The HIPAA NPRM and the ASTM standard mention continuity of signatures, but I haven't heard anything from the SDOs today about what this problem really involves and I see it as a major issue for the NCVHS to take on. Essentially, continuity is extending the interoperability problem over time, beyond bankruptcy, beyond technology change, beyond ownership of intellectual property.

MS. EMERSON: Yes. I just wanted to make one comment and that is that the -- you know, it came out in this morning's session -- the emphasis on the showstoppers was to try to make this deadline of within the first year. That may have been sort of really an artificial deadline to try to meet anyway. Were the work groups not trying to meet the deadline of changes within the first year, they may not have concentrated just on the showstoppers. Maybe there is not really a need to do that. DR.

MS. KAMINSKY: Well, earlier we addressed something to the affect of, we all believe that the other non bolded recommendations have merit, so we could either reinsert that or we could take out the bolds. DR. DANAHER: Let’s take out bold, I just think it’s just not accepted. I mean if we want to summarize the top priorities -- DR.

DR. NEWACHECK: Not on this point but on another. A couple of suggestions on 26, the one page handout. I think it would be helpful to suggest also that translations and other common languages be available. And on number 28 where we talk about vulnerable populations, I’d like to add in that parenthetic reference low income persons. DR. MCDONALD: Come back to 26.

MS. WEIKER: We are meeting right now once a month per the MOU unless there is an emergency or something like that. We have in our last meeting discussed this with them. There was some modifications, comments. I believe today Mary will be discussing some of that today as well. So, by February we hope to have it all finalized so we know that, for example, a question was asked about the errata.

In regard to X12, as Kepa said, they were not at the multiple joint meeting that we had in Orlando and they are not here today. So, I don't think anybody in this room can say whether X12 has agreed or not to participate. DR. ZUBELDIA: In a letter to us saying this is the agreement of the SDOs. It doesn't have to be a full-blown memorandum of understanding. It is just reflected in a more formal way because they are not here today. MR.

DR. HARDING: Could everybody do their best to speak right into the microphone? I’d appreciate it.

DR. MCDONALD: Well, I just wanted to say I think currently there are, we hear of various mappings around but I think it'd only be legal if somebody already held a license to CPT. I've actually made a contact at AMA to try to discuss this kind of thing and one option might be they would distribute the mapping, or they could manage the licensing and we wouldn't have to worry about it. That's not what they said, that's just in my mind. But yes, I think something could be done and it should be done.

DR. HARDING: What was in the Medicare bulletin was a kind of a generic privacy is now important kind of statement. DR. DANAHER: I think tomorrow we should just figure out, I think it’s a very good idea and it is a very good vehicle, I just think we might, what exactly else do we want included in there. DR.

DR. DANAHER: Clem, just to reiterate I think the point Richard was making. The context in which this point came up and was brought up was that we were all talking about what the Gramm-Leach-Bliley, how we get all these bills from banks, etc., these things. And the net effect is we toss them in the garbage. So we kind of looked at the patient or the consumer and said, come April 14, 2003, they are going to get four or five different Notice of Privacy Practices.

MR. BLAIR: I did. It is on a slightly different topic here. So, I could save my question if there are still people that want to resolve the current discussion. DR. FITZMAURICE: First, on the current discussion, following Don's comments on situational. I am from Indiana and I think we are fairly reasonable people. So, if Indiana Medicaid says they need a variable and it convinced the standard developing organization. I am inclined to think that maybe it is reasonable.

Okay. It has been a long meeting and we want to thank everyone for tremendous participation and involvement. Obviously, this is getting to be very interesting at this point. I think it is going to be successful, but we obviously need to move quickly at this point.

DR. MCDONALD: I'm taking about 10. I just don't understand the numerocity(?) of the code. My understanding is that it's mostly expanded in the injury area and that it really is very similar in the other area. MS. PICKETT: No, there are actually some other expansions in other areas of the classification. The WHO basic version is an alpha-numeric four digit code. The 10-CM is an alpha-numeric six digit code with extensions for certain chapters.

DR. MCDONALD: Yes. I mean if in fact this is the case that is required, and this is sort of hinted, is this just the beginning of what you should do to keep the patient obscured whenever you’re trying to deal with them. DR. COHN: I think without getting into specifics it sounds like we need to remove the example, the example may be causing some problems. Paul. DR.

DR. COHN: This is Simon Cohn. I think as you all know I’m chair of the Subcommittee on Standards and Security. I just wanted to give everybody sort of a brief, maybe much higher level overview then where Jennifer is going to talk about just because I wanted to reflect for a minute on the process and I think as you all know the Subcommittee and indeed the full committee has been involved with these issues for a number of years.

DR. MCDONALD: Well, it's a question/comment. I think that I agree with everybody, but what I'm not sure if I'm hearing that we just want to change labels around, the way I think of it is you've got this inventoriable thing, which includes the package size, the brand and everything, that to me now is associated with the NDC code.

DR. COHN: Well actually want to thank you for helping assure the successful implementation of the administrative and financial transactions. MS. TRUDEL: I believe the way the implementation guides are structured the NPI would be used and other for instance UPINS, etc., would not on the transactions but again there's an understanding that for some period of time, maybe permanently, people are going to need to do behind the scenes cross mapping to existing identifiers. MR.

MS. GRAHAM: Actually if I could, this is Gail from the VA. We have certain carriers that require us on the claim to crosswalk CPT procedure codes to ICD-9 out of Volume 3 procedure codes. This is specific carriers and we had actually hoped that the HIPAA implementation date would resolve the issue because we're having to manually pull these and put the ICD-9 codes on them because we code all the outpatients in CPT. MR.

MS. PICKETT: That's the AHIMA/AHA information is actually included in the NCVHS timeline. The first document on the development of 10-CM/PCS again just contains the complete history of the development of each of the respective classifications. MS. PICKETT: Well I can if that's what everyone would like but given that this document hasn't changed that much we can through this in a very summary fashion just to cover everything.

All you really need to begin practicing yoga is your body, your mind, and a bit of curiosity. But it is also helpful to have a pair of sweat pants, leggings, or shorts, and a t-shirt that's not too baggy. No special footgear is required because you will be barefoot. It's nice to bring a towel to class with you. As your practice develops you might want to buy your own yoga mat, but most studios will have mats and other props available for you.

This is up for debate, but generally 12mph is the lower limit to actually get up on a board. More advanced riders can ride in less, down to around 9-10 mph on some days.

The answer to this question varies with individuals, but during treatment for chronic complaints office visits usually occur about once every four weeks. Again, individual situations may sometimes call for a different schedule; if, for example, the complaint is acute, one visit is often sufficient; if the situation is severe or otherwise demands more attention, more frequent visits may be required for a period of time.

Your written permission for Froedtert and/or the Medical College to let him use your blood for the study.

DR. MAYS: I’m sorry, did I not read it right? These data are urgently needed to adequately monitor, these data are, it is plural in this letter, that’s all I wanted to know, is in this letter I’ve made it plural. These data are urgently needed to adequately monitor the differences in the health status and health care quality of the diverse U.S. population.

MR. HUNGATE: No, it is not related to the hearings. Assume that our word creation has gone more smoothly than it has, and that we had all agreed to all the words. All the words that are said there are these candidates for consideration, 23 total recommendations. It is the conclusion of my workgroup that the first 10 of those would normally be the joint responsibility of standards and security and the quality workgroup.

DR. HUFF: I don't have any objection, if I understood the previous discussions though there's a difference between the finished dosage form and things that are named at the level of the NDC code, because the NDC code basically includes packaging, so you get a different NDC code for each size of package whereas the pills in all the packages could be the same.

DR. COHN: No, I think we're getting rid of including finished drug dosage form, that's what I think we're trying to get rid of. DR.

DR. HUFF: They came from the FDA through HL7, through the structured document committee of HL7. So the FDA and other interested parties at HL7 said as part of proposing this standard for HL7 said these are the label sections that we want, we would like those label sections to be in LOINC so that came from basically the FDA and the people in the structured document committee of HL7 posed a set of codes to LOINC which were subsequently included in the LOINC terminology.

DR. ZUBELDIA: So that brings my question that I noted here, it says that there's no other terminology for labeling, and I thought that the FDA already had some labeling requirements, very specific labeling requirements for manufacturers -- DR. ZUBELDIA: But I don't see any mention of the FDA in this, and I think it probably would benefit to know that it is in fact the FDA expressed as LOINC codes but it is the FDA requirements for labeling expressed as LOINC codes. DR.