DR. COHN: And I think we will pass this, and give the chair the ability to do additional word smithing as needed.

DR. CARR: That here is the steps, here is the way we can shorten them and that includes Michael’s idea about the—instead of an NPRM process, the final rule with the comments. I think the responsibility for us is to say, the process right now can go up to 7.5 years. On average, it is 5 years. We’re going to take a half of a year out of here, and a one year out of here, and our goal is that it would just be no more than a three year process or less. MR.

DR. OVERHAGE: I like the direction of trying to set up the goals and how we can get there. I think that really helps people understand what we’re trying to accomplish and helps lay out the plans. I think that’s the right direction.

MR. REYNOLDS: The second number, the percent of claims is pretty well consistent across the country even though other people may not have as many numbers. MR. UBL: That is what I am seeing from our personal standpoint at Blue Cross and talking to some organizations. We did not go through that statistically in our surveys. MR. UBL: I think that where we are at in our position on this is that, because everybody is operating on different schedules right now.

MS. DOO: And that is a private question. So just to go back to many years ago, the final security rule to make sure that we are all clear, applies to electronic protected health information. So the privacy rule covered all information. Security rule was written very specifically related to electronic protected information that was either stored, created, maintained, or transmitted by the covered entities primarily to protect confidentiality. The right people are seeing the information.

DR.COHN: Alissa, first of all, thank you very much for joining us. Being someone who deals a lot with policy issues, I share, I think, concerns in these issues about HIPAA. I know, when I think of my own organization, which is Kaiser Permanente, that we have lots of people involved in these processes, but as you commented, they are typically the technical people. Usually, when it finally rises up to an NPRM or whatever, suddenly you get strategic and business people and all of that. MS.

DR. WARREN: Take actually and move it in front of has. It should read, actually has implemented. You split your verb up.

MR. FITZMAURICE: A couple of suggestions since this is our final look through.

MS. GILBERTSON: In answer to Simon’s question, these were the three SDOs. This was not a testimony from the DSMO. So that really should be one of the clarifications we submit and the other—from the testimony in the last sentence that is being discussed, from what I recall the testifiers were discussing they want to be able to still submit policy comments to HHS.

MS. GILBERTSON: In the proposal that we submitted to the committee, we had the current timeframe and a proposed timeframe and the savings could be yours because NPRMs take a very, very long time to see the light of day usually. So, your in a factor of years. The other thing to point out is that step one and step two happen concurrently. When the SDO is bringing forth standards, they’re going through their ANSI processes at that same time. MR.

MR. REYNOLDS: No, I was just saying we have to produce a letter. More than likely we will use a lot of the working out of here, I’m just saying we need to actually bring forward a letter that has wording in it. I wasn’t necessarily pointing or not pointing. I think that is a great question. Okay, third one.

MS. DOO: Ideally, if you believe that a modification or additional rule making on security to address issues that are coming up with health IT that this body would consider that and make such a recommendation as it is part of the regulatory process. SO if you deemed it appropriate given what is going on in the industry not just from the enforcement standpoint but from the changes that we need to be more explicit. That is what would be more helpful. MS.

DR. FITZMAURICE: Could I suggest that it might be "and to include substance abuse, mental health and HIV providers" – replace "the inclusion" with "to include." I think that's the sense of it. MR. ROTHSTEIN: Okay. "...to identify and address the privacy interests of consumers and to include substance abuse, mental health and HIV/AIDS providers?" MR. ROTHSTEIN: It's still not great, but it's better. It was great before and then Simon got a hold of it.

MR. ROTHSTEIN: Let me ask Harry and Maria and others what you would think of, at the end of 10.2, just adding these words: "Communicate guidance to the industry on handling privacy issues or take other regulatory action as necessary." DR. FITZMAURICE: I would think that by saying taking other regulatory action, you're saying that's regulatory action – putting guidance out is regulatory action. I think it is. DR. FITZMAURICE: I don't think that's regulatory action.

MS. WATTENBERG: Yes. My concern is about 10.1 and the parenthetical material about identifying the privacy issues within the context of the HIPAA privacy rule. I'm sure many of you will know what I'm going to say, which is – [laughs] – is are we also going – I talked previously with Maria about the issue of the Part II and that it has sort of a higher level of restrictions on some information.

DR. WARREN: I guess I have no problems with it. I am just looking at how many times and how many places do we need to say the same thing? I guess my problem is we have laid out the issues where the delay is, and now we’re talking about the implications of that. So I do not see that we need to refer people back to the previous page. I am fine if we want to put a parenthetic to refer them back to page one, step four. It’s only like two paragraphs previous. It is a style issue. MR.

MR. FITZMAURICE: I would go with the contingency as it is, that is, you can use UPINs if you have them. You get new providers or you have a need for a new number then go with the NPI. I’m just making this as a suggestion to the committee. I am not trying to exert my will on anybody. I am looking for incentives and driving forces to let people ease into it, and this is pretty easy I think. Mr. BLAIR: To me it seem.

MR. NACHIMSON: Neither one. We have plenty of other reasons to slow down. We put it in that rule, and it is still in that same package. MR. REYNOLDS: Let's talk about, so what are our -- you know, we have had the day and a half of hearings on this. What do we want to do as our next steps. I am turning it over to Simon. DR. COHN: I thought we had some very interesting testimony from the DSMOs, and obviously we have a report from them.

DR. FITZMAURICE: It adds to the case being better, but we can't say that it is substantially a change for fear of the secretary saying -- MR. REYNOLDS: No, that is fine. I just wanted to make sure I understood. So, let's go to the next paragraph. Based on, let's start the next paragraph. DR.

DR. FITZMAURICE: Recommendation two. Because time is of the essence for permitting the industry to implement SCRIPT 8.1, NCVHS also recommends the Secretary waive notice and comment rule making under an administrative procedure act exception for the adoption of SCRIPT 8.1 as a foundation standard, so that it may be implemented as rapidly as is feasible for the identified foundation standard functions.

DR. COHN: No, I just had a little bit of word smithing. When you say, for the adoption of SCRIPT 8.1, for the identified foundation standard functions. DR. COHN: Get rid of the rest of the sentence. No, so that it may be implemented as quickly as is feasible, period. So, keep going and put a paragraph after feasible. Now get rid of the rest of it. MR. REYNOLDS: Simon, I know you have got to go to a call. What I would like to do is entertain a motion to accept the letter. DR.

GLENN: Indeed, Melinda. Tonight I'll be attempting to set a new world's record for punching a blogger. Specifically, Frank J. of IMAO. I tried it once in May of 2003, and it was so delightful, I thought I'd indulge myself repeatedly. Heh. GLENN: Heh. Well, as much pleasure as it would give me to bitch-slap that little poofter, I'm afraid the Sullivan-punching record is COMPLETELY out of reach.

MR. REYNOLDS: Well, the process, I think, is set up that the pilot tests are to be reported back to NCVHS.

Um, did I mention that I don't have funding yet? I have no idea when that will happen, so I have no idea when the database and published version will appear.

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