’re going to be able to produce what we need so that we need to make sure that we have more of a content committee perception than a standards, and an SDO perception so we more a business sense from the AMA, the AHA, and from the plans as to what the impacts are going to be – over and above the normal well it all depends on vendor readiness; it all depends on vendor testing. Those issues are going to be with us every single time.
MS. TRUDEL: So we have those issues, but then we have these others that are related to the business of 5010.
MR. REYNOLDS: That’s why we come up with the categories and that’s why we sent the questions out that we want them to answer.
MS. TRUDEL: Exactly and I think we need to keep – Denise and I need to keep circling back and making sure that we’re getting there.
DR. COHN: Well for the record, I just want to remind everybody and I think we tend to forget, I believe there is an NCPDP standard.
MR. REYNOLDS: When I say this, its all about – DR. COHN: I also, well I just want to make sure that we are all getting _______ people invited and all of that – are we? Maybe not.
MS. TRUDEL: I was told you just wanted 5010 right now.
DR. COHN: I’m glad I am bringing the question up.
DR. COHN: I think the question is do we want to at this hearing at least get a briefing similarly and hear pharmacy support.
MR. REYNOLDS: We got a lot more on NCPDP when Lynn Gilbertson presented it last time than we did on 5010.
MR. REYNOLDS: Remember she gave us a lot more on that, we got nothing on 5010.
DR. COHN: Okay, well I guess I would just say it would be useful for I think to at least maybe one panel for more of a review of the business case plus potentially hearing from some either pharmacy or pharmacist or whatever.
MR. REYNOLDS: Some PBMs, et cetera.
MS. GREENBERG: I just wanted some clarification – will the NPRM which we anticipate, include both the 5010 and the NCPDP changes or would they be separate NPRMs?
MS. GREENBERG: They’d be separate.
MS. TRUDEL: They’re on the agenda as separate documents.
MS. GREENBERG: We’d have to do separate letters in any event.
MS. TRUDEL: No, they could be the same.
MS. GREENBERG: But they’ll be separate NPRMs. I mean, we had the transactions rule included them together, right?
MS. GREENBERG: But these would be separate.
MS. GREENBERG: I was just thinking that some of the substantive changes of 5010 as opposed to final clarification, some of them will enable certain things then it’s a separate question as to whether those things will actually be required. Then other changes, like you said, either be a required new data element or going from optional to required which will have, just by adopting 5010 will have an impact where some of the things are enabled by 5010, but other types – I mean like with ICD obviously -adopting 5010 won’t adopt ICD, it’ll just enable the adoption of ICD.
MR. REYNOLDS: Right, but what it will do is make the field alphanumeric and the minute the field becomes alpha numeric every system that is only numeric now is going to have to change.
and then it’s up to others whether they are going to require it or not.
MR. REYNOLDS: But the point is the databases have to be able to do it.
MR. REYNOLDS: And that’s where we’re going to go with this. So those are the kind of discussions we have to have because that tells you whether it’s this big, this big or what else it is and what other kind of issues and questions that we need to deal with. Is that helpful in the discussion? So that’s why this will be interesting to watch because if we jump in this other process we’re going to have to be that player that maybe brings a lot of that long, or some of our recommendations to some of our testifiers in the end may be that they need to basically step up the people that they have in their initial sessions and other things where they have another process after say they’re finished before it gets to us which is bringing some more people in the room and saying “here’s what it is now how’s it affected” then they come see us rather than us trying to drag that out of everybody.
DR. WARREN: I have a question. Back to the streamlining, given the scenario you’ve just painted if it requires us to hear more testimony then are we still streamlining, because we estimated our process our time limits in that process based on a current volume and meeting budget and stuff like that so if that increases that means we don’t some of the other work if we stay within the same number of meeting and budget or we pas on some new things that are coming down the pike because we don’t have the bandwidth to handle that. Am I tracking where you’re trying to go?
MR. REYNOLDS: You are tracking right on. If you listen to the testimony, the testimony was the more indifferent people would be included in the SDO process.
MR. REYNOLDS: I’m talking about what we were talking about. And, if you remember, I challenged it. I said are you saying you’re going to have business people that are going to be involved in that because if not, where do they go – cause right now they put a lot of their stuff through the NPRM process, they put it through, they send them in and then people have to react to them so if that’s gone – so it SDO us secretary.
DR. WARREN: See and I think the use case they were using was the HL7 experience with the EHR recommendations where they did get business people coming in. They got a huge influx of folks coming in for those very special meeting as they were writing up the description of the EHR that HL7 balloted later and they also allowed those people to ballot without paying HL7 dues. But there was also a huge effort, a lot of done by people in the Federal government who are going out and saying you need to come to these meetings, you need to be process and suddenly there was a solicitation kind of experience and that while it made for wonderful meetings, I mean, Paul is absolutely right – it just lengthened the dialog in trying to get those documents ready to go to ballot. So there was a lot of extra effort and even some extra funding that HL7 had to go to find to support that process. What, you don’t remember that?
DR. STEINDEL: No, I remember it all too well because I was involved with it from basically day one and yes, what you’re saying is absolutely true – we did attract a lot of business people. One of the key drives was a new member to the HL7 process – AHEMA, who is continuing it to this day and I actually think it enhanced the process faster than the normal HL7 ballot. I think we got it through quicker because of those people. We are able to drive the meetings faster to closure and conclusion. These were people who were goal oriented and that’s not common a lot of time in the SDOs. What I’m seeing today – and it not necessarily has shown up at HL7 though they’re starting to spot in a little bit – within in HITSBY and within CCHIT we have the business people.
business people in them. They may have M.D. after their name but they are located in the business office, they’re located in the process, they are trying to figure out “okay how is this certification going to affect my product.” And HITSBY is starting to see the same sort of things especially when they’re putting together the use cases.
DR. WARREN: I guess my concern is the TC that I participated in and chaired at one time at HL7 was patient care, and we desperately needed to have clinicians to come and tell us the appropriate content of the messages. We had plenty of techie guys and computer guys to help us model it and create those things but the actual content of what needed to be in there was difficult to get out.
MS. STEINDEL: And they’re still not showing up.
DR. WARREN: Still not showing up.
MS. REYNOLDS: Remember we asked the question, when we heard the hearing we brought this up as a significant issue so what I’m saying is this next hearing’s going to allow us to build a body of work that is changed and is a little bit like the EHR and it’s going to move along, we’re going to hear it and we’re going to give good input to CMS and we’re not going to have to have six hearings to get it or we’re going to find out there’s a hole.
DR. WARREN: So you’re expecting him to come back and talk about this new process?
MR. REYNOLDS: Plus the industry – fine – but I’m saying the actual one to kind of explain in business terms what it is, that’s what WEDI’s taken on as an aside.
DR. CARR: What did they promise to do at the end of that hearing? I know we had a little bit of back and forth.
MS. REYNOLDS: They did not promise anything at the end of that hearing.
MS. REYNOLDS: Basically WEDI was not prepared to say anything.
MR. REYNOLDS: They now have committed that by the end of July they will do this. That’s our hearing, end of July.
DR. CARR: Well I mean so is there any preview before the hearing of what they’re putting together – I mean what if they don’t have anything?
MR. REYNOLDS: That’s what I’m saying, we will cancel the hearing.
DR. CARR: When will you know this?
MS. TRUDEL: I think that’s the point I was trying to make I think while you were out of the room Justine, that we need to chunk up this workload and put some deliverables and dates on the table so that we can keep checking the progress as we go and at some point make a go/no go decision.
MR. REYNOLDS: I totally agree with you. We have sent them the list of questions and that will be Denise’s and my responsibility, we will do that.
the middle of July – two weeks ahead of time. I mean I’m not going to recommend anybody spending the money if we don’t have a good hearing coming.
MR. REYNOLDS: That’s exactly right.
DR. COHN: Which is one of the things, I suspect, CMS would be very concerned about.
MR. REYNOLDS: Right, that’s exactly right. But again I think we all feel a significant pressure anybody that’s in the industry, there are a succession of things that are trying to happen and there are things in Congress talking about timing of certain things so I feel a real responsibility to try to help make sure we think about these things in sequence, so 5010’s got to move, one way or the other, its got to move somewhere because if it doesn’t then the rest of the train is not going anywhere and then that’s fine, if we say that the industry has not even prepared itself to deal with 5010 then attachments may come out at some point. You know at some point, what’s been interesting watching it from a viewpoint, there are so many things going on that its funny because the same people that these two just mentioned would go to the EHR hearing about what might happen in the business are probably the same people that would may be have been looking at 5010 and some of the other things at least from a standpoint of how they may do it or not because there so many committees doing so may things, when does a new reg – lets take 5010 – when does it jump to the front of the line versus use cases versus other things that are happening that appear to be tomorrow, the next day, or the day after. It’s going to be interesting to see the capacity of the industry to do what it needs to do and step up and do what it needs to do.
MS. STEINDEL: We had a comment made earlier about the other HIPAA transactions that are going to be coming out which are based on 4010, right? There’s going to be more, we have a claims attachment and some that – are they all in play?
MS. TRUDEL: They’re all 5010.
DR. STEINDEL: Are they all in play Karen?
Everything except the claims attachment?
MS. TRUDEL: And we have gotten comments in the public comment process that said don’t do 4010, go to the 5010 version.
MS. STEINDEL: So what I’m actually thinking about then when I started my statement is that there are a bunch of the 4010 transactions that are really not being used well today that we’re aware of.
MS. TRUDEL: Oh for the 278 for instance?
MS. TRUDEL: Right, they’re not, and one of the reasons that their not is not because the transactions don’t work but because there are business flow issues that nobody’s tackled and that’s a different issue that I definitely think is of interest to the committee because when you have a standard transaction you don’t necessarily have the business functions behind it as we discovered very graphically with the 270/271.
MS. STEINDEL: One thing we need to find is if 5010 addresses some of these issues.
MS. TRUDEL: I don’t think it does in that as I said, a lot of the transactions are not used as business flow.
MR: REYNOLDS: It has nothing to do with it, it has nothing to do with data missing, it has nothing to do with capability it has making it part of the workflow, making it part of the vendor packages, making it part of things that would make it automatic and their workflow issues. Everything we wrote up is to, where’s the RRI and some of things is not because of 4010, 5010, 6010, 8010, its because if you don’t make it part of your business process where you’re automatically everyday somebody’ in the hospital you’re automatically pinging with a 270 to see if they’re still covered, and you don’t have to have somebody pick up the phone, or go to a transaction and key it in, that’s what makes the difference in whether these things get implemented and whether start really saving money. I haven’t heard a single – anybody we’re dealing with talk about “well I can’t wait until 5010 and I’ll do these other transactions”, that’s never been a discussion that we’ve had, you haven’t had it either. No that’s got nothing – zero to do with where we’re headed; but its good that its coming out in 5010 because you wouldn’t want the industry to do everything else in 4010 and we get a brand new come out, a 5010, and a brand new one comes out in 4010 – so I think that’s the right approach. So, had enough on 5010, we’ll keep you tuned – were trying to work with all the people to do it. It is our duty to give the department something before they put this out as part of the process and so we’re on it. We’ll do it diligently and we will be good stewards of the Governments’ money and your time.
MR. REYNOLDS: There is a desire though to hear from us soon.
MS. TRUDEL: I don’t actually recall whether its in the regulations agenda or not, but I k now its not on the quarterly provider updates, the CMS QPU, because that only goes out two quarters, so the QPU only goes through December.
MS. GREENBERG: The reason I ask is because you said this probably won’t be the only hearing.
REYNOLDS: No, I’m sayng it was my understanding working with Karen that it may be good for us to have something in September, not as a final, for their planning.
MR. REYNOLDS: Not as a final for their planning.
Yes, again, we may hear a lot. In other words we cancel the hearing we may have something in September that we couldn’t even get enough interest to have a hearing. That is a statement, that is a definition of where the industry is, it’s not right or wrong, its that as a fact. So we’re taking it seriously, as to the process we’ll see whether or not we have enough information to actually make something go. Try to filter everybody’s needs, come up with something that makes sense. Okay.
DR. WARREN: One of the things I think you should consider, and I can forward the documents to you, is I literally this morning in my email got a document AMEA is pulling together a group that is going to be developing a taxonomy of secondary data use and they’re putting this taxonomy together so that people can start talking about the different kinds of secondary data use that are there. My preliminary screening of the document is that it is very physician centric, so as we’re having hearings and stuff, again a reminder that there are other people that use secondary health data other than physicians to do research, so we need to consider that. I don’t know, does this group – I guess I should find whether or not I can share the document – but if I can share the document does this group want to see that ahead of time?
MR. REYNOLDS: We already have it don’t we?
DR. COHN: Yea, Justine and I were there.
MS. GREENBERG: Which presents this taxonomy or the status of the work?
the meeting was on the website.
DR. COHN: Is this the AMEA document?
DR. WARREN: Which I got this morning to take a look at and respond to.
MS. REYNOLDS: Yea, that’s what I got – Simon you gave me the link and I went on and got it out there so – but again, I didn’t want to spend a lot of time on it today I just wanted to make sure since we have the Standards group together and at some point, whatever is going to happen I just want to make sure that we at least discussed it here if people think of things let us know so that we take it into consideration as we are doing what we’re doing. We probably ought to do that with each of the committees, and subcommittees that we have.
MR. REYNOLDS: That’s why I put it on here.
DR. STEINDEL: Harry, the ONC just released the final version of the use cases and HITSBYs meeting this week but the population health work TC of HITSBY has taken on the quality use case and one of the things they’ve been asked to do in that is to define a dataset for quality and defining the standards for using that data set.
DR. STEINDEL: To identify the standards which are appropriate to use in that area.
MS. STEINDEL: Well HITSBY actually also developed a bio-surveillance data set as well until AHIC took it over.
MS. REYNOLDS: But the filter we’re using is obviously the NHIN. And so if every subject is going to come up with their own standard and their own data set then that could put us right back where we came from, which was everybody having their own thing. We’ve talked about adjudicating this, you keep the NHIN in mind you look at the datasets but we make sure we don’t – if you sell out, basically/philosophically sell out to a use case as to what, that’s the data set or the only data set, and that data set doesn’t come from other standards or so on, an interoperability is a word as we go forward that immediately as you try to build it in one way you crush it in another way.
MS. STEINDEL: But the charge to HITSBY, and this is from the very beginning, is they are to harmonize interoperability standards for use on the NHIN.
MS. REYNOLDS: As we listen to these people in other words we need to also be the ones who make sure we keep that filter in mind also because if there’s going to be standards then and you’d be standard not 26 standards.
MS. STEINDEL: And that’s the whole purpose.
MS. WARREN: I have another concern though – if HITSBY going to driven only by the use cases that AHIC has, there are all these other folks out there, I mean right now there’s a big RFP out of NIH for medical centers to develop Centers for translational and something research – I cant remember – maybe its clinical research or something. But I mean our university is going for it, I’m on the writing team, and they are going to be having here at NIH a council where there will be an informatics person from each one of these centers coming together to determine data standards that these centers will be using. Its still in very broad terms but you know my first comment to that was interoperability. If each health science center is going to be doing this I can see doing it in within their own science center but now there is going to be this council of these folks trying to come to consensus on these centers and a big part of this is going to be KBIG which also is looking at data standards to participate in that effort; so this could quickly get out of hand on this secondary data.
MS. GREENBERG: I’m still back at the taxonomy that AMEA is developing. I know it was a recommendation I think of the first meeting but am I correct that the work that the National committee is going to be doing in this ad-hoc workgroup where the initial at least developing the framework and then drilling down to the use case but the overall framework will need to have some kind of high level taxonomy?
DR. COHN: That’s actually from my introduction this morning. That’s actually what I was discussing with everybody. And there’s no reason for us to develop _______.
MS. GREENBERG: Oh no, I agree.
be working together on that part of it because we certainly don’t want these two different taxonomies.
MS. TRUDEL: You mean medication management?
DR. CARR: Yeah, it’s very hard to keep track of all the groups that are working on the same topic and what the hierarchy is – is it just me? Can you make a diagram or something?
DR. STEINDEL: Justine, I’m on about most of those groups and I can’t keep track.
DR. COHN: It’s late in the day so maybe I will hold my comments until tomorrow. I think you may be asking for a level of organization that maybe the United States has not ever really been keen on. I think there’s sort of different ways that you arrive at best. I mean one is an organization approach where you organize, you put everybody into slots and you develop the long range plan; there are other more indigenous chaotic or whatever where really the best rises to the top. And I would suggest that this has really been the history of the United States when you look at standards.
MS. GREENBERG: The question is whether this is controlled chaos or uncontrolled chaos?
DR. CARR: Well I think duplication is just my concern.
DR. COHN: And I think, Harry, you were being probably much more global in your views.
MR. REYNOLDS: Than yours? Okay. Is that good or bad? Oh, Okay, thank you.
MS. REYNOLDS: Thank you very much. We’ve covered everything. You will hear plenty more from us on 5010. Thanks.