American Health Information Community

Biosurveillance Data Steering Group #4

August 18, 2006

**Disclaimer**

*The views expressed in written conference materials or publications and
by speakers and moderators at DHHS-sponsored conferences do not
necessarily reflect the official policies of the DHHS; nor does mention
of trade names, commercial practices, or organizations imply endorsement
by the U.S. Government.*

**[\>\> Kelly Cronin:]{.underline}**

Welcome. This is Kelly Cronin, Director of Program and Coordinators and
Office of the National Coordinator for Health IT. Thanks everyone who
has made the trip to meet with us in person today, we appreciate it.
Through our Web conferences to date, but it really does make a
difference and we can all meet and see each other and get a feel for not
all what we\'re saying on the phone and trying to communicate but
actually really try to spend the whole day together to really get
through what I think is going to be an important part of our agenda.

For those joining us on the phone, we appreciate your participation as
well. We will have time at the end of the meeting for public comment. So
if you could hold off until about 3:55 for your public comments, we\'d
appreciate if you could contribute at that time. But for all of the
members of the Steering Group, I think most are here today in person.
We\'ll be able to talk openly and get through our agenda, hopefully on
time. And with that, I\'ll turn it over to \-- I guess, Matt, you don\'t
need don\'t need to do a roll call. What would be best for all of us to
go around the room and do some brief introductions since we\'ve
introduced ourselves before over the phone now we can match the name
with the face.

**[\>\> Bill Stephens:]{.underline}**

I\'m Bill Stephens.

**[\>\> Eileen Koski:]{.underline}**

Eileen Koski.

**[\>\> Perry Smith:]{.underline}**

Perry Smith from New York State Health Department, representing the
Council of State and Territorial Epidemiologists.

**[\>\> Lynn Steele:]{.underline}**

I\'m Lynn Steel with CDC National Public Health.

**[\>\> Steve Hinrichs:]{.underline}**

Steve Hinrichs, Nebraska Public Health Lab.

**[\>\> Art Davidson:]{.underline}**

Art Davidson from Denver Public Health.

**[\>\> Marty LaVenture:]{.underline}**

I\'m Marty with Minnesota Department of Health.

**[\>\> Edward Barthell:]{.underline}**

Ed Barthell, representing HITSP Group.

**[\>\> Scott Holter:]{.underline}**

Scott Holter from Bearing Point.

**[\>\> Angela Fix:]{.underline}**

Angela Fix from Association of State and Territorial Health Officials.

**[\>\> Paula Soper:]{.underline}**

Paula Soper from the National Association of County and City Health
Officials.

**[\>\> Judy Sparrow:]{.underline}**

Judy Sparrow, director of the American Health Information Community,
AHIC.

**[\>\> Laura Conn:]{.underline}**

Laura Conn, ONC.

**[\>\> Kelly Cronin:]{.underline}**

Great, that\'s everyone here who is officially part of our group. And
Matt, I wanted to make sure we\'re not missing anyone who has called in?

**[\>\> Matt McCoy:]{.underline}**

Nope.

**[\>\> Kelly Cronin:]{.underline}**

Okay. And are we expecting one or more members to join in? Two of them?
Okay, hopefully they\'ll be able to join us shortly. With that I\'ll
turn it over to Co-chairs to get us started.

**[\>\>:]{.underline}**

Thank you all for coming together here, and for your continuing work on
this important project. Glad to mesh the faces with all the voices.
It\'s terrific to see both old friends and some new ones as well. So
thank you, I\'m looking forward to a very productive day here again as I
think \-- as thoughtful discussions along the way.

**[\>\>:]{.underline}**

I agree. We have a pretty full agenda today. I hope we can cover most of
the items that we\'ve planned to address. And move this thing along. The
project is \-- has really done well, and amazingly, over the phone
we\'ve gotten a fair amount of progress and organization done. Looking
forward to what can happen in the face to face meeting.

**[\>\>:]{.underline}**

So I guess our first item of business is to review the notes, the
summary of the minutes from July 7 meeting. Has everybody had an
opportunity to look them over or comments? We\'ve gone beyond them
already, a little bit dated.

**[\>\>:]{.underline}**

And I have not received any formal comments through e-mail. I had one
thing as I read through this, on page 4 it talked about \-- and the six
points the MDS should be complimentary to accessing patient data in
order to minimize the effort involved. I wasn\'t really sure what we
meant by complimentary there. A small point. I don\'t know that it
matters. We\'ll come back to this later. This is a relatively minor
thing we can pick up on later. Anybody have any other comments about the
summary?

**[\>\>:]{.underline}**

One.

**[\>\>:]{.underline}**

On page 4, actually the same paragraph here, just my version says Dr.
Perry. It should be Dr. Smith.

**[\>\>:]{.underline}**

Yes, right.

**[\>\>:]{.underline}**

So I don\'t know if we need to approve these minutes. Is that the
intention to officially approve these minutes? Okay.

**[\>\>:]{.underline}**

If we want, you know, since this is a summary, this is not a transcript
and there is an official transcript, that sentence can be edited,
removed, whatever the group would like to do at that point, I think.

**[\>\>:]{.underline}**

Well, maybe we can spontaneous little time. How do we complement to
reduce effort? I wasn\'t sure. Maybe, Perry, is that a thought you still
have? Was that just captured from the transcript?

**[\>\>:]{.underline}**

Which \--

**[\>\>:]{.underline}**

What that actually meant. That last line.

**[\>\>:]{.underline}**

It may be you attributed this comment but it wasn\'t what you really
intended to say. Just trying to clarify.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

Yeah, I think the point I was making was that the MDS doesn\'t have to
replace all of the acquisition of patient data for public health needs.
That there are other \--

**[\>\>:]{.underline}**

Okay, that\'s being fleshed out. \[multiple speakers\]

**[\>\>:]{.underline}**

I think that\'s what that is referring to. What my point was.

**[\>\>:]{.underline}**

Actually, just did a quick search within the transcript, and there is no
complement word, so it was taken in context.

**[\>\>:]{.underline}**

Okay. So we \--

**[\>\>:]{.underline}**

Yeah, motion to accept as amended.

**[\>\>:]{.underline}**

All in favor?

**[\>\>:]{.underline}**

Aye.

**[\>\>:]{.underline}**

Great.

**[\>\>:]{.underline}**

Opposed.

**[\>\>:]{.underline}**

First order of business achieved. Okay.

So maybe we should just move right into the updates here for HITSP.

**[\>\>:]{.underline}**

An update.

**[\>\>:]{.underline}**

This week, HITSP group is focused on getting a initial draft written
with respect to the interoperability and just to review, I think most of
you probably realize but HITSP\'s broken into three different sections.
There\'s one that is dealing with the EHR; one that is dealing with PHR,
Patient Health Record; and Biosurveillance Group is the third one. With
the latter one, \[indiscernible\] DHR, focused on lab results reporting,
and that\'s also a component of \-- there\'s fair overlap. Some of the
challenges was having people bounce between the different groups and
making sure we\'re going down a path getting everyone \--
\[indiscernible\].

In the technical committee, the analyzed the use case, the harmonized
use case, great detail and extracted out what appeared to be the data
elements specified in the use case. We then cross-mapped that with some
of our interim work that we\'ve done in this group where we took a
series of scenarios that were what data elements we would like to be
able to manage those scenarios, and they come \-- they map up very well.
I mean, it\'s really the crosswalk of those two things, efforts, a very
close match, and some of the spreadsheets.

So then this week we were pinning down what\'s the standard we want for
each of these data elements to be able to citizen to and get that
written into an implementation guide. So we sat in the committee
meetings and had some very painful wordsmithing with documents up on
screen and that went on and on. I think we made good progress.

We split our recommendation into three components which we call three
functional scenarios. So the data is split into a patient-specific data
and then research data. And the patient-specific data can be spent
either using messaging methodology or kind of a document-based
methodology, reflecting that there\'s still some schism there between
the \[indiscernible\] and traditional \[indiscernible\] messaging role.

Research stuff in developing \-- messages, HL7 messages. \[extraneous
background noise\] without getting into too much detail, we\'re making
progress. We\'ve reviewed the individual data elements and I\'ll make
comments on those a little bit later when we go into the section on
\[indiscernible\] I don\'t know if you want to \--

**[\>\>:]{.underline}**

Maybe a couple of little things. We also did occasionally under some
issues that weren\'t expecting because we really have been trying to
harmonize. We had one spec for data transmission for biosurveillance we
would like to see free text data, but an issue arose \-- and also for
the EHR Group they would like to create longitudinal data records and
look at data over time. But the \[indiscernible\] there may be clear
regs that if your EHR, if depositing data in the EHR, is the form your
medical report takes, there may be clear restrictions on what you can do
with respect to transforming that data. So we\'re going to form a small
subgroup to make sure we address that. It may be as simple as adding a
code and keeping the sub-text as well. But we have to look into that
just to make sure that we don\'t do anything that would violate clear
regs. So we\'ve got a small group that\'s going to follow up on that,
including the Chairs and Co-chairs of the two groups involved with that.

**[\>\>:]{.underline}**

And did you have any HHS support in trying to figure out what the CLIA
implications are?

**[\>\>:]{.underline}**

We can look into that. We just unearthed this problem and haven\'t
really started the process of looking into it. And it may not end up
being a big deal but it\'s something we need to be careful of because
now some mechanism to do actually deposit data directly into an EHR, and
that is the only format the official medical report takes, so we can\'t
risk violating the regs. I\'ll contact you.

**[\>\>:]{.underline}**

That would be great.

**[\>\>:]{.underline}**

That was one issue, but otherwise I think that what Ed said, did fairly
represent \-- it is tough \-- we had a lot of people go from one group
to the other to Consumer Empowerment because there\'s an overlap and we
need to be in synch that caused us to be going back and forth. But I
think, you know, we do the best we can with trying to make sure we keep
everything in synch, and keep everybody \-- keep all the activities
coordinated.

**[\>\>:]{.underline}**

For demographics and things in the registration summary, I guess
there\'s probably some similar conversations happening in the technical
committees. Right.

**[\>\>:]{.underline}**

We\'re all trying to come to the same conclusions.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Just go back to the clear regular thing. There was a meeting, an AHRQ,
that I think ONC and CMS were in attendance back in June, that I was
part of, part of the State regional demonstration process and this came
up, the clear regular. And the representatives from CMS and ONC were to
go back to their respective agencies and bring this up. So I know this
is an issue, but I understand it more to be an issue in terms of the
PHR, or just EHR, is what was described. But I don\'t know how it really
would relate to biosurveillance as a secondary use of the data.

**[\>\>:]{.underline}**

It doesn\'t except that we felt in HITSP that it was important as much
as possible to not have different geeds of data for different purposes.
And so to try to harmonize the way the feeds are created to the extent
it\'s possible. So we\'re trying to make it the same so that you don\'t
have too much burden of people having to create one feed for
biosurveillance and one for EHR we\'d like to make it simpler.

**[\>\>:]{.underline}**

I see.

**[\>\>:]{.underline}**

So \-- and I\'ve been in touch with the folks back at Quest to \-- that
took part in the meeting and we\'ll be following up. We don\'t expect it
to be a major problem. But it is something that came up that was kind of
\--

**[\>\>:]{.underline}**

I wanted to go back because I maybe missed one of the points. You said
there were three focus areas and I captured patient specific and
resource specific. Did you mention a third one or did I miss it?

**[\>\>:]{.underline}**

The three functional scenarios that we have a spec, design, HITSP
surveillance \-- \[indiscernible\] patient specific in two different
manners. Sending it either document \--

**[\>\>:]{.underline}**

Okay, that\'s fine.

**[\>\>:]{.underline}**

Messaging for the traditional \--

**[\>\>:]{.underline}**

And that seems to apply as well for the resource?

**[\>\>:]{.underline}**

Well, yes, but we\'ve only got one spec because we\'ve got at least
there we\'ve got a common set of data and it\'s just two different ways
to send it across the wire. That\'s combining it and that\'s how
there\'s three.

**[\>\>:]{.underline}**

And actually, the one thing we were doing yesterday before I left was
really reviewing the gap analysis where there are no standards, that
have been accepted for some of the components where you would like to
have coded data but where there really are not yet good standards
available. Or at least widely used and accepted. And one example was for
example lab orders as opposed to lab results, that one example, where
there are some developing standards but there\'s nothing that\'s really
been accepted at this point.

**[\>\>:]{.underline}**

Okay, so pretty good update. This is just \-- this just happened
yesterday, right?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Any particular issues you think from those meetings that we need to be
looking at today? As we look through this?

**[\>\>:]{.underline}**

I think we could wait for the data element for comparison.

**[\>\>:]{.underline}**

Terrific. Thank you.

**[\>\>:]{.underline}**

Shall we move on to \-- Kelly?

**[\>\> Kelly Cronin:]{.underline}**

An update? Okay. Judy and I are working closely with David B. in trying
to plan the rest of the year, and actually plan 2007, too, with the
American Health Information Community agenda. And we\'re trying to make
sure we \[indiscernible\] everything so when the panel has their work
finished and they present all their final deliverables to the Secretary
and the Community \[indiscernible\] from the Nationwide Health
Information Network, and the Certification Commission, and the
respective Workgroups, so we have a sequence in mind and we know, you
know, the appropriate target dates that everyone should be working to.
Particularly now, with the existing Workgroups that have been working
since January, there are going to be going through a privatization
process trying to identify the use cases for 2007.

So with that in mind, we\'re trying to figure out the ideal target dates
for this group to be looking at in trying to come up with some final
recommendations to present to the Secretary on minimum dataset, on the
other more specific things in the scope of work. And we thought that in
talking to Art and Marty, that we should propose perhaps a timeline that
we should all shoot for as a target. And then we\'ll see how we can try
to work to meet that. And as a first date, to have some preliminary
results on our minimum dataset, and feasibility assessment, September 21
is going to be when the Workgroup, chaired by Dr. Gerberding, and we
thought it would be helpful to bring them up to speed on what our
findings are and get their input. I think you know we have additional
State and local health representation on that group, give them a chance
to contribute and share what their thoughts are based on their
experience.

So I think that would be a good chance to not only orient them towards
the process, but also really give a substantive update on exactly what
we think, based on the scenarios, based upon the feasibility assessment,
on the short-term public health function that is we agree on, hope any
today, what we think the most solid minimum dataset is.

So for the first target date would be September 21, and that would be
more for a preliminary report to them.

And then we have the next opportunity to meet with them, with a more
final set of recommendations on October 17, and then the report or
presentation to the Community and the Secretary would be on the 31st of
October. Yeah, it would have to \-- and I believe that would be Art and
Marty presenting on October 31, as a final target date.

So that gives us roughly, what, about nine weeks, nine to ten weeks to
try to really finish all our work, and at least for this phase, and then
we can make an assessment on the need to continue on.

So I thought it would be good to get people\'s reaction to that, and
give you a chance to weigh in on what you think is realistic or not
realistic.

**[\>\>:]{.underline}**

Any comments from the group? About this 9-week sprint?

**[\>\>:]{.underline}**

How does that line up with the HITSP timeline?

**[\>\>:]{.underline}**

\[indiscernible\]

**[\>\>:]{.underline}**

They\'re sprinting as well for October 31, presentation, or is that \--
are they both in your mind are those coming together?

**[\>\>:]{.underline}**

Ours will be sooner than that.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

As long as we shrink the data elements, HITSP will be happy. But if we
add anything \--

**[\>\>:]{.underline}**

Sounds like at least there\'s some time to harmonize, if necessary, or
synchronize between those two. If any surprises come out between now and
the 21st. As to incorporate into the HITSP report on the 29th, if
necessary, at least they could consider if for some reason \--

**[\>\>:]{.underline}**

Yeah. And I also think if a lot of the work here will be more
feasibility-oriented over the next several weeks, that as long as we
have our superset of what we think we might need, we\'re probably safe
for then. If we end up paring down, and that\'s going to be a proper,
more of a practical implementation issue.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So on the 21st, will that \-- we\'re kind of getting to the item later
in the day, the timeline. But since you brought it up, are we expecting
that someone from this group would be presenting to the Biosurveillance
Workgroup?

**[\>\>:]{.underline}**

On both September 21 and the 17th, which could be again through the Web
conference, it wouldn\'t necessarily have to fly to Washington.

**[\>\>:]{.underline}**

Okay, great.

**[\>\>:]{.underline}**

17th and 31st.

**[\>\>:]{.underline}**

17th, October would be when the Biosurveillance Workgroup is, another
public meeting that would give us a chance to present final
recommendations that we have. And get feedback on that prior to then
going to the Secretary and AHIC.

**[\>\>:]{.underline}**

Still opportunity to adapt it before the 31st?

**[\>\>:]{.underline}**

Yeah, it would be two chances for the Biosurveillance Workgroup to weigh
in, and I guess we\'d be hopeful with the preliminary up \-- most of the
substantive comments would be \[indiscernible\] at that point.

**[\>\>:]{.underline}**

\-- would be raised at that point.

**[\>\>:]{.underline}**

I didn\'t want to jump into this timeline prematurely Art or Marty, but
if you wanted to \-- this is sort of where we are.

**[\>\>:]{.underline}**

I guess the context of your thinking. Great.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Okay. We can keep that in mind, I think, as we move through the agenda
today how can we best meet the targets as we move forward. Deal with the
next steps issue and the feasibility.

**[\>\>:]{.underline}**

Okay, so we can move along to the next item on the agenda, and \--

Next draft assumption, our definitions. And some other preconditions.
Scott, I think we have them in here, right?

**[\>\>:]{.underline}**

Correct.

**[\>\>:]{.underline}**

First line is biosurveillance work, preconditions for deciding on
dataset element. It\'s just one page.

**[\>\>:]{.underline}**

You\'ve seen this last time, had some modifications to this. At this
point I think we\'re looking at final additional changes to or updates
to the precondition.

**[\>\>:]{.underline}**

We need whoever is speaking to be much closer to a microphone, very hard
to hear over the Internet right now.

**[\>\>:]{.underline}**

Speak up; is that a little bit better?

**[\>\>:]{.underline}**

Yes, that is, thank you.

**[\>\>:]{.underline}**

Great.

**[\>\>:]{.underline}**

We could turn it off mute, would that help?

\[laughter\]

**[\>\>:]{.underline}**

That\'s usually helpful.

**[\>\>:]{.underline}**

Thank you for those comments and sorry about the sound connection.

**[\>\>:]{.underline}**

What we wanted to try to do was just again update as we move forward on
the preconditions from our last meeting, and Art, any initial comments
on those in.

**[\>\>:]{.underline}**

I\'ve got some wordsmithing on the document on the plane flight out but
I don\'t think there\'s \-- unless someone has other comments. Yes?

**[\>\>:]{.underline}**

One comment. Number 6, I think we better add authorize healthcare, and
public health officials.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Healthcare and \--

**[\>\>:]{.underline}**

And line 5, is a word missing?

**[\>\>:]{.underline}**

Should be and for the other.

**[\>\>:]{.underline}**

And number 1, I thought we had talked about \-- and I forget who made
the suggestion, data should be readily available in new and emerging
data systems.

**[\>\>:]{.underline}**

The concern \-- I wrote it down from our last discussion.

**[\>\>:]{.underline}**

Maybe what \-- the simpler change maybe say obtainable?

**[\>\>:]{.underline}**

Yep.

**[\>\>:]{.underline}**

What I had done for this one, I modified this a little bit. I took what
was the tail of 3 and incorporated that in one. And I just left 3 at
"Data will be available within 24 hours." And then changed 1 to now
read, "Data will be readily electronically available with minimal new
clinician and/or facility effort from ambulatory care," parentheses,
"ED, outpatient settings, in-patient, hospital, settings and
laboratory." So I thought the emphasis in this one was about its
availability, and in the other one it\'s \-- number 3 was about the
timeline of its availability. Kind of separating those two out. We can
continue to wordsmith on these, yeah.

**[\>\>:]{.underline}**

I think what we\'re setting is 24 hours as a minimum, but I think we
personally believe that data is much more important, the real-time
becomes important. Is there some way we can say \--

**[\>\>:]{.underline}**

The maximum or do you want to change \--

**[\>\>:]{.underline}**

Yeah, real-time but not exceeding 24 hours.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

And wherever it would fit with what your edit, your restructure.

**[\>\>:]{.underline}**

Should we just plug these in? I can plug \-- if we want to project them.
Is there \--

**[\>\>:]{.underline}**

Perry\'s comment incorporated in number 1? I think that will be
addressed with the wording \--

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

So is there a way to plug in?

**[\>\>:]{.underline}**

New and emerging \--

\[multiple speakers\]

**[\>\>:]{.underline}**

The Internet connection.

**[\>\>:]{.underline}**

I\'ll check.

**[\>\>:]{.underline}**

Just a comment on if we\'re looking at further justification of our
efforts, and actually expansion, we may want to consider that this issue
of situational awareness is also relevant to response to
\[indiscernible\] and it can be used to monitor our effectiveness of
response to crisis or epidemic as well as just detecting it and its
spread.

**[\>\>:]{.underline}**

Maybe the side locations, control.

**[\>\>:]{.underline}**

All those work.

\[laughter\]

**[\>\>:]{.underline}**

Can let Art be the official wordsmither.

**[\>\>:]{.underline}**

I captured that.

**[\>\>:]{.underline}**

Thank you.

**[\>\>:]{.underline}**

I was actually wondering, Point 5 indicates the information is only
going to be used for biosurveillance and public health purposes. If
Point 6 we shouldn\'t say for registered and authorized users and not
totally constrain it at this point because in an emergency we\'re not
sure, I mean it\'s only going to be for this purpose but \-- no? Okay.
We\'ll.

**[\>\>:]{.underline}**

We\'ll get into HIPAA restrictions if we don\'t really limit it to
healthcare and public health.

**[\>\>:]{.underline}**

Okay. Is \--

**[\>\>:]{.underline}**

And it\'s one of the biggest concerns is who else has access to the
data.

**[\>\>:]{.underline}**

I understand that. No, I think we have to limit that.

**[\>\>:]{.underline}**

Doesn\'t mean that analyzed data can\'t be shared in emergencies.
\[multiple speakers\]

**[\>\>:]{.underline}**

You want to say patient-specific \--

**[\>\>:]{.underline}**

Patient-level.

**[\>\>:]{.underline}**

Yeah, patient-level information.

**[\>\>:]{.underline}**

Okay. And I guess the other issue is do we want to leave \--

**[\>\>:]{.underline}**

That\'s what I was thinking \--

**[\>\>:]{.underline}**

Patient-s \--

**[\>\>:]{.underline}**

Patient-specific or patient-level.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Data.

**[\>\>:]{.underline}**

Do we want to specify healthcare payment, treatment and operations? If
you leave it silent it could be research \-- if we\'re concerned about
HIPAA treatment and operations would be \--

**[\>\>:]{.underline}**

Clinician \--

**[\>\>:]{.underline}**

Right, versus just general \--

**[\>\>:]{.underline}**

To be used by healthcare clinicians. But then \--

\[multiple speakers\]

**[\>\>:]{.underline}**

We have constrained it which generally would not include clinicians,
treatment and payment operations \--

**[\>\>:]{.underline}**

You\'re on.

**[\>\>:]{.underline}**

There we go.

**[\>\>:]{.underline}**

Who was that?

**[\>\>:]{.underline}**

So you think \-- your suggestion initially was to add healthcare because
you think there will be other healthcare purposes that are not publicly
\--

**[\>\>:]{.underline}**

There are other authorized healthcare users. I mean, when we \--

**[\>\>:]{.underline}**

I\'m talking about BioSense, but if we talk about healthcare users are
users of this system because somebody like a Kaiser can now see across
all their facilities, it\'s important that we say they are also
authorized users. Right?

**[\>\>:]{.underline}**

But then that violates the constraints in number 5. If somebody like
Kaiser is looking for their facilities, is that for public health.

**[\>\>:]{.underline}**

Biosurveillance purposes. It\'s to help public health to interpret their
data.

**[\>\>:]{.underline}**

And again maybe the healthcare facility owns the information anyway, so
we don\'t \--

\[multiple speakers\]

**[\>\>:]{.underline}**

And that\'s what makes them authorized. So you\'re right, maybe we
don\'t need this.

**[\>\>:]{.underline}**

I mean, if we keep it strictly to public health purposes, that\'s still
broad.

**[\>\>:]{.underline}**

I retract my question to number 6.

**[\>\>:]{.underline}**

So we\'re scratching \--

\[multiple speakers\]

**[\>\>:]{.underline}**

The point is they\'re already authorized.

**[\>\>:]{.underline}**

They\'re not necessarily public health officials so we want to change it
to say registered and authorized users in.

**[\>\>:]{.underline}**

Health officials?

**[\>\>:]{.underline}**

Health officials?

**[\>\>:]{.underline}**

You\'re withdrawing the healthcare because they already had rights.

**[\>\>:]{.underline}**

They have rights because it\'s their data.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So then we just go back to the health officials, health officials does
not \-- you it\'s not jurisdictional. It could be non-public health. A
plan.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

So we\'re \-- okay. So you want to withdraw that in.

**[\>\>:]{.underline}**

I withdraw. Scratch the last ten minutes of my life.

\[laughter\]

**[\>\>:]{.underline}**

Are we looking at a case that the health officials would want to look at
data of different health systems?

**[\>\>:]{.underline}**

Right. I mean, does it hurt to leave healthcare in here?

**[\>\>:]{.underline}**

It doesn\'t hurt.

**[\>\>:]{.underline}**

If it\'s authorized.

**[\>\>:]{.underline}**

Because if there was a circumstance where we might want to let somebody
see somebody else\'s data and they were authorized and they were
healthcare workers, we\'re sort of covered.

**[\>\>:]{.underline}**

It could be acting in a public health capacity and in an institution but
not be considered public health officials.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Control practitioners.

**[\>\>:]{.underline}**

Absolutely.

**[\>\>:]{.underline}**

So we\'re putting it back in, you think?

**[\>\>:]{.underline}**

Yeah.

\[multiple speakers\]

**[\>\>:]{.underline}**

So healthcare users or professionals?

**[\>\>:]{.underline}**

Healthcare and public health officials.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Healthcare professionals and healthcare professional.

**[\>\>:]{.underline}**

Healthcare professionals and public health officials.

**[\>\>:]{.underline}**

I thought your point was that \-- there may somebody sharing of data,
non-patient-specific data, resource data that would be valuable to
emergency planning. So \-- I thought that what we were doing is allowing
ourselves to share some of the resource data outside. You want to put
patient specific \-- precede both of those?

**[\>\>:]{.underline}**

Uh-huh.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

I want to make sure we don\'t paint ourselves into a corner.

**[\>\>:]{.underline}**

I think protected health information has really \-- HIPAA restrictions
which means we couldn\'t get\
ZIP code, we couldn\'t get some of the \--

**[\>\>:]{.underline}**

I don\'t really think we need \--

**[\>\>:]{.underline}**

Not suspension for public health \--

**[\>\>:]{.underline}**

Deemed not essential for public \-- authorized public health purposes.

**[\>\>:]{.underline}**

Are we asking for a ZIP code \-- something that\'s not permitted to be
sent?

**[\>\>:]{.underline}**

If you\'re really following HIPAA de-identification, you cannot \--

**[\>\>:]{.underline}**

You can get the three usually, but not \--

**[\>\>:]{.underline}**

Three, not five.

**[\>\>:]{.underline}**

Are we suggesting introduction to 7?

**[\>\>:]{.underline}**

Protected health information deemed not essential for authorized public
health purposes.

**[\>\>:]{.underline}**

So is this \--

**[\>\>:]{.underline}**

So we\'re not explicit about who filters. We\'re just saying that it\'s
retained by this admitting authority.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

And that was something actually \--

**[\>\>:]{.underline}**

No, this isn\'t Scott. This is \-- I just \-- loaded up from here.

**[\>\>:]{.underline}**

Is it possible for me to \-- okay.

**[\>\>:]{.underline}**

So what we\'re saying here is that ZIP code writs needed by public
health will be collected.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Even though it\'s protected or not deemed. And in implementing that, at
least in discussion with our lawyers, we are not allowed to collect ZIP
code in \[indiscernible\] unless something is reportable in New York. So
if we were to say as a group, we need ZIP code because we need to do ZIP
code analysis for all of the need for biosurveillance, is that \-- are
the lawyers going to have a problem with that? Because at least at the
State level, saying has to be in statute or regulation to be public
health. Can we just unilaterally say it\'s essential, or \-- I\'m not
sure the process to implement what we just have written down here.

**[\>\>:]{.underline}**

Do you have legal authority in New York to do biosurveillance?

**[\>\>:]{.underline}**

We can\'t collect without patient consent, under HIPAA we can\'t get
anything we want to collect from the patient record unless it\'s
reportable. To public health. That\'s the difference between \-- so \--

**[\>\>:]{.underline}**

One is not an authorized public health purpose.

**[\>\>:]{.underline}**

How are we going to do that at the national level for \-- how are we
going to implement this? Not every State law is like. This Maryland, for
instance, it\'s basically there\'s a clause in there, any other public
health purposes. Authorization to collect information.

**[\>\>:]{.underline}**

Prevention and early detection.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Really is going to depend upon State statute.

**[\>\>:]{.underline}**

Until you get your State law changed or lawyers to agree it\'s for a
public health purpose \--

**[\>\>:]{.underline}**

Your lawyer said what? \[indiscernible\].

**[\>\>:]{.underline}**

But I think it depends upon the State. And I\'m no lawyer, but I don\'t
think our health department can unilaterally decide well, we need to
have such and such ZIP code reported because we deemed it as public
health essential.

**[\>\>:]{.underline}**

It\'s in public health law.

**[\>\>:]{.underline}**

It sounds like that\'s not the case.

**[\>\>:]{.underline}**

No, probably \-- I think most States have generic language that they can
have leverage to collect as they see fit.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

Anything they see fit.

**[\>\>:]{.underline}**

Especially since the 9/11 and anthrax and a lot of States have \--

**[\>\>:]{.underline}**

All right, certainly \-- \[indiscernible\]

\[laughter\]

**[\>\>:]{.underline}**

Usually something generic like control, protect, and prevent.

**[\>\>:]{.underline}**

Minnesota would be similar to New York in that sense for there\'s going
to be greater scrutiny about the justification for data of a particular
event or disease that we\'re looking at.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

That clause will be invoked only in special circumstances.

**[\>\>:]{.underline}**

I will say the commissioner has the emergency \-- or emergency powers
which have to be approved with our public health council a month later,
they meet every month. So there is a mechanism we can collect anything
we want, but there\'s a review process and so that\'s how it works.

**[\>\>:]{.underline}**

There\'s something we discussed at HITSP also about the whole process of
\[indiscernible\] that involve really invoking a service and not yet
getting to the point of dictating exactly where this happens. And this
might really support even further the need for that, because then you
could customize it a bit by the recipient in terms of what data got
filtered out before they \-- before the person was able to work at it if
it came from the original naturing source like a hospital, but you
aren\'t yet entitled to it, that would be filtered out for you and other
people could get it.

**[\>\>:]{.underline}**

Perry\'s comments are important now that I read number 7 again on the
deemed not essential for public health purposes. Is early detection
prediagnostic, special filter something that considered for public
health purpose?

**[\>\>:]{.underline}**

I hope so.

**[\>\>:]{.underline}**

Filter out a ZIP code because of the standard or whatever. That\'s going
to upset the apple cart.

**[\>\>:]{.underline}**

I think the \-- have already looked at in New York and elsewhere are
actively collecting it so I think they\'re interpreting your State
statute to allow for it.

**[\>\>:]{.underline}**

Just confirming.

**[\>\>:]{.underline}**

Would collecting it in de-identified ways, so I didn\'t \-- I was
reacting to the point that HIPAA says that it\'s \-- what \--

**[\>\>:]{.underline}**

Protecting health information.

**[\>\>:]{.underline}**

Not the same as being exempt.

**[\>\>:]{.underline}**

Are we okay on number 7 here?

**[\>\>:]{.underline}**

I think so.

**[\>\>:]{.underline}**

We\'re trying to pull it up on the screen here for everybody.

**[\>\>:]{.underline}**

Because the latest wording of that \--

\[multiple speakers\]

**[\>\>:]{.underline}**

Are there other items on here that people have for suggestions?

**[\>\>:]{.underline}**

Is everyone comfortable with number 8 in particular?

**[\>\>:]{.underline}**

Significantly modified that so I\'m hoping we\'ll get \-- I\'ll read the
latest version of that. First of all, I changed the wording to have the
future tense, it was all will. There\'s a variety of tenses throughout
this. I changed them all to will. But the wording I put down was a
randomized data linker will assure that authorized users are able to
link and unlink data to the appropriate facilities.

I don\'t know if that made it any clearer.

**[\>\>:]{.underline}**

Can you read that again?

**[\>\>:]{.underline}**

Randomized data linker will assure that authorized users are able to
link and unlink data to the appropriate facilities.

**[\>\>:]{.underline}**

Under what conditions?

**[\>\>:]{.underline}**

Do we want to talk about \--

**[\>\>:]{.underline}**

Under what conditions?

**[\>\>:]{.underline}**

Authorized public health \--

**[\>\>:]{.underline}**

Authorized users.

**[\>\>:]{.underline}**

That applies, yeah. Conditions above.

**[\>\>:]{.underline}**

This is a sticky \-- I mean, you could be an authorized user of the
system and not have authorization as a \-- part of an investigation,
necessarily.

**[\>\>:]{.underline}**

That\'s a good point.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

This is a sensitive one. I think be more specific, the better.

**[\>\>:]{.underline}**

I agree.

**[\>\>:]{.underline}**

Both the users and the purpose is what I\'ve heard suggested here, to
incorporate into this.

**[\>\>:]{.underline}**

The concern is that this should only be done by local public health
officials. If we want to try to create language that says there could be
a national event, where, you know, Federal public health would be an
authorized entity to get that information. But that\'s the slippery
slope here.

**[\>\>:]{.underline}**

Let\'s just deal with the purpose, and so you were saying during an
investigation, if we add that as a clause at the end of this, is that
the notion that we heard? There was a purpose notion. So just
investigation? Are we looking at tying it to number, like, 2c,
basically, investigations and routine public health followup in I think
that\'s the notions that are here.

**[\>\>:]{.underline}**

I would also say something about assessment because we\'re looking at
protocol, developing protocols for assessment as well as investigation.

**[\>\>:]{.underline}**

Keep it generic say for authorized public health investigation.
\[indiscernible\] it may be different in different jurisdictions.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Part of the problem is we\'re dealing with a theoretically different
concept in terms of the data element because there\'s some place that is
are able to find them now, but given the State of patient
identification, across different data sources, this is not going to be a
simple thing to apply and that\'s probably hindering us in trying to
figure out how we\'re addressing it because of that. Also relevant to
focus on the word "randomize." Because with that you\'re not going to
unlink. You mean encode or encrypt.

**[\>\>:]{.underline}**

Yeah, that\'s better.

**[\>\>:]{.underline}**

Also, the way this is written, I read this to mean that you\'re
unlinking, identifying the facility that\'s reporting. But there\'s also
the level of unlinking the patient record within the facility. So there
are two levels. And this only deals with keeping the facility
confidential.

**[\>\>:]{.underline}**

No.

**[\>\>:]{.underline}**

It\'s where the facility \--

**[\>\>:]{.underline}**

I think we need a unique data linker.

**[\>\>:]{.underline}**

I think it should be reworded.

**[\>\>:]{.underline}**

Unlinked data to the appropriate facility to the case records at each
facility. Is that what that means?

**[\>\>:]{.underline}**

The concept we came up with anonymize, where you\'re getting the data
and you\'re not going to be able to link back but just getting less
statistics and can get an idea of what is happening at the time but you
don\'t have the ability to say I need to go back and say \-- or how many
individuals versus how many repeated incidents are there and so on.
Where the synonymized linker was one where you could go back and create
that case and access the case and get additional data about it. So
that\'s kinds of where we were trying to deal with this. They\'re very
different things. And much easier to anonymize because you basically are
just removing identifying \[indiscernible\] where creating the ability
to track back. It depends upon the context.

**[\>\>:]{.underline}**

In certain circumstances.

**[\>\>:]{.underline}**

Exactly. But creating the ability to track back is a whole other story.

**[\>\>:]{.underline}**

I first heard the word "anonymize" at the BioSense presentation in
April. Prior to that, I think you had used a different term. Maybe I
missed that before. Was there a change to that term? No? You had always
said \-- wasn\'t it de-identified before?

**[\>\>:]{.underline}**

No. We really were \-- what we were saying was patient demographics with
obvious identifiers removed and in fact that\'s still the lump we try to
use. Even the word "anonymize" gets \--

**[\>\>:]{.underline}**

Means different things.

**[\>\>:]{.underline}**

Should we not \-- should we use those words? Is that \--

**[\>\>:]{.underline}**

We don\'t call \--

**[\>\>:]{.underline}**

The identified users.

**[\>\>:]{.underline}**

Limited.

**[\>\>:]{.underline}**

What was that again, would you say it one more time.

**[\>\>:]{.underline}**

When we talk about demographic data or patient-level information with
obvious identifiers removed. Then we say "i.e.," or "e.g.," name and
address.

**[\>\>:]{.underline}**

Change the word "randomized" to "encrypted" or "encoded"?

**[\>\>:]{.underline}**

I don\'t think it is.

**[\>\>:]{.underline}**

It\'s randomly generated. Number.

**[\>\>:]{.underline}**

Doesn\'t come encrypted because we have to know what it is in order to
link back.

**[\>\>:]{.underline}**

That implies you have national number generator.

**[\>\>:]{.underline}**

No, it\'s not \--

**[\>\>:]{.underline}**

Locally generated.

**[\>\>:]{.underline}**

The key goes back to the facilities.

**[\>\>:]{.underline}**

But then they can \--

**[\>\>:]{.underline}**

The facility can \--

**[\>\>:]{.underline}**

That\'s why you use the word "encoded."

**[\>\>:]{.underline}**

But that definitely implies that you\'ve not \-- a patient record number
of some sort that you\'re carrying through the facility in order to
randomize that number if you\'re getting patient data on a transactional
basis, and you randomize it, then won\'t link anything. It only works if
\--

**[\>\>:]{.underline}**

Just the process we use, authorize.

**[\>\>:]{.underline}**

You want to read what you have there?

**[\>\>:]{.underline}**

Another notion, I\'d like to read it back and make sure you capture in 8
there\'s a reassurance factor, sort of we have a certain amount of
anonymous information. That\'s being collected in general and only link
it back, it\'s sort of implicit and not explicit. Are we losing anything
by moving to a simpler view?

**[\>\>:]{.underline}**

Can we read what we\'ve got?

**[\>\>:]{.underline}**

Shortly.

\[laughter\]

**[\>\>:]{.underline}**

It is a little long right now. I\'ll read it.

**[\>\>:]{.underline}**

I\'m seeing if this is actually it.

**[\>\>:]{.underline}**

That is the one I worked on.

**[\>\>:]{.underline}**

It says, "A process" \-- and we can remove this, but \-- "e.g., a
randomly generated encoded linker," close parentheses, "will assure that
patient-level identified information, i.e., name and address, will be
removed and only authorized users able to link to the appropriate
facilities during routine or emergency public health investigation."

**[\>\>:]{.underline}**

Should I put this back on?

**[\>\>:]{.underline}**

Sure.

**[\>\>:]{.underline}**

We can remove \-- we can leave it at a process without the "e.g.," and
\--

**[\>\>:]{.underline}**

I like to help clarify at this level. So we can be as clear as we can,
and moving these forward to others that haven\'t been on this
discussion.

**[\>\>:]{.underline}**

We had authorized use once before.

**[\>\>:]{.underline}**

We want to authorize both the user and the \--

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

And at the end of that, where you see linked to the facility, I think
you mean linked to the patient record. You\'re not linking to the
facility. You\'re linking to a record, I believe.

**[\>\>:]{.underline}**

We were just talking about that here.

**[\>\>:]{.underline}**

Should I remove the word "facilities" or leave that in?

**[\>\>:]{.underline}**

Patient-level identified information \-- I\'m sorry. A process will
assure that patient-level identified information \-- i.e., name and
address \-- will be removed and only authorized users able to link to
the appropriate facilities and patient record information during a
public health investigation. Is that \--

**[\>\>:]{.underline}**

Close.

**[\>\>:]{.underline}**

I can work on it.

**[\>\>:]{.underline}**

Just so long as we\'re not encoding or processing the facility to strip
off anything. Because we\'re not \-- we\'re only encoding personal or
patient-level stuff. Not the facility-level stuff.

**[\>\>:]{.underline}**

I had done a little work on the ninth point, and I think we should spend
a little time, we\'re a little over time already, but I do want to touch
on how the reference as to biosurveillance definition. And we can work
on the wording of that over time.

**[\>\>:]{.underline}**

Nine, I changed to the BDSG will utilize as a working definition for the
group. Rather than recognizes the \-- and shall we actually state what
that definition is in this preconditions document? We\'ll just insert it
there afterwards in italics or something like that.

**[\>\>:]{.underline}**

We could \--

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Is that agreed, we move that to the top?

**[\>\>:]{.underline}**

I\'ve got it. Biosurveillance is often referred to as \[indiscernible\];
however, the ability to detect events early requires a broader set of
information than that of syndrome. While there\'s no single agreed-upon
definition, there\'s agreement that such biosurveillance systems take
advantage of integrated data from multiple sources including public
health information, electronic health information, not traditionally
monitored by public health. Biosurveillance systems must leverage two
major surveillance methods. One, well-established public health
surveillance methods and sources used for tracking, monitoring, and
reporting of health-related information, such as epidemiologic
investigations and infectious disease outbreaks or environmental
conditions, as needed to ensure broad coverage of data sources, to use
as baseline comparison, and to support the accuracy and reliability of
biosurveillance findings. And two, early event detection and situational
awareness, the use of an automated system to evaluate case and suspect
case reporting, along with statistical surveillance and data
visualization of pre-diagnostic and diagnostic data to support the
earliest possible detection of events that may signal a public health
emergency is an essential component for near-real-time detection of
natural or man-made health events.

**[\>\>:]{.underline}**

We\'ve had this discussion before, and this is a concept is fine. To my
way of thinking, it defines biosurveillance as encompassing under number
1, I believe, the traditional established public health practice of
surveillance where we collect all sorts of detailed case information.
When we put this into our preconditions and say we\'re going to use this
definition as our working definition for the group, for necessity blurs
the criteria on which we choose the minimum dataset. Because this
definition includes a huge amount of detailed data that we\'re not going
to be able to get with the minimum dataset. So conceptually, I find this
difficult.

**[\>\>:]{.underline}**

If we start that as our definition earlier and Republican venting that
definition, number 2, our current number 1, we could say add
biosurveillance data and then we will focus on \--

**[\>\>:]{.underline}**

How, about actually, I think \-- can you move up to number 5 on this?

**[\>\>:]{.underline}**

If we move that to immediately after reference to the definition \--

**[\>\>:]{.underline}**

And then moving into what you\'re saying.

**[\>\>:]{.underline}**

This is what we\'re going to be doing.

**[\>\>:]{.underline}**

Move this below number 9?

**[\>\>:]{.underline}**

Well, 9 now is number 1. And then when you get 9 to 1, then 5 will be
number 2.

**[\>\>:]{.underline}**

Is there a randomized data linker here?

\[laughter\]

**[\>\>:]{.underline}**

Says must leverage two data link \[indiscernible\] just saying
leveraging that method.

**[\>\>:]{.underline}**

For 2, I\'m saying shall focus on data that is readily available \-- or
readily \--

**[\>\>:]{.underline}**

Say one more time.

**[\>\>:]{.underline}**

Two, the \[indiscernible\] will focus on \--

**[\>\>:]{.underline}**

Yeah, right.

**[\>\>:]{.underline}**

Getting stronger each time we review this.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Kind of had some other renumbering. Did we capture all those?

**[\>\>:]{.underline}**

It means Perry\'s piece moving the numbers on zero around. Art, did you
have any other wording pieces?

**[\>\>:]{.underline}**

No, I think we can set this as the next draft. Move on, next topic here.
And we\'ve made a little progress in the preconditions. I think it\'s
getting a little \--

**[\>\>:]{.underline}**

Great comments.

**[\>\>:]{.underline}**

Thank you all, yes.

Transition to our next item. Which is the functional area which I
believe is our spreadsheet. And again I\'ll be continuing on the work
from the last call. We had made some agreement on the areas in green,
and I think the \[indiscernible\] color copies as well. \[rustling of
papers\]

We\'re going to move on to looking at the \-- in terms of the long-term,
short-term piece.

Art, did you edit this one as well?

**[\>\> Art Davidson:]{.underline}**

No, I didn\'t.

**[\>\>:]{.underline}**

Just kidding. Sorry. Long flight. We can go through this in a couple of
different ways. Perhaps as the last one. Walk through this document as
well. Let\'s see. Let\'s take a look at where we need the most work
done, in terms of our time and lunch. If I recall, we had the challenge
here was the items that were sort of \-- weren\'t falling in any
particular camp. Either in scope or out of scope. And we need to make a
decision if we were looking at them in the original short-term version
versus the long-term. Is that how you remember it as well?

**[\>\>:]{.underline}**

Now I\'m wondering if we should \-- give than we spent so much time on
these preconditions and a fair amount of time on that where it says
\[indiscernible\] identification of public health event, situational
awareness. I think one bullet up from this, you know how to move that
\--

**[\>\>:]{.underline}**

Arrow up. There we go.

**[\>\>:]{.underline}**

Yeah, so these are our \-- we call these out in this document. So maybe
we should just keep that in mind as we kind of run through this
functional area set, rather than having \-- I think we could go on in
this discussion for a long time. I\'m worried it\'s going to take too
long for us to come to closure on this document. So maybe just to frame
it in that sense, that I think we\'ve done a lot and got greens on the
early event detection. But if indeed it\'s about reportable disease
casing, reportable disease case \-- case reporting from clinical care,
kind of redundant. But we do think this is part of this effort, right in
I think there was a question at one point, I think Perry was the one who
sort of wondered whether that was in or out. As a biosurveillance
activity. Does BioSense think that it will be doing support for case
reporting?

**[\>\>:]{.underline}**

Depends how you define it. The short answer is yes.

**[\>\>:]{.underline}**

Okay. So then \--

**[\>\>:]{.underline}**

Complete a picture, so if clinician doesn\'t do the \[indiscernible\] it
allows public health to then follow up. Does it replace case reporting
in the earliest \[indiscernible\]? No. That\'s the conundrum that I keep
having, talks about this document.

**[\>\>:]{.underline}**

Actually, one of our preconditions was we would not cover all data
elements needed for traditional case reporting.

**[\>\>:]{.underline}**

Well, I don\'t think we need to worry that it covers it all, but if \--

**[\>\>:]{.underline}**

Absolutely contributes.

**[\>\>:]{.underline}**

It contributes. So if we look under outbreak management. I would like
for all of us to figure out which of these lines in outbreak management
are going to be green and which will be salmon colored or \--

**[\>\>:]{.underline}**

Our focus, areas in white and in terms of salmon or green. That\'s our
task here.

**[\>\>:]{.underline}**

If I look at the first three, 1, 2, and 3, under outbreak management, I
entirely with what Lynn just said, that \-- we do actually agree.

\[laughter\]

**[\>\>:]{.underline}**

The minimum dataset will definitely assist whatever word we used
earlier, but anyway, complement or whatever, routine case surveillance.
However, it won\'t replace it. One way I would suggest that we think
about 1, 2, and 3, is how does it affect our decision making regarding
specific data elements? And we voted twice on this and I can\'t
remember. I think I\'ve changed my vote.

\[laughter\]

**[\>\>:]{.underline}**

But I think the way I came down maybe the second time was to say no,
this is out of scope, or at least longer-term, because I couldn\'t think
of data elements that would be affected by it. So I thought, well, I\'m
going to simplify my decision-making and take it out of scope because
it\'s not going to change what I decide. That\'s kind of the way I would
approach \-- or suggest to the group that we make this decision, is does
it change the data elements? Knowing that the case investigations,
public health has to go back anyway to get all the data elements. So
that\'s how I thought about it.

**[\>\>:]{.underline}**

1, 2, and 3, Perry?

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

Does that affect the color in terms of green or salmon?

\[laughter\]

**[\>\>:]{.underline}**

Right, yeah, using the rationale that I just gave, I would think it\'s
salmon.

**[\>\>:]{.underline}**

Green.

**[\>\>:]{.underline}**

No, green.

\[laughter\]

**[\>\>:]{.underline}**

Longer-term.

**[\>\>:]{.underline}**

Well, I don\'t think it would change \--

**[\>\>:]{.underline}**

Chartreuse.

\[multiple speakers\]

**[\>\>:]{.underline}**

White.

**[\>\>:]{.underline}**

So you\'re saying that this would not be green? I get distracted here
but I thought we were on our way to green.

**[\>\>:]{.underline}**

Maybe I\'m saying it doesn\'t matter because it\'s not going to change
what data elements \-- it\'s irrelevant, so therefore \-- to simplify
it, I put it out of scope, in my mind.

**[\>\>:]{.underline}**

But it is in scope.

\[laughter\]

**[\>\>:]{.underline}**

But it is filling a functional role.

**[\>\>:]{.underline}**

Oh, sure.

**[\>\>:]{.underline}**

What we\'re talking about is this biosurveillance activity is filling a
component of the function of outbreak management through case
investigation.

**[\>\>:]{.underline}**

Et cetera.

**[\>\>:]{.underline}**

So maybe it is a different.

**[\>\>:]{.underline}**

I think what we\'re trying to get to is this a functional area. In
itself of this activity.

**[\>\>:]{.underline}**

I have to say, if we were just \-- we had a 20-minute discussion about
whether or not we were linking or how we were linking back to
patient-level data, for a case investigation, I have to believe that
this is going to support case investigation in the near term.

**[\>\>:]{.underline}**

I agree.

**[\>\>:]{.underline}**

So green?

\[laughter\]

**[\>\>:]{.underline}**

That\'s fine. Up to a point.

**[\>\>:]{.underline}**

That doesn\'t capture all the data \--

\[multiple speakers\].

**[\>\>:]{.underline}**

I\'m hearing agreement on 1, 2, and 3 to green.

**[\>\>:]{.underline}**

The thing I\'m worried about in 2 and 3 is it presumes that we have
exposure information available electronically.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

And I don\'t know that \-- pardon?

**[\>\>:]{.underline}**

That concerns me, too.

**[\>\>:]{.underline}**

I don\'t know that we have figured out what minimum dataset elements
would contribute to the exposure knowledge.

**[\>\>:]{.underline}**

That was why I brought that up, one of the very first meetings. Because
that\'s in our consensus dataset for exactly that reason, in the early
outbreak sort of investigation phases. And it\'s not the \-- the answer
is it\'s not easily available right now and it\'s going to require some
\--

**[\>\>:]{.underline}**

Maybe I\'m thinking more broadly, that you would be looking \-- if
retrospectively if you\'re trying to look for people who might be
exposed you would use health data sources in a certain geography to
potentially identify cases. That\'s how I\'m thinking \--

**[\>\>:]{.underline}**

That\'s right.

**[\>\>:]{.underline}**

It\'s not the verification that this is all of these people have been
exposed, but this is another data source that helps you begin that
exposure.

**[\>\>:]{.underline}**

Right, right.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So again, it doesn\'t replace \-- we\'re not trying to replace
traditional public health. We\'re trying to say, is this build such a
system functionally support these types of public health activities in.

**[\>\>:]{.underline}**

That\'s how I \--

**[\>\>:]{.underline}**

I think that\'s an important distinction that we should really be
mindful of when we start actually drafting and explaining what comes out
of this process. Because we\'re not trying to replace anything that\'s
traditional public health reporting and I think we need to set that
context so people don\'t feel we\'re trying to take over or \--

**[\>\>:]{.underline}**

Do you want to wordsmith this a little and say supporting initial
investigation and triggering formal traditional investigation?

**[\>\>:]{.underline}**

That\'s kind of what you\'re talking about.

**[\>\>:]{.underline}**

I think it is \-- that traditionally have been done by going back \--

**[\>\>:]{.underline}**

Say that again.

\[multiple speakers\]

**[\>\>:]{.underline}**

I want us to kind of \-- capture what you\'re saying here so we can
figure out how we\'ll present this.

**[\>\>:]{.underline}**

I heard added to or \-- the word to me \-- the word that helped me was
"geographic." When we think of public health, we think of the source,
not the tunnel. Is there any way we could get that issue into this?

**[\>\>:]{.underline}**

I\'m waiting for Lynn.

**[\>\>:]{.underline}**

I\'m not sure what you\'re saying again.

**[\>\>:]{.underline}**

In traditional public health when we think of source we think of it came
from that water, it came from that restaurant. So but I hear you say is
what we\'re saying is we\'re trying to identify where was the outbreak
occurring, Boston.

**[\>\>:]{.underline}**

Correct.

**[\>\>:]{.underline}**

Can we use the word "geographic"?

**[\>\>:]{.underline}**

I also heard the notion of, from Lynn, this is about information, the
process.

**[\>\>:]{.underline}**

How about triggering and information case investigation?

**[\>\>:]{.underline}**

Well, it\'s almost like prior to the determination, if there is, and I
think we\'re using the word "assessment."

**[\>\>:]{.underline}**

Yeah, it\'s an assessment thing, and without some sort of
geographic/historical \-- whatever you want to call it.

**[\>\>:]{.underline}**

That\'s what I \--

**[\>\>:]{.underline}**

Starts touching on traditional public health things, but \--

**[\>\>:]{.underline}**

I understand.

**[\>\>:]{.underline}**

That\'s the foundation.

**[\>\>:]{.underline}**

It is the foundation, that\'s right.

**[\>\>:]{.underline}**

Information from BioSense will help \-- what did I say?

**[\>\>:]{.underline}**

BioSense.

**[\>\>:]{.underline}**

Oh!

**[\>\>:]{.underline}**

Well, \--

**[\>\>:]{.underline}**

Is this recording?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Will provide direction to outbreak management, or inform. Somebody else
used the word "inform." And in that sense is in scope for outbreak
management. However, biosurveillance \-- the minimum dataset is not
going to include a lot of the added data that will be needed in an
outbreak management system such as exposure data.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Help identify.

**[\>\>:]{.underline}**

Exactly.

**[\>\>:]{.underline}**

It may \--

**[\>\>:]{.underline}**

What I summarize from your comment was trigger an investigation and
inform about broad levels of exposure in a specific geographic area. Is
that \-- did I capture what you\'re saying?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Nice.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Thank you.

**[\>\>:]{.underline}**

You\'re hired, Art.

\[laughter\]

**[\>\>:]{.underline}**

Okay. So then one \-- I think we agreed to as green. And 2 and 3 with
this qualifier, or explanation, is the group now saying is green, or is
it still \-- is there still debate about this?

**[\>\>:]{.underline}**

We may need to be a little more specific. We know anticipated specific
exposure is expected.

**[\>\>:]{.underline}**

To me, we can make it green. I don\'t think the color or in scope or out
of scope is important. The important point I think is Laura or somebody
said it; that we need to make sure that the audience that sees this,
understand what we mean by in scope. It won\'t meet all the need of
outbreak management systems. That\'s the point.

**[\>\>:]{.underline}**

May be a comment for the entire functional areas, what I hear you saying
as well, not necessarily meeting the issue of supplemental versus
primary.

**[\>\>:]{.underline}**

So we have 1, 2, and 3, I\'m hearing in green. Do we have a view where
we put the Y? As in the short-term or longer-term? Certainly the need to
have them for longer-term.

**[\>\>:]{.underline}**

I would tend to say longer term because we\'ve been struggling so much
with whether or not we should include them.

**[\>\>:]{.underline}**

I think it depends upon what data elements are already capturing and if
it already supports it.

**[\>\>:]{.underline}**

It redefines 1 Art just read to us. You could say as Y.

**[\>\>:]{.underline}**

I would say 1, but the other 2.

**[\>\>:]{.underline}**

I think it\'s depending upon can we link back to the clinical record,
which supports all of this.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So if we can link back and we\'re expecting to be able to link back now,
in short-term, if we don\'t expect we\'ll be able to do that in
longer-term.

**[\>\>:]{.underline}**

I\'m sorry, Paula, could you \--

**[\>\>:]{.underline}**

It\'s important from a situational awareness standpoint to do it sooner
rather than later.

**[\>\>:]{.underline}**

Number 1, short-term?

**[\>\>:]{.underline}**

I guess I don\'t \-- the instruction that is, came with this form. If
we\'re trying to determine are these functional areas that
biosurveillance did, does it matter if it\'s short-term or long-term or
that \-- they are, or they are not?

**[\>\>:]{.underline}**

Well, I think the AHIC is expecting that we have some specific
recommendations for the current year. Is that not right?

**[\>\>:]{.underline}**

I think that it\'s going to help us with \-- it\'s going to pull in to
our feasibility assessment as well as what we think will be
implementable immediately, and I think there is this \-- I mean,
there\'s been previous conversations in the Workgroup and if we have
some kind of recognition of what we think is both needed and feasible in
the short term, it\'s going to be helpful for the Secretary to then take
what he receives and try to act on it.

With the idea that there is a migration plan, and that as we have more
capacity or more standards and more infrastructure in place, we can
start, you know, capturing the ideal data for public health. But that it
helps with more or less a road map in going in the right direction. But
I mean, you know, there\'s also an argument that, you know, at least for
the purposes of functional areas, that you need because you need it, and
that\'s never going to change.

**[\>\>:]{.underline}**

Well, have we said that we don\'t need it, but by putting it in
longer-term? Do you suggest that implies that, Lynn?

**[\>\>:]{.underline}**

I guess if everything we\'ve talked about in the development of this
system will inform these activities from the minute we have the system.
So to say that\'s a longer-term goal that \-- maybe what we\'re saying,
it\'s a longer-term goal to understand how to use this data for these
specific functions. That\'s what we\'re saying, then maybe I can live
with it, being longer-term.

But the truth is this is the data source that will help inform early
case investigation, early identification of potential exposures, early
linking of \[indiscernible\] anyway.

**[\>\>:]{.underline}**

Linking cases in context to exposure sources.

**[\>\>:]{.underline}**

Maybe what we\'re saying in longer-term is we\'re demonstrating how this
data will be used or validating these. That\'s longer-term. As soon as
we have the data, we\'ll be trying to use it for this. Otherwise what\'s
the point?

**[\>\>:]{.underline}**

Exactly.

**[\>\>:]{.underline}**

We have short timeframe limited resources, I look at this as phases.
What do we do right now first, and then \--

**[\>\>:]{.underline}**

We get the data. I mean, maybe that\'s what we\'re saying. All our
efforts are focused on getting the data.

**[\>\>:]{.underline}**

Write up tools, evaluation and support, look at feasibility number 1 \--

**[\>\>:]{.underline}**

How they\'re used for these additional things, I guess, later.

**[\>\>:]{.underline}**

Basically everything goes \--

**[\>\>:]{.underline}**

That\'s what I was going to say. It just seems like it\'s within scope
and in the notes they, getting data is the short-term, and the
feasibility and the usefulness of the data is the longer-term.

**[\>\>:]{.underline}**

We can put all the Xs right on the \--

\[laughter\]

**[\>\>:]{.underline}**

I\'ve heard two views here. One is just a \-- that 2 and 3 can go in
either category. And part of this, I think is a distinction of what
we\'re making between short- and long-term. What does it really mean in
the current context going forward? Is it that we still need that
distinction at this point?

**[\>\>:]{.underline}**

I guess typically when you\'re doing a case investigation for a
communicable disease, you\'re typically going to be doing contact
tracing as part of that. So if you\'re already getting the data for the
case investigation, as a \-- and we\'re identifying that as short-term,
it just is different \-- you know, getting or using the data that you
were already getting for that short-term goal, to do that portion of the
investigation.

**[\>\>:]{.underline}**

My concern here is that we\'re starting out with this exposure contract
tracing, and defining exposure at this trigger an investigation and
inform about broad levels of exposure in a specific geographic area.
What you\'re talking about is something that\'s way beyond that. You\'ve
\-- you\'re now doing a public health investigation, typical one, we
collect the information and we\'re trying it use that to kind of define
the exposure, but we\'re talking here about secondary data use and
we\'re again I think Lynn correctly pointed us in the direction about
this broad geographic value, and assessment. But I\'m now getting into
this third point here about exposure source investigation and linking of
cases and context with exposures sources. Now, that\'s really \-- the
word "source" to me now means we\'re beyond just geographic areas.

**[\>\>:]{.underline}**

A source could be a person.

**[\>\>:]{.underline}**

Well, that\'s the typical meaning \-- so now we\'re \-- we now need to
qualify source in this functional area because most of us who read
source think, well, this is the point source or whatever. The personal
contact.

**[\>\>:]{.underline}**

I guess \[indiscernible\] read this and think SARS. What we were doing,
we were trying to identify who else was ill.

**[\>\>:]{.underline}**

Who was not ill.

**[\>\>:]{.underline}**

And who was not ill. And if we had a healthcare data source, you would
be looking to identify those people who presented ill and whether they
had contact with one of the known case patients. That\'s is what this
says?

**[\>\>:]{.underline}**

That\'s what geographic, I mean \--

\[multiple speakers\]

**[\>\>:]{.underline}**

Will a secondary data source, when you take care of a patient are you
thinking about collecting that information.

\>\>:

But the minute you get back to the contact information and the patient
record, you can get to the ZIP code and you can start to look at
geographic information to see if there are other cases potentially in
that ZIP code.

**[\>\>:]{.underline}**

So again we\'re back at that geographic \--

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

So how do we define source here? Go back \--

\[multiple speakers\]

**[\>\>:]{.underline}**

I mean, you can find a geographic association, and clustering.

**[\>\>:]{.underline}**

If source is going to completely depend upon is it a bomb, is it a
plume, is it a person? I don\'t know if we can define source
specifically.

**[\>\>:]{.underline}**

But we need to because if one of us has to present this to the Community
and we say \-- we\'re talking about source investigation, everybody in
public health is thinking the traditional way \-- we\'ve even referenced
the traditional biosurveillance method in the ASTHO definition, I don\'t
think it will hold up.

**[\>\>:]{.underline}**

Because when I look at the minimum dataset and I look at this, I\'d say
there\'s no relationship between the data in here. And yes, I agree with
you about the geographic association looking for the clusters and giving
you a reason to go back and trigger this investigation. But in terms of
what the actual contents of the minimum dataset are, I mean, \--

**[\>\>:]{.underline}**

The point earlier, yeah, it doesn\'t change the dataset in a way, but
you can\'t do it off of the data \--

**[\>\>:]{.underline}**

Diagnosis of influenza type illness, SARS, wouldn\'t help you identify
potential ill patients who may have been part of an exposure.

**[\>\>:]{.underline}**

Yes. Yes.

**[\>\>:]{.underline}**

Absolutely. And that\'s why \--

**[\>\>:]{.underline}**

Doesn\'t tell you \-- that\'s why I have no problem with number 1 in
terms of near-term. But numbers 2 and 3, I don\'t see anything in the
minimum dataset that helps you with those that we would look at
near-term. That\'s all.

**[\>\>:]{.underline}**

Most people in public health would look at 2 and 3 and not think that
the minimum dataset is relevant.

**[\>\>:]{.underline}**

Exactly.

**[\>\>:]{.underline}**

That\'s all I\'m saying.

**[\>\>:]{.underline}**

Except in the way you\'ve explained, Lynn, so that\'s why it could be
either way. But I think there\'s less confusion, actually, if you take
it out of scope of the audience.

**[\>\>:]{.underline}**

But it still does inform the process early on.

**[\>\>:]{.underline}**

Absolutely, there\'s no question.

**[\>\>:]{.underline}**

I think again are we arguing whether it\'s immediate-term or
longer-term? What I hear you saying is we have to demonstrate the use of
this data for this purpose. Maybe that\'s longer-term.

**[\>\>:]{.underline}**

No, our charge is to come up with a minimum dataset and it seems \-- it
seems to me it will not affect that decision. Out of scope for that
consideration. Not that it\'s irrelevant to these uses. But that\'s \--

**[\>\>:]{.underline}**

You\'re saying the minimum dataset will never help you complete the
exposure contact tracing or the exposure source investigation. So by the
mere fact that the minimum dataset will not help public health to
complete this, and by putting it in here, it would imply that we need a
lot more data than we\'re planning \-- see, that\'s not how I\'m
thinking about that. We\'re on different sort of \--

**[\>\>:]{.underline}**

Support of is the way \-- it was not to complete it.

**[\>\>:]{.underline}**

Then it absolutely will support it in the earliest stages and at the
times where your timeliness might be important.

**[\>\>:]{.underline}**

What I\'ve heard is two concepts, one is the notion that, is it
relevant. Is this relevant to support. And then what\'s the value. Doing
a comprehensive view of the function. And perhaps we need to capture
that in a comment section related to this area. Does that make sense?

**[\>\>:]{.underline}**

I\'m trying to capture these thoughts in the comments section here.

**[\>\>:]{.underline}**

So what we\'re \-- I \-- the two concepts implied here, that is the
notion of relevance to numbers 2 and 3 and value. That minimum dataset
may be relevant to doing those functions but in a limited way, until we
gather at least more data in our evaluation of it. What I\'m hearing is
proposal to move it to 2, with that consideration. That it is \-- we
believe it has some relevance, we want to determine the value to some
degree of what that is or may be minimum as we look at it today. So I
think two notions what I\'m hearing in that. So that would suggest
leaving it green, moving the yes in 2 and 3 to the longer-term and add
to the comment section that about the notion of relevance and value.
Including evaluation. Is that consistent with a general comments so far?
Were there some other comments, too?

**[\>\>:]{.underline}**

I just had sort of the same comment again. If it\'s important in terms
of the minimum dataset that we\'re going to get, in supporting the
situational awareness, so we\'re saying the only reason we\'re moving it
to the longer-term is just to keep it in there for exploring utility.
And not putting any \-- not putting any urgency things on it, in other
words.

**[\>\>:]{.underline}**

Yes, I think so. That\'s what I was hearing. The discussion of the value
\-- there\'s a general agreement we believe it\'s relevant, but the
value to supporting the comprehensive view of these functions may be
quite limited, or may be more valuable. But we\'ll have \-- that\'s
going to need a little bit more exploration getting there.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Just to summarize, I\'ve captured 1 as short-term, and 2 and 3 as
long-term, correct?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Green.

\[laughter\]

**[\>\>:]{.underline}**

I hear the mention of purple come up.

**[\>\>:]{.underline}**

Purple it is.

**[\>\>:]{.underline}**

Black and blue from all the \--

\[laughter\]

**[\>\>:]{.underline}**

I hate to go backwards, but I just have one minor proposal to make, and
just a qualifier on the early identification of public health events.
I\'m wondering if we could say that would be following initial event
detection.

**[\>\>:]{.underline}**

Just back on the precondition.

**[\>\>:]{.underline}**

Yeah, sorry. But it\'s also relevant to the green. You know, actually,
I\'m sorry in early event detection we don\'t have an explicit one that
translates to. Other than \-- yeah.

**[\>\>:]{.underline}**

So you want to add a qualifier to the early \--

**[\>\>:]{.underline}**

The precondition, yeah.

**[\>\>:]{.underline}**

And I\'m sorry, state that again.

**[\>\>:]{.underline}**

From the early identification of public health events, following initial
event detection.

**[\>\>:]{.underline}**

That might be our first event detection.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

That\'s what I thought it was.

**[\>\>:]{.underline}**

Early characterization of public health \--

**[\>\>:]{.underline}**

You want to say that we \--

**[\>\>:]{.underline}**

Getting the focus away from strictly \--

**[\>\>:]{.underline}**

How about early identification and characterization.

**[\>\>:]{.underline}**

Confirmation or \--

**[\>\>:]{.underline}**

Confirmation.

**[\>\>:]{.underline}**

Early indication.

**[\>\>:]{.underline}**

And/or.

**[\>\>:]{.underline}**

It may be \--

**[\>\>:]{.underline}**

We only say confirm or review.

**[\>\>:]{.underline}**

Confirm or \--

**[\>\>:]{.underline}**

Public health hazard.

\[multiple speakers\]

**[\>\>:]{.underline}**

All your work isn\'t for naught.

**[\>\>:]{.underline}**

I\'m holding out hope.

**[\>\>:]{.underline}**

Put a and/or in there.

**[\>\>:]{.underline}**

We\'re working on 2 here.

**[\>\>:]{.underline}**

To confirm and/or \--

**[\>\>:]{.underline}**

Early identification and/or to confirm the \-- in other words, our
purpose is to identify at the beginning.

**[\>\>:]{.underline}**

Maybe it\'s \--

**[\>\>:]{.underline}**

I think identification, confirmation \--

**[\>\>:]{.underline}**

But don\'t we expect the system to be potential as part of the initial
event detection?

\[multiple speakers\]

**[\>\>:]{.underline}**

Either it\'s confirmed or not. You don\'t need to say confirmation and
refute. It\'s implied. Early identification and confirmation.

**[\>\>:]{.underline}**

And/or.

**[\>\>:]{.underline}**

Early indication of public health events and/or to confirm?

**[\>\>:]{.underline}**

I had early identification \-- I like the word "characterization."
And/or confirmation of public health events.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

So \-- don\'t worry, Art has it.

**[\>\>:]{.underline}**

What do you have again?

**[\>\>:]{.underline}**

I\'ll have it by the end of the day.

**[\>\>:]{.underline}**

I think you need to sleep on the plane.

**[\>\>:]{.underline}**

I will, I\'m sure.

**[\>\>:]{.underline}**

Okay, so we managed to get through the first of the \--

**[\>\>:]{.underline}**

Can I just comment for one thing because this has been a point of a lot
of controversy and I want to make sure everyone is really comfortable
with what this means in terms of what \-- if one of our premises is that
we\'re sharing data across jurisdictions at the same time, that means
that the Federal Government is going to have access to the same data
that these local jurisdictions are going to have access to, and that
they\'ll both be at the same time have the ability to do initial event
detection, according to what this says. And does that make everyone feel
comfortable?

**[\>\>:]{.underline}**

Say that \--

\[multiple speakers\]

**[\>\>:]{.underline}**

I don\'t want to make anyone uncomfortable.

**[\>\>:]{.underline}**

This came up last \--

\[laughter\]

**[\>\>:]{.underline}**

I\'m sorry if I \-- I, if I, Vice President been clear enough, but I
think that\'s been one of our other working sums, we\'re talking about
sharing data the same exact time across jurisdictions.

**[\>\>:]{.underline}**

I thought we tabled that.

**[\>\>:]{.underline}**

That\'s been \-- I mean, that\'s in the recommendations of the
biosurveillance \--

**[\>\>:]{.underline}**

That\'s why it hasn\'t been a topic here, because it\'s already
simultaneous data flow to all jurisdictions.

**[\>\>:]{.underline}**

And you already got \--

\[laughter\]

**[\>\>:]{.underline}**

I\'m not talking to you anymore!

\[laughter\]

**[\>\>:]{.underline}**

I\'m just kidding.

**[\>\>:]{.underline}**

Are you saying you want to reemphasize that in our preconditions?

**[\>\>:]{.underline}**

Well, I mean, all I\'m saying, I\'m mostly wanting the State and local
jurisdictions to be really comfortable with the fact that you agree that
this data should be used for this purpose when the Federal Government is
going to have at the same time.

**[\>\>:]{.underline}**

Let me \-- I read the scope of work again last night on the plane also
\--

\[laughter\]

**[\>\>:]{.underline}**

In a specific charge, it states, "Identify the requirements for data to
be shared inventory data," but it says for multijurisdictional
biosurveillance. Now, from a local public health point of view, I\'m
talking about Denver County and Tricounty. I\'m not talking about
necessarily sharing it with the Fed. And there\'s nothing here that
defines that. So now you\'re saying that definition has been set.

**[\>\>:]{.underline}**

That\'s an assumption going into this Workgroup, that\'s what we\'re
talking about.

**[\>\>:]{.underline}**

And furthermore, that your county data will be seen by other counties
and identify your county. Is that the assumption?

**[\>\>:]{.underline}**

Well, I mean \--

\[multiple speakers\]

**[\>\>:]{.underline}**

There\'s an explicit expectation that this will happen. So Marty
whispered to me, we need to deal with this at a later point and really
get this put into the preconditions. Because that\'s not listed anywhere
in the preconditions, and \--

**[\>\>:]{.underline}**

I probably should have brought it up earlier, but it\'s just an
important point that really, folks need to be comfortable with. It has
to guide our judgment.

**[\>\>:]{.underline}**

You know, this data will enable data share, or we will enable data
sharing and encourage collaboration.

**[\>\>:]{.underline}**

Right, it\'s just when it comes to \-- to that first initial event
detection, who you want to be doing it, and who do you want to have the
data to be acting on it. That is a point of sensitivity need to be real
clear and come to consensus on how Federal, local, and State
perspective, are you okay with that.

**[\>\>:]{.underline}**

Might be worthwhile to share the language and look at the \--

**[\>\>:]{.underline}**

I did that, to make copies of the recommendation for us all.

**[\>\>:]{.underline}**

Is this from \--

**[\>\>:]{.underline}**

No, the recommendation was \--

**[\>\>:]{.underline}**

Yeah \-- the health, actually.

**[\>\>:]{.underline}**

Sounded like \[indiscernible\]

\[multiple speakers\]

**[\>\>:]{.underline}**

We\'re focused on the functionality and minimum dataset. I think it\'s
important we finish that piece. This is an important issue about
process. And the flow of the information. And I think it will be good to
spend a little bit of time where we can think about \-- we can take a
warm fuzzy to say that agreements will be established. Between the
parties and agree upon how that\'s going to work. Or we can try to weigh
in additional details of what we think is important with this minimum
dataset. And I think it\'s worth a little bit more time to do that. I\'m
not sure the best time when. But whether we have some time later today
or not. But it is, I agree, an important issue, I think we should spend
a little time and include it in your preconditions, some type of
statement about it because it\'s going to come up. And we need to hear
from everybody on that. Does that sound okay? Art \--

**[\>\>:]{.underline}**

There is some specific language in the recommendations that are about
agreement, cross-jurisdictions, I don\'t remember exactly what they
said.

**[\>\>:]{.underline}**

And specific language about not interfering with the traditional
functioning of the public health. Yeah, you know, investigations at
local, State \--

**[\>\>:]{.underline}**

Maybe we can get copies of that and then after lunch find a few minutes
and we can look at that language and see how we want to incorporate it
into the preconditions statement. Is that sounding okay? Good point.
Let\'s not miss that. Great.

**[\>\>:]{.underline}**

I captured that, thank you.

**[\>\>:]{.underline}**

We have a few more whites to turn to salmon or green.

**[\>\>:]{.underline}**

Or purple.

**[\>\>:]{.underline}**

No purple. It\'s \--

**[\>\>:]{.underline}**

Created a new color.

\[multiple speakers\]

**[\>\>:]{.underline}**

All right.

**[\>\>:]{.underline}**

Kind of shocking.

**[\>\>:]{.underline}**

Really, it\'s \-- salmon, I like that.

**[\>\>:]{.underline}**

Got a lavender.

**[\>\>:]{.underline}**

5, 6 and 7 left in the management area. We have a few minutes before
lunch. We can try to not think about lettuce and tomato and sandwiches
and drinks too much. Art didn\'t get much breakfast on the plane.

**[\>\>:]{.underline}**

Got stuck in the elevator.

**[\>\>:]{.underline}**

I\'m sorry.

**[\>\>:]{.underline}**

Don\'t get on the elevator on the far right.

**[\>\>:]{.underline}**

We got stuck and we can\'t tell you everything that happened.

\[laughter\]

**[\>\>:]{.underline}**

Now I\'m going to get in trouble.

\[laughter\]

**[\>\>:]{.underline}**

We are approaching lunch here.

**[\>\>:]{.underline}**

Can we use some of the similar logic from the 1, 2, and 3, applying it
to this with comments? We can look at it maybe in that context. May help
us. We are not getting lunch until we \--

**[\>\>:]{.underline}**

Good incentive. But you knew that would be my \--

**[\>\>:]{.underline}**

Yeah, right.

**[\>\>:]{.underline}**

6 we should be able to make green right away.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

All green on that.

**[\>\>:]{.underline}**

6 is green, all right.

**[\>\>:]{.underline}**

Yellow or purple.

**[\>\>:]{.underline}**

The integration with early event detection and countermeasure
administration.

**[\>\>:]{.underline}**

If countermeasures are given following an event. Vaccine, prophylaxis or
adverse event.

**[\>\>:]{.underline}**

You have a health data source. Clinical care data source, that would
help you do that type of integration.

Another integration \-- isn\'t "integration" a tough word?

**[\>\>:]{.underline}**

Sounds like data sharing or \--

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

Rather than a data standards.

**[\>\>:]{.underline}**

Like information public health. But to make determinations about who
might need countermeasures. I think early antiviral treatment.

**[\>\>:]{.underline}**

I see what you mean.

**[\>\>:]{.underline}**

I don\'t care about the word. It\'s just the concept. That we could
possibly agree, this data would again inform decision-making around \--

**[\>\>:]{.underline}**

Indications for and results for.

**[\>\>:]{.underline}**

Outcomes related to.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Keep talking, just keep talking.

**[\>\>:]{.underline}**

Then Perry has to help us decide if it\'s green or purple.

**[\>\>:]{.underline}**

I think I was on salmon.

**[\>\>:]{.underline}**

So we can agree, it\'s at least in scope, correct? No?

**[\>\>:]{.underline}**

I thought I heard a salmon here, too. Salmon speaking to me.

**[\>\>:]{.underline}**

You\'re thinking of lunch again.

**[\>\>:]{.underline}**

We\'re not going to get lunch.

**[\>\>:]{.underline}**

Be very cautious, Marty. Between us and \-- it\'s \--

**[\>\>:]{.underline}**

I know.

**[\>\>:]{.underline}**

Perry. Think of this scenario. There\'s a city that has an outbreak of
a GI illness \-- you want to look at this and say well, yes, that\'s
true in that city, but these other three cities don\'t have an outbreak
of GI illness so we don\'t have to worry about that there, so it would
be informing where there\'s an indication of treatment, not treatment.
Driving down into more detail.

**[\>\>:]{.underline}**

Flu is a good example because you\'re talking about vaccine \-- not
antiviral where illness might just be starting.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

 \-- resource information also in terms of data availability and stuff.
I thought it was resource linkage in there, if you knew you have
patients in an area, that you have resources to handle \--

**[\>\>:]{.underline}**

Rather than integration risk with perhaps informing?

**[\>\>:]{.underline}**

We changed that.

**[\>\>:]{.underline}**

Yeah I think we got hung up on \--

**[\>\>:]{.underline}**

You\'re talking about sharing of resource \-- this is specific to
resource data elements?

**[\>\>:]{.underline}**

We\'re just saying \-- it might be diagnostic, too, but \-- just
informing you in terms of where you need to make an intervention, or
what the results of your intervention were.

**[\>\>:]{.underline}**

I think this is green.

**[\>\>:]{.underline}**

So I\'m hearing green for 5 and 6, but changing of the wording of 5. To
reflect more of the \-- role of this function.

**[\>\>:]{.underline}**

Eileen had a comment.

**[\>\>:]{.underline}**

I do have a comment.

**[\>\>:]{.underline}**

\-- situational \--

**[\>\>:]{.underline}**

And Eileen, comment 6, I\'m sorry.

**[\>\>:]{.underline}**

Yeah, my concern about 6 is if you\'re getting data from a bunch of
different sources and everybody is using their own different scheme for
creating this anonymized linker, how do you expect to link these things
back? Because in the absence of national identifiers, nobody is going to
be using the same randomized or anonymized linkers. It\'s an
implementation issues more than a theoretical issue, but that might \--

**[\>\>:]{.underline}**

You\'re still going to be able to link that data.

**[\>\>:]{.underline}**

The ultimate goal is \--

**[\>\>:]{.underline}**

Public health is going to be able to.

**[\>\>:]{.underline}**

Not only that, but you\'ll be able to make an observation of the
clinical data, and you\'ll be able to make an observation of laboratory
data, and both observations will point to an outbreak. That could be a
definitional thing.

**[\>\>:]{.underline}**

 \-- capture \--

**[\>\>:]{.underline}**

Say that again?

**[\>\>:]{.underline}**

Yeah, I like that, that makes sense.

**[\>\>:]{.underline}**

Let me go back to this linkage statement, here.

**[\>\>:]{.underline}**

Maybe correlation would be another way of \--

**[\>\>:]{.underline}**

Yeah, yes, instead of linkage, yes. Now I\'m happy.

**[\>\>:]{.underline}**

Still in green.

**[\>\>:]{.underline}**

We should have little cards. Correlation \--

**[\>\>:]{.underline}**

Good idea.

**[\>\>:]{.underline}**

Thumbs up, green cards, salmon cards \--

**[\>\>:]{.underline}**

Purple cards.

**[\>\>:]{.underline}**

Correlation of leverage, right there.

**[\>\>:]{.underline}**

5 and 6 green with some words added, how about 7?

**[\>\>:]{.underline}**

7, I didn\'t know what it meant.

**[\>\>:]{.underline}**

Can we just kill that one?

**[\>\>:]{.underline}**

Can I summarize real quick, 5 and 6 were \--

**[\>\>:]{.underline}**

Green.

**[\>\>:]{.underline}**

And both short-term?

**[\>\>:]{.underline}**

Green.

**[\>\>:]{.underline}**

Both short-term.

**[\>\>:]{.underline}**

And we don\'t understand 7, so who wrote 7 or who wants to advocate for
it?

**[\>\>:]{.underline}**

Well, Laura wrote it.

\[laughter\]

**[\>\>:]{.underline}**

What does 7 mean, Laura?

**[\>\>:]{.underline}**

This is having the flexibility to add data elements, and it\'s really a
system requirement. Ability of the system to add data elements. As you
learn and go along in an outbreak.

**[\>\>:]{.underline}**

 \-- transmission of biosurveillance data that may have not been in the
dataset?

**[\>\>:]{.underline}**

Well, this is really a functionality of a true outbreak management
system, I would say, not necessarily a biosurveillance system. Because I
don\'t think we\'re talking about turning on new data elements in the
middle of an outbreak.

Maybe that\'s a longer-term goal, but I would say that \--

**[\>\>:]{.underline}**

 \-- the system.

**[\>\>:]{.underline}**

And do we want \-- \--

**[\>\>:]{.underline}**

Am I hearing salmon?

**[\>\>:]{.underline}**

Salmon?

**[\>\>:]{.underline}**

It would be comment on the functionality of the systems. This is minimum
dataset. At some point in the future, you know \-- want to know what is
functionality of supporting outbreak management and what is \-- assuming
this works down the road, but have the minimum datasets can change, and
perhaps support functionality.

**[\>\>:]{.underline}**

Looks like 7 is going to go the exact opposite of \-- dataset.

**[\>\>:]{.underline}**

If that functionality were there, it might change the way \--

**[\>\>:]{.underline}**

You wouldn\'t need a dataset.

**[\>\>:]{.underline}**

That\'s what RHIOs are trying to do, a query on clinical setting.

**[\>\>:]{.underline}**

I think we\'ve \-- well, I don\'t know if lunch is here. We\'ve earned
lunch.

**[\>\>:]{.underline}**

We certainly have earned it. Therefore we get bonus. Desserts now.

**[\>\>:]{.underline}**

Dessert \--

**[\>\>:]{.underline}**

We have a few more white ones then we\'ll take a break.

**[\>\>:]{.underline}**

Sure.

**[\>\>:]{.underline}**

The next is connecting laboratory systems, a white one, number 3.

**[\>\>:]{.underline}**

Can we convert that?

**[\>\>:]{.underline}**

That\'s the frequency of orders issue, I can tell you that HITSP is not
going to give you a standard when \[indiscernible\].

**[\>\>:]{.underline}**

We need orders.

**[\>\>:]{.underline}**

But it\'s also the resource \--

**[\>\>:]{.underline}**

Because when we look like the specification, we have a rationale for
knowing how many beds a facility has, and then for how much availability
they have, but I\'m not sure there\'s any data source right now that
would tell you what the ultimate resources of a laboratory would be in
terms of how much volume they could handle. And I think that\'s what
we\'re trying to get at, here. At least that\'s what it looks like.

**[\>\>:]{.underline}**

I think there is some of that in the LRM labs.

**[\>\>:]{.underline}**

Okay.

 \-- but the capacity and overflow.

**[\>\>:]{.underline}**

Do you get what Ed is saying? He\'s not going to give us anything \--
any kind of orders.

**[\>\>:]{.underline}**

No, no. We don\'t need a standard for this, all you need is time and
volume.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

Time and volume and \--

**[\>\>:]{.underline}**

Time and volume generates \--

**[\>\>:]{.underline}**

But they\'re only going to give us results.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

There\'s not \-- they\'re not going \-- so \--

**[\>\>:]{.underline}**

The middle of the \-- the dataset includes test orders.

**[\>\>:]{.underline}**

We\'ll talk about that when \[indiscernible\] minimum.

**[\>\>:]{.underline}**

And I want it to.

**[\>\>:]{.underline}**

Well, okay.

**[\>\>:]{.underline}**

We are saying the same thing.

**[\>\>:]{.underline}**

Come back, or what?

**[\>\>:]{.underline}**

Do we either table it or \--

**[\>\>:]{.underline}**

I don\'t know what the objection to that is.

**[\>\>:]{.underline}**

You\'re not going to make it green you\'re not going to get the
standards so you\'re either going to get purple \--

**[\>\>:]{.underline}**

Purple.

**[\>\>:]{.underline}**

Purple.

**[\>\>:]{.underline}**

And I\'ll explain why later.

**[\>\>:]{.underline}**

Do we have other business or comments on 3 as purple, any comments we
should add to that?

Discuss the nuances, sounds like, in the next page after our salmon
lunch.

We have 7 more whites, 8, 9, 10. I\'m sorry, countermeasures.

**[\>\>:]{.underline}**

I think some of these are standard.

**[\>\>:]{.underline}**

We\'re not down to drugs administered in dataset at this point.

**[\>\>:]{.underline}**

But 1 is just the same thing we were talking about before.

**[\>\>:]{.underline}**

I think so, too. So if during a large outbreak the reason for a visit to
division offices that we\'re tracking is to receive vaccinations, and we
could capture it in the data. So that\'s how I would look at this. So it
does support how you might track the \--

**[\>\>:]{.underline}**

Support efforts to administer. You\'re really not tracking because you
don\'t have enough data to really track it.

**[\>\>:]{.underline}**

That\'s right.

**[\>\>:]{.underline}**

I based the terminology around the word track in other settings. I think
what you\'re saying is that you are being able to audit or some
administration effect.

**[\>\>:]{.underline}**

I would definitely add the word "some."

**[\>\>:]{.underline}**

I agree.

**[\>\>:]{.underline}**

We\'ll use some, that makes it easier.

**[\>\>:]{.underline}**

You could do support and track administration of \-- definition there

**[\>\>:]{.underline}**

You\'re saying that the \[indiscernible\] code would help do you that?

**[\>\>:]{.underline}**

Or a reason for visit. Especially when you\'re talking about ambulatory
care data it\'s not a chief complaint, it\'s a reason for visit. And
it\'s a reason for visit to receive vaccines.

**[\>\>:]{.underline}**

You\'re not going to go to EDs,

**[\>\>:]{.underline}**

No.

**[\>\>:]{.underline}**

So \--

**[\>\>:]{.underline}**

 \-- permitting our data collection to \--

**[\>\>:]{.underline}**

Don\'t we have a \-- don\'t we refer to specific ambulatory care
facilities?

**[\>\>:]{.underline}**

Yeah, uh-huh.

**[\>\>:]{.underline}**

Aren\'t we talking on a large scale \-- it will probably not be in an
ambulatory care facility, but rather a site set up specifically for that
purpose?

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Okay, I see what you\'re saying.

**[\>\>:]{.underline}**

So \--

**[\>\>:]{.underline}**

During a flu \-- so your community is going to see flu. Do you really
think the only option is that you go to a point of distribution clinic?

**[\>\>:]{.underline}**

Can flu or seasonal flu? Can flu I would say no they would not be going
to their provider, because by and large supply will be in the public
sector.

**[\>\>:]{.underline}**

We\'re planning on setting up sites to vaccinate 50,000 people.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

So while we haven\'t included those data sources, we may want to
change \--

**[\>\>:]{.underline}**

\-- flu, same with GI illness, you just want to see if there\'s an
outbreak of GI illness in the city or not.

**[\>\>:]{.underline}**

There are some countermeasures we make recommendations for very specific
population \--

**[\>\>:]{.underline}**

\-- even an indication.

**[\>\>:]{.underline}**

I think \-- okay, I think I agree with you, but it\'s when it gets to
certain scales that the public health is going to have to set up
alternative sites.

**[\>\>:]{.underline}**

Right. I agree with you. Right.

**[\>\>:]{.underline}**

Will there be sufficient data out of these systems to do the monitoring
and tracking.

**[\>\>:]{.underline}**

What about this, so everyone is supposed to go to the point of
distribution clinic to get their vaccine or antiviral, but this family
says we already got ours at our clinician, and you go oh yeah, we could
probably \-- look at that. Again, it\'s helping to inform the data.

**[\>\>:]{.underline}**

You\'re talking vaccine, you\'re going to have to do it with CPT codes.
If you actually want to capture the kind of vaccine.

**[\>\>:]{.underline}**

We\'re not building a countermeasure in response to it.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

I think that\'s point. So again, can you make a case that
these \[indiscernible\] clinical data would support \-- enough for us to
say \--

**[\>\>:]{.underline}**

I think as you have more EHR in outpatient settings I think there\'s a
case for some as reason for visits. But again, you know, so much of
other stuff we\'ve discussed are limited so \-- limited application.
Some supporting information might be available.

**[\>\>:]{.underline}**

So am I hearing a purple here?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

With a qualification or note similar to what we did on 5?

**[\>\>:]{.underline}**

No, 5 will remain green.

**[\>\>:]{.underline}**

What about the suggestion to add some before vaccinations and
prophylaxes?

**[\>\>:]{.underline}**

Sure.

**[\>\>:]{.underline}**

And to remove track.

**[\>\>:]{.underline}**

Read it again, what does it say?

**[\>\>:]{.underline}**

Administration of some vaccinations and prophylaxes.

**[\>\>:]{.underline}**

I would say support and monitoring \[indiscernible\] supported by \--

**[\>\>:]{.underline}**

That\'s okay.

**[\>\>:]{.underline}**

Monitor administration?

**[\>\>:]{.underline}**

You\'ve got other systems that are really going to be monitoring \--
yeah \--

**[\>\>:]{.underline}**

Support administration \[indiscernible\].

**[\>\>:]{.underline}**

Supporting it or monitoring it?

**[\>\>:]{.underline}**

It\'s monitoring it, really.

**[\>\>:]{.underline}**

It\'s not monitoring.

**[\>\>:]{.underline}**

It\'s informing it.

**[\>\>:]{.underline}**

So we\'re purple, we\'ve got wording, who has the last wording on this?

**[\>\>:]{.underline}**

I\'m not sure.

**[\>\>:]{.underline}**

That\'s been captured? I think we should take a break.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

But this is the first time that we actually changed the wording from the
original document. So it\'s time for us to take a break.

\[laughter\]

**[\>\>:]{.underline}**

We\'ll come back about \--

**[\>\>:]{.underline}**

I never go anywhere without purple.

**[\>\>:]{.underline}**

Can we reconvene in a half-hour? 12:45.

**[\>\>:]{.underline}**

We\'re going to go ahead and take a break now.

**[\>\> Matt McCoy:]{.underline}**

Okay. Just give us a shot when you\'re ready to get going again, but
leave the phone connected and you can just tell me when you\'re ready.

**[\>\>:]{.underline}**

12:45.

\[break\]

**[\>\> Matt McCoy:]{.underline}**

Okay, are you ready to go?

**[\>\>:]{.underline}**

Thank you.

**[\>\> Matt McCoy:]{.underline}**

Also it looks like Richard Melton has called in and is on the phone now.

**[\>\> Richard Melton:]{.underline}**

I\'m in.

**[\>\>:]{.underline}**

Good.

**[\>\>:]{.underline}**

Hi, Dr. Melton.

**[\>\>:]{.underline}**

How are you folks today?

**[\>\>:]{.underline}**

Good.

**[\>\>:]{.underline}**

I don\'t know if you heard, but we are jumping right into the minimum
dataset spreadsheet that we have from Ed Barthell and HITSP along
with \-- from the biosurveillance that I had sent out, it\'s got three
tabs on it.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

We are ready to go, and I have the document up.

I\'m going to hand out a long spreadsheet, is that all right?

**[\>\>:]{.underline}**

Yes, sir.

**[\>\>:]{.underline}**

Okay, notice we have some limits on Ed\'s time with us today, so we want
to move right into making sure we worked on this.

And I think from a document point of view, that if we could settle on a
number as well as a name at some point, and at least get some of them
carried over, so we can start having our minimum dataset formed, then I
think we have something to work from for the rest of the time in between
the meetings.

**[\>\>:]{.underline}**

Why don\'t we \-- do you want to stick to the numbers, eight-column \--

**[\>\>:]{.underline}**

Sure. If you notice, the D and E here, the columns are kind of what I
merged from the Biosurveillance \-- the group here, and the HITSP
Technical Committee, and if they were shaded green they were an exact
match, even with the numbering. So 1 through 4 was pretty much a dead
match. Number of facility beds and number of licensed beds, the
terminology is different. And again, I wanted to make sure that the
group was clear on \-- you know, whether they are meaning the same
thing, whether they are the same. You know, I wanted you all to come to
consensus on that.

**[\>\>:]{.underline}**

Let me back up, if I can. The HAVE column on the far right is also
\[indiscernible\] below, I\'ve got some comments from HITSP, and HITSP
spent a lot of time on the HAVE specification, and in front of the OASIS
Standards Workgroup right now, it\'s not yet formally approved. In fact,
there\'s a two-month comment period that opens, I think, next week. So
it\'s a little bit of a strange one because there was no other good
standard on which to match all these data elements. So we kind of
selected it as on a presumptive basis that it\'s going to be finalized
pretty much as an informative thing. Also because it still has a
two-month public commentary, it\'s interesting, it allows us to make
suggestions to final edits to that standard if we wish to. So that it
really does match exactly what you want.

For instance, right now, HAVE uses a term "organization ID," and in
HITSP we talked about probably "facility ID" is what we want. We don\'t
want to necessarily limit it to hospital, because some of those might be
an ambulatory care clinics. I think what we may want to have when we get
to our final version, is call it facility ID, I think that\'s going to
be HITSP\'s recommendation.

If you have some facility ID, and presumably it will be a Medicare
number, but that really is an implementation issue. If you\'ve got a
facility ID as your data, if that\'s a good ID, you don\'t really need
the hospital system line at all, which is number 2. That\'s what I have
on the far right, NA.

Frankly you could argue that you don\'t need 3 or 4 either because there
would be some lookup table somewhere, but we thought it would be nice to
have that there just for a validation so that your ID is correct.
Organization name, organization location. Which would actually be
facility name, facility location.

**[\>\>:]{.underline}**

Why don\'t we need hospital system? Because we can \--

**[\>\>:]{.underline}**

If we identify facilities we know what system they\'re in, right?

**[\>\>:]{.underline}**

Maybe. Medical center, university hospital \-- you don\'t necessarily
know they\'re connected in a hospital facility.

**[\>\>:]{.underline}**

There should be a way to look that up, rather than having to put it on
every message.

**[\>\>:]{.underline}**

I agree with that, there\'s always a problem with that. And you want to
keep them linked together because the way that you provide authorization
rights for the health care facility users, I mean, you have to have it.

So \[indiscernible\] hospital system they have systemwide users but they
also have the infection control professional only at that specific
hospital, so you need both.

**[\>\>:]{.underline}**

Okay, but if it always \-- somewhere it always is registered, and you\'d
be able to find \-- go back up or find those relationships. Wouldn\'t
that \--

**[\>\>:]{.underline}**

You don\'t necessarily need it, and I agree you don\'t \--

\[multiple speakers\]

**[\>\>:]{.underline}**

This is a standard \[indiscernible\] message for biosurveillance. I
don\'t think you necessarily need name and address.

**[\>\>:]{.underline}**

That\'s what I was \-- that\'s why I was questioning.

**[\>\>:]{.underline}**

Thought we put it in \-- gives you some validation on your message
transfer.

**[\>\>:]{.underline}**

So getting back to 1, 2, 3, and 4, we have consensus between the
Steering Group and HITSP coming with the Medicare number. What I\'m
hearing from Ed, that HITSP now prefers facility ID. And have \-- has
organizational ID. Do we need to change this, or does the group feel
that we need to change this to facility ID, if in fact HITSP is moving
in that direction? Or do they mean one and the same thing?

**[\>\>:]{.underline}**

I think they mean the same thing.

**[\>\>:]{.underline}**

I think \--

**[\>\>:]{.underline}**

And I think facility is better.

**[\>\>:]{.underline}**

Uh-huh.

**[\>\>:]{.underline}**

Just more generic, and it covers \-- for \[indiscernible\] columns.

**[\>\>:]{.underline}**

I think we should leave the HAVE as it is.

**[\>\>:]{.underline}**

Number of facility beds, which is number 8. Column 8, or Row 8, I\'m
sorry, is kind of a difficult issue. Because I think the idea that that
becomes some number that assigned \-- it doesn\'t necessarily vary over
time, but it\'s essentially the overall capacity of the facility. So
that value goes with the facility, just like its address does. And it\'s
really kind of a maximum capacity.

The number that tends to be easily available for that is license, number
of licensed beds. The problem is there\'s a lot of hospitals that have
closed down wings or \[indiscernible\] sections of their hospital, even
though they\'re licensed for 600 beds they would be at their maximum
capacity at 400.

The only idea is how in the world would we ever \[indiscernible\] that.
I don\'t know if you want to leave it in. If you don\'t want to leave it
in, or what. I think that\'s some kind of relative measure to say
you\'re going to look at a list of hospitals and say how big are they
relative to one another, it doesn\'t necessarily give you a true
capacity.

**[\>\>:]{.underline}**

Does it? I\'m struggling with this, we\'ve had a bit of this
conversation, Ed and I. If what we\'re trying to do is maybe a data
source that would allow us, we could look at the number of patients in
the hospital because we\'d have their diagnoses and we\'d know what the
licensed beds are, it would help a decision-maker know how many people
potentially could be put in that facility.

Now, if they haven\'t used 200 of their 600 beds for 20 years, you know,
it\'s not as though they could \-- would have 200 places to put people
tomorrow. But it is saying you can plan for that. And so if there\'s a
struggle between whether we\'re capturing this, we\'re capturing this
static number that is sort of the legal limit, or we\'re capturing what
is the typical number of patients in the hospital. Whether that\'s
staffed today or staffable.

**[\>\>:]{.underline}**

So beyond the legal limit, I think what you\'re saying is what is
the \-- you know, the physical number of beds in the hospital, the
licensed beds, it\'s a legal limit, and you\'re talking about \--

**[\>\>:]{.underline}**

Which do we want, from a public health standpoint?

**[\>\>:]{.underline}**

Well, you\'re going to see we\'re going to get the more specific
capacity.

**[\>\>:]{.underline}**

Right, when we talk about search capacity, a physical number of beds, it
may be valuable to know that, because some \[indiscernible\] is coming
in that can help staff that. I don\'t know that \-- these each have
meaning to different situations. And I don\'t know, maybe what \--

**[\>\>:]{.underline}**

Table this for now?

**[\>\>:]{.underline}**

I don\'t know let\'s table it, I think one of the things might be to say
that these two things are not equivalent.

We may need to define.

**[\>\>:]{.underline}**

But the BDSG needs us to say what it is.

**[\>\>:]{.underline}**

Well, do we want to know the facility beds and the number of licensed
beds? Is that coming out of this discussion?

**[\>\>:]{.underline}**

\-- break this into different categories. You could just have a
summation function that adds up the census and the capacity in all those
different categories, essentially that\'s your total. Then you don\'t
need this data on that, it will be a separate number. That\'s a
different thing than saying number of licensed beds. Or potential beds,
when you really go over the top.

**[\>\>:]{.underline}**

So leave this as TBD for right now?

**[\>\>:]{.underline}**

I\'d like to go back to 2, 3, and 4, are these acceptable names to move
forward, and numbers?

**[\>\>:]{.underline}**

I\'m sorry \--

**[\>\>:]{.underline}**

I think you were going to meet with us \--

**[\>\>:]{.underline}**

Okay, I just want to come to consensus on name and number, right now.
Just so that we have a list moving forward to work off of. And
discussing what each one of these I think is good, with the facility
beds and the licensed beds, let\'s table that, and move forward, and
kind of start coming and match up the HAVE, the HITSP, and the BDSG, and
then move forward with more discussion within each one.

So \--

**[\>\>:]{.underline}**

All right, let\'s table that.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Keep that thought.

**[\>\>:]{.underline}**

So number 5, we\'ll table.

2, 3, and 4, is everybody okay with those? Names for our group.

**[\>\>:]{.underline}**

Well, I think we were coming to the fact that if we had the facility ID,
there were other sources of data that could give us the things we would
need to have it in a message, in every message.

**[\>\>:]{.underline}**

For number 2.

**[\>\>:]{.underline}**

Well, 3 and 4.

**[\>\>:]{.underline}**

I\'d defer to David \[indiscernible\] on this.

**[\>\>:]{.underline}**

We felt pretty strongly that we wanted to have a facility name, at
least.

**[\>\>:]{.underline}**

And address, in addition.

**[\>\>:]{.underline}**

And I fully support that.

**[\>\>:]{.underline}**

There may not be \-- we\'re talking about outpatient areas, there may
not be a hospital system. Could we change it to something that works \--
Kaiser Permanente in Colorado has no hospital, but they\'re going to
contribute \--

**[\>\>:]{.underline}**

\-- the facility.

**[\>\>:]{.underline}**

I\'m talking about the second line, what does that now mean.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

\-- organization \--

**[\>\>:]{.underline}**

Scott wants to know, for line 2, what are we going to do there.

**[\>\>:]{.underline}**

HAVE.

**[\>\>:]{.underline}**

So delete.

**[\>\>:]{.underline}**

We can delete that, right?

**[\>\>:]{.underline}**

Facility means facility.

**[\>\>:]{.underline}**

The other reason to keep facility name and address on, is who knows,
maybe there\'s a temporary hospital you put up that doesn\'t have a
Medicare number or something. That lets you just name it and address it.

**[\>\>:]{.underline}**

Agreed.

**[\>\>:]{.underline}**

Okay. Number 3.

**[\>\>:]{.underline}**

Facility name, facility \--

**[\>\>:]{.underline}**

\-- want ID, because that \--

**[\>\>:]{.underline}**

It\'s already up there on number 1, right?

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So just facility name?

**[\>\>:]{.underline}**

Facility name, and actually it should be facility location, because
that\'s a composite data element.

**[\>\>:]{.underline}**

Facility location? Okay. Not address, but location, correct?

**[\>\>:]{.underline}**

Right, location.

**[\>\>:]{.underline}**

Yes. GIS coordinates. \[laughter\]

**[\>\>:]{.underline}**

Okay, if we move down to line 6, we\'ve got type of bed.

**[\>\>:]{.underline}**

We can \[indiscernible\] that for now, some of that is repeated below
it.

**[\>\>:]{.underline}**

You got it. So you want me to head down to the facility summary?

**[\>\>:]{.underline}**

Yes, those three items I think fit very nicely in the HAVE scheme, and I
think everybody is agreeing that HL7 \[indiscernible\] send that data or
XML we send that data so \--

**[\>\>:]{.underline}**

Okay, if you notice, HITSP has actually got a date and time of message.

**[\>\>:]{.underline}**

And I don\'t think you have to worry about that, it\'s a separate data
that we specify. In other words \--

**[\>\>:]{.underline}**

It\'s going to come.

**[\>\>:]{.underline}**

That time stamp is a system issue, we don\'t have to say it separately.

**[\>\>:]{.underline}**

Okay, so 8, 9, and 10 here are \-- I mean, from our perspective, here,
these three lines are okay, moving forward, naming, correct?

**[\>\>:]{.underline}**

Uh-huh.

**[\>\>:]{.underline}**

Okay. Looks like I\'ll just have to renumber them later. So moving down
to the \--

**[\>\>:]{.underline}**

We talked about the concept is the hospital even open or not. And you
have that kind of divided concept. That \[indiscernible\].

In other words if you\'re overwhelmed during the flu pandemic and you
can\'t accept another single patient you may be closed, and you\'re
still taking outcare patients.

Whereas the facility status which may say you just got hit by a tornado
and you\'re closed. So that\'s the term they split into the HAVE spec.

If that matches what people would want to know, then we don\'t have to
change that, either.

**[\>\>:]{.underline}**

Just to be clear, the hospital facility \[indiscernible\] there\'s
specifications for the clinical and facility staff?

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Because this is \-- because HAVE is an XML thing, lets you do in
hierarchy. The hospital \[indiscernible\] status as an outline, there\'s
two components, there\'s a clinical status and \[indiscernible\].

**[\>\>:]{.underline}**

HAVE has additional elements that we don\'t have in here, service,
availability, and surgical service, et cetera. We did not think that
necessarily matched our needs for biosurveillance.

**[\>\>:]{.underline}**

What does HAVE stand for?

**[\>\>:]{.underline}**

Hospital AVailability Exchange.

**[\>\>:]{.underline}**

Is everybody familiar with the HAVE \-- on your agenda I put links down,
so electronically you\'ll be able to get to it. It\'s just copyrighted
and you have to fill out all your information in order, so I don\'t want
to distribute that without \--

**[\>\>:]{.underline}**

OASIS?

**[\>\>:]{.underline}**

And (indiscernible) are going to have to copyright this.

**[\>\>:]{.underline}**

Correct.

**[\>\>:]{.underline}**

Just like for HL7 users. It\'s like an open-source license.

**[\>\>:]{.underline}**

Right, but they want to know who is coming in to grab the specification.

**[\>\>:]{.underline}**

I understand the concept of clinical status, but what does that data
look like? Is it a bed number, or is it \--

**[\>\>:]{.underline}**

No, you want to go down to the actual data element, the descriptions of
them?

**[\>\>:]{.underline}**

No I agree with the descriptions that the level you provided as being
useful.

**[\>\>:]{.underline}**

All these data elements are described in a lot of details in the HAVE
spec, which you all should have access to.

I\'m just trying to get the naming conventions.

**[\>\>:]{.underline}**

The notion last time was the concept is the facility open, that\'s what
we had talked about. In general. And the ability to move to adopt this
term to represent the notion of open \[indiscernible\].

**[\>\>:]{.underline}**

Even more than HAVE I think we\'re getting more specific about what open
means. Open for care to patients that are there, versus \--

**[\>\>:]{.underline}**

Closed for admissions as opposed to completely closed.

**[\>\>:]{.underline}**

Right, thank you.

**[\>\>:]{.underline}**

I think that detail for planning purposes makes sense, what we talked
about last time. So can we move to adopting this to represent our open
concept?

**[\>\>:]{.underline}**

That\'s good.

**[\>\>:]{.underline}**

All right. That becomes green. I\'ll change the thing.

**[\>\>:]{.underline}**

Ability to comment on \-- supply problems staffing problems, we have
decontamination ability, \[indiscernible\] and we don\'t have to read
\[indiscernible\]. Things that you think are worthwhile for us to know
in our biosurveillance capacity.

**[\>\>:]{.underline}**

We did \[indiscernible\].

**[\>\>:]{.underline}**

We talked about a similar concept, here. We had staffing issues. Supply
issues. The notion of earlier rows, that we had talked about, we wanted
to move to a little more refined view of those \[indiscernible\] data.

**[\>\>:]{.underline}**

Yeah, this resource, there\'s a focus here in HITSP and HAVE about the
decon capacity. In the five scenarios, decon probably plays in one of
the five. What are some other resource issues that may play out in the
other four that \-- it\'s called out here, just decon.

**[\>\>:]{.underline}**

Well, ventilators have really got \[indiscernible\] down and probably
should be \--

**[\>\>:]{.underline}**

What happens if there\'s no electricity, where would that be recaptured?
That\'s in infrastructure. Is that one of the values, you have the
values.

**[\>\>:]{.underline}**

I\'d have to look that, I don\'t think it gets down to that specificity.

**[\>\>:]{.underline}**

No Internet connectivity, something like that.

**[\>\>:]{.underline}**

Of course this is an antibase system, you\'d never be able to
\[indiscernible\].

**[\>\>:]{.underline}**

Zero days after 9/11 you could always overwhelm the system, you can
always. In these discussions. But if we don\'t have Internet access, we
don\'t have any of these \[indiscernible\] right now, that\'s true. We
don\'t have database \--

**[\>\>:]{.underline}**

It\'s one of the preconditions of moving forward. Is that there\'s got
to be electronics. So if \-- 

**[\>\>:]{.underline}**

Just one other example of \-- botulism, for example.

**[\>\>:]{.underline}**

Do we need to get to that level of specificity here? You\'ve called out
for decon capacity specifically here, and I just wonder if you think
there\'s value, given we\'re supposed to be focused on these five
scenarios, should we be looking at similar sorts of needs?

**[\>\>:]{.underline}**

I\'m going to divert your question on this table, because I\'m not the
one that\'s going to be \--

**[\>\>:]{.underline}**

\-- decon in a way in addressing some of the \[indiscernible\].

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

I don\'t think you\'re going to be able to preempt every single thing
you might collect data on. You know, is this ever really going to be
part of normal \[indiscernible\] system in a hospital or is this always
going to be a Web-enabled kind of thing, and I spent some time this week
with HAVE, a bed, EM systems, and I\'m convinced that this is routinely
collected data because it\'s useful to the facilities. So that helps
them to make decisions about diversion. So it\'s not like you\'re asking
somebody to do something that \-- they\'re doing it because it\'s
helpful to them. When you get down to all of these other data things
that might be used maybe sometime \--

**[\>\>:]{.underline}**

You\'re not going to get it.

**[\>\>:]{.underline}**

You\'re not, because it\'s not useful to their day-to-day work. So it\'s
still this sort of \-- I think, the way they track ventilators used in a
hospital, that has to be in a system somewhere. That\'s where we\'re
coming in the bio \-- it\'s probably in the database somewhere how many
ventilators they have because of maintenance contracts, et cetera, but
we haven\'t explored that fully.

What we\'re really saying is how do we get existing information from
whatever data systems exist, because we\'re getting data feeds. Putting
these on a list is a good thing, but I think the more you put, the less
likely they are to find a data source for that. We\'re not going
\[indiscernible\] to enter data.

**[\>\>:]{.underline}**

Intersection between nice to know.

**[\>\>:]{.underline}**

And again, it\'s a minimum dataset.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Not a nice-to-have dataset.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

From the last meeting we had infrastructure problems, I believe, and
with staffing as a \[indiscernible\] Art\'s question, does this capture,
is water available, where are they having some problems, is this likely
be where to capture that piece?

**[\>\>:]{.underline}**

It would be where to say there is an infrastructure problem, maybe
depending on the system field you use, comment field or
component \[indiscernible\] infrastructure problem.

**[\>\>:]{.underline}**

Propose to adopt that in a hierarchal sense, do we just adopt the
hospital resource staff, with that assumption underneath it? Do we in
essence \[indiscernible\] meeting decon capacity?

**[\>\>:]{.underline}**

In my mind, I\'m wondering whether you want to keep it in the list at
all. Maybe this is part of the minimum dataset we want to collect on
day-to-day.

**[\>\>:]{.underline}**

What\'s the granularity parts for decontaminate capability is it just a
yes or no?

**[\>\>:]{.underline}**

It\'s a capacity, it\'s a number.

**[\>\>:]{.underline}**

It\'s a number.

**[\>\>:]{.underline}**

Which might be zero, so that\'s \[indiscernible\], although I guess that
doesn\'t tell you whether or not they have it, just whether or not it\'s
available.

**[\>\>:]{.underline}**

\-- acting potentially as staffing, and it sort of gets back to what\'s
the available staffed beds. I don\'t really care what their staffing
level is, I want to know what their capacity is relative to the staff
that they have on site. Know if we\'re going to have to get multiple of
these in order to discern that, or if we think we can get to that by
these other \--

**[\>\>:]{.underline}**

I think the concern was in \[indiscernible\] and there may be some sort
of major disaster, that \[indiscernible\] the hospital staff, they might
have initially had 800 staffed beds, but it doesn\'t mean that they
actually at that time have the staff to cover that. So, you know, they
might have 1,200 beds, 800 \--

**[\>\>:]{.underline}**

Do we have to combine data elements to really get to what we\'re looking
for, is there a clean way to \--

**[\>\>:]{.underline}**

I guess that\'s where this element came from. But \--

**[\>\>:]{.underline}**

I mean, what is this? Staffing, is that current staff for the day, or is
that total staff for the facility \--

**[\>\>:]{.underline}**

My recollection is the values are things like no staffing problems,
experiencing some staffing shortages, experiencing major staffing
problems, or something like that.

**[\>\>:]{.underline}**

Major categorical \--

**[\>\>:]{.underline}**

Are these things biosurveillance? Do these things fit our definition?

**[\>\>:]{.underline}**

Response, so \--

**[\>\>:]{.underline}**

Resource utilization.

**[\>\>:]{.underline}**

And situational awareness.

**[\>\>:]{.underline}**

At the last meeting we talked about, you know, types of granularity, and
infrastructure problems

**[\>\>:]{.underline}**

That\'s what you would get in the message. From the staff. So adequate,
insufficient. But again, I think I\'m more concerned with us having a
list and a name right now, and then flushing some things out, so at
least we have a baseline \--

**[\>\>:]{.underline}**

If they\'re comfortable with the names we can readdress it in the
feasibility discussion, too.

**[\>\>:]{.underline}**

This document is not one we can get, right?

**[\>\>:]{.underline}**

No, you can get to it, it\'s just it\'s copyrighted, I did not want \--

**[\>\>:]{.underline}**

You have to sign \--

**[\>\>:]{.underline}**

You have to just enter your e-mail address and \-- \-- station it\'s
free \--

**[\>\>:]{.underline}**

\-- get it off OASIS just now, just need to go through the process.

**[\>\>:]{.underline}**

Yes, sir.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Right, I mean, it\'s \-- you don\'t have to be public health official
or \--

**[\>\>:]{.underline}**

If I\'m reading this correctly, it would seem to fit the intent of what
we identified as some data type concepts last time. So that would
suggest we should put it on a list, and come back to it in terms of the
detail to make sure that HITSP can help us identify what it is that\'s
going to meet our needs for biosurveillance.

**[\>\>:]{.underline}**

Correct.

**[\>\>:]{.underline}**

And if we could work through that same type of thought process for the
rest of these, that would sure alleviate us in getting out of here.

**[\>\>:]{.underline}**

Hospital resource status, all three are in at this point?

**[\>\>:]{.underline}**

I think so.

**[\>\>:]{.underline}**

All three?

**[\>\>:]{.underline}**

All three.

**[\>\>:]{.underline}**

Move them over to Column E.

Move on to the next one, Ed?

**[\>\>:]{.underline}**

This is where I need to get you all to define what you really want to
know. \[indiscernible\] and the HAVE has got that split into various
categories broken down.

Traffic status is whether or not you can accept ambulances or if you
have a problem having ambulances. Most ERs when they get too full they
say, well, we\'re open to walk-in patients, but don\'t send any more
ambulances. If you\'re sending ambulances, go down the street.

**[\>\>:]{.underline}**

Here\'s what the spec says.

**[\>\>:]{.underline}**

The terms that are used at a local level for this vary across the
country. It seems like every city has their own terms, but they can be
all mapped to kind of these \--

**[\>\>:]{.underline}**

Common \--

**[\>\>:]{.underline}**

These three values, here.

**[\>\>:]{.underline}**

These are basically opened or closed.

That\'s ambulance traffic, are you accepting ambulances. Which
\[indiscernible\] capacity, is now saying we have an ability to take X
number red patients, Y number of yellow patients and Z number of green
patients right now.

Systems that are set up to do this don\'t generally do this on a
day-to-day basis. They fire that up for that form designated in a
specific event.

I don\'t know that we want it we can get it routinely from
\[indiscernible\].

**[\>\>:]{.underline}**

But if we were pulling it routinely even if it was blank, when it was
then used, we would start to get it.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

I mean, that seems a little more useful than rerouting ambulances to me.

**[\>\>:]{.underline}**

We can still leave it as a separate element. I\'m just trying to find a
name \--

**[\>\>:]{.underline}**

Go ahead.

**[\>\>:]{.underline}**

\-- as opposed to EMS census \--

**[\>\>:]{.underline}**

Cable.

**[\>\>:]{.underline}**

They\'ve all gone DLL.

**[\>\>:]{.underline}**

Sorry.

**[\>\>:]{.underline}**

Cable \-- the other end of the cable, maybe?

**[\>\>:]{.underline}**

Where is the other end of the cable?

**[\>\>:]{.underline}**

Is it under my foot?

**[\>\>:]{.underline}**

That\'s it.

**[\>\>:]{.underline}**

\-- consensus is number of patients in the department at that time.

**[\>\>:]{.underline}**

So again it\'s \--

**[\>\>:]{.underline}**

No, it\'s not even that.

**[\>\>:]{.underline}**

The red, yellow, green.

**[\>\>:]{.underline}**

Oh, yeah, it\'s \-- interdepartment impact, again split into the
category. That might be something you turn on again during a disaster,
but not necessarily \[indiscernible\]. The one I think in my opinion we
can drop off is the offload minutes which will allow all the
\[indiscernible\] which is an ambulance show up at the hospital they
hang out waiting to drop off a patient before \[indiscernible\] so, even
though that\'s used a lot I\'m not sure that\'s real helpful for us.

9, is that at least one that we can say not \[indiscernible\] at this
point?

**[\>\>:]{.underline}**

\[indiscernible\] for now.

**[\>\>:]{.underline}**

Right, so traffic, capacity, and census.

There\'s a lot of talk about EMS up to this point as related to facility
activity. Are we comfortable putting it in relative to facility status
involves \[indiscernible\] at this point. We can always figure out later
as well, but in terms of the next step this would be the set of fields
we would consider at least.

The access of an ED is tracked in the status? Of the EMS status? Where
does it say this doesn\'t apply to this institution?

**[\>\>:]{.underline}**

Capacity.

**[\>\>:]{.underline}**

In capacity?

**[\>\>:]{.underline}**

Maybe it\'s census.

**[\>\>:]{.underline}**

Just want to be sure that there is a place where you can say it doesn\'t
apply.

**[\>\>:]{.underline}**

Here\'s capacity right here.

**[\>\>:]{.underline}**

Go up one more, maybe it\'s \-- that\'s it, okay that\'s it, traffic
\[indiscernible\] table.

**[\>\>:]{.underline}**

\[indiscernible\] table.

**[\>\>:]{.underline}**

In emergency \--

**[\>\>:]{.underline}**

You also can make decisions about not capturing the data when you\'re
talking about specific data types.

**[\>\>:]{.underline}**

Sure. Absolutely.

**[\>\>:]{.underline}**

And so if we define patient type as an outpatient, and \[indiscernible\]
transmit these \[indiscernible\].

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

I think that\'s what you\'re saying.

**[\>\>:]{.underline}**

Well, but I\'m thinking that there would be \-- I think what we\'ve
heard earlier, HITSP is thinking in terms of patient-specific reporting
and facility-specific reporting or resource \[indiscernible\].

**[\>\>:]{.underline}**

Facility.

**[\>\>:]{.underline}**

Facility, okay, that the patient may not have any resources \--

**[\>\>:]{.underline}**

Agreed. Agreed. Because we haven\'t been thinking that way.

**[\>\>:]{.underline}**

Okay. Are we all right on moving the EMS over, can we move on to the
next ones?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

We\'ve moved all three over and tabled \-- we\'ve offloaded the offload.

**[\>\>:]{.underline}**

Okay, the next is kind of bed categories, and we look at the OASIS
definition of this, this is staff \-- available and staffed. So
available physically, and available with staffing. Which seems to match
what \[indiscernible\]. I don\'t know if we need to spend time on it. If
somebody is wondering about a surgical ICU versus surgical or coronary
care unit, et cetera, all those we lumped for purposes of
\[indiscernible\]. There is a capability in the HAVE spec to break those
down.

We were thinking at our level, we just kind of want to know if there are
any ICUs getting \[indiscernible\].

**[\>\>:]{.underline}**

\-- more detail?

**[\>\>:]{.underline}**

Lynn is looking like \--

**[\>\>:]{.underline}**

Well, it goes back to my hospital \[indiscernible\] days, you know, the
way we track section rates we use \[indiscernible\] the last 30 years as
part of a national formula that\'s \[indiscernible\] available, so
unless there\'s some reason to want to be \[indiscernible\] surveillance
for that purpose. Which wouldn\'t lump \[indiscernible\] necessarily.

**[\>\>:]{.underline}**

This is a little different than EMS categories too, it\'s a whole other
way \--

**[\>\>:]{.underline}**

I know.

**[\>\>:]{.underline}**

This is lumping \[indiscernible\] beds with orthopedic beds with other
beds, right? Into Med Surg as one category.

**[\>\>:]{.underline}**

That\'s correct, lump \[indiscernible\] Med Surgery.

**[\>\>:]{.underline}**

A way of BioSense to get this is to know what those units were from the
hospital calculated on the number of people in there, not to have a
Web-enabled system. We\'ve been struggling because right now we just
have units in the hospital, which don\'t mean anything to anyone. There
has to be translational mapping, there has to be updated, so until we
make a decision we\'re not making \--

**[\>\>:]{.underline}**

Even with that if they change Unit 4C from general surgery unit to a
trauma unit because there\'s a disaster event, you won\'t know that. I
mean you won\'t know \--

**[\>\>:]{.underline}**

Change dynamically, right.

**[\>\>:]{.underline}**

Right, if we\'re going to track by bed type, then we would have to have
a way for that to be updateable.

**[\>\>:]{.underline}**

This is just showing the definition.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

And this is the HAVE standard.

**[\>\>:]{.underline}**

Is HAVE \[indiscernible\] hospital at all, or urgent care \--

**[\>\>:]{.underline}**

Hospital available \-- 

**[\>\>:]{.underline}**

So from the biosurveillance and facility available issue, does this
still fit to look at availability of urgent care people
\[indiscernible\] including lining up of other locations to take care of
individuals? In an emergency situation?

**[\>\>:]{.underline}**

I think that would be all \[indiscernible\] for an urgent care center.
For EMS capacity. \[indiscernible\] the numbers \[indiscernible\]

**[\>\>:]{.underline}**

The last time we talked about \-- started a specific bed
\[indiscernible\] to room type availability, that\'s still
\[indiscernible\] maintain for biosurveillance, that level of detail,
types of beds?

**[\>\>:]{.underline}**

I think we need the type of beds, we just haven\'t determined
\[indiscernible\] the granularity there. I think that question is I
think a pretty easy \[indiscernible\]

**[\>\>:]{.underline}**

So we\'re looking \--

**[\>\>:]{.underline}**

For minimum, do we think it\'s acceptable to initially say "Med Surg,"
then, if we come up with use cases we \-- 

**[\>\>:]{.underline}**

If we can say we want more granularity, we can try to devise that.

**[\>\>:]{.underline}**

So the proposal is to bring over Medical Surgery under Hospital Status?
Whole group \-- you want them all or just \-- I heard medical surgery.

**[\>\>:]{.underline}**

I was just using that as an example.

**[\>\>:]{.underline}**

So the whole group.

**[\>\>:]{.underline}**

Oh, yeah.

**[\>\>:]{.underline}**

The whole group is there.

**[\>\>:]{.underline}**

Ventilators, got an "N/A" because there was not a specific thing in the
HAVE spec for ventilators.

**[\>\>:]{.underline}**

\-- you can still have it.

**[\>\>:]{.underline}**

We could go ahead with these \--

**[\>\>:]{.underline}**

I think that\'s yes or no \--

**[\>\>:]{.underline}**

Ventilator?

**[\>\>:]{.underline}**

Can you look for ventilator in \[indiscernible\].

**[\>\>:]{.underline}**

I will.

**[\>\>:]{.underline}**

Oh, you did already.

**[\>\>:]{.underline}**

Oh.

**[\>\>:]{.underline}**

That was used as an example. There is a generic \-- they have
availability to say generic resource, so you say you include the field
for what\'s the name of the resource, and how many of them you have, or
what the status of the resource.

**[\>\>:]{.underline}**

This would be like an X?

**[\>\>:]{.underline}**

Just using an example of how that structure could be used, and
ventilator information.

**[\>\>:]{.underline}**

So the structure is there, if we should ask for it, if possible we
could \--

**[\>\>:]{.underline}**

Yeah, ask for it.

**[\>\>:]{.underline}**

I think we should \--

**[\>\>:]{.underline}**

This is the HAVE standard. It is the \-- are the data important, is the
individual data element important.

**[\>\>:]{.underline}**

We want to leave it there.

**[\>\>:]{.underline}**

Go ahead and move this name over here. Correct?

**[\>\>:]{.underline}**

Yep.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

So do we need the \[indiscernible\] backup.

**[\>\>:]{.underline}**

Just a question on clarification. I realize we\'re going to have another
iteration of this to the \[indiscernible\].

**[\>\>:]{.underline}**

As to the \[indiscernible\].

**[\>\>:]{.underline}**

As to whether this data is available. If it\'s available \-- let\'s say
it\'s not available, but we really think it\'s needed, we\'re really
defining data that would be needed in special situations. That\'s making
it onto the list, here. We\'re not saying, are we, that we need to know
available ventilators, 365 days a year.

**[\>\>:]{.underline}**

No, we are. Talking about a \[indiscernible\] that\'s being sent.

**[\>\>:]{.underline}**

We are saying that.

**[\>\>:]{.underline}**

\-- capabilities, and if it turns out that it\'s not feasible, then \--
and this is required, then what would be a message that this committee
or group might recommend to acquire that. And would it be that we would
suggest it happen on a daily basis, or we have a mechanism available to
deploy at the moment that it\'s necessary? I don\'t know.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

That will come in the feasibility thing.

**[\>\>:]{.underline}**

All right.

\[multiple speakers\]

**[\>\>:]{.underline}**

So I think we\'re moving on down here to the \--

**[\>\>:]{.underline}**

Now we\'re moving to the patient-specific stuff. Data linker, officially
this round HITSP does not deal with \[indiscernible\] security issues
we\'ve been talking about a lot about \[indiscernible\] of data and how
it would happen \[indiscernible\] the service, so it\'s clearly being
pursued although I don\'t know if that\'s going to be part of our spec.

**[\>\>:]{.underline}**

I don\'t think it will.

**[\>\>:]{.underline}**

\-- concept, the spec probably won\'t have it this fall.

**[\>\>:]{.underline}**

Is that the term you\'re using, this round? This round might be the
linker?

**[\>\>:]{.underline}**

\[indiscernible\]

**[\>\>:]{.underline}**

The term may change, but \--

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

I mean, I think we can certainly keep it in our recommended data list,
because we need it for our whole premise of \[indiscernible\].

**[\>\>:]{.underline}**

And we\'ll add in a comment section then a description on that.

**[\>\>:]{.underline}**

Good.

**[\>\>:]{.underline}**

Okay, so leave it?

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

I think this encounter data I think you definitely need, in fact down
below we had diagnosis date, which we talked about that being kind of an
irrelevant thing, nobody really fills that in, we really wanted the
encounter data.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

That\'s encounter date time.

**[\>\>:]{.underline}**

It should be time, too, right.

**[\>\>:]{.underline}**

You want to move date and time?

**[\>\>:]{.underline}**

Yep.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

That\'s what I thought. And again, I did not assume anything, I wanted
to make sure that everybody \--

**[\>\>:]{.underline}**

Go ahead.

**[\>\>:]{.underline}**

I was going to say for the randomized weren\'t we use dominant data
linker? I think that\'s what we were using.

**[\>\>:]{.underline}**

For \-- yeah. Use \[indiscernible\].

**[\>\>:]{.underline}**

NON, is that it?

**[\>\>:]{.underline}**

IMITED \--

**[\>\>:]{.underline}**

DSY \--

**[\>\>:]{.underline}**

No, DSEU.

**[\>\>:]{.underline}**

What time was your plane, Ed?

**[\>\>:]{.underline}**

Three minutes.

**[\>\>:]{.underline}**

So I think date of birth becomes two data elements, month of birth and
year of birth, in ours.

**[\>\>:]{.underline}**

I think we should then specify that. Now, there was discussion that if
we want to be HIPAA compliant, if someone is 89 years old, you\'re
supposed to say "over 89." \[indiscernible\] rather than date of birth,
because so few people are over 89 \[indiscernible\].

Now discussion of ZIP codes, less than 20,000 people you should only use
three digits, rather than five digits. I think with the preconditions
the way they are, I think we\'re covered.

So we can move date of birth.

**[\>\>:]{.underline}**

Month and year of birth.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

I think it will end up the same \--

**[\>\>:]{.underline}**

\-- calculated.

**[\>\>:]{.underline}**

I forgot to look at this \--

**[\>\>:]{.underline}**

Age, correct?

**[\>\>:]{.underline}**

If date of birth is not available.

**[\>\>:]{.underline}**

Right. Just say "five-digit ZIP."

**[\>\>:]{.underline}**

"State" we moved over.

**[\>\>:]{.underline}**

Okay. Date and time of last update.

**[\>\>:]{.underline}**

This is \[indiscernible\] constraints.

**[\>\>:]{.underline}**

And State and Territory are non \--

**[\>\>:]{.underline}**

There was not a lot of concern about these \-- this next group, really.
There is some practical issues of getting some of this
\[indiscernible\].

The diagnosis date is one you can kill. Is that \--

**[\>\>:]{.underline}**

The diagnosis date?

**[\>\>:]{.underline}**

That becomes the encounter date up above.

**[\>\>:]{.underline}**

Oh, not necessarily.

**[\>\>:]{.underline}**

No.

**[\>\>:]{.underline}**

There\'s a big discussion about this.

**[\>\>:]{.underline}**

I\'ve had a few myself with Dr. Barthell. As you update, you\'re
receiving different types of diagnoses. They\'re being updated, you need
that time stamp.

**[\>\>:]{.underline}**

That\'s the time that that \[indiscernible\]?

The whole argument was there was no documentation in current hospital
systems of the time that you would find that diagnosis.

**[\>\>:]{.underline}**

Maybe there should be a time stamp.

**[\>\>:]{.underline}**

\-- you interpret it.

**[\>\>:]{.underline}**

The time and date of last update?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

So we\'re saying that\'s a system time stamp as opposed to \-- that\'s
what the argument was about, it\'s you know, I don\'t assign a time that
I decide a diagnosis, is this \--

**[\>\>:]{.underline}**

But it does not necessarily put down a time.

**[\>\>:]{.underline}**

I know we were trying, but it doesn\'t exist. But again, is this
something that we are trying to drive forward because we think it\'s
important to know?

If we\'re increasingly moving toward electronic real-time diagnoses
being entered in health care IT systems, and as a clinician updates
their diagnoses, they do put a time associated with it. Or the system
\[indiscernible\] put that time. Is that not something we would want,
that you have the most current up-to-date diagnosis on a patient, and
you would know when it was made for that patient, in association with
when they presented for care.

So again any one of those \[indiscernible\] is important, is it
feasible?

**[\>\>:]{.underline}**

Any system that has an audit of who \-- how that data got in there,
it\'s going to date and stamp that, and the audit \[indiscernible\]
actually spit it out.

**[\>\>:]{.underline}**

Date and time stamp will be expected on all \--

**[\>\>:]{.underline}**

I\'m thinking of the day-to-day process. I write bronchitis as a
diagnosis, I hand it to the clerk, who maybe an hour later types it into
the ADP system.

**[\>\>:]{.underline}**

But what if as we move you write it on a computer, it\'s captured as an
electronic message, then the computer knows when you\'ve written it on
there and can send that data element.

Again, do we think it\'s important? Even if we\'re not able to get it
right now because it\'s not common practice, do we think it should be?

I personally do. If we think real-time clinical diagnosis information is
important. Just trying to think of how to come up with a standard. Good
luck with that.

**[\>\>:]{.underline}**

Should we TBD this right now, and come back to it? I\'m just thinking of
Dr. Barthell\'s time.

**[\>\>:]{.underline}**

We\'re arguing that knowing it is important, we\'re talking about how
you get it. So I think leave it on the list \-- we should leave it on
the list, and then we should talk about how we get it later.

**[\>\>:]{.underline}**

Okay, so date and time of last update, correct?

So it looks like the rest of these were correct, and Dr. Barthell, when
you say HL7 here, what \-- are we talking 2X, or \--

**[\>\>:]{.underline}**

I mean just \--

**[\>\>:]{.underline}**

I did not \--

**[\>\>:]{.underline}**

Patient class, whether there was \[indiscernible\] tends to be a local
thing, different hospitals assign different numbers, so it\'s hard to
get a standard way to \--

**[\>\>:]{.underline}**

I think we\'re all thinking \--

**[\>\>:]{.underline}**

\-- outpatient inpatient or ER, but it may actually come across as very
different things. That\'s more of an implementation issue.

**[\>\>:]{.underline}**

I have a question about a potential gap here maybe \[indiscernible\]
healthcare issues

**[\>\>:]{.underline}**

Where is that in the \--

**[\>\>:]{.underline}**

There is no need for order information biosurveillance. Why do you need
that?

**[\>\>:]{.underline}**

Why? All kinds of whys. Because it\'s easier to inline the data if it\'s
all seen by one physician, it\'s easier to follow up on what the problem
is by calling the physician.

**[\>\>:]{.underline}**

Does the linker give you that?

**[\>\>:]{.underline}**

No.

**[\>\>:]{.underline}**

The linker won\'t but the facility might.

**[\>\>:]{.underline}**

There could be thousands \--

**[\>\>:]{.underline}**

You have to go back to the record, look it up and find the doc.

**[\>\>:]{.underline}**

That\'s what I\'m saying, why not capture it there

**[\>\>:]{.underline}**

Right, we haven\'t in \[indiscernible\] because they haven\'t \--

**[\>\>:]{.underline}**

I just wonder has this committee excluded it? Because it seems such an
obvious data element.

**[\>\>:]{.underline}**

That would be \-- that would be an ID for each doc.

**[\>\>:]{.underline}**

We have that in the national system.

**[\>\>:]{.underline}**

An ID.

**[\>\>:]{.underline}**

Uh-huh.

**[\>\>:]{.underline}**

And you really think it would be \--

**[\>\>:]{.underline}**

Yeah, but \-- I spaced for a minute, so hopefully I\'m \--

**[\>\>:]{.underline}**

We\'ll bring it up again when we get to lab data because that becomes an
essential \--

**[\>\>:]{.underline}**

It\'s really interesting because we haven\'t done it, and you know, some
of the decisions that were made last summer were really related to about
making sure we weren\'t using data sort of for care quality comparisons.
I wonder if we sort of took that out thinking if you track by doctor you
can look at it \--

**[\>\>:]{.underline}**

Makes the doctors nervous?

**[\>\>:]{.underline}**

Yeah. You can say the same thing at the healthcare facility level.

**[\>\>:]{.underline}**

Oh, absolutely.

**[\>\>:]{.underline}**

You can see how long he\'s been in with this diagnosis in this facility
versus this facility, so we\'ve given reassurance the data won\'t be
used by that. So I wonder if we didn\'t address the physician thing
because of some of that logic

**[\>\>:]{.underline}**

The uncomfortable factor, that could be true for any reason.

**[\>\>:]{.underline}**

I know. I propose we put it in there.

Treating physician.

**[\>\>:]{.underline}**

Treating physician or ordering?

**[\>\>:]{.underline}**

Well, that could be multiple.

**[\>\>:]{.underline}**

Part of the complexity is the number of different \-- which physicians.

**[\>\>:]{.underline}**

Right, I know.

**[\>\>:]{.underline}**

What is it really \--

**[\>\>:]{.underline}**

\-- \[indiscernible\] it would be admitting physician.

**[\>\>:]{.underline}**

It\'s to do public health followup, I think I agree with that, you
don\'t necessarily as a public health official go to the patient, nor do
you even go to the \-- you know, the individual provider. You don\'t if
you work in a State where the infection control or hospital epidemiology
community owns a lot of \[indiscernible\] public health interfaces.
That\'s not the way it is everywhere.

**[\>\>:]{.underline}**

If the purpose is to facilitate followup and investigation is a key
element, then it\'s available.

I\'m hearing \--

**[\>\>:]{.underline}**

I\'m wondering \-- you know, you increase another complexity, do you
actually display that data in a surveillance system to authorize public
health users, so we\'re not displaying a name, we\'re not, do you then
display the name of the physician.

**[\>\>:]{.underline}**

But that\'s part of HIPAA, and HIPAA doesn\'t address too much the
identity of the provider, it\'s really primarily looking at the privacy
of the patient.

In UK the privacy laws also attach to the physicians, but they don\'t
really here.

**[\>\>:]{.underline}**

We can put the UPIN number, it doesn\'t really have to be the name of
the doctor.

**[\>\>:]{.underline}**

Sounds like it\'s used in addition to \[indiscernible\] related to the
randomized data linker as well. If we\'re going use it selectively for
following up, then it\'s selective use, similar to what we\'ve been
using with \[indiscernible\] the detail with the patient.

But it would be tied to the section related to the patient \-- tied to
the section related to the diagnosis.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

It could occur in laboratories as well.

**[\>\>:]{.underline}**

Each of those \-- right.

**[\>\>:]{.underline}**

In what functional area, then, does that come back to? Because if
you\'re doing followup,

**[\>\>:]{.underline}**

It\'s outbreak management.

**[\>\>:]{.underline}**

Does that come back to outbreak management?

**[\>\>:]{.underline}**

\-- in all three, if it matched in all three, you\'ve got it nailed.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Why don\'t we put it on and we can come back and revisit it, but it
sounds like we got stuck enough in that portion that it needs to stay
there for awhile.

**[\>\>:]{.underline}**

Under the clinical here what are we going to call it?

**[\>\>:]{.underline}**

Provider number.

**[\>\>:]{.underline}**

Provider.

**[\>\>:]{.underline}**

Provider ID?

**[\>\>:]{.underline}**

Provider ID.

**[\>\>:]{.underline}**

Okay. We\'ll carry that forward over here.

**[\>\>:]{.underline}**

And we know we have to put it in other places as well.

**[\>\>:]{.underline}**

Excellent.

**[\>\>:]{.underline}**

\-- \[indiscernible\] physician, it could be nurse practitioner.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

What happened to the \[indiscernible\] element.

**[\>\>:]{.underline}**

We had a lot of questions about text, the problems with text, because
security problem, you know, \[indiscernible\] symptoms first,
explore \-- you know \[indiscernible\] consult \-- there was a lot of
concern about that.

Date and time of onset of illness ended up being a text
\[indiscernible\] not traditionally coded.

Chief complaint a text, the nurse\'s, triage nurse of text.

**[\>\>:]{.underline}**

Triage notes help you interpret clusters.

**[\>\>:]{.underline}**

That\'s exactly what I told them. That was the quote I gave them almost
exactly.

**[\>\>:]{.underline}**

Look, we\'re done here.

\[laughter\]

**[\>\>:]{.underline}**

It\'s coded for, but understand there are some problems.

**[\>\>:]{.underline}**

I know. Right.

**[\>\>:]{.underline}**

When it comes to feasibility.

**[\>\>:]{.underline}**

Exactly.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Should we carry over nurse triage notes, then?

**[\>\>:]{.underline}**

Is it really feasibility of sending text, or is it the interpretation
and analysis of that text?

**[\>\>:]{.underline}**

It\'s security issues around sending it because it might contain \--

**[\>\>:]{.underline}**

Names.

**[\>\>:]{.underline}**

Personal information. And then it\'s feasibility around the parsing it
to extract the usable context from the raw text.

**[\>\>:]{.underline}**

So can we just modify this comment, there, to include that last thought,
that it may compromise confidentiality? I think we\'re hearing not
included. Is that right?

**[\>\>:]{.underline}**

No. No.

**[\>\>:]{.underline}**

Not necessarily.

**[\>\>:]{.underline}**

\-- it\'s a feasibility question, there are some issues here.

**[\>\>:]{.underline}**

But there are ways you can remove names from that.

**[\>\>:]{.underline}**

Right, and that comes out in a feasibility study.

**[\>\>:]{.underline}**

The orders, which you can leave in there for now, just understand \--

**[\>\>:]{.underline}**

\-- \[indiscernible\] vital.

**[\>\>:]{.underline}**

Let me say my two bits; then you guys can go back and \-- \[laughter\]
Just understand that orders will not be coded for by HITSP, and part of
that is we\'ve got three HITSP groups, right? EHR is one of them.
Biosurveillance didn\'t want to come up with a coding system for orders
until we\'ve had input from EHR. It was a big part of EHR.

There is not a great coding system for it as it is, and so if we get
through to that point we felt that had to be done in collaboration with
the EHR Group. So it\'s been deferred. We can keep it in as something in
there that\'s valuable, but just understand HITSP won\'t be coding for
it this cycle.

**[\>\>:]{.underline}**

For the September deliverable.

**[\>\>:]{.underline}**

Correct.

**[\>\>:]{.underline}**

There\'s no reason not to say that orders \[indiscernible\].

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Just deferred.

**[\>\>:]{.underline}**

Keep it In our list, but \[indiscernible\] where HITSP was with it. And
I\'ll let Elaine go through the lab stuff I just put HL7 as a general
pattern of how the \--

**[\>\>:]{.underline}**

Yeah, cycle.

**[\>\>:]{.underline}**

Thank you everyone. Have a good day.

**[\>\>:]{.underline}**

Thank you.

**[\>\>:]{.underline}**

We\'re pretty excited about the lab stuff.

**[\>\>:]{.underline}**

\-- sequence, what do they mean by \-- did we mean by sequencing of
procedures, here?

**[\>\>:]{.underline}**

Do we want to finish \-- did we finish the stuff higher up before we
move \[indiscernible\].

**[\>\>:]{.underline}**

Okay. Go ahead. Where were you pointing towards?

**[\>\>:]{.underline}**

I was pointing towards fever because we thought one of those things it
made more sense for this to be temperature. And, you know, in
biosurveillance system, we\'re only collecting some of this for certain
patient classes, so only emergency department patients.

**[\>\>:]{.underline}**

But it\'s still a useful element, correct?

**[\>\>:]{.underline}**

Right, but in an inpatient setting, you don\'t have a need to
\[indiscernible\] vital signs.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Can be a refinement in the feasibility.

**[\>\>:]{.underline}**

In implementation. And then I think the others are pretty much \--

**[\>\>:]{.underline}**

Temperature, and then the others.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Do I see nodding?

**[\>\>:]{.underline}**

Yes, temperature.

**[\>\>:]{.underline}**

BP, heart rate, Pulse Ox?

**[\>\>:]{.underline}**

I think the second most important one, but we\'re not collecting the \--

**[\>\>:]{.underline}**

I see nodding on Pulse Ox? Okay.

**[\>\>:]{.underline}**

For specific patient type \--

**[\>\>:]{.underline}**

BP and heart rate? I definitely I think that\'s part of the
recommendations that we would \-- put that feasibility \-- you know,
the \-- yes, no, Lynn, Perry?

**[\>\>:]{.underline}**

I\'ll \[indiscernible\] it in my mind.

**[\>\>:]{.underline}**

She\'s still on salmon.

\[laughter\]

**[\>\>:]{.underline}**

We didn\'t necessarily think it would be all that useful.

**[\>\>:]{.underline}**

Yeah. Okay.

**[\>\>:]{.underline}**

Fairly nonspecific from a biosurveillance standpoint.

**[\>\>:]{.underline}**

Again I\'d just like to focus on our naming conventions, then we can lop
things off or keep things on.

**[\>\>:]{.underline}**

As they were we didn\'t change them.

**[\>\>:]{.underline}**

For blood pressure and heart rate?

**[\>\>:]{.underline}**

Yes. I would just take them off.

**[\>\>:]{.underline}**

That\'s fine. That\'s fine.

**[\>\>:]{.underline}**

Fever, Pulse Ox.

**[\>\>:]{.underline}**

So temperature and Pulse Ox lopped off. Nursing triage notes, provider
ID, got the \[indiscernible\] against the nursing triage notes \-- okay,
down here to laboratory radiology orders. You have order number carried
over, correct? And ordered test, and ordered test name. And I kind of
left that to the group here to \-- test name?

**[\>\>:]{.underline}**

Test name, because of the fact that there isn\'t really a standard set
that we can apply yet for the ordered tests. Test names.

**[\>\>:]{.underline}**

Okay, so just test name?

**[\>\>:]{.underline}**

For now, yes.

**[\>\>:]{.underline}**

Order number, we\'re talking about the ID for the test that\'s been
ordered? What do we mean by order number?

**[\>\>:]{.underline}**

I think it is sort of to have this test be tracked.

**[\>\>:]{.underline}**

I\'m having trouble with the semantics of the word.

**[\>\>:]{.underline}**

Right. Right.

**[\>\>:]{.underline}**

Order number.

**[\>\>:]{.underline}**

I think it \-- so the test identifier?

**[\>\>:]{.underline}**

It\'s an identifier. So if you have a preliminary result and a final
result it gets back to the same result.

**[\>\>:]{.underline}**

I see.

\[multiple speakers\]

**[\>\>:]{.underline}**

Requisition ID, professional ID, I got it. Whatever it is.

**[\>\>:]{.underline}**

So \[indiscernible\] number, session ID.

**[\>\>:]{.underline}**

\-- HITSP called it order number, we just want to make sure we\'re \--

**[\>\>:]{.underline}**

But I just need to know \-- I was confused.

**[\>\>:]{.underline}**

There\'s a whole big discussion about that, that\'s sort of quite
contentious because of the issue of \--

**[\>\>:]{.underline}**

I can imagine.

**[\>\>:]{.underline}**

Right, but you should really have a specimen ID, but the problem is that
from orders that \-- \[indiscernible\] specimens are used for more than
one order, and \-- and I don\'t think it\'s quite gotten resolved yet.
So I think for now you just want to make a note of it.

**[\>\>:]{.underline}**

I\'ll put session ID, HITSP TC, specimen ID, but we\'ll need the name
carried forward as order number, is that okay with everybody?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

We have test name, frequency of procedures, we have on our list.

**[\>\>:]{.underline}**

The way I look at that, I think that means the number that you give
this. And \[indiscernible\] from the raw data that you send.

**[\>\>:]{.underline}**

Yes, exactly.

And if there are multiple procedures on the same person, or multiple \--
tests, they were captured.

**[\>\>:]{.underline}**

I think we meant how many chest X-rays does the facility do, but we\'ve
mixed it in here with patient-level data. And I\'m not sure it\'s \--

**[\>\>:]{.underline}**

That\'s also, that could be calculated on a per-day basis, I don\'t
think you\'d ask the hospital to report that. Unless you ask the system
to calculate it and send it as a message.

**[\>\>:]{.underline}**

Radiology orders, and I think \--

**[\>\>:]{.underline}**

Should we come back at some point to what are calculated values?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

As an item \[indiscernible\] tests later on? And then these are valid
\[indiscernible\]-level data.

**[\>\>:]{.underline}**

Have system calculated date and times, and we\'ve got output.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Part of our data assumptions. They are calculated, I think the frequency
is \[indiscernible\].

**[\>\>:]{.underline}**

I think we\'ll note that and come back to this item later on.

**[\>\>:]{.underline}**

Can you note that field then?

**[\>\>:]{.underline}**

You want me to bring it over?

**[\>\>:]{.underline}**

No \--

**[\>\>:]{.underline}**

No.

**[\>\>:]{.underline}**

Okay, but put a comment here?

**[\>\>:]{.underline}**

It\'s not part of a minimum dataset if it\'s something you\'re deriving
other thing from the dataset so I \--

**[\>\>:]{.underline}**

We\'ll come back to this and maybe organize it in some other place or
something.

**[\>\>:]{.underline}**

Right. Exactly.

**[\>\>:]{.underline}**

Same point as before, if you want it, \[indiscernible\] an ordering
physician ID.

**[\>\>:]{.underline}**

One thing I do want to point out, though, you have tests named there,
and you have frequency of procedures. So is tests a procedure?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Okay, or \-- again, it\'s a semantic of naming convention, at that
point.

**[\>\>:]{.underline}**

\-- radiology, you know \--

**[\>\>:]{.underline}**

Because are radiology tests?

**[\>\>:]{.underline}**

They could be called procedures, too.

**[\>\>:]{.underline}**

And that\'s what I\'m getting at.

**[\>\>:]{.underline}**

It\'s just a more generic term. \[indiscernible\] should be on there
anyway at this point. This is how you analyze or roll up all of this
information.

**[\>\>:]{.underline}**

That name is fine \[indiscernible\].

**[\>\>:]{.underline}**

Okay, we could change that to "test/procedure name." That way it will
cover \-- I think in radiology more often they use the word procedure.

**[\>\>:]{.underline}**

Uh-huh.

**[\>\>:]{.underline}**

Test, slash procedure name.

**[\>\>:]{.underline}**

Somebody can type this on another page.

**[\>\>:]{.underline}**

Gee. And \[indiscernible\] don\'t have spell check either. 

**[\>\>:]{.underline}**

\-- continuing to put red lines.

**[\>\>:]{.underline}**

That really highlights your \--

**[\>\>:]{.underline}**

Can we finish this off in about five minutes here?

**[\>\>:]{.underline}**

I think we\'re pretty good.

**[\>\>:]{.underline}**

Are those really the only fields that we need now in terms of the
radiology test orders, too? Radiology? I mean, that gets chest X-rays,
gets any other kind of \--

**[\>\>:]{.underline}**

Yeah \--

**[\>\>:]{.underline}**

Should we put "laboratory/radiology methodology"? We will collect the
same data from radiology tests.

**[\>\>:]{.underline}**

Radiology and \[indiscernible\] I kept getting pulled in out of
different stuff, but radiology was something that they weren\'t sure
about the orders for radiology, because they weren\'t sure kind of how
useful is it to know how many chest X-rays you give. What is more
important was to know how many chest X-rays had what kind of outcomes.

So I think they deferred the \[indiscernible\] of tracking just the
orders for radiology.

**[\>\>:]{.underline}**

\[indiscernible\] what\'s important. If you don\'t have a real-time
clinician diagnosis and you have a whole bunch of people reporting with
the same chief complaint, you can understand maybe those people who are
truly ill by understanding who has what order. So it\'s part of the
clinical workup. That was the intent of the discussions last year.

**[\>\>:]{.underline}**

Well as I say it was just part of the discussion, part also has to do
with the fact that there isn\'t a good standard for the names of the
test, so it was something they needed to look at a little bit more.

**[\>\>:]{.underline}**

I\'ve heard a couple of questions. One is do we have enough related to
radiology in line 26, and \[indiscernible\].

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

When I look at that, it looks like to me you\'re going to have to have a
pretty sophisticated kind of thinking on \-- pretty sophisticated parse
or something here to extract all the possible \-- you know, universe of
things that would go in there. Lab, microbiology, radiology, everything
else.

**[\>\>:]{.underline}**

That was the way our discussion at the service, where you may have
to \-- like the \[indiscernible\] surveillance system \[indiscernible\].

**[\>\>:]{.underline}**

Okay, comment then for do we have enough as it pertains to radiology?
Okay, Lynn, I think \[indiscernible\].

**[\>\>:]{.underline}**

So someone just mentioned the service, should we call out whether it\'s
radiology or laboratory in this section? As an identifier for which \--
whether we\'re referring to a test or procedure? In laboratory or
radiology respectively?

**[\>\>:]{.underline}**

You mean like have a category field to say is \--

**[\>\>:]{.underline}**

The hospital service \-- the service code.

**[\>\>:]{.underline}**

Yeah, we just talked about \-- I think it\'s \-- we don\'t have it in
here, of service \-- we did talk about a service code. It was one of the
gaps that we identified, was the service code, whether it was radiology
or laboratory, and that was basically the order name. So that was one of
our standards gaps. But that would still be more specific, I\'m not sure
we were thinking in terms of simply saying it\'s radiology versus
laboratory in this section. But it was definitely something we called
out as a gap.

**[\>\>:]{.underline}**

Are we going to be parsing the test name, or are we expecting that the
tests will have a standard ID? This is what \--

**[\>\>:]{.underline}**

The test will not have a standard ID because there is currently no
accepted standard coding system for the testing. There are a variety of
things that are encoded, and so \-- \[indiscernible\] codes part of it,
CPT encodes part of the testing, there are LOINC codes for some testing,
but there is not one currently generally accepted particularly for
laboratory coding system. And plus, we realized that particularly with
laboratories, you also have to allow for some degree of local coding
because even if you take a standard body, laboratories are developing
and introducing new tests and actually performing them before the
standards bodies have assigned codes to them.

**[\>\>:]{.underline}**

Are we talking radiology or laboratory?

**[\>\>:]{.underline}**

Laboratory. But the same holds for radiology in the terms of there not
be a current accepted standard. Probably CPT for radiology is not too
far off, but there are a lot of new radiology procedures, as well, being
developed. So \--

**[\>\>:]{.underline}**

I think that represents feasibility.

**[\>\>:]{.underline}**

Yeah. Yes. Right.

**[\>\>:]{.underline}**

\-- \[indiscernible\] think we need \-- need a standardized coding
scheme, we\'re going to have to move towards it. For better mapping.

**[\>\>:]{.underline}**

Right, this is something that we identified as a gap that we have to
work on identifying better tools to standardize \--

**[\>\>:]{.underline}**

\-- be sure we get those in the feasibility, which is coming up in a
little bit.

**[\>\>:]{.underline}**

Exactly, yes.

**[\>\>:]{.underline}**

Is the Order Test 36 the same as 27? There\'s actually quite a few
things wrong if this is \[indiscernible\] to what we can do.

So for example, if you want to start off with assessment of ID, that
would be the first thing that would fall in there
after \[indiscernible\] report status. So there\'s assessment ID, report
status and test status, I wouldn\'t know what that difference is, why
that\'s \[indiscernible\] 44 and 31?

**[\>\>:]{.underline}**

Okay, that partly had to do with the fact that you may record partial,
and so we realize when you\'re sending a message over, the status of the
report \-- or the status of the message may be final, in that we are in
fact reporting a preliminary result or a partial result. We\'ve
identified the organism.

The test is still preliminary. Partial. But the message is final. So we
took it at the level of the message, and so the status of that report to
you, that we have reported the preliminary results, that message status
is final, but the test is still \--

**[\>\>:]{.underline}**

If a report is \-- if a message is sent out, it\'s final.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

And at that point meaning \-- that flow of information is captured under
report status. But if you take a different opinion on that, I don\'t
have a problem with that. All I\'m saying now then, in the current way
in which we\'re structuring \[indiscernible\] the same thing. The other
point is that an ID is available if you want that, whereas a collection
method is \[indiscernible\] is identified as assessment source.

I guess what I\'m getting at is do you want that type of detail right
now or not?

**[\>\>:]{.underline}**

I think we should make sure we capture the comments related to these
fields.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

We\'re going to have to work out the difference. So what I\'m hearing is
on 34, that it\'s specimen source, we were talking about, right? Comment
that \--

**[\>\>:]{.underline}**

You want it source or \-- we can change the name.

**[\>\>:]{.underline}**

Do we know that today, do we \--

**[\>\>:]{.underline}**

It\'s called specimen source in your HL7 message.

**[\>\>:]{.underline}**

Then we need to change that to source.

**[\>\>:]{.underline}**

And then do you want that specimen ID, meaning every specimen we receive
has a different number.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Didn\'t mean to interrupt. Just \--

**[\>\>:]{.underline}**

But you did. \[laughter\]

**[\>\>:]{.underline}**

I got him in the building.

**[\>\>:]{.underline}**

Good to see you, John.

**[\>\>:]{.underline}**

Okay, so specimen ID is something you could consider, there. Every
specimen gets an ID.

**[\>\>:]{.underline}**

So for 34, we\'re changing it to specimen source, correct?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

And then 35 would be specimen ID, or is that what it is?

**[\>\>:]{.underline}**

Yeah, that\'s still a big question, because I think in reality
although \-- ideally every specimen would have an ID, in fact that\'s
not necessarily the way it\'s handled.

**[\>\>:]{.underline}**

You mean every specimen doesn\'t an ID number?

**[\>\>:]{.underline}**

Right, it may have a session number.

**[\>\>:]{.underline}**

Well, that\'s the same thing.

**[\>\>:]{.underline}**

Yes, but there may be more than one specimen, and the way they handle
them separately is \--

**[\>\>:]{.underline}**

All I\'m getting at is there is a number associated with each one.

**[\>\>:]{.underline}**

Yes. Yes.

**[\>\>:]{.underline}**

We should be consistent between 40 \-- line 89 and line \-- we\'re now
on 102.

**[\>\>:]{.underline}**

Can I go back to the question \--

**[\>\>:]{.underline}**

Is that the same thing in both or not?

**[\>\>:]{.underline}**

Well, I don\'t see a specimen type anywhere. And was that the intent of
the specimen \-- in other words, what is the specimen.

**[\>\>:]{.underline}**

Yeah, we didn\'t \-- we didn\'t deal with that \--

**[\>\>:]{.underline}**

What do you mean by specimen type?

**[\>\>:]{.underline}**

Well, blood, urine \--

**[\>\>:]{.underline}**

That\'s also listed under source, that\'s a specimen source.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Or it\'s part of the nature of the test but we didn\'t have that as a
field.

**[\>\>:]{.underline}**

Let me go through a couple other comments. Results other than organism,
it\'s still a result. So it\'s still handled the same way. It\'s result
or not result. So because it\'s an organism isn\'t anything different,
but that could be struck, line 58.

**[\>\>:]{.underline}**

Line \-- excuse me?

**[\>\>:]{.underline}**

58\.

**[\>\>:]{.underline}**

The result is the result.

**[\>\>:]{.underline}**

107\.

**[\>\>:]{.underline}**

Oh, okay, yeah.

**[\>\>:]{.underline}**

But then you have to change \-- don\'t you have to change organism
identified in result?

**[\>\>:]{.underline}**

That\'s correct, so organism identified as result.

**[\>\>:]{.underline}**

That\'s what HLP is using?

**[\>\>:]{.underline}**

That\'s what HL7 uses.

**[\>\>:]{.underline}**

So result other than organism we are deleting, correct?

**[\>\>:]{.underline}**

Yes

**[\>\>:]{.underline}**

Then 56 two lines above becomes "result."

**[\>\>:]{.underline}**

What is result of test, just so we\'re clear?

**[\>\>:]{.underline}**

Well, I think that could be your \-- what somebody may have meant, is
that may be the LOINC order test?

**[\>\>:]{.underline}**

No, the result of test, it\'s really the result as opposed to \-- the
test may be a chemistry, and the result would be a sodium, potassium. So
that\'s the difference between the order and the result.

**[\>\>:]{.underline}**

But it\'s not the answer.

**[\>\>:]{.underline}**

Right, it\'s \--

**[\>\>:]{.underline}**

Is what we\'re getting at.

**[\>\>:]{.underline}**

It\'s the nature of the result. What kind of results am I giving you.
The identity of the result. As opposed to the value of the result.

**[\>\>:]{.underline}**

We typically say like analyze and then result value, but \--

**[\>\>:]{.underline}**

Would you say analyze care instead of result of test? This will fall out
in the \[indiscernible\].

**[\>\>:]{.underline}**

Those are LOINC.

**[\>\>:]{.underline}**

Yeah, that\'s definitely LOINC.

**[\>\>:]{.underline}**

That\'s where we would use the LOINC.

**[\>\>:]{.underline}**

Susceptibly is also a test result, so I understand the importance, you
want it.

**[\>\>:]{.underline}**

Right, it\'s just another result.

**[\>\>:]{.underline}**

It\'s interpretation.

**[\>\>:]{.underline}**

Under \--

**[\>\>:]{.underline}**

Yeah, but you still have result.

**[\>\>:]{.underline}**

It comes out in its own box as the result.

**[\>\>:]{.underline}**

It\'s \[indiscernible\] stuff.

**[\>\>:]{.underline}**

Could we \-- line 105, Scott, make sure under result we capture that it
includes susceptibly in a comment, and that it also includes \-- what
did we have?

**[\>\>:]{.underline}**

I would say includes test results of all types.

**[\>\>:]{.underline}**

Yep.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

Test results of all types.

**[\>\>:]{.underline}**

And then that gets back to this issue of ordering physician, and again I
didn\'t know if you wanted that under your \[indiscernible\] radiology
or here or not, but it\'s out there.

**[\>\>:]{.underline}**

Although I have to say in our universe, it\'s not only very specific to
a provider, because if we have group accounts, we\'ll get a UPIN number,
but it\'s \-- the UPIN number\'s physician of record on the account. So
if we have a hospital account, they may give us one UPIN number, and
100 \--

**[\>\>:]{.underline}**

For example it might be the chief of staff, but it was really the
resident that ordered.

**[\>\>:]{.underline}**

Exactly.

**[\>\>:]{.underline}**

\-- it allows you to do followup \[indiscernible\] if you want the data.

**[\>\>:]{.underline}**

Right, it was just a comment on the nature of the data may not be as
specific as you think, but it\'s still \-- it\'s still useful data.

**[\>\>:]{.underline}**

So do we need, on line 112, then, add the \--

**[\>\>:]{.underline}**

Ordering physician ID.

**[\>\>:]{.underline}**

Ordering provider ID.

**[\>\>:]{.underline}**

If you want.

**[\>\>:]{.underline}**

Is that likely to be a referring lab, when a reference lab does the
test?

**[\>\>:]{.underline}**

Right, exactly. The provider \-- it may be a hospital ID, it may be a
referring lab ID, it may be an individual physician.

**[\>\>:]{.underline}**

Okay. Are you going to work on that a little more? So we had \-- include
all types of test results, include \-- just in parenthesis, we dropped
off "susceptibly," we dropped off \--

**[\>\>:]{.underline}**

We didn\'t drop it.

**[\>\>:]{.underline}**

Well, but \--

**[\>\>:]{.underline}**

Leaving it in there.

**[\>\>:]{.underline}**

We absorbed it.

**[\>\>:]{.underline}**

Susceptibly. Non-organism results. All that is \-- all goes
\[indiscernible\].

**[\>\>:]{.underline}**

In terms of the standards for \[indiscernible\] 47 lab reporting ID, we
were going to use CLIA. For now.

**[\>\>:]{.underline}**

No, no. This is our number here.

**[\>\>:]{.underline}**

Okay, so 28 and 29. Those would be CLIA.

**[\>\>:]{.underline}**

Okay, and then CLIA again.

**[\>\>:]{.underline}**

That\'s it.

**[\>\>:]{.underline}**

We\'re done?

**[\>\>:]{.underline}**

Yep.

**[\>\>:]{.underline}**

All right. Shall we move on?

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

If we have a comment \[indiscernible\] names, we\'ve matched them
against the HAVEs and HITSPs so far, so we\'re heading to at least a
name set of minimum data elements. And I think we still have some \--
our next version of this, go back to make sure they\'re all \--
reconfirm that they\'re all in, and then any qualifying comments that go
with those. Those would be the ones we would refer out to HITSP for
detail. That heads toward our deliverable then.

**[\>\>:]{.underline}**

One thing we can add, there needs to be some discussion about calculated
values, we capture that back here.

**[\>\>:]{.underline}**

And \[indiscernible\] good point. Excellent, okay.

**[\>\>:]{.underline}**

Progress.

**[\>\>:]{.underline}**

Yeah, good comments.

**[\>\>:]{.underline}**

So we\'re running about a half-hour behind, but I think we can \--

**[\>\>:]{.underline}**

We are going to finish up at 4:00. People have to head out for planes.

**[\>\>:]{.underline}**

So in our next section, here, the 1:45 section, was proposed approach
for doing a crosswalk, then studying the feasibility. And we\'re hoping
with the group we have here divide up into two groups and have one group
work on the crosswalk, and then the other the feasibility, and come back
together and report back in about \-- let\'s see, report back in about
20 minutes.

But let\'s say we gave each group the real 40 minutes, then \-- and then
so we would be reporting back at 5 to 3:00, and then we\'ll make those
quick, I think we can collapse some of the things that we were going to
do in that last \[indiscernible\].

Can I ask the group real quick the categories that we have, such as in
line 2, here, we have institution data, base facility data from HITSP,
and then we have the HAVE. Can I just for our sake move over our name,
and then we can discuss the \-- I\'ll call them a category later.

**[\>\>:]{.underline}**

I wouldn\'t call it facility data, since we changed \--

**[\>\>:]{.underline}**

Okay, so maybe we can go through these real quick, what do you think?
Before we \-- we\'ll try to get a spreadsheet to each group, maybe, and
that way we \[indiscernible\].

**[\>\>:]{.underline}**

While there\'s breakout groups maybe we can work on doing that, just to
save some time. I think we can generally agree to those things.

**[\>\>:]{.underline}**

We were going to do \-- raise your hand, who is interested in the
crosswalk, and who is interested in feasibility?

Crosswalk? Two? Just two? And feasibility? Five?

**[\>\>:]{.underline}**

I\'ll do whatever.

**[\>\>:]{.underline}**

So how about if I do crosswalk with Perry and Bill, and if you would
move over, that would be helpful. And then Marty, you\'ll do the other
group?

**[\>\> Marty LaVenture:]{.underline}**

Sure.

**[\>\>:]{.underline}**

The feasibility? We\'re going to work on them all together, this is just
first pass at this.

And I think we can \-- one group can go next door into the office.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

And do we want to each walk through \--

**[\>\>:]{.underline}**

We have some instructions, and we\'ll be all \[indiscernible\] through.

So Group 2 here, Group 1 next door. Let\'s gather together.

**[\>\>:]{.underline}**

Matt, are you there?

**[\>\> Matt McCoy:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Is there anybody else dialed in?

**[\>\>:]{.underline}**

Dr. Melton, are you in?

**[\>\> Matt McCoy:]{.underline}**

Dr. Melton is on.

**[\>\>:]{.underline}**

You\'re on the Feasibility Group.

**[\>\>:]{.underline}**

Perfect.

**[\>\>:]{.underline}**

Did you have any comments, I\'m sorry, we kind of left you hanging
there.

**[\>\>:]{.underline}**

I\'ve just been listening, and I think things are going well.

**[\>\>:]{.underline}**

Okay. Well, thank you for being patient with us, I\'m sorry that we kind
of left you in virtual reality there.

**[\>\>:]{.underline}**

I would have jumped in if I had anything major.

**[\>\>:]{.underline}**

Matt, we\'re going to take about a 10-minute break.

**[\>\> Matt McCoy:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Five-minute break, I\'ve been overruled.

\[break\]

**[\>\>:]{.underline}**

How about somebody from American Hospitals, is that an important \--

**[\>\>:]{.underline}**

Yeah. Yes, absolutely.

**[\>\>:]{.underline}**

Do we know if \--

**[\>\>:]{.underline}**

\[indiscernible\] gave me a name yesterday, I can get it.

**[\>\>:]{.underline}**

That would be great.

**[\>\>:]{.underline}**

Who under Phillip?

**[\>\>:]{.underline}**

Hang on. Gail Nortonberg. Tina Zarkol.

**[\>\>:]{.underline}**

Tina is on maternity leave. So it was Michelle Mead.

**[\>\>:]{.underline}**

Did she have the baby?

**[\>\>:]{.underline}**

Yeah, adorable.

**[\>\>:]{.underline}**

One more, that\'s Tim Morris.

**[\>\>:]{.underline}**

Meigs, M-e-i-g-s.

**[\>\>:]{.underline}**

We need more than one hospital.

**[\>\>:]{.underline}**

Large health systems, I\'m thinking maybe Kaiser?

**[\>\>:]{.underline}**

Kaiser, let\'s see.

**[\>\>:]{.underline}**

Which one?

**[\>\>:]{.underline}**

Maybe I can talk to Joann Larson from Kaiser. She\'s on the TC HITSP
panel, she may be able to help.

**[\>\>:]{.underline}**

Lynn, Michelle, there\'s a particular system she\'s working with, too,
that would be great. I think the large system.

**[\>\>:]{.underline}**

Joann Larson, L-a-r-s-o-n. Of course anybody\'s name I give you
obviously I\'m going to check with. These are what my targets are, but I
obviously can\'t commit their time.

**[\>\>:]{.underline}**

Nominate \[indiscernible\] for this.

**[\>\>:]{.underline}**

\[indiscernible\] so he\'s gotten it back.

**[\>\>:]{.underline}**

Is there a commercial lab organization?

**[\>\>:]{.underline}**

ACLA.

**[\>\>:]{.underline}**

And what about \[indiscernible\] IHIE, Dave Ross? I\'m just putting them
out there.

**[\>\>:]{.underline}**

They did do the \-- for feasibility, are we not thinking more who is
sending you data, right now, and whose \[indiscernible\] would be
standards. It\'s like the hospitals, EMS department.

**[\>\>:]{.underline}**

Can we go back to NACCHO for example, as well?

**[\>\>:]{.underline}**

Well, with the APCs. They\'re NACCHO.

**[\>\>:]{.underline}**

I think it\'s a good group.

**[\>\>:]{.underline}**

I think so, too.

**[\>\>:]{.underline}**

You need more hospitals.

**[\>\>:]{.underline}**

Might be one other plan, is there someone on the East Coast or Midwest
groups that would make sense. We\'ve got several, but they\'re not
participating.

**[\>\>:]{.underline}**

Would be \[indiscernible\] to say Mayo Clinic or something like that?

**[\>\>:]{.underline}**

Mayo or Health Partners.

**[\>\>:]{.underline}**

Yeah, either one.

**[\>\>:]{.underline}**

Mayo is systems more than informatics side.

**[\>\>:]{.underline}**

Large health system makes sense. Peter has been spending time on this,
so he might actually have some data.

**[\>\>:]{.underline}**

What was the name, Peter?

**[\>\>:]{.underline}**

Elkin, E-l-k-i-n. No S.

**[\>\>:]{.underline}**

And he is from Health Partners?

**[\>\>:]{.underline}**

From Mayo.

**[\>\>:]{.underline}**

Terrific.

**[\>\>:]{.underline}**

That was too easy. Is there anything else in our MDS that we haven\'t
covered with these groups? I think we\'ve pretty much got \--

**[\>\>:]{.underline}**

Where do we then capture the issue of that some data elements like
\[indiscernible\] ER status, is reflected on a daily basis
\[indiscernible\] other elements like \[indiscernible\] and lab and
radiology. \[indiscernible\] talk about that?

**[\>\>:]{.underline}**

Well, I don\'t know if it was here or in one of the HITSP meetings that
people were concerned that hospitals would not want to give on a daily
basis necessarily their bed utilization.

**[\>\>:]{.underline}**

Well, let\'s go back, then I think if we\'re done with this for now, and
the other group may have some experts, unless you know some burning
issues on that I\'d like to skip that right now.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

If there is particular feasibility like \-- I\'m not sure the *MMWR*
framework for evaluating \[indiscernible\] surveillance. An *MMWR*
article that I think relates to this topic that we could add that should
at least be looked at for feasibility concepts. The next step gets to
the question, if Scott will scroll up \-- let\'s give this to him,
too \-- up to the questions, what questions do we want to ask this
group. And what are we going to measure. And that gets to this part
about are we filtering for reportable conditions, are we collecting on
all data, what\'s \-- how do we visualize some type of table or
something when we have \-- for each of these data fields, how do we ask
them the question about feasibility. What are the right questions to
ask, is \[indiscernible\] to ask how do we do that.

**[\>\>:]{.underline}**

Where are we on the report here, I didn\'t see the questions.

**[\>\>:]{.underline}**

Look to what extent \-- so for here, we ask Peter Elkin, for this
dataset, what are the questions we want to ask. Is it filtering,
what \-- is it available electronically now, or what do we have to do in
the future.

**[\>\>:]{.underline}**

How about something like this, is it reasonable to expect hospitals to
provide a daily tally relative to their operating status.

**[\>\>:]{.underline}**

And I think in a couple of ways \-- I like that, in one of the second
bullets, it gets to that question, the second bullet says okay, if it\'s
not available, what do you need to do to make it available. What would
be necessary, in a sense. Is it a small, modest, medium, or impossible
dream. To get there.

Another question. Should we limit our request from \[indiscernible\]
laboratories, embryology, to reportable condition, to reportable or a
modified reportable conditions list of diseases?

**[\>\>:]{.underline}**

This is actually going to be I think one of the key feasibility
questions \-- and filtering is part of this, because the question is
going to really boil down depending on how the providers have their data
today, how much \-- is it easier or harder for them to filter versus
sending everything. And \--

**[\>\>:]{.underline}**

It\'s a BioSense question, right?

**[\>\>:]{.underline}**

Yes, and if people are \-- for example, if they\'re using a lot of free
text today, say it\'s radiology reports, and it\'s all free text, or
pathology reports that are free text, the amount of work it would take a
provider to filter that and only give you what you care about might \--

**[\>\>:]{.underline}**

I think we can put that in terms of a question. The question is what
software tools are available for filtering at the local level.

**[\>\>:]{.underline}**

Or what\'s more feasible, to provide it all or to filter.

**[\>\>:]{.underline}**

Yes. Exactly. And that was one of the things where we talked about
coming up in ANSI HITSP to the realization that we identify filtering
and assigning anonymization identifiers as services because we weren\'t
sure they would end up. Because of these questions, because if providers
can\'t do the filters, you can\'t just say you\'re not going to get any
data. But you have to figure out how that happens.

**[\>\>:]{.underline}**

\-- words for this, but I\'ve got send all data versus filters the data
source. Okay?

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So the daily reports on bed availability. And there was a third
question, Dr. Hinrichs.

**[\>\>:]{.underline}**

If you want, that would be I think it would be interesting to conduct a
survey of what software packages are available to do surveillance, or to
do filtering, what cost products are out there.

**[\>\>:]{.underline}**

That will get into cost questions.

**[\>\>:]{.underline}**

Then that gets to the next question, what\'s the anticipated cost to an
institution for providing these types of data.

**[\>\>:]{.underline}**

Third bullet capture that?

**[\>\>:]{.underline}**

Partly, you might actually move this under there.

**[\>\>:]{.underline}**

Underneath the filtering source?

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

The cost question.

**[\>\>:]{.underline}**

What needs to be done in order to make \-- what are the costs.

**[\>\>:]{.underline}**

So what are the costs?

**[\>\>:]{.underline}**

No, the cost question, the last question, the last bullet that was
already there, what are the costs associated.

**[\>\>:]{.underline}**

I\'m sorry.

**[\>\>:]{.underline}**

Yeah, might belong under there.

**[\>\>:]{.underline}**

I gotcha.

**[\>\>:]{.underline}**

One of the questions I think we definitely should ask is what standards
are people using today. Are they using \[indiscernible\] HL7. Because
that\'s \--

**[\>\>:]{.underline}**

And we talked about this, just for a quick background, you know,
there\'s the recommendation by NACCHO that \-- and CSTE, that HL7 2.6 be
implemented by 2008. Well, that\'s great. But 2004 has been out there
for many years, and it hasn\'t moved a dime. So, you know, what is the
standards that would be employed for activating \[indiscernible\].

**[\>\>:]{.underline}**

You want HL7 in here also?

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

In that case it might be what version.

**[\>\>:]{.underline}**

Right. What version.

**[\>\>:]{.underline}**

What version of HL7 is currently being employed, and could be deployed
within one year.

**[\>\>:]{.underline}**

Exactly. If they\'re 2.4, it\'s probably unrealistic to think they can
be \[indiscernible\] to do CDA in a year.

**[\>\>:]{.underline}**

What version is currently in use, right? Versus planned \--

**[\>\>:]{.underline}**

One year out, right?

**[\>\>:]{.underline}**

Uh-huh.

**[\>\>:]{.underline}**

Planned one year out?

**[\>\>:]{.underline}**

I would say possible or \--

**[\>\>:]{.underline}**

Feasible.

**[\>\>:]{.underline}**

You can\'t define feasible with feasible, but feasible within one year.

**[\>\>:]{.underline}**

Yes, they may not plan to do it, but it may not be impossible.

**[\>\>:]{.underline}**

Planned upgrade? Planned feasible?

**[\>\>:]{.underline}**

Put feasible to do in one year.

**[\>\>:]{.underline}**

Okay, what version is currently in use. And what \-- the question again?

**[\>\>:]{.underline}**

And what version could they upgrade to within one year?

**[\>\>:]{.underline}**

Would be feasible to upgrade.

**[\>\>:]{.underline}**

Would be feasible to upgrade, one year. I think we absolutely need to
ask another question about patient identifiers. Because the whole issue
of these randomized linkers, a very different situation if you have a
tight medical record number control within your universe, and you have a
central source of identity for a patient, versus \[indiscernible\] such
as ours or radiology society where \-- I mean, we get a trend actually
from physicians. We have no central repository.

**[\>\>:]{.underline}**

MPI.

**[\>\>:]{.underline}**

That was the word I was looking for, we don\'t have an MPI. We may have
in a few years, but we don\'t have one now. So creating an ID for a
patient when you don\'t track that is a very, very different situation
than when you\'ve already got a medical record number. But even in
hospitals that system may not be that mature. So I think we need to ask
some question about their feasibility of creating these anonymized \--

**[\>\>:]{.underline}**

Should that go under the filtering part?

**[\>\>:]{.underline}**

No, I think it\'s a different question.

**[\>\>:]{.underline}**

A different question, okay.

**[\>\>:]{.underline}**

The filtering \-- and maybe we ought to qualify, filtering is for
the \-- well, I could spend all day \-- filtering verse data source,
maybe we should say filtering by condition, and then it\'s clear what we
mean by filtering.

**[\>\>:]{.underline}**

At the data source?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

I think that was the intent of our question.

**[\>\>:]{.underline}**

At the data sources, what is the relative burden. And then \--

**[\>\>:]{.underline}**

So MPI?

**[\>\>:]{.underline}**

Yeah, do they have or \-- an MPI, and if not, how hard would it be for
them to create.

**[\>\>:]{.underline}**

Is that a question for the second column? Bullet?

**[\>\>:]{.underline}**

Yeah, that\'s probably the question \-- yes, you\'re probably right,
that probably goes under the next bullet.

**[\>\>:]{.underline}**

Okay. So MPI status. Possibly?

**[\>\>:]{.underline}**

Yeah, that\'s good.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

So do they also have the ability to create some type of randomized.

**[\>\>:]{.underline}**

Linker, yes.

**[\>\>:]{.underline}**

Tight control?

**[\>\>:]{.underline}**

That\'s two questions, it\'s what is their MPI status.

**[\>\>:]{.underline}**

And that might get into the cost question again, too.

**[\>\>:]{.underline}**

Because I can tell you, for us, that\'s death. No, I\'m serious.

**[\>\>:]{.underline}**

Is what? I didn\'t hear you.

**[\>\>:]{.underline}**

Death. Death. I mean, we process over a half a million requisitions a
day, and we have no MPI. If you asked us to create \-- we\'re just \--

**[\>\>:]{.underline}**

It\'s got to \[indiscernible\].

**[\>\>:]{.underline}**

It\'s either got to come with it or somebody else has got to do it.
It\'s impossible right now. Whereas for some hospitals that might not be
very hard at all, if they\'ve got an MPI and it creates \--

**[\>\>:]{.underline}**

And \[indiscernible\] is a multi-State operation, are there any legal
obstacles to participating in this from large multi-State reference
laboratories? 

I guess the question is, is it a question.

**[\>\>:]{.underline}**

And that would apply to any organization. I think there are issues, once
you start crossing State boundaries. But in this scenario, because \--
the problem is the State reportables, there are some States that require
certain things, and other States that actually forbid you to give
certain things.

But there hasn\'t ever been a direct national data feed to a national
source before, and that can partly be synapsed by saying if you\'re from
New Jersey and you\'re not allowed to see X, when you go into the system
that\'s somehow masked from you, that\'s an implementation issue as
opposed to us giving it \--

**[\>\>:]{.underline}**

Maybe the way to get it around it is to say would we want to query to
say each State Attorney General\'s office, or whoever is in charge,
asking, do they foresee any obstacles to participating in a system with
\[indiscernible\] data.

**[\>\>:]{.underline}**

Do you know how long it would take from the AG's office?

**[\>\>:]{.underline}**

I think that\'s already happening within this office, already looking at
the barriers and regulations that are preventing us from exchanging
information, much less just pertaining to biosurveillance.

**[\>\>:]{.underline}**

We should link this I think to the RTI initiative.

**[\>\>:]{.underline}**

That\'s right.

**[\>\>:]{.underline}**

You know, maybe that should be on our preconditions. That the
legislative barriers \--

**[\>\>:]{.underline}**

Are examined in \--

**[\>\>:]{.underline}**

Examined and addressed.

**[\>\>:]{.underline}**

By \--

**[\>\>:]{.underline}**

We defer?

**[\>\>:]{.underline}**

Well, by all. By \--

\[laughter\]

**[\>\>:]{.underline}**

Identified at least.

**[\>\>:]{.underline}**

Right, identified.

**[\>\>:]{.underline}**

At least that\'s an outcome of that study that relates directly to
biosurveillance reporting.

**[\>\>:]{.underline}**

Yes, you\'re right, that has been a \--

**[\>\>:]{.underline}**

Is there anything else, bullet that you think that \-- notions related
to \-- what would we be asking ourselves in that group about how do we
make this feasible? We know some of it isn\'t feasible today, but what
needs to be done. Degree of difficulty, is what I\'m looking for.

So I don\'t know if I just thought of this or was general knowledge, I
thought I saw in the newspaper that Secretary Leavitt was going to ask
the President for a national directive, a presidential directive to do
this. Is that \-- did anybody else see that or heard that?

**[\>\>:]{.underline}**

\[indiscernible\]

**[\>\>:]{.underline}**

Here\'s what happened, Secretary Leavitt spoke at the National Governors
Association, and he said that he was frustrated with this process, that
he was going to ask for a presidential directive to make it happen, and
he asked the governors to begin to work in each State to make it happen.

**[\>\>:]{.underline}**

Biosurveillance specifically?

**[\>\>:]{.underline}**

Yeah, that\'s the way it came back to me from our office.

**[\>\>:]{.underline}**

Does he have the impression there\'s really nothing going on?
That\'s \--

**[\>\>:]{.underline}**

That it\'s going too slow, is his opinion.

**[\>\>:]{.underline}**

Yeah, we had a recommendation on AHIC about it, first responder of EHR.

**[\>\>:]{.underline}**

Yeah, I thought that was EHR and not \-- 

**[\>\>:]{.underline}**

But I didn\'t read the article.

**[\>\>:]{.underline}**

\-- fill it up with trucks.

**[\>\>:]{.underline}**

When you go back to issue, it\'s are there other activities that are
going to enhance this or make it more feasible that we should be aware
of? Certainly if ONC doesn\'t know about it, what \--

Maybe you should ask what do you need in order to make this happen? What
needs to be done in order to make this feasible?

**[\>\>:]{.underline}**

That\'s right, yeah, what would you need.

**[\>\>:]{.underline}**

It might also be a good idea to go back and review the data that Andrew
and I collected several months back on what States and locals said they
could do already.

**[\>\>:]{.underline}**

Could we list that as \[indiscernible\] attachment?

**[\>\>:]{.underline}**

Yeah, I will.

**[\>\>:]{.underline}**

Can you give the reference to Scott as Item 7 or 8 here?

**[\>\>:]{.underline}**

We have it, it\'s on the Website too.

**[\>\>:]{.underline}**

I want to make sure we get it out to everybody as part of that.

**[\>\>:]{.underline}**

I actually have a revised version but I\'m not going to be able
to \[indiscernible\] \--

**[\>\>:]{.underline}**

We\'ll have 7 and 8 added, one the amended, one we just passed down, and
then the ASTHO.

**[\>\>:]{.underline}**

And NACCHO. Mostly the same questions, but two different surveys.

**[\>\>:]{.underline}**

What do you need to make this feasible. Okay? We\'ve been looking at
acceptance but to some degree there\'s big gaps at the health
departments at the State and local level to make this work, as well.
Just getting it \-- you know, getting it from \-- getting Quest to do
it, you get it to us \-- if it\'s simultaneous, which will be that other
debate we have, to use it, to utilize it effectively.

**[\>\>:]{.underline}**

\[indiscernible\] cost thing is that, is there infrastructure or
hardware requirements required at the State or local levels to
participate in this.

**[\>\>:]{.underline}**

Yeah, we did ask that question.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Do you want \--

**[\>\>:]{.underline}**

Well, I know we did, I\'m not sure it passed through, come to think of
it.

**[\>\>:]{.underline}**

Hardware? We\'ve got software up top, should we do software, slash,
hardware up top?

**[\>\>:]{.underline}**

Filtering is a different question.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Infrastructure question.

**[\>\>:]{.underline}**

This is all predicated on the fact that there\'s electronic data, right?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

So first of all, can the State collect it, and then can the State send
it on to Federal \[indiscernible\] without any more cost.

**[\>\>:]{.underline}**

Yeah, and I think the number was actually even higher with NACCHO, but
64 percent of the States said the technology infrastructure was a major
obstacle, and it was third \-- no, it tied for number one as the biggest
obstacle. No, funding. Funding was one. Trained personnel and then
technology infrastructure was the next two.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

I think it\'s time.

**[\>\>:]{.underline}**

It is.

**[\>\>:]{.underline}**

So I got hardware infrastructure, what is \[indiscernible\] local and at
the State level \--

**[\>\>:]{.underline}**

In order to participate.

**[\>\>:]{.underline}**

Security. I think because we \--

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

We realize there is some security and HIPAA risk for data providers. So
that would be under the second bullet. Would security or HIPAA issues
need to be addressed.

**[\>\>:]{.underline}**

Second bullet?

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

That\'s very important.

**[\>\>:]{.underline}**

Excellent.

**[\>\>:]{.underline}**

In this context we ended up telling people they couldn\'t have any test
results, because they wouldn\'t \--

**[\>\>:]{.underline}**

HIPAA and privacy and security barriers?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Terrific.

**[\>\>:]{.underline}**

Okay now, how do I \--

**[\>\>:]{.underline}**

We get to break. \[indiscernible\] colorful \-- purple, green \--

**[\>\>:]{.underline}**

Whatever Bill Gates put in here as my track changes. I\'m sure you can
change it.

**[\>\>:]{.underline}**

I guess this is going to be a pretty quick report, so I guess we\'re
going to basically tell them that we fleshed out some of the questions,
we made some minor modifications to what we think are the assumptions,
and we started to make a list of sources, potential sources, to go to to
interview, to ask these questions.

**[\>\>:]{.underline}**

And this may be in the form, and Judy \--

**[\>\>:]{.underline}**

Assumptions \-- and the questions.

**[\>\>:]{.underline}**

Judy will have to correct me if I\'m wrong, but this may be in the form
of some sort of testimony at this point? Or how they present \-- I\'m
not sure of the formalities.

**[\>\>:]{.underline}**

Well, we\'ll have to see. It would be nice to \-- we could get these
folks on a call. Could do a consensus call, those who could make it, or
we could do interviews with them would be nice.

**[\>\>:]{.underline}**

They\'re probably going to want written testimony.

**[\>\>:]{.underline}**

That would be great.

**[\>\>:]{.underline}**

Given our time constraints, the likelihood of actually scheduling a call
with all these individuals at the same time, in the next couple of
weeks, probably means that for practical purposes we would probably have
to contact and interview people, and maybe at some point in the future
try to schedule a call. But if we wait to do it on a call, we\'ll never
get these folks together.

**[\>\>:]{.underline}**

I agree.

**[\>\>:]{.underline}**

But in September we\'re actually going to have the folks in Boston on a
call.

**[\>\>:]{.underline}**

In Boston?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Good luck.

**[\>\>:]{.underline}**

The \[indiscernible\].

**[\>\>:]{.underline}**

Put in invite written \-- we could certainly invite written comments, if
we get our questions, but in the meantime it would be great to get on
the phone and just to I think better inform our answers on the
feasibility piece.

**[\>\>:]{.underline}**

Do you need to go back home \-- \[multiple speakers\]

**[\>\>:]{.underline}**

Since ours is out should we just wait for everybody to come back in?

**[\>\>:]{.underline}**

Are we ready?

**[\>\>:]{.underline}**

Yeah. I think so.

**[\>\>:]{.underline}**

Okay, report from the breakout groups. Group 2, Eileen is going to
report. Correct thinking and advice.

**[\>\>:]{.underline}**

Okay, we started with our working definition of feasibility, and what\'s
in black is what was there already, so that was what you had in your
handout, and what\'s green is what we added during our session. So what
got changed.

So we started out feeling that we had most of the issues there, degree
of availability, level of data quality, the utility of the data, type
and extent of the facilities. But we didn\'t have the timing, so we
added that because there may be electronic data sources that have very
high quality, and very complete data, but because maybe their claims
systems have it two or three weeks later, and the timing makes it not
very useful. So we added that. And we agreed this is not a definitive
study, we\'ve got a limited time frame. And September 1 we realize is
probably a little optimistic, but we\'re thinking in September we\'re
hoping to get some data.

And what we did was we \-- if you could pull down, Scott. We have some
questions, we started out with three and we got a little more granular
with them, and then \-- and just quickly could you scan down, and I\'ll
go back to the questions, and so what we started doing \-- keep going,
thank you. We got a bit more granular with the questions, but before
that we started to think about, well, who do we go to with these
questions to give us input. And we have some documents of sources \--
documented sources, but we also felt we needed to approach the people.

None of the names that you see on here know that they\'ve been
volunteered for this task, so we obviously can\'t assume their
individual participation. But we\'ll be contacting them, or their
associates, to try to find somebody to give us some input of trying to
identify the folks who would be likely able to give us at least some
input, both on behalf of hospitals and \-- resource groups for
hospitals, and other medical \[indiscernible\] hospitals as well as from
laboratories.

So those are just the folks that we thought of at this point, that list
may grow. We will probably interview them individually initially,
because the logistics of pulling these folks together in tight time
frame is probably \-- precludes a meeting of this group, at least
initially. So if you don\'t mind we can go back up to the questions now.

**[\>\>:]{.underline}**

Does that make sense to \--

**[\>\>:]{.underline}**

\[indiscernible\] Schulman from AHA?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Basil and Schulman.

**[\>\>:]{.underline}**

Would be nice to think about \[indiscernible\].

**[\>\>:]{.underline}**

That\'s not who I was thinking of that\'s, somebody else that I\'m
thinking of that I\'m blanking on. Another woman that I \--

**[\>\>:]{.underline}**

\[indiscernible\] split this domain area.

**[\>\>:]{.underline}**

Once we get to one we\'ll get the others.

**[\>\>:]{.underline}**

Is that \-- take SH after CH \-- I\'ll put question marks.

**[\>\>:]{.underline}**

Kelly knows, we both have contact information.

**[\>\>:]{.underline}**

And if anybody has any comments on any other either organizations or
\[indiscernible\] they think would be good, just throw it out there.

**[\>\>:]{.underline}**

That\'s Farzad?

**[\>\>:]{.underline}**

We probably should say NYC, rather than New York \-- because it\'s a
separate health department.

**[\>\>:]{.underline}**

And they are not technically \-- they are not \[indiscernible\] practice
medicine, it\'s in addition to the APC.

**[\>\>:]{.underline}**

Put "APC," comma.

**[\>\>:]{.underline}**

Farzad is really the ID?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

He\'s the Director of Primary Care Information Branch, something like
that?

**[\>\>:]{.underline}**

I\'ll do a quick Web research when I get back on line and tidy it up.

**[\>\>:]{.underline}**

The person from Kaiser that you\'re referring to here \--

**[\>\>:]{.underline}**

\-- is on the \[indiscernible\] he may not be the person but I thought I
would start with \-- 

**[\>\>:]{.underline}**

One other person is Jamie \-- there\'s a group in Kaiser in Colorado
that had been \[indiscernible\] advance program, or out in Ohio, and the
woman who is in charge of that is Debra Rotsweiler, I think, or
Ritz \-- 

**[\>\>:]{.underline}**

Yes, we weren\'t necessarily saying these people, we were just kind of
throwing out somebody as a contact. Fitsweiler?

**[\>\>:]{.underline}**

Ritzwoller, R-i-t-z-w-o-double-l-e-r.

**[\>\>:]{.underline}**

Which one, for Kaiser?

**[\>\>:]{.underline}**

The person at Kaiser.

**[\>\>:]{.underline}**

James Owens.

**[\>\>:]{.underline}**

James? Okay.

**[\>\>:]{.underline}**

Alrightee. Okay. So \--

**[\>\>:]{.underline}**

Another person might be Richard Platt at Harvard. And then at Harvard
also \-- or Pratt? P-l-a-t-t. Another person at Harvard would be Ken
Mendel.

**[\>\>:]{.underline}**

And Ken participated on the ad hoc group that we \--

**[\>\>:]{.underline}**

Okay. -l-e?

**[\>\>:]{.underline}**

No, -e-l:

**[\>\>:]{.underline}**

Okay. Probably can come up with some others but \--

**[\>\>:]{.underline}**

Yeah, but this is just a start, and we wanted to have folks we could \--

**[\>\>:]{.underline}**

Particular APC site that we\'re thinking of?

**[\>\>:]{.underline}**

There\'s four you could really work \-- Cambridge, Montgomery, Santa
Clara.

**[\>\>:]{.underline}**

Montgomery.

**[\>\>:]{.underline}**

Who was the \--

**[\>\>:]{.underline}**

Santa Clara.

**[\>\>:]{.underline}**

\[indiscernible\] is not \-- 

**[\>\>:]{.underline}**

That\'s not one of their areas of specialization.

**[\>\>:]{.underline}**

Jeff Duchen.

**[\>\>:]{.underline}**

I know Bill Wilker was doing something \--

**[\>\>:]{.underline}**

\-- way too much for Pam \[indiscernible\] so I wouldn\'t touch it.

**[\>\>:]{.underline}**

Harvard is one of the NCFE centers of excellence, \[indiscernible\] is
the other. If you want to do it in that context that\'s fine.

**[\>\>:]{.underline}**

I think this is a pretty good list. It kind of takes awhile.

**[\>\>:]{.underline}**

How about nine months for \-- 

**[\>\>:]{.underline}**

Why don\'t we \-- okay, why don\'t we separate Ken off the Harvard line
and just put in his NCFE, and then we could question whether we should
contact Bill or not.

**[\>\>:]{.underline}**

Just one I.

**[\>\>:]{.underline}**

Bill Lober on there as well, L-o-b-e-r.

**[\>\>:]{.underline}**

Okay? Good list?

**[\>\>:]{.underline}**

Okay, any comments on ones on here? Want to go back and look at the
questions?

**[\>\>:]{.underline}**

Okay, here question go.

**[\>\>:]{.underline}**

Okay, so we \--

**[\>\>:]{.underline}**

Can we go back?

**[\>\>:]{.underline}**

Sure. Sure.

**[\>\>:]{.underline}**

\-- \[indiscernible\] for a minute and say what about somebody from
BioSense, and what they\'ve learned already?

**[\>\>:]{.underline}**

Sure.

**[\>\>:]{.underline}**

In addition to the \[indiscernible\] \--

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Sure.

**[\>\>:]{.underline}**

You can put and shall identify who \--

**[\>\>:]{.underline}**

Can instill people \-- \[indiscernible\]

**[\>\>:]{.underline}**

Wayne \--

**[\>\>:]{.underline}**

Wayne Meyers.

**[\>\>:]{.underline}**

Dr. Ron McGough. M-c-G-o-u-g-h, right?

**[\>\>:]{.underline}**

Rich and \--

**[\>\>:]{.underline}**

I know Wayne.

**[\>\>:]{.underline}**

And what\'s his name, Marty \--

**[\>\>:]{.underline}**

Drawing a blank.

**[\>\>:]{.underline}**

The essence guys.

**[\>\>:]{.underline}**

We\'ll turn out the list, and I\'m sure about 2 o\'clock in the morning
everyone will go, "Aha."

**[\>\>:]{.underline}**

I want to quickly run through the questions. We have three general
categories of questions, first was to what extent are electronic data
available now or in the future. And some of the questions under that is
the feasibility of sending all data versus filtering, for some sites one
or the other may be more problematic.

Is it reasonable to expect hospitals to actually give you daily reports
on bed availability. We\'ve heard some indications that they might not
be willing to do it, other than during some sort of crisis. So we need
to find out how likely it is that they would.

For the sites that have electronic data, what standards are they using
now. And in some cases what standards do they think they could upgrade
to within the coming year. Because the fact that the data is not
transformed does not at all mean that it\'s standardized.

The second general category is what needs to be done in order to make
the collection of the elements feasible. If you wouldn\'t mind scrolling
down thank you. MPI status was the first, because of the issue of
whether or not an institution actually has currently good control over
patient identity, or not. And how that would work. And then there were
issues about possible legislative or regulatory barriers or HIPAA
barriers, if we want to get free text data, that a hospital \-- that a
provider might not normally give because it might contain patient
identifiers, and if they accidentally divulge something, you know, what
are their issues.

So those kinds of things we need to explore.

And then the final thing had to do with the costs in general, what
products are available, what kind of infrastructure do people have,
and/or would need to do this, and who actually pays the cost of doing
this. Which is going to \-- you know, vary quite a bit.

So those are \-- I mean, this is sort of draft form, obviously, but
generally, kind of where we were going.

**[\>\>:]{.underline}**

Good. Good start. Thoughts on any of those initial thoughts? A chance
to \--

**[\>\>:]{.underline}**

\[indiscernible\]

**[\>\>:]{.underline}**

 \-- at that age.

**[\>\>:]{.underline}**

She just turned two yesterday, so \-- which file?

**[\>\>:]{.underline}**

Well, we were still \-- any thoughts.

**[\>\>:]{.underline}**

Oh, I\'m sorry. I apologize for jumping. I don\'t know why we have \--

**[\>\>:]{.underline}**

The kinds of questions we want to ask. Just going to capture from
\[indiscernible\] group together individually, these are the three types
of notions. \[indiscernible\] lab, what do you need to do to make these
data elements work, and what are the costs or resources necessary to do
it.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

This would be the basic core types of questions.

**[\>\>:]{.underline}**

Our group is not going to propose a feasibility plan.

**[\>\>:]{.underline}**

None of these initial, because the idea was we were going to do some
initial data gathering from people about feasibility.

**[\>\>:]{.underline}**

So we\'re just going to report initial impressions of feasibility,
rather than really doing a feasibility, we\'re proposing a plan. It\'s
not in our scope, is that right?

**[\>\>:]{.underline}**

I think we just want to say, you know, we came up with a list, we did a
little bit of background on feasibility and, you know, we based our
recommendations on what we\'ve learned.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

And provide that as \--

**[\>\>:]{.underline}**

We may want to consider, with a comment with our data element, in our
view from what we know of today, this is feasible, or has to do a lot to
make it feasible, and what is that, from our point of view, for various
categories.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

I think we could offer a committee\'s view of that analysis of what
we\'ve learned.

**\>\>:**

The Secretary\'s also always looking for things he can ask the market to
do to help with this stuff. I mean, having recommendations of \-- these
standards aren\'t in place, but you know, or \-- here\'s an
infrastructure problem that\'s not out there. It\'s totally within the
realm of the \[indiscernible\].

**[\>\>:]{.underline}**

Terrific.

**[\>\>:]{.underline}**

We also did have one question about testimony, and whether or not we
would just do conversations with these folks and report back, or if we
wanted any kind of testimony from them, either written or oral.

**[\>\>:]{.underline}**

\-- asking about data gathering and feasibility, do we need to do it as
formal testimony to this group or can we just have conversations?

**[\>\>:]{.underline}**

Since it\'s a public hearing we\'ll probably want to \[indiscernible\]
more on the order of testimony. \[indiscernible\] whether they could
come in and present, but we\'ll \[indiscernible\].

**[\>\>:]{.underline}**

Could it be written testimony?

**[\>\>:]{.underline}**

It could be written as well, or oral, right.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

You have to be clear, when we talk to people, that that\'s the
\[indiscernible\] for the record.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

\-- if they\'re willing to \--

**[\>\>:]{.underline}**

I think we\'re probably going to get to a meeting where we have a \--
you know, a half a day of testimony, and we give everybody 15 minutes,
or invite them to give written.

**[\>\>:]{.underline}**

Question, clarification. Under the assumptions, we have usefulness, and
I assume what that refers to is something that is not readily available,
that has the potential for being very useful to the institution, would
be an incentive, and therefore higher priority. Is that what usefulness
refers to? How does that fit into feasibility?

**[\>\>:]{.underline}**

Well, it\'s kind of, what we\'re looking at, we\'re evaluating
electronic systems, do they have data that\'s actually useful, I\'m
trying to think of a good example of data that\'s readily available but
not very useful.

**[\>\>:]{.underline}**

Oh, useful to our purposes.

**[\>\>:]{.underline}**

I think yeah it\'s more useful to our purposes.

**[\>\>:]{.underline}**

Oh.

**[\>\>:]{.underline}**

Just \[indiscernible\] real quick, if there\'s a different word to \--

**[\>\>:]{.underline}**

\-- key data in an electronic system for biosurveillance.

**[\>\>:]{.underline}**

The one that Dan \-- \-- I just gave it to Scott MWR? With Hopkins?

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

I looked at that. Could try to harmonize it.

**[\>\>:]{.underline}**

I think we don\'t want to put the \--

\[multiple speakers\]

**[\>\>:]{.underline}**

We don\'t want to say we don\'t know if the data is useful or not so we
shouldn\'t get it, at this point. There\'s recommendations within the
broader scope of evaluation, and \-- I was just saying I don\'t think we
want \-- I mean, we wouldn\'t want to get folks coming in and saying
it\'s not proven data yet, so we don\'t want to get it. But I mean, we
have a recommendation in the letter that you have to \-- you know, have
a group that pays attention to evaluation of this data. So I think it\'s
a good point to clarify what usefulness means. Because we may not know
necessarily about \--

**[\>\>:]{.underline}**

We could reference that document again.

**[\>\>:]{.underline}**

For example, usefulness under laboratory data that\'s filtered for
reportable conditions is extraordinarily useful.

**[\>\>:]{.underline}**

We know that

**[\>\>:]{.underline}**

It\'s not always feasible through this, how do we make that \-- how do
we get there. We want electronic exchange of that type of data.

**[\>\>:]{.underline}**

But I guess my question is, what does it have to do with an evaluation
of the feasibility? You already \-- we already decided what we think is
useful. That\'s my \--

**[\>\>:]{.underline}**

I see what you\'re saying.

**[\>\>:]{.underline}**

That\'s a good point.

**[\>\>:]{.underline}**

I thought you were \-- after I understood what you meant useful to us,
there was something in our notes, and I can\'t find it, but somebody
made the comment, well, if it\'s low-hanging fruit we ought to grab it.
And so I thought maybe this was to counteract that. Just because it\'s
low hanging, because we have all this financial data, we wouldn\'t use
it.

**[\>\>:]{.underline}**

In that document there, is the word feasibility used? I think it is,
isn\'t it? Is feasibility at the same level as usefulness? Or is it \--
is usefulness a subset of feasibility?

**[\>\>:]{.underline}**

We\'ll take a look and \--

**[\>\>:]{.underline}**

We ought to come back to it, we need to sort this out. It will be
referenced in this \-- I\'ll put a link down there for it so \-- okay?

**[\>\>:]{.underline}**

And I don\'t want to get sidetracked too much, but the ELINCS thing that
you saw was partly a reference of something in HITSP we were looking at
potentially limiting, if all data was too much to handle how would you
filter. And one potential sort of subset we thought of were basically
\[indiscernible\] deliverable data, all of the category A, B, and C
agents, all the State reportable, and \-- I\'m missing something else.
Microbiology.

But anyway, it was \-- I forget all the entire list, but it was
basically that was one potential, not definite, but one potential way of
targeting a high value subset of data.

**[\>\>:]{.underline}**

So we have the feasibility of data acquisition, then we have the
feasibility of the filtering, as well, right?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

That\'s a separate category?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

And I think cost is also.

**[\>\>:]{.underline}**

Right, and cost.

**[\>\>:]{.underline}**

Yes, the cost of filtering.

**[\>\>:]{.underline}**

The three major.

**[\>\>:]{.underline}**

In terms of time, are we ready to move on to the next group?

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

I wasn\'t going to take that long, I think it will be pretty fast. So
it\'s the one that has EED at the end of it, it\'s the top one of the
HITSP TC and \[indiscernible\] and you may want to just \--

**[\>\>:]{.underline}**

You got it.

**[\>\>:]{.underline}**

Not that small.

**[\>\>:]{.underline}**

And maybe go to the top of the page. I think it\'s \-- yeah, it\'s
frozen still with the \-- you know, so EED 1, we only got through on
this functional areas list through outbreak management. We didn\'t get
to the other areas today. So the references in Columns C through H are
the Early Event Detection Item 1, which is green, 2, and 3, which is
green, also. And then outbreak management, 1, 5, and 6.

So what we tried to do in this crosswalk was just take the items that
we\'ve decided the previous session were on our EDSG official list, and
then created these green categories, meaning it seemed like it was a
pretty good lineup, and we have a few that are in yellow that we\'re not
quite sure about. And then white means we really had nothing that we
could find as a linkage between the element on that \-- on the left-hand
side, and the fix function on it that we\'re running into now.

So at least it\'s a method to represent this. As we move forward and get
to the other functional areas, I\'m sure there will be a couple more
greens, or I assume there will be more greens, then we can fill this
out.

And I don\'t know that we need to go into too much detail because it\'s
going to take a fair amount of discussion for you to go through this,
but what happened soon after we went through the first couple of these
was to realize quickly, you could just kind of drag the green all the
way down through an area.

But you can see, for instance, in EED 1 \-- and I\'ll just look now at
the clinical phase, which is line 11. We did not think that EED 1, which
is the use of secondary data for early identification of public health
events, that whether a facility was open or not would not help us with
event detection. But it may help us with the situational awareness of
the size, location, and spread, which is EED 3. That\'s why you can see
this discrepancy \-- it seemed like everything was being filled in for
awhile, then it got down to this area where some of them were dropping
out.

For instance, for OM 5, which is the integration with early detection,
and countermeasure administration capabilities, we gave this yellow
category, because we weren\'t really sure if there was some relationship
between this outbreak management functional area, integration of early
detection and countermeasure response. So for instance, this yellow
is \-- I think, I believe, that this yellow is there because it\'s not
about bioterrorism, but if there were this trauma event, that this would
be valuable for that type of scenario.

So, you know, typically we\'re thinking in terms of biologic events, but
we should be broader than that.

You can go down a little farther, you can see this is going to center
around the patient data elements, most of it is filled in. Then we got
down to laboratory reporting, and the lab orders were really not that
helpful in outbreak management, but the results were helpful in terms of
case investigation and linking laboratory test results, of course, with,
by definition, with clinical case data.

But again, you see yellow in the OM 5 category, which is early detection
and countermeasure administration, and we came up with one example, but
maybe you can think of others, where, you know, post vaccination,
vaccinia infection where that might be something that would be
identified after someone were vaccinated.

We didn\'t do the complete job here, it\'s just as much a start of this,
just this \-- as you were doing it in your group. And I think we have at
least a way to describe this, and maybe at the beginning of an artifact,
to share with others, as we kind of move forward, just that we have gone
through this process. And if there\'s an item that does not have a green
anywhere, then we really should question whether it needs to be on this
list.

**[\>\>:]{.underline}**

And I think you can also put that to \-- let\'s just look at laboratory
orders, too. And if there is no more green moving out to the functional
areas, well, that might not be a priority to develop that standard
moving forward as a recommendation.

Yes, it would be useful in the early event, but outbreak management and
the rest of the functions, but \-- we think that\'s \--

**[\>\>:]{.underline}**

Nice model.

**[\>\>:]{.underline}**

So thank you, group. Laura is not here anymore.

**[\>\>:]{.underline}**

No?

**[\>\>:]{.underline}**

She didn\'t want to present?

**[\>\>:]{.underline}**

As we get through the rest of the context that\'s one of the things on
our to-do list is complete the functional areas, right?

**[\>\>:]{.underline}**

The other piece of feasibility and methodology and function. Great.

Great. Well, that I think advanced both of these significantly here in
terms of our tasks. Thanks, everyone.

We are in the last 29 minutes. With what to work on today. And we have a
few I think key next steps that we wanted to move into on the agenda.

And I have kind of highlighted perhaps three possible areas, given our
time. One is to, given the work we have to do, sort of setting our
calendars. What\'s our feasibility of \-- how do we approach the work we
need to do over the next about four to six weeks, not a lot of time.

The second is really how do we discuss now or in the next steps sort of
the issue that Kelly brought up this morning on the State-local process
for data. And then the third was just other parking lot kind of issues
that we have been identifying that we want to make sure we deal with
sometime in the next six weeks \[indiscernible\].

**[\>\>:]{.underline}**

First frame up this \-- 

**[\>\>:]{.underline}**

Should we look the calendars, Scott you had \[indiscernible\].

**[\>\>:]{.underline}**

And given our work \-- we have lots of work to do.

**[\>\>:]{.underline}**

And I know that each member here represents a national organization or a
different aspect within public health. If it\'s pertinent to this group
or \-- \[indiscernible\] could you please let me know and I\'ll allot it
for the calendar, so at least the rest of the members are aware of this,
and make this our calendar moving forward.

**[\>\>:]{.underline}**

After the annual meeting?

**[\>\>:]{.underline}**

Exactly like that. So at least we\'re aware of it, it may not implicate,
but at least I know not to schedule a meeting at that time.

**[\>\>:]{.underline}**

September AHIC meeting? I don\'t know where I am. HITSP meeting.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

We have been about two or three weeks between phone calls, the next
meeting is a two-hour phone call. I think we can build on the work
that\'s done here. Starting today. Really need to move along quickly, I
think, on the feasibility, and the process on the crosswalk. I think the
concern on feasibility is because it involves others, and getting that
off the ground.

So we also have the holiday coming in. The 5th, Labor Day, is in this
mix. So what do you \-- don\'t have everyone here, but what of those
here do you think is feasible with our turn-around time? Looking at the
week of the 4th?

**[\>\>:]{.underline}**

The 7th and 8th we have two other workgroups scheduled on those days,
although the one on the 7th will be in the morning, so I\'d to have
check with our contractors, but there\'s a possibility of doing a
two-hour telephone meeting that afternoon.

**[\>\>:]{.underline}**

The next HITSP meeting is the first week, is the Labor Day week, after
Labor Day.

**[\>\>:]{.underline}**

It is?

**[\>\>:]{.underline}**

Yes, it is. Just trying to find my schedule.

**[\>\>:]{.underline}**

They\'re working you guys like dogs.

**[\>\>:]{.underline}**

You bet.

**[\>\>:]{.underline}**

In terms of conflict or dependencies?

**[\>\>:]{.underline}**

Conflict.

**[\>\>:]{.underline}**

For the HITSP?

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

The dependency would be another Workgroup in the same space. We need at
least an hour in between meetings, correct, Judy?

**[\>\>:]{.underline}**

What\'s that? Oh, absolutely.

**[\>\>:]{.underline}**

For the Web \-- at the very least. So I couldn\'t schedule a
back-to-back.

**[\>\>:]{.underline}**

No.

**[\>\>:]{.underline}**

September 6 through 8 is the HITSP.

**[\>\>:]{.underline}**

So HITSP?

**[\>\>:]{.underline}**

The 8th?

**[\>\>:]{.underline}**

Is that over the weekend?

**[\>\>:]{.underline}**

No it\'s \--

**[\>\>:]{.underline}**

Wrong month, sorry.

**[\>\>:]{.underline}**

You guys have other jobs?

**[\>\>:]{.underline}**

Is that the \[indiscernible\] meeting or full panel?

**[\>\>:]{.underline}**

Did \[indiscernible\] go away for the afternoon?

**[\>\>:]{.underline}**

Yeah, it\'s HITSP the whole time.

**[\>\>:]{.underline}**

So the 5th is the only day that week.

**[\>\>:]{.underline}**

Yep, right after Labor Day.

**[\>\>:]{.underline}**

The 6th, what was that, HITSP again?

**[\>\>:]{.underline}**

6th through 8th.

**[\>\>:]{.underline}**

Of course we are in the D.C. area, so \--

**[\>\>:]{.underline}**

What times do they run, does HITSP run all day?

**[\>\>:]{.underline}**

We\'ve been starting at 8 a.m. and running to 6:00, 6:30.

**[\>\>:]{.underline}**

Holy cow.

**[\>\>:]{.underline}**

So you really need a break from that. Two hours of something different.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

So any objections on the 5th?

**[\>\>:]{.underline}**

Would it be beneficial for you to have another meeting here before going
into the HITSP meeting?

**[\>\>:]{.underline}**

That was the \[indiscernible\] I\'m going to be in this area, anyway.

\[multiple speakers\]

**[\>\>:]{.underline}**

Okay, so pencil in 2:00 to 4:00, like we\'ve been doing?

**[\>\>:]{.underline}**

That\'s Eastern we\'re talking about?

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

That\'s the 5th. 2:00 to 4:00.

**[\>\>:]{.underline}**

Well, I\'m not sure I\'m available, that\'s what I\'m trying to look
for.

**[\>\>:]{.underline}**

And our target is that 21st preliminary report to the Biosurveillance
Workgroup. Which is on the 21st.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

I am available.

**[\>\>:]{.underline}**

Okay. So is it possible for us to go ahead and schedule two weeks after
that, the 19th?

**[\>\>:]{.underline}**

Okay, on that day we have another Workgroup meeting, the EHR Workgroup,
and it\'s the NCVHS subcommittee meetings on the 18th and 19th, if
anyone is involved in that.

**[\>\>:]{.underline}**

I thought it was the 13th.

**[\>\>:]{.underline}**

No. Well, it is, it\'s 13th, 14th, 15th, 18th, 19th. And HITSP full
panel is on the 20th. And HIMS rural is on the 21st.

**[\>\>:]{.underline}**

And the Biosurveillance is on the 21st.

**[\>\>:]{.underline}**

The 21st.

**[\>\>:]{.underline}**

So we may be occupying the phone line for \--

**[\>\>:]{.underline}**

You know, I don\'t have a time, here, I could check on the time, it\'s
generally 1:00 to 3:00, and then we\'d have to do an hour in between, so
that would be \--

**[\>\>:]{.underline}**

1:00 to 3:00 on the 19th?

**[\>\>:]{.underline}**

No, that\'s been taken, I believe.

**[\>\>:]{.underline}**

That\'s what I meant, 1:00 to 3:00 on the 19th is taken.

**[\>\>:]{.underline}**

Right, we would end up doing it 4:00 to 6:00.

**[\>\>:]{.underline}**

We\'ve been typically doing \--

**[\>\>:]{.underline}**

You could do it earlier in the day.

**[\>\>:]{.underline}**

Yes, but for the West \-- you know, the western part \--

**[\>\>:]{.underline}**

The \[indiscernible\] the West doesn\'t matter. Two hours, right? When
you start at 9:00, you can do this from home at 7:00.

**[\>\>:]{.underline}**

Cup of coffee.

**[\>\>:]{.underline}**

Yeah.

**[\>\>:]{.underline}**

\-- \[indiscernible\] don\'t realize.

**[\>\>:]{.underline}**

10:00 to noon Eastern on the 19th?

**[\>\>:]{.underline}**

I\'ll have to double check with that, but let\'s pencil that one in,
too.

**[\>\>:]{.underline}**

10:00 to noon Eastern on the 19th.

**[\>\>:]{.underline}**

And then you make your report on the 21st.

**[\>\>:]{.underline}**

You guys are coming in for that.

**[\>\>:]{.underline}**

We don\'t know that yet.

**[\>\>:]{.underline}**

We heard this could be a \[indiscernible\] presentation.

**[\>\>:]{.underline}**

That\'s correct, you don\'t have to.

**[\>\>:]{.underline}**

I prefer not to fly if I don\'t have to.

Do you want to come here?

**[\>\>:]{.underline}**

The 19th would be \[indiscernible\] Eastern.

**[\>\>:]{.underline}**

You\'re Central? 9:00 to 11:00.

**[\>\>:]{.underline}**

Then obviously, the 20th would be wordsmithing whatever preliminary
report coming out, kind of our group\'s approval of moving that forward,
and having the presenters go forward with that.

**[\>\>:]{.underline}**

PowerPoint and some graph tables maybe, I don\'t think we have a lot of
narrative, perhaps. We\'ll have to see what we have.

**[\>\>:]{.underline}**

Can be just the PowerPoint, right? Does it need to be actual draft
documents?

**[\>\>:]{.underline}**

What are we talking about?

**[\>\>:]{.underline}**

The preliminary report to the Biosurveillance.

**[\>\>:]{.underline}**

Oh no, you can just do a PowerPoint presentation. And I need to also
find out, you know, how long do they want it. I can find out all the
particulars. Of the parameters.

**[\>\>:]{.underline}**

Fly in for 15 minutes.

**[\>\>:]{.underline}**

Corporate jet. Engines running.

**[\>\>:]{.underline}**

You can be a ventriloquist, I\'ll be your dummy.

**[\>\>:]{.underline}**

Charlie McCarthy.

**[\>\>:]{.underline}**

Dr. Melton, do you have a corporate jet we can borrow?

**[\>\>:]{.underline}**

None here.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Use CDC corporate jets.

**[\>\>:]{.underline}**

There you go.

**[\>\>:]{.underline}**

Should we look, two weeks after that would be the 3rd, is that right? Of
October?

**[\>\>:]{.underline}**

That\'s actually a totally free date.

**[\>\>:]{.underline}**

Whoa.

**[\>\>:]{.underline}**

Pencil in 2:00 to 4:00 again, our usual \--

**[\>\>:]{.underline}**

I have a full day preparedness training thing all day. I don\'t know
what will happen. I think I can get out of it, but I don\'t know, for an
hour or two. So 2:00 to 4:00, that would be at least over lunch hour.
Let\'s go ahead and do that, and then I\'ll see what the instructor
says.

**[\>\>:]{.underline}**

You need a note?

**[\>\>:]{.underline}**

Get Michael Chertoff to send one.

**[\>\>:]{.underline}**

I\'ll get right on it.

**[\>\>:]{.underline}**

Maybe you can get Pat Murphy to send you one.

**[\>\>:]{.underline}**

That might work.

**[\>\>:]{.underline}**

All right, again, the target would be the final report to the
Biosurveillance on the 17th.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So again, I think taking into account presenting to the work before
group on the 21st back in September, that gives almost a week, and a
couple of days to \-- you know, review, give us \-- we\'ll probably put
a timeline on there, comments back to us.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

And then \--

**[\>\>:]{.underline}**

When do we have the testimony? Will it be in those two-hour sessions
that we\'re scheduling now?

**[\>\>:]{.underline}**

Well, you know, we need some time to organize that, so \-- you know,
so \--

**[\>\>:]{.underline}**

If it\'s written, it could be \-- yeah, it could be, you know, anytime.

**[\>\>:]{.underline}**

So are we saying when we\'re ready to present on the 21st, we would then
submit to reviewers for testimony?

**[\>\>:]{.underline}**

I don\'t know, what do you \--

**[\>\>:]{.underline}**

Well, how \-- if we \--

**[\>\>:]{.underline}**

I\'m sorry, when it\'s \-- I got the wrong date. On the 21st of
September, when we\'re presenting for the first time to the
Biosurveillance Workgroup, would at that time we\'d be targeting sending
this out for testimony, comments? Or are we going to be doing that
later?

**[\>\>:]{.underline}**

Seems to me you want to be gathering that information ahead of that. Be
part of your clarification, and, you know, general intelligence on the
issue.

**[\>\>:]{.underline}**

We may need to continue on after that, but at least get some of it \--

**[\>\>:]{.underline}**

Maybe we should look at the 19th.

**[\>\>:]{.underline}**

Some of the data elements we\'re definitely going to be able to put a
stamp of yes, no, that type of yes, we\'re collecting, it\'s up running,
it\'s available. Versus a couple more of these that maybe needed to
flesh out.

**[\>\>:]{.underline}**

That\'s why it helps to have more people than we originally started out
with, because some will respond more quickly than others.

**[\>\>:]{.underline}**

So then let\'s back it up, so when would this group decide to send it
out for comment? What should be our target date for that?

**[\>\>:]{.underline}**

For the total package, feasibility and dataset?

**[\>\>:]{.underline}**

Wait, I don\'t think we\'re going to be sending anything out. You mean
sending out comment to the people that we listed up there?

**[\>\>:]{.underline}**

No, we would have them come to us, and give us information.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

So we\'re not asking them to look at anything.

**[\>\>:]{.underline}**

No. No. We are the advisory group.

**[\>\>:]{.underline}**

We\'re not going to ask them to be commenting on anything, other than
the concept of feasibility for \--

**[\>\>:]{.underline}**

Right, they\'re going to be reporting to you on their thoughts. And you
are the advisory group to the AHIC.

**[\>\>:]{.underline}**

I hesitate to say this without Angela in the room, but I\'ll put it out
there at least for NACCHO. Would it be worthwhile, once we have decided
or gotten more clarification on exactly which data elements we think we
want in and out, to send it out to folks that we know have
biosurveillance systems, say are you currently collecting this, if not,
do you have a plan to collect this, and \-- I don\'t know if we want any
other comments. I think that would be a fairly quick and dirty survey
compared to the other one we did. Angela may kill me on this one,
but \-- if she doesn\'t want to do it she doesn\'t have to.

**[\>\>:]{.underline}**

We would send out our list \--

**[\>\>:]{.underline}**

Basically, yeah.

**[\>\>:]{.underline}**

And after this check off which ones they have \--

**[\>\>:]{.underline}**

We may need to define it, actually define what we need, because I think
some of the names we have right now might not be too descriptive. But
yes, basically the concept would be a list with some check boxes, do you
currently collect this, if not, are you planning on it. If they aren\'t
planning on it, why.

**[\>\>:]{.underline}**

Right, what obstacles might be \--

**[\>\>:]{.underline}**

So when do we want to do that? I\'m just trying to get it so we can back
into this, use the data when we get to presenting.

**[\>\>:]{.underline}**

I\'m not sure if it would be before that September 21, or if it would be
after. Because last time we ran into tremendous obstacles of actually
trying to analyze the darn data before we made it available for
presentation, so \--

**[\>\>:]{.underline}**

Why don\'t you look into it. We know what our date \-- what our
deadlines are, and you can sort of work backwards.

**[\>\>:]{.underline}**

Okay. I will talk to Angela.

**[\>\>:]{.underline}**

We\'ll take some public comment here in a little bit. So \--

Just to review, right now we have another Workgroup meeting on September
5, 2:00 to 4:00. Another then one on the 19th of September, 10:00 to
12:00. Make your presentation on September 21, and I\'ll find out how
long, and just what the format of that will be.

October 3, another work group meeting 2:00 to 4:00, and then a
presentation to the Biosurveillance Group on October 17. Right?

**[\>\>:]{.underline}**

And the 31st.

**[\>\>:]{.underline}**

And the 31st being to the full AHIC, right.

**[\>\>:]{.underline}**

Full schedule of a lot to do. Can do a fair amount by e-mail I think as
well.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

And again, I think that report to the \-- that preliminary report
wouldn\'t necessarily have to encompass everything, but maybe here\'s
what we\'re finding out, here\'s where we\'re going, here\'s what \--
you know, we\'ll have more for you, a definitive set for you, on \--

**[\>\>:]{.underline}**

Two weeks later.

**[\>\>:]{.underline}**

Well, potentially a month later.

**[\>\>:]{.underline}**

Yeah, a month. Right.

**[\>\>:]{.underline}**

Okay, so shall we ask Matt to bring in the public now, and \-- it takes
a minute, we can continue to talk.

**[\>\>:]{.underline}**

I guess I want to be sure that we know what\'s in the parking lot. And
maybe we can update that in the next \-- in the next week, make sure
what things are in or out of our scope, what things we want to be
tracking on. And I want to be sure that either with some discussion just
now about soliciting input from other colleagues, and making sure that
the definitions are there. I know we have a glossary, but I don\'t know
in the glossary is really related to the data element list, and at some
point we need to start getting into more detail about people who will
say I know what they\'re talking about here. Apart from issues of link
on \[indiscernible\], just what is it specifically, because we had
some \-- our own difficulties today. So \--

**[\>\>:]{.underline}**

Yeah, I would almost recommend that we take the glossary that I have
sent out and start tailoring that to Biosurveillance Steering Group,
having several of these terms I actually \-- pseudoanonymized. Linkage,
correlation, source investigation. Those are not \-- those were not in
there. But I would put that out there for \--

**[\>\>:]{.underline}**

I think if we\'re actually going to be disseminating this, we really
need data definitions.

**[\>\>:]{.underline}**

We need a dictionary. I\'m sure we\'ll build it, but we\'ll also kind of
match up that word here with the dictionary definition, so that the
viewer can take a look at that and check yes or no.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

Thank you.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

The other thing on that list is the whole notion of process, State,
Federal, local, receiving.

**[\>\>:]{.underline}**

Oh yes, multi-jurisdiction, we have to get back to that.

**[\>\>:]{.underline}**

State sharing across jurisdiction.

**[\>\>:]{.underline}**

Protocol, is it uniform nationally, is there \[indiscernible\] local,
State priorities.

**[\>\>:]{.underline}**

It\'s kind of like there were some position papers or endorsements that
you \[indiscernible\].

**[\>\>:]{.underline}**

Formal documents that would be \--

**[\>\>:]{.underline}**

The formal document is this.

**[\>\>:]{.underline}**

The \[indiscernible\] copy.

**[\>\>:]{.underline}**

Those are right now \-- any other parking lot issues before we end up
here?

**[\>\>:]{.underline}**

I just have one quick scheduling comment. I think October 19 to 20 is
the Biosurveillance \[indiscernible\].

**[\>\>:]{.underline}**

Yeah, it is.

**[\>\>:]{.underline}**

I don\'t know if that\'s \-- if there\'s any \-- if that\'s that
presents an opportunity to \[indiscernible\] just before the final \-- I
guess it\'s after the final report, but before the recommendations. Just
thought that a lot of us might be there.

**[\>\>:]{.underline}**

\[indiscernible\] and I talked about doing some kind of a focus group.
It was a little different focus, but might be able to rethink it.

**[\>\>:]{.underline}**

So the 19th and 20th?

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

So maybe we should target October \--

**[\>\>:]{.underline}**

The 18th?

**[\>\>:]{.underline}**

Have I got the dates wrong?

**[\>\>:]{.underline}**

I thought you said September.

**[\>\>:]{.underline}**

October.

**[\>\>:]{.underline}**

So I wonder if we could take the message of \[indiscernible\] canvass.

**[\>\>:]{.underline}**

The workshop for the AHIC \--

**[\>\>:]{.underline}**

Before the final report.

I wonder if that might be an opportunity to think about canvassing
people not necessarily in the ASTHO/NACCHO group, but there may be
either in the public surveillance conference.

**[\>\>:]{.underline}**

That\'s exactly what \[indiscernible\] and I were talking about, it is a
different group, and there will be more people than just ASTHO/NACCHO
people, there will be hopefully some academics, some hospitals, some
labs.

**[\>\>:]{.underline}**

 \-- issue of the parking lot \[indiscernible\] very different sort of
agenda.

**[\>\>:]{.underline}**

Final report.

**[\>\>:]{.underline}**

Where if we \-- we\'ll talk about \--

\[multiple speakers\]

**[\>\>:]{.underline}**

\-- maybe an interim report.

**[\>\>:]{.underline}**

Do you know if this group ends at the time that we present to AHIC? Or
are we continuing?

**[\>\>:]{.underline}**

I don\'t know.

**[\>\>:]{.underline}**

That will have to be \--

**[\>\>:]{.underline}**

I thought we were continuing with feasibility, and monitoring some of
these recommendations, after moving forward.

**[\>\>:]{.underline}**

What is the word \-- final report of what to AHIC?

**[\>\>:]{.underline}**

Will we not present something \--

**[\>\>:]{.underline}**

Final report may mean for our dataset.

**[\>\>:]{.underline}**

Yes.

**[\>\>:]{.underline}**

Final report to the MDS.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

That\'s our first main accomplishment and goals.

**[\>\>:]{.underline}**

Then we have to work on the wording, "Phase 1 MDS Report," or something,
it may not be a final, final report. If we\'re collecting some
feasibility piece, if we feel we need to do that.

**[\>\>:]{.underline}**

Right.

**[\>\>:]{.underline}**

That would be another parking lot issue is clarification of the reports.
Excellent.

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

So can we open it up?

**[\>\>:]{.underline}**

Okay.

**[\>\>:]{.underline}**

To comment.

**[\>\>:]{.underline}**

Matt, are you there?

**[\>\> Matt McCoy:]{.underline}**

Yeah, we could \-- we\'ve had the number up for call-in for about two
minutes now, and nobody has called in yet, so I think if we give it
another 30 seconds and nobody calls in, everybody has had the
opportunity to do so. And there is still an e-mail address up there, if
people want to send their comments or questions in that way.

**[\>\>:]{.underline}**

Thank you very much.

**[\>\>:]{.underline}**

Thank you, Matt.

**[\>\>:]{.underline}**

Thank you everybody.

**[\>\>:]{.underline}**

Thank you everybody.

**[\>\>:]{.underline}**

An opportunity finally to answer all the faces to all the places and you
look better than voices sound.

**[\>\>:]{.underline}**

\[laughter\] So do you.

**[\>\>:]{.underline}**

It\'s my raspy voice.

**[\>\>:]{.underline}**

It\'s a very good group. I think you accomplished an awful lot today.
Very interesting.

**[\>\>:]{.underline}**

Thank you.

**[\>\>:]{.underline}**

Thank you, everybody in the room here.

**[\>\>:]{.underline}**

Anything we can do to help here at HHS, we stand ready.

**[\>\>:]{.underline}**

We appreciate that.

**[\>\>:]{.underline}**

Thank you very much.

**[\>\> Matt McCoy:]{.underline}**

Doesn\'t look like we\'re going to get any comments, so you\'re free to
adjourn on that front.

**[\>\>:]{.underline}**

Thanks, Matt.

**[\>\>:]{.underline}**

Thank you.

**[\>\>:]{.underline}**

Excellent.

**[\>\>:]{.underline}**

Five minutes early.

**[\>\>:]{.underline}**

A record.

**[\>\>:]{.underline}**

Thank you all.