**AMERICAN HEALTH INFORMATION**

####### COMMUNITY SUCCESSOR MEETING

**AUGUST 17, 2007**

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## 

## Hubert H. Humphrey Building

## 200 Independence Avenue, SW, Room 800

## Washington, DC 20201

#### TABLE OF CONTENTS

-   Call to Order: Robert Kolodner

-   Introductory Comments: Robert Kolodner

-   AHIC Successor Organization: Background and Overview: Robert
    Kolodner

-   Question and Answer Session: Secretary Leavitt

-   Presentation and Roadmap for AHIC Successor: Robert Kolodner

-   Question and Answer Session (in-person, phone-in, or email
    questions)

PROCEEDINGS (10:00 am EST)

DR. KOLODNER: Well good morning, and welcome to all of you, both those
of you here and those of you on the Web. And welcome to the first public
meeting of the AHIC Successor. The purpose of this meeting is to offer
the public an opportunity to hear the vision and strategy for achieving
a successor to the American Health Information Community. The new entity
is intended to maintain, enhance, and accelerate the progress that the
current AHIC has made to improve the quality, safety, and efficiency of
healthcare, and the health and well-being of individuals and communities
in the U.S. by achieving the reliable, secure, trusted exchange of
health information across the nation.

In addition to the room full of attendees that we have here today, I
want to extend a special welcome to a few of you out there on the Web
who have preregistered, in particular to Nancy Davenport-Ennis, who is a
member of the AHIC, to Dr. Mark Leavitt from CCHIT, and Dr. Don Berwick
from the Institute of Healthcare Improvement, as well as over a hundred
others who have joined us today by Webcast.

Regarding the format of the meeting, we're going to have two segments
for today's meeting. I'll start the first segment by giving a brief
refresh about the plans for Successor to the American Health Information
Community, or the AHIC, better known as the Community. And for
shorthand, we've also been referring to the AHIC Successor as AHIC 2.0.

When \-- Secretary Leavitt will join us at 10:15 east coast time. He's
en route from the White House. And at that time, he'll discuss his
vision and the long-term strategy for the AHIC 2.0. And you'll then have
an opportunity to participate in an interactive question and answer
session with the Secretary to discuss that vision and high-level
strategy. We'll take questions both from those physically here in the
room as well as those participating by the Webcast. If we're not able to
get to all the questions, we'll capture all of them and post the answers
to \-- those that have the most interest to the larger community as FAQs
on the AHIC Transition Web site.

In the second segment of today's meeting, after the Secretary leaves
somewhere around 11:15, we will present more detail of the actual
process of designing and establishing the successor. And we'll address
the cooperative agreement, its funding, and how we envision people and
organizations coming together to plan and form this new entity. We'll
then have a second question and answer period to deal with the questions
that you have on these more detailed issues.

I also want to mention that there will be a more detailed technical
session that we'll be holding on September 5^th^ to review aspects of a
prototype model that exemplify the key attributes we envision the new
organization will have. And I'll have more details about this upcoming
meeting at the end of today's session, and we'll also be posting more
information on our AHIC Transition Web page. With that, let's get
started.

Since 2005, the AHIC, or AHIC 1.0 as Secretary Leavitt has referred to
it, has provided the venue to advance recommendations to realize the
adoption of health IT. But as an advisory committee, the AHIC can take
the nation only so far toward that goal of health information
interoperability. As an advisory committee, it can't take direct action
or decide how to drive the nationwide agenda forward. Its function is to
make recommendations to HHS, and while HHS and the federal government
play a pivotal role in healthcare and in moving it forward, we also need
to align both the public and private stakeholders to most rapidly and
effectively achieve this interoperability together.

We're aiming to transform the healthcare sector into a true healthcare
system, delivering high quality efficient care as well as fostering the
opportunity for each and every person to play an active role, to the
best of their ability, in managing their own health and well-being. To
accomplish these goals will take a much greater time span than a single
HHS Secretary's tenure in office. And because of the length of time
required for such transformation, we need strong leadership in both the
public and private sectors. As you'll hear from Secretary Leavitt
shortly, we believe the best way to achieve this long-term success is to
transition from AHIC 1 to AHIC 2.0, from an advisory committee into a
public/private entity that can take action directly. And now is the time
to make that transition, starting now and finishing by late fall 2008.

Interoperability is critical to realizing the needed improvements in
quality and efficiency. And as we've seen over the past two years,
national leadership was needed to generate the momentum and focus the
energy of the many different initiatives aimed at automated healthcare
information. Through Secretary Leavitt's leadership, the advice of the
AHIC members, and the hard work of hundreds of volunteers, we have made
significant progress in that short time.

It's important that this focused momentum not be lost. And honestly,
there is real risk to the momentum stemming from the periodic changes
that occur in government administration and legislative leadership. So
we need to transition the AHIC from a federal advisory committee to an
independent entity, which has active government participation, and one
that will continue to provide the glue that's needed to keep the many
different efforts coordinated and moving in harmony. HHS will continue
to be actively engaged, will have a significant role in the AHIC
successor, and will be working to clarify how we can maximize
participation by federal government appointees and representatives on
the board of such an entity.

Since they were endorsed by the AHIC in April of 2007, the guiding
principles for governing the AHIC Successor have remained constant.
While also meeting the needs of other relevant and affected parties, the
AHIC Successor ultimately must exist to benefit the individual people of
this nation. Now, there was a lot of discussion at the AHIC about
"What's that right term? Is it consumer, is it individual, is it person,
is it citizen?" There was no right term that we could ultimately choose,
and so you'll hear us going back and forth a little bit between person,
individual, and consumer. But the idea is the individuals in this
country.

The Successor also should engender trust among the many different market
sectors. And those who have a stake in the decisions that are made must
be represented in this organization: the consumers, the employers, the
insurers, the clinicians, and others. Again, there's a problem of the
limited words to choose from. You'll occasionally see us use the term
"healthcare industry," but it's meant to be a proxy not just for the
large corporate interests, but is meant instead to be the full spectrum
of healthcare related and health related stakeholders, especially
including individuals and communities.

The Successor should be able to act decisively and make progress toward
interoperability, but be governed in a way that the interests of all the
stakeholders are addressed by these decisions. Now, that doesn't mean
that everybody's interest in every decision will necessarily hold sway.
There are tensions and differences in some of those interests, but the
point is that on the whole that each stakeholder group will feel that
its interest was protected, was honored and respected, and moved forward
by the whole of the decisions that are made. And as I mentioned,
government will be at the table as a responsible board member, and at
the table in both the design stage and the operational stage, and I'll
talk about that later.

AHIC 2.0 should be relatively simple to establish but sophisticated
enough to adapt over time as the healthcare delivery system morphs and
changes. And just think about the changes that we've had in healthcare
over the last 50 years. We're now moving and changing at an exponential
rate, so the next 50 years are not going to be just the level of changes
that we've had in the past 50, but will be multiples of that as we move
forward. And this organization has to be able to adapt to that.

In order to assure \-- ensure that these principles are part of the
Successor organization, we identified six key attributes for AHIC 2.0,
all of which were detailed in a White Paper that we published on the
AHIC Transition Web page. And those are linked to the Web page for the
AHIC itself. These key attributes address vision and membership,
governance, rights and obligations, and protections and corporations, as
well as management and staff.

An entity like we envision for the AHIC Successor has not existed before
in health and healthcare. And many of the views that we have about an
organization are biased and guided by the experiences we've had in other
types of organizations, but this is really unlike anything that we've
had experience with before. And in trying to set up such a new
organization, there's certain risk in establishing something brand new.
So in looking at how we could decrease the risks in order to have a
higher chance of succeeding, we identified several success factors.

First, we need continued government participation. That was \-- that
came across loud and clear from much of the feedback that we've
received. This is a key to the success, and when it comes into
existence, government will be a major participant, along with other
thought leaders in the industry. The government is a major payer and
provider of healthcare, and we will be at the table.

Other success factors for the AHIC Successor include the need to have,
as its principle person, a strong, esteemed individual with exceptional
leadership skills, who can attract an exceptional leadership team and
staff, as well as engender trust among potential members. We also need a
clearly articulated list of planned accomplishments for the short term,
an adequate financial backing and plan for obtaining that backing, in
addition to the government grants and government's fair share of the
membership fees, if there are any that will be collected. And we also
need broad commitment and participation from both the public and the
private sector organizations and individuals.

We started the AHIC succession process in April of this year, and have
been able to move swiftly from that point by leveraging the unique and
remarkable Visa experience of Dee Hock, who was the founder and first
CEO of Visa International. Dee worked with us to synthesize the input we
requested, and that we received on the governance concepts, and to
identify the key attributes and success factors for the AHIC Successor.
There are some characteristics about Visa, in terms of how it's formed
\-- while it's in a different industry and while it is more uniform
membership, some of those principles are ones that we feel will be very
important to have in the AHIC Successor as it moves forward.

We then identified illustrative examples of how different attributes of
the AHIC Successor could be implemented. And, we will be describing what
we learned from this activity in greater detail at that September 5^th^
meeting that I mentioned, when we conduct the second public meeting to
review the technical details of the grant. In the interim, if you want
more information you can read the published White Paper that further
describes the different attributes of the Successor. The public comment
period for the White Paper started on August 6^th^ and continues until
September 10^th^.

In weighing the alternatives, we chose an implementation strategy that
allows for a joint public/private process to actually design and
establish the AHIC 2.0. It's an ambitious strategy that began with the
publication of the public comment period of the White Paper, that
describes the vision and key attributes of the Successor organization,
and then the strategy culminates in an award of a grant, which brings us
to today, and to this public meeting.

On August \-- on Monday, August 13^th^, we posted the notice of funding
availability for the grant, and we're here today to answer your
questions, and encourage you to collaborate and make the vision of AHIC
2.0 a reality. Secretary Leavitt will be coming shortly \-- as I
mentioned, he's en route \-- and at that time, he'll make a few remarks
and answer questions that you might have about this transition. When we
do take questions for him, we'll be taking both from the audience here
as well as from those of you who are watching on the Web. And those on
the Web will be able to submit those questions either directly from the
Web or by calling a toll-free number that will show on the screen during
that time.

I would ask that \-- for the Secretary, that you hold those questions
about the grant process until the later portion of the session, after he
leaves, and after I provide some additional detail about the grant
process. And then we'll have a second question and answer session. And I
believe that the Secretary has still not made it here so what I'd
suggest we do is just pause for a couple minutes until he arrives, and
then we'll resume at that time with the Secretary's comments and the
questions and answers for him.

\[break\]

DR. KOLODNER: We'll resume at this time. I understand that there
actually may be some problems with the Web cast, so it's not clear yet
whether people on the Web are hearing us or not, or whether they're just
not able to see the slides. But what we're doing now is being recorded
and will be posted, but hopefully we'll get that working in just a
moment.

It's my great pleasure now to turn the mic over to Secretary Leavitt,
who has been a strong advocate both of the AHIC in its current form and
in the transition of the AHIC and creation of a public/private entity in
the private sector that will take over the functions for the AHIC. So,
Mr. Secretary?

SECRETARY LEAVITT: Thank you Rob. Thank you ladies and gentlemen, all of
you, for spending the time to be with us today, whether you're here
directly or on the Web.

I want, today, to start just with the assumed \-- I want to be able to
assume that all of us are here because we have a shared belief that
electronic health records and personal health records and some kind of
secure network to connect them together has to happen, and that \-- I
mean, we've been talking about this for decades and it just hasn't
happened yet. We're making progress; you can go around the country and
see it in institutions, but you cannot \-- we have not yet accomplished
it as a nation. I think we all have a fairly clear emerging vision of
what this could and should look like, but we haven't accomplished it.

I think we have to ask the question, "Why?" If it were easy, it would
have happened a long time ago. This is a hard proposition. This is a
complicated, complex matter of literally organizing the entire health
sector into a system. It hasn't happened, I would say, primary for two
reasons. One is \-- three reasons. One is that it's a \-- it is
complicated, but there's just a lot of conflicting tensions in terms of
conflicted interests. And the other is there is a lot of turf battles
here. This is a very complex part of society and finance, and in the
past there have been some technology barriers, but most of those have
disappeared. I don't think there's anyone in this room who would argue
the fact that we have the capacity to do this technologically, that it's
not the technology that's in our way; it's the sociology. And so we're
really here today to talk not so much about the technology, but the
sociology.

As I mentioned, we've been talking about this for a couple of decades
now. We, I believe, in the last 23 months have finally started to make
some progress. I think the first important step in that \-- on that
pathway was for the President to issue the executive order, which
essentially said, "If you're going to do business with the federal
government in the future, you need to adopt some IT standards. And, if
you're going to do business with us in the future, you need to be able
to begin adopting some quality measures. If you're going to do business
with us in the future, you need to know that we're going to start
looking for ways to create incentives for people, and that we need to
also be able to measure the price." All of those were part of an
important statement on the part of the federal government.

We organized AHIC. AHIC now has \-- I think we've had 15 meetings and
we're making some progress. We first defined a use case process, and we
mapped out more than a hundred potential use cases that need to be
developed, and we started slowly ticking off the \-- from the list. Our
first year, we did three. The next year I think we had four. The next
year we've got planned for six. We're making slow incremental progress.
This year we will have recognized some 30 harmonized interoperability
standards. We've created a certification process through CCHIT. We now
have 80 different products that have been certified. We've got \--
that's basically 40 percent of the market. We began trial implementation
on a variety of different configurations for the National Health
Information Network. These were important steps, and after two decades
we're beginning to see progress made.

I need to tell you I feel extremely positive about the work that we're
doing, and we ought not to see this as any casual accomplishment. After
two decades of talking about it, whether it's as fast as we'd like it to
be or as perfect as we would hope it could be, we're making progress.
We're making enough progress that I've heard people say, "Well maybe we
ought to just keep it and let it continue to operate," because as you
know, our strategy from the very beginning has been to get it up and get
it functioning and then to move it out of government into a
private/public partnership in the nonprofit space.

Obviously, government has a profound interest here, and I just want to
say unequivocally that government needs to play that interest and will
continue to. HHS will not only be a participant, but will also be
adopting the standards ourselves, and will be insisting that anyone else
who does business with us, just like the executive order says, will need
to be adopting these standards. So the desire of HHS to say there is a
need for us to move to the next generation, or to the Successor
organization, has nothing to do with the lack of commitment on our part.
It is our commitment to continue to move this forward.

I believe that government not only has a role, but we also have to know
when the limit of our role has been reached. I don't think we can get to
where we need to get without government being deeply involved in it. On
the other hand, I think there is a point at which government becomes a
drag. Let me describe what I'm talking about by using an analogy that
some of you may have heard me use before, and that is of a rocket
launch.

This is a somewhat tortured analogy, but let me use it anyway. When a
rocket leaves the launching pad, it has a giant canister at the bottom
that has lots of rocket fuel, and it explodes and then has to very
slowly lift off that pad and then it picks up speed until it gets into
an orbit. And then the canister has to fall off so that the actual
capsule can be in an orbit of its own. If that capsule hangs on too long
it begins to drag it down.

I believe that's exactly the role that government has here. You can't
get this started without the government being the launch and the fuel
and the means of being able to get it started. But, at a certain point,
the government has to step back and cease to be the \-- cease to play
the role of the owner. It needs to now become the organizer, and it
needs to become a full participant. And so that's the transition that
we're talking about here, not the government stepping away from it as
much as the government changing its role. We need to have the government
clearly there as a major participant, and it would be the government's
intention to do that.

So it's been our strategy from the very beginning to see this transition
occur, and let me just elaborate a little bit more on why I think that's
so important. How could the government become a drag on this process?
Well, there are a lot of ways. One is that we're going to go through a
transition in about 17 months. It's a transition that will occur every
four years, and it would be a drag on the process if there wasn't any
certainty about whether it would continue or not. It's also clearly part
of government's way of having rule-making authority and other kinds of
things, and we've created very deliberate process to follow, for good
reason. But it can't move fast enough to meet the demands of innovation.
So there's the certainty; there's the speed.

I would say there's a third: there needs to be a level of continuity.
This organization ultimately needs to have an executive team that has
continuity to it, that isn't done by political appointment but is done
by a structure of participants who have a point and have confidence in
them and who can continue.

So, there's continuity, there's certainty, and another thing I would
mention is the need for a business model. It is not \-- if Congress has
to continue to appropriate money to this and someone gets unhappy with
it, then there's not certainty to it if they can de-fund it, in essence.
This entity needs to have a sense of perpetuation or needs to be
operating in perpetuity. What I'm suggesting is that I think this needs
to be a democratic institution. It needs to have characteristics of
democracy, but more closely approximating a corporate democracy as
opposed to a political democracy.

The question is, how do we get there? How do we accomplish this
transition? I want to use another analogy. As I mentioned, I think
you've got two processes to make that happen. One, that we've got a
technical problem, which I think we've all agreed can be solved in time.
The second is the sociologic problem, which is how do we create a
governing process for this? I've just been reading a book on a subject
all of you have studied, and it is \-- when our country was formed, in
essence what we had was a governance discussion. How were we going to
govern this country? How were we going to organize the decision-making
and the priority setting and the power structure within this country?

You'll recall, we were \-- early 1780s \-- we had just extracted
ourselves from England, we were operating under the Articles of
Confederation; it was not working particularly well. There were parts of
Vermont that were claimed by two other states, and there was no federal
court system to be able to sort it out. We had no taxation system, and
consequently we had this \$60 million debt and no way to raise it. We
weren't being taken seriously as a country by others because we had no
capacity to generate foreign policy. There were trade barriers beginning
to set up among and between the various components of the states, and
they were starting to \-- and it was a mess. And they had this great
idea, and everyone knew they wanted a country, but it just wasn't
functioning. They needed a better governance structure.

So, as I remember the story, you had a couple of really thoughtful state
legislators \-- James Madison was one, Alexander Hamilton was another
\-- and they knew that George Washington was quite concerned about the
fact that this country that they had worked so hard, and paid with blood
to establish wasn't functioning on a track they wanted it to. And they
concluded they needed to have a better governance process.

Alexander Hamilton and James Madison and a number of other state
legislators got together to talk about one issue: could they resolve
some trade matters within a certain number of states? And they concluded
they really needed to get this larger discussion started, and so they
began contacting other states about having a larger collaboration to
come up with a solution.

Well no one was particularly interested in attending unless they thought
this was going to be credible. And so they went to the one person that
they thought if he attended it would give it enough credibility that
others would come. It was George Washington. Washington, as I read the
history, was a little bit reluctant to attend. He didn't know if he
wanted to get back involved, and yet he could see this problem beginning
to develop. And, ultimately he was persuaded, and they began to hold
this \-- what now we know was the most important public policy
discussion in western history, the Constitutional Convention.

Here's the point. Here's the point I want to make. In that process,
there had to be a convener, and there had to be conveners of stature
that would bring everyone else to the table. They then had to develop a
convention, which was a meeting to design, if you will, what this
government would look like. They then wrote a constitution, which in
essence became the bylaws of the way this would work. They then had to
get ratification, that is to say they had to get people to buy into
their vision and to subscribe to this operation. And then lastly, they
had to implement. They had to literally elect the president and a
Congress and begin to function.

I would suggest to you that the process we need to go through to get
from AHIC 1.0 \-- where we are today, and have a functioning operation
with work groups and a process moving forward \-- to AHIC 2.0 is not all
that dissimilar to what they want through. We have got to form this new
entity \-- the Successor entity, which is AHIC 2.0 \-- and then effect a
transition in an orderly way just as they did from the Articles of
Confederation, where we are today, to the Constitution, which would be
where we want to go.

Now, in order to get there we have to go through the basic same steps.
There's got to be a convener. There's got to be a group of people who
can come together to say, "We represent a broad, well-balanced,
well-thought-through group of people who are prepared to put our
reputations on the line to make this thing move forward." We then need
to hold meetings and come up with a way in which we can articulate what
this should be. We need to put it into documents. We then need to have
people buy into it. And then we've got to implement it.

This meeting, in my judgment, is about asking the question, "Who is
George Washington? Who should be the entity that forms up AHIC 2.0 in
terms of its concept?" so that we can move to the next step, which would
be actually developing documents, so we can move to the next step which
would be asking people to buy in, and then actually implementing it.

Some have said, "Well maybe it ought to be the head of HHS." I would
suggest to you that in a political environment that may not be the right
answer, that the right answer would be for that convener of stature to
emerge not as one person but as a group of organizations. But they will
need to be organizations who can demonstrate their capacity to bring
together the constituencies that will create a sense of confidence in
AHIC 2.0.

Now, the job of this convener of stature then will be to reach out and
to try to draw everyone in, in the same way that James Madison and
Alexander Hamilton and George Washington were able to do in the
Constitutional Convention. I think it's worth noting that history
demonstrates that Alexander Hamilton and James Madison didn't exactly
see eye-to-eye on everything. In fact, what they had agreement on was
that something needed to change. I think that's a very important part of
this formula, is that we've got to bring together the James Madisons and
Alexander Hamiltons of the IT world together, to work together in a
process that will create balance, and that the combination of these
conveners of stature bringing together all the disparate points of view
ultimately is the way we'll create AHIC 2.0 in a way that it can take
this baton, if you will, from AHIC 1.0 and continue to develop the
progress that we're making.

So HHS has concluded that we will call all of the potential James
Madisons and Alexander Hamiltons and ask, "Collectively, could we create
a George Washington here?" And we need to ask all of you to begin
thinking through what the structure would be. It seems to me that's a
far better idea than the Secretary of Health and Human Services simply
saying, "Here are my ideas. I'd like all of you to adopt them." I'm
prepared, as Secretary, to say if we could have even two or three
people, two of three organizations or groups step up and say, "Here's
how we would do it," that would be a good idea, because maybe in the
combination of those two or three, we would find a larger collaboration
that could be shaped.

This is a very important moment in the history, I think, of healthcare
in the United States. We've struggled for two decades. We're finally
making some progress. We're very clearly going to go through a
transition 17 months from now. We'll either be going from this
administration to a new administration and the uncertainty will be, will
that new administration want to start over again, whether it's
Republican or Democrat \-- or will they want to continue on, or will
there be six or eight months, or twelve months, when we won't know and
everything will stop \-- or do we want to go through a transition where
we go from what we know today to something we can create that we'll
begin to perpetuate? Do we want to go through this transition once, or
do we want to go through it every four years? Do we want to have the
uncertainly that will undoubtedly exist if we keep this on its current
course, or do we want to bring into place a more permanent process that
can live in an atmosphere of continual innovation? Well, obviously my
belief is that we can make the transition once, and that we can create a
business model that will sustain itself, and that will allow these
standards to develop.

There's a couple of other things I want to just comment on before we
open it up for conversation. The first is the question of how much of
this has to be done by government, and how much of it can be done by the
AHIC Successor. I don't know the answer to that. I don't think anyone
knows the answer to that. And I think the answer to it is that some of
it will have to be done by government, and some of it will have to be
done outside government. But it will \-- those things will emerge as we
go.

For example, I don't see the issues related to privacy being determined
here. I see those having to be done in a larger public policy sense.
What we're developing is an entity to develop technical standards. And
those are things that are not done well in political processes. I have
some experience with that. The operation of government is a hard place
to develop technical standards. On the other hand, we couldn't go
outside of government and start doing things that are clearly in the
bailiwick of public policy that will have to be done within government.
But we don't have to determine which of those will be contained today.
What we have to create is a process to determine what we can accomplish
with it, design the organization to do it, and then move it forward.

Rob, I think we have 30 or 40 minutes now that \-- I hope I've
engendered enough controversy to stimulate conversation. I don't doubt
that I have. So, who would be willing to get us started with either the
right question or a suggestion? Yes, sir. Congratulations, and thank
you.

MALE SPEAKER: My pleasure. Does this work? It works, great. My name is
Jim \[unintelligible\] from a medical device manufacturer called Welch
Allyn. I think one of the concerns that we have at Welch Allyn, as a
private sector medical device manufacturer, is we all understand that
the medical industry has a problem, especially when it comes to the
payers, the providers, and the consumers themselves, and it's the cost
of healthcare. And we know we can help that cost by actually developing
the standards that allow interoperability to happen. Now, our concern
from a technology standpoint is the amount of dollars that we'll save
will be transferred to the 30-plus standards that have been identified,
and managing those over a lifetime. But one of the things that we
consider essential to that process is the ability to create, as you say,
a sustainable technology that does not require the maintenance that
traditionally standards have in the past. Otherwise, all we're doing is
passing dollars from one to the other.

So I guess my question would be, in endeavoring this to the Successor,
is there the opportunity to look at the technology and the standards and
the business of doing standards, and find any efficiencies that allow us
to do the job, but also to minimize the cost burden? Because the cost
burden in the end relies on, or falls on, the medical device
manufacturer, or the system provider, potentially.

SECRETARY LEAVITT: I hope so. I mean, let's acknowledge the fact that
that's essentially what we all want to accomplish. The question is, what
is the entity, and how do we create the entity that will create the
capacity to innovate fast enough, and will be sensitive to the entire
marketplace? I can just tell you this, that if we end up with a proposed
process that looks to be skewed to one segment of the industry or
another, we will have failed.

If the medical device people are represented in a way that they're
satisfied with, and the healthcare providers, doctors and hospitals, are
represented in that process in a way that they feel good about, if the
insurance industry feels like they're represented, if the payers feel
like they're interested, if Capitol Hill feels like that they have some
confidence that what we've created has some balance in it, we will have
achieved our goal. If any one group begins to feel as though others are
disproportionately represented, they will leave and this will fail.
That's the way all collaborations are.

That's the reason, frankly, that it's not right for the Secretary to
just line up and say, "I want you and you and you and you and you and
you to design this." That's the reason we have to bring everyone
together and say there's a lot of value in having the market begin to
organize itself, because the market then has set the rules on itself, as
opposed to government imposing those ideas and then being subject to
various parties saying the government favored one over the other. This
is really what we're talking about here, is collaboration. We're forming
a collaboration to be able to solve this problem.

MALE SPEAKER \[Jim D., Welch Allyn\]: Can I ask another question? My
next question is a regulatory concern, which is a government concern.
One of the issues, I think, that the Successor will face is the fact
that an open network of devices and interoperability presents a huge
challenge from a regulation standpoint. My hope is, and my question
would be, will there be proper representation in the Successor to ensure
that FDA and governance around medical devices and medical systems are
covered properly? Because currently, today, that is a very big gap in
the medical industry when it comes to walking in with a device, for
example, and plugging it into a system, and then all of a sudden it
works without having tested that. So it may fall in part of the
compliance testing, in part of the regulation, and is there enough focus
in the plan of the Successor to ensure that there's that governance?

SECRETARY LEAVITT: I'm going to invite others who are here who would
like to comment on it, if they have thoughts, but let me comment.

I think the heart of what you're raising is, will government and our
legitimate governmental functions be in some way connected to this
closely enough that they operate in sync? That's where I suggest the
government cannot just simply delegate this. We have to be at the table
as full participants committed to the fact that we're not only going to
use the standards, but we're going to enforce the standards. For
example, in the future, once these standards are established, well
developed, and accepted, and a process in place, government payment in
various ways needs to be linked to that. Otherwise, there's no reason to
call it a standard.

Now that's one of the ways that government needs to continue to play its
legitimate governmental function, and at the same time be a full
participant at the table in the development of the standards. So I see
government, be it the FDA or IHS, Medicare or Medicaid, the Department
of Defense, the Veterans Administration, Indian Health \-- whoever it
is, we need to be at the table as a major participant. And I underline
the word "major" because we're clearly going to be one of the biggest
payers, and we've clearly got one of the biggest interests, because we
pay a lot of the bills. But we ought to be there next to the people who
are involved in the medical \-- from the physicians, from the hospitals,
from the others, so that we're all at the table as participants.

Now, I'm going to go off and play my role as a regulator, but I want to
link my regulatory decisions to the standards that have been developed
by the industry. Now I could, as HHS Secretary, I suppose just go out
and set these standards. But I'd likely get them wrong, and I'd probably
not come up with the best solution.

When it comes down to it, there's only three ways you can set standards.
First, you can have the government set them, and we'll probably get them
wrong because we'll do them in a vacuum. Or second, you can use what I
call the "last vendor standing," which is just to wait and see who
eliminates who, but that doesn't work in this space because we've found
several different ways you can accomplish the same goal. Or third, you
can go through this kind of a process, and it's hard, and it's painful,
and it's slow, but nevertheless, when you get there you have something
everybody's agreed upon. Once that's occurred, the government then needs
to utilize its regulatory functions in a way that supports those
standards, as opposed to dictating those standards.

MALE SPEAKER: Thank you.

SECRETARY LEAVITT: Will someone else take charge of the microphone and
pass it around so that I'm \-- Adam, why don't you come down and \--
actually I think I'm fouling the system up. I think the system is if you
have a question you're either supposed to get in line or jump up and
I'll call the one at the microphone.

MR. SMITH: Thank you Mr. Secretary. My name is Todd Smith. I'm with the
American Healthcare Association, and we have been an industry, if you
will, long-term care, which has been growing in this area, and the
preliminary designs for the direction of the AHIC are making us feel
like we're going to be playing a larger role. At least, we hope that's
the case. I just want to make one point.

SECRETARY LEAVITT: Excuse me just one second. I'm going to make a
command decision here. I have a feeling that there will be several of
you standing in line longer than you want to. I'm going to ask Adam,
when this is done, to take the microphone and to pass it to your chair.
And that way, you can sit down and you won't have to stand there. That
be all right? All right. Excuse me. Go ahead.

MR. SMITH: That's fine. This morning you've talked about, in essence,
creating an HIT congress of sorts, to decide the governance structure
ahead. And as you look through some of the process elements that will
lead up to the point when AHIC 2.0 takes over, a lot of the process may
well be set in stone for a period of a year or two. In other words, you
bring new creative minds to the table, but they have before them an
agenda that was set in the previous era. I just wanted to make the
recommendation that as you move forward, particularly in areas of
developing use case and business models and the like, that flexibility
be utilized to ensure that all of these new creative minds can actually
move the process forward from the first day, as opposed to having to
wait a year or so before having any impact.

SECRETARY LEAVITT: Thank you. And let me just say I think you've raised
a couple of issues I'd like to comment on. One is AHIC 1.0, as I like to
refer to it, is operating and will for some time into the future, at
least until the end of this administration. We have a full agenda of
things that need to happen, and I am resolved to attend, as I have in
the past, every meeting, and to drive that forward as far and as fast as
we can get. At some point, again to mix metaphors here, there's got to
be a passing of the baton.

I don't want the new entity to have to remake all the work groups, to
have to remake all of the priority selections, to have to remake all the
progress that we've made. It ought to be an adoption. There ought to be
a merger here where the baton is passed, and maybe even a period of time
where there is sort of simultaneous operation. But the sooner we get
that created, the more smoothly that will happen. So I am hopeful that
the new entity doesn't lose any momentum, because it essentially just
takes over the priority setting. That's the second point I wanted to
make.

AHIC 2.0 should not become the place where all of the work is done. It's
the Workgroups where the work is done. AHIC 2.0 needs to become the
coordinator, the priority setter, the means by which people can impact
the process. But, if an industry, as you just pointed out, is able to
come up with their own standard, and it can be harmonized with what else
is happening, they ought to do that. I mean, we ought to get there as
fast as we can. Now on the other hand, if an industry segment goes out
and invents something that's quite inconsistent with everything else
that's going on, that's the world we're living in now. What we want is
that, if industry develops a standard, they ought to know the other
standards they need to harmonize with so that as they develop their own
standard it adds to the momentum, it doesn't detract from it.

Okay, Adam?

DR. KOLODNER: We do have the Webcast now going on, but I think that some
of the people who are out there need to know how to get their questions
asked, so I'm just going to give that information and step back out of
the way. If you are listening to this by Webcast, you can contact us and
ask questions either by calling a phone number \-- and that's
877-705-6008, or on the Webcast page itself, you can email questions
using the live event feedback form. So we do want to get some questions
from those of you, the hundred or so, who are out there on the Internet.
And we look forward to getting some if you'll use one of those two
means. Thank you.

MS. CORLETTE: Thank you, Mr. Secretary. My name is Sabrina Corlette. I'm
with the National Partnership for Women and Families, and I wanted to
pick up on your analogy to the Constitutional Convention, which I
thought was very apt.

SECRETARY LEAVITT: Those analogies are always dangerous, aren't they?

MS. CORLETTE: But I think history has shown that one big problem with
the Constitutional Convention was that there were huge swaths of the
public that were not represented at that convention. And as a result, we
had big upheavals, social upheavals \-- whether the Civil War, or the
Equal Rights Movement \-- and so one thing we really appreciate is your
emphasis on broad participation.

But one problem we've had \-- we represent women and families and
consumers, and one problem that consumers and other organizations that
perhaps do not have the resources of some of the bigger healthcare
stakeholders have had, is being able to stay engaged in the process.
These are highly technical issues, staffing questions, resource issues
\-- whether it's paying dues to a private entity or providing an initial
capital contribution \-- are huge problems for consumer groups, perhaps
local public health organizations, local governments. I'm just wondering
if you could address your vision for ensuring that such under-resourced
organizations can participate at a board level, and maintain meaningful
participation in the process. Thank you.

SECRETARY LEAVITT: Let me first acknowledge that that is a legitimate
need, and I believe a spec that ought to be part of the proposals that I
hope will emanate from this. Let me just use your question to create
another analogy, all right? Someone this is the way my mind works.

I had a fascinating experience when I was governor of Utah. This is just
going to take a minute, but I think it will \-- when I became governor,
one of the first things they did was take me out under the overpasses
and bridges in our state and say to me, no work's been done on this for
forty years and it's a mess. And I didn't have \-- I mean, I knew that
the traffic would back up every day from about three o'clock until seven
o'clock. And we had these two-lane highways that were 40 years old, and
something had to be done. But there were 18 miles of freeway that went
right through the middle of Salt Lake City, and they told me it would
take ten years and \$2 billion to fix it.

And I knew that if you took one overpass down, or if you had any
construction contract going in that corridor, that it shut the entire
corridor down. So we were facing ten years, \$2 billion, of having the
entire artery of the state \-- it's actually not just that, it's the
intersection of the interstate system \-- it would be shut down for ten
years. And I knew in my heart that if they said ten it would likely be
15 or 20, and I knew if they said two billion it would likely be four.
This was a big problem. Then, Utah got the Olympics, so now I'm facing
the idea of having all the freeways shut down and the Olympics and the
world coming. This is not a good scenario.

So we decide we've got to do something entirely different than we have
in the past. In the past, we had let contracts one at a time, and the
contractor would work, and we'd let another contractor \-- we might even
do two at the same time, just depending on how much you felt like you
could manage. And the state would assume all the responsibility for
laying out risk \-- laying out the specs, and we'd tell them exactly how
many yards had to be moved, and how wide it was to be, and what the
grade would be. So we concluded we had to do something different, and a
very smart engineer brought the idea forward that maybe we ought to use
a design-build process.

And here's the way the design-build process would work. We'd do it all
at one time, and we'd just say this is basically what we want this road
to look like, and we want you to not only build it, we want you to
design it according to some broad specifications we'll provide you. And
we know that you're going to do all 140 structures at the same time, and
all 18 miles at the same time, that it's going to be too big a project
for any one contractor. So, we want you to form into teams and come up
with the best plan to meet all of these, and we're going to put a \$50
million incentive out for those who do it \-- for the successful
contractor if they can meet our expectations. And one of our
expectations is you need to keep the public happy. And we're going to
measure how you do that.

Now I can assure you that if we had gone with the traditional method of
letting contracts over a period of time, the public would not have been
happy. But because we allowed innovation to occur \-- let me describe
that. We ultimately said we're going to choose four different \-- five
different teams. And we want all the subcontractors to begin joining in
a team to plan this. And we want you to use your imagination. And we
actually said, "We're to pay you to do it, so we can take your ideas and
use them."

Here's the point. They were ingenious in the way they developed plans to
do this, things we never would have thought of. And so, to your point,
you're right. And that needs to be part of what those of you who start
to think about this need to solve. But I don't think I'm the \-- in a
position to say the best way to do that is X, Y, and Z. I want the
groups that begin to form this up to do that.

Now, I will tell you the end of the story is we formed \-- we gave five
teams the chance to go out and work on this, and all the subcontractors
from all over the country joined into teams and began planning how
they'd build this road. We ultimately narrowed it down to one. We gave
them the contract, and four and a half years later, we finished the
road. The contractor earned all of their bonuses and the public was
remarkably happy, and we saved over \$100 million. Actually the cost was
\$1.7 billion.

That's the kind of energy I want to unleash on this problem. I would
like the people in this room to say somebody needs to organize this AHIC
2.0. I'm prepared \-- I think I could reach out to the medical
community, to the hospital community, to the vendors. I believe we could
begin to create that institution, and with your ideas, I'd then like to
see my role as being listening to your ideas and hopefully some of you
will get together and in a very short period of time, we'll end up with
a convener, not to become the organization, but to the organization that
can create the organization. Does that make sense?

Now that was a long \-- you didn't ask any of that, but I really enjoyed
saying it.

MS. FREIDMAN: Good morning, Mr. Secretary. I'm Maria Friedman, and I
represent RXHub, which is a major provider of content, connectivity, and
interoperability in the e-prescribing space. And my question to is about
the future of the HITSP, and how do you envision its relationship to the
AHIC Successor. Will it stay, will it go, will AHIC 2.0 kind of manage
the process and provide priorities and direction and that kind of thing?

SECRETARY LEAVITT: Well, first of all, I think CCHIT and HITSP have been
a great success. And it's a success because people are buying in and
doing the work and were actually doing the hard work of putting these
together. So absolutely they have to continue. What will their
relationship be? Well, I think that's one of the things that these
various groups need to contemplate. It seems very clear to me that they
need to be responsive to this new group, and it may be that they're the
same \-- they have the same relationship with AHIC 2.0 that they have
with AHIC 1.0.

But I don't believe that for me today to prescribe that would be
consistent with the strategy I'm laying out. I want groups that come
together to think that through. It's clear to me they have to have a
relationship. It's clear to me that they have to continue, but the
precision of what they should \-- how they should interact I think
should be part of what the convener develops.

MR. KENNEDY: Hello, Mr. Secretary. Charles Kennedy from Wellpoint. We've
been experimenting with a variety of e-prescribing and electronic health
record pilots, and what we've been seeing is that the value is in the
sharing of data across institutional boundaries. That's where we're
really seeing I guess the value play out. The question I had for you is
of all the areas in the health information technology development that
we've been going through, probably the weakest area has been the RHIO.
And my question is how do you see AHIC 2.0 influencing RHIO development,
because on the one hand, you know, picking up on your rocket analogy,
the booster \-- it's the timing of the booster departure, and I wonder
if we're too close to earth for that booster to be reduced.

SECRETARY LEAVITT: A technical point, those of you ask a question from
now on, stand up, because we want you on TV.

Let me again remind us all that what we're establishing here is a
standard setting or establishing organization, and it's very clear to me
that there does need to be a link off into whatever the RHIOs. But the
RHIOs basically will begin to flourish, in my judgment, when two things
occur. One is we have adequate standards, which is the basic function of
AHIC 2.0, and second of all, when we have a sustainable business model,
which I don't think will occur until payment is linked to use. And
production of data. So it's a chicken or egg proposition. We've got to
have payment linked to use of standardized, accredited systems, and we
also then have to have standards so that that can happen.

MS. KLOSS: Mr. Secretary, thank you so much for this opportunity and for
the leadership shown in the White Paper. I'm Linda Kloss from the
American Health Information Management Association, and I have a
question about scope of the entity. It is very much focused on technical
standards, and coordination of technical standards and acceleration of
technical standards, but in an earlier letter to you from a project, the
State Level Health Information Exchange Entity, they were calling for
coordination between 2.0 and the quality initiatives going on, and I
would appreciate your thoughts or comments on how this scope was set
forth and what you envision as the relationship for AHIC 2.0 and the
quality transformation initiatives.

SECRETARY LEAVITT: In order to create the vision that I have in my mind,
and I think many others share, of competition based on value, there
needs to be four things, and I've articulated them as the four
cornerstones, and most of you have heard me do that before. But the
first part of that is health information technology, because without
health information technology standards, we can't collect the data
that's necessary for the quality measurement.

Today, quality measurement is a nurse who comes in on a Saturday
afternoon and takes a big stack of medical records that are paper, and
sorts through them, develops some information, sends it on to somebody
else who puts it into a computer and then eight or nine months later, it
gets into an actionable form that someone can look at. That doesn't
work; it's got \-- so these are in my mind completely dependent on each
other. If we're going to \-- or at least, I think quality \-- the actual
implementation of the quality vision is completely dependent on our
ability to create health IT standards.

Now, you have a group of people who are working to develop what those
standards should be, and we have a group of people who are ultimately
developing the standards and priorities, that's the AHIC, and those
clearly have to have some relationship. We also have the same thing
happening in every state, as you point out. We have a group working in
each state on standards, sometimes it's the RHIO, sometimes it's a
quality management organization.

Very clearly those need to be linked. The key to linking them continues,
in my mind, to be standards. We have to develop the standards. Now at
some point in the future it's clear that those who are developing the
technology standards need to begin to coordinate their priorities, but I
don't personally believe they have to be the same organization. I think
they have to be codependent on each other, and committed to follow one
another's standards. The health IT folks clearly need to be looking at
what the standards folks are doing so that they're gathering the right
data in the right way. At the same time, as the quality people develop,
then the priority setting of the health IT standards need to be paying
close attention to that.

Maybe at some point in the future, there is a logical reordering of the
way that works. That seems more complicated than we need to be today,
but I will say this, somehow we've got to connect up what's going on
with the states with the national. The states need to be working in a
way that will drive the success of the national standards and not
developing their own.

Last question, I'm told. How about we do two. All right.

MR. GENDLEMAN: Thank you for the opportunity. My name is Brent
Gendleman, and outside of the role that I play as the leader of 5AM
Solutions, which is a small software company dedicated to building
software for life, I've also played the role of father, and insured, and
patient, and I'd like to address your initial question, which is who's
going to be the George Washington of this entity.

And you've limited the role of government to one of regulation that
carries a big stick, as a payer of bills. The government also represents
the people, and in this kind of entity, is the most likely the strongest
one to hold the weight that would allow the technology standards to be
arbitered against some business requirements, which are fundamental to
individuals. And that is increase the quality of care, and increase the
\-- decrease the cost. And each of the major players in the healthcare
industry don't share that interest independently in their business. The
insurance company is likely to desire to wait as long as possible to
pay, and the hospital is most interested to get that money as quickly as
possible.

In looking at who can be the George Washington, any individual group is
unlikely to be able to lead across those very conflicted interests, so I
can't imagine a better party in some fashion, no pun intended with the
government, than the government. Because as the lady said earlier, small
patient advocates are not going to have the right kind of seat at the
table, so it's both the George Washington and a desire from a software
company that says technology standards independent of business
priorities and really government, the people's priorities, I think will
fall similar to \-- and I hope I don't make any enemies with this
statement \-- HL7 or CDISC, which have, I think, fallen flat, and why
we're needing to have this organization now.

SECRETARY LEAVITT: Very well teed up question. Let me respond. We meet
today at the Department of Health and Human Services, standing before
you as the Secretary of the Department of Health and Human Services. The
government has to be involved in this and will. The question is what is
the government's role. Is the government a better organizer, or should
it own the system?

I would argue that there are certain aspects of this the government has
to own. The government has to own the whole question of what are the
norms of our society with respect to privacy. That is a process through
which \-- that is well adapted, in fact can only be decided in the way
that we have subscribed ourselves as individual citizens and
institutions.

Only the government is in a position to be regulating this behavior, et
cetera, et cetera. There are many functions the government has that only
the government can play. Only the government, for example, can say, if
you're going to do business with Medicare or Medicaid, you need to be
ultimately using systems that are consistent with the rest of the world.
So government has an important role, both as an organizer and in its
other functions, and it needs to continue, and as far as I'm \-- as long
as I'm Secretary, it will continue. And I think that's a very important
message.

However, would you really like Congress deciding between HL7 and some
other standard? I mean would you like them developing the standard? I
don't \-- I think that's the point here. This is an organization \--
well, I'm not sure George would want to do it either. But there are
smart people who can come up with a better technical solution and that's
\-- that's what I'm \-- I'm arguing let's create an entity that can
operate with participants as opposed to politics.

I'm not naïve enough to believe there won't be some version of politics
that will exist in this entity. But it'll be a different kind of
politics than the partisan politics, whether it's either party. And the
successful organization will be designed in a way as to accommodate
that, and to organize it. We haven't succeeded at this for two decades,
because of conflicting interests and because of the \-- and because of
turf. And AHIC, in the last 23 months, to a significant degree, has
succeeded in being able to organize that so as to manage around those
conflicts and to create an avenue of certainty, and we need to
perpetuate that.

Last question, go ahead.

I'll be short and have both of you.

DR. PERLIN: Good morning, Mr. Secretary, I'm Jon Perlin, I'm the chief
medical officer of HCIA, the nation's largest private healthcare system.
Let me first thank you very, very much for the leadership, not only in
today's endeavor, but throughout AHIC. I think the progress that we've
all seen is truly extraordinary. We've gone from a world which didn't
have standards \[unintelligible\] and certified health systems to things
that, for example, my organization can buy with confidence because they
meet certain criteria and are proven, demonstrated to be interoperable.

As like my colleague, I'm also a parent, a child, and we as an
organization have a role as employer. As well, that our role in public
sector. And one can envision this Constitutional Convention occurring,
where individuals have many self-interests. And I appreciate our
leadership and the candor with which you address that specifically. But
I think also all of us realize that there is a point where our
collective interest is really our self-interest. Whether we look at the
health of our society with the epidemic of childhood obesity and
diabetes, an aging population, cost of healthcare, preventable
challenges that we face every day. A child who watched a parent's
procedure almost go awry for having to fill out a clipboard that didn't
exactly have the right information.

I know you shared the vision to move to a world where that clipboard is
really relegated to the dustbin of history, and on behalf of my
organization and colleagues, really look forward, whether it's our
organization or our colleagues, look forward to the dialogue that will
occur at that constitutional congress, because I think our self
interest, in fairness, is the collective interest that moves forward the
public health and the ability to provide safer, effective, more
efficient, and more compassionate healthcare. So count us in, whether
individually or whether on behalf of colleagues who represent us. We
think this constitutional congress is both the collective interests and
in fairness, serves the ability to advance healthcare.

SECRETARY LEAVITT: Thank you.

MR. LIEBER: Good morning, Mr. Secretary. Steve Lieber, HIMSS. Earlier
you said you are feeling very positive about the accomplishments, so far
over the past 23 months and we along with probably all the people in the
room share those very positive feelings about the accomplishments. Now
I'm not saying that to suck up, because there's a but that follows this.

SECRETARY LEAVITT: Somehow I sensed that.

MR. LEIBER: We all recognize that with any process there's room for
improvement. And one of the things that we recognize at the, kind of the
backend of this process is a lack of connection between policy setting,
standard setting, certification, and then the driver to make sure that
implementation happens. That there's a continuum here, and right now we
have something of a disjointed process. And I know that you're not
trying to lay out tea leaves here that we can really read all that well,
but can you give any kind of reaction to that view that I have about the
relationship between these various activities in the successor
organization?

SECRETARY LEAVITT: The more imperfections we can cure and heal, in going
from 1.0 to 2.0, the better. I don't hold 1.0 out as anything other than
a start. But it has created at least a few steps forward. The beauty of
what I believe can come out of this is that we're saying to all of you,
help us design the future. Build on what we have, but help us design the
future.

I'd like to just \-- I know I've got to close, and I only use this just
as a \-- the world \-- this is bigger than just healthcare, though we're
focused on healthcare. This is really about how nations learn to prosper
in the 21^st^ century. What we're talking about here and what is well
exemplified here is the new frontier of human productivity. The world is
beginning to intuitively organize itself into networks. Networks require
standards. Standards are best developed when people collaboratively work
together to design and divine the path. The society that learns to do
this efficiently will be the prosperous society of the future. I mean
think about it. It's happening everywhere. Nations are beginning to
operate in networks. We're fighting a networked enemy. We've had to
learn how to deal with that, and it isn't with a mainframe army. We have
to learn how to collaboratively solve problems related to the network,
and collaboration is essentially the sociology of a network. So what
we're engaged here is in building a new skill set in society on how we
can create these kinds of collaborative problem solving organizations
because it's the way networks form.

Collaborations like this don't always succeed. But when they do, they
are powerful beachheads around which progress beings to leap forward.
The tasks that we have laid out and ask all of you to consider is not a
simple task. There is no apparent solution. If there had been, it would
have been solved a long time ago. But we have had is two decades of
people talking about it and very little progress until the last 23
months when we have begun to see at least the beginning of progress.

What I'm laying out to you today is a challenge to come together and to
think through how we create the next frontier of human productivity in
healthcare. With the thought in mind that this is not just about
healthcare; it's about a new skill set of how the world begins to
operate. And I believe that we will accomplish this, and I think we will
see over the course, ten years from now, looking back, that this
exercise, while not perfect, did begin to move us forward toward that
new frontier. Do we have all the answers? No. But we think collectively
we can find sufficient numbers of them that we can move this forward and
that this process will be looked to as a very important day in
healthcare's history. Thank you.

\[applause\]

DR. KOLODNER: We'll take a break right now and we'll resume at 11:30
east coast time.

\[break\]

DR. KOLODNER: Joining us on the Webcast, we'll, at the end of this, when
we get into the next Q&A, we'll also have the directions posted on the
slides about how to make sure that you get through both on phone and by
your questions.

Now that we've had an opportunity to discuss the AHIC Successor with
Secretary Leavitt, I want to explain the grant process to you in more
detail, and then answer further questions that you might have about the
AHIC Successor or the grant process. We'll talk a little bit about the
AHIC successor itself. More of that will be a discussion of the
attributes and the models of that also on September 5^th^.

As I mentioned briefly, earlier this morning, we've begun the grant
process by publishing the notice of available funding on the grants.gov
Website. The grant is for a 24-month period, and we start by funding the
first 12 months. The first 12 months are divided into two stages, with
the first stage lasting approximately four months, and focused on the
work of designing and establishing the new legal entity to be the AHIC
Successor or AHIC 2.0. And that's the Constitutional Convention,
Constitutional work that we were talking about previously.

The second stage of the grant will be focused on operating the new legal
entity and the grant will actually go to that legal entity itself rather
than that convening collaborative. HHS plans to play a substantive role
for the entire 24-month period, first as a collaborator with the grantee
in the design, and then as a very active participant and member of the
new legal entity as you heard from Secretary Leavitt.

Let me step you through the facts of the grant. The type of grant we
will be awarding is a cooperative agreement, which allows for the
substantial government participation. I mentioned it's a two-year grant.
We'll grant up to \$5 million for the first 12-month budget period, with
a potential for an additional \$8 million for the rest of the grant
period. There's no restriction on eligibility to apply. We're truly
seeking, again, as you've heard, a multi-stakeholder collaborative or
collaboratives to step forward, and that would ideally coalesce into a
single collaborative, although we know that a few may actually form and
apply. But as you've heard, what we want is to encourage the
collaboratives to form together and be representative of the whole.

We want it to be made up of individuals and organizations that can look
beyond any specific special interests, again, as you heard. And while
having that perspective that they can design and establish the
successor. The ideal collaborative is one that includes those
individuals, those George Washingtons, and Alexander Hamiltons, and
James Madisons, who are above reproach, and who are held in the highest
esteem, and who are trusted by all sectors of the healthcare community,
even though they may come from a specific sector and may have particular
points of view which are not always in line with one another, but at
least they're able to work together and keep the dialogue going.

The purpose of the grant in Stage 1 is that design establishment of the
organization, and then Stage 2 is the operation of the legal entity. To
find the grant's notice on grants.com, you can use the funding number
that's on the screen or you can find it by using a keyword search, and
keyword on the word "AHIC."

I want to provide you with more information about that first budget
period and why we're approaching it in stages. Stage 1 is needed because
we believe that at present there is no existing legal entity that
embodies the vision and all of the key attributes of the AHIC successor.
Stage 1 is intended to stimulate that formation of the multi-stakeholder
collaboratives of individuals and of organizations, to come together in
order to design and form a new entity that embodies the full set of
attributes.

Now we do recognize that there are different organizations out there
that have some of those attributes, and these are the attributes that
were laid out in the White Paper that I mentioned earlier that's
published. And so we encourage those organizations that already embody
some of those attributes to step forward, to be a part of the
collaborative that forms, and to bring their experience with those
attributes to support the design of the AHIC successor.

Stage 2 occurs in the spring, or starts in the spring in 2008, after the
legal entity is incorporated, and the bylaws are established, and the
initial set of members have joined from multiple health sectors,
including the government, and there is a functioning board of directors.

Now what exactly do we mean by design and establish, and you see up in
front of you, what, for some of you in the back of the room, and maybe
on the Web, is an eye chart. But those in the room have the slide and
those on the Web will be able to download it. As you might imagine, it's
a long list of actions, but ones that we are confident can be
accomplished in a relatively short timeframe by the right mix of
collaborators.

There is a need to develop the membership rules, the operational
structure, and the roles and responsibilities of officers and members.
The governing documents such as bylaws and initial policies and
procedures need to be established, and a certificate of incorporation
must be filed. These will cover such details as how to encompass a
balanced board, the rules around voting, quorum, super majorities,
double majorities, and those will require considerable time and effort,
and expertise during this Stage 1. In fact, that's where we think most
of the work will occur.

And they're important because it's that governance that in fact creates
the balance and creates the environment where the trust can build, that
this organization is one that equitably and fairly represents, and
respects all of the members and all of the sectors.

The collaborative also needs to identify what, if any, additional
resources and capital are needed to recruit membership and at the same
time, identify and recruit candidates for key management positions.
Toward the end of Stage 1, there needs to be a common and clear
understanding of how the entity plans to pursue the focus of
interoperability through its initial activities, communication plan, and
have plans for transitioning the appropriate responsibilities from the
current AHIC to itself.

By the spring of 2008, we will be entering into the second stage and
operating the new legal entity. As mentioned, the focus of this new
entity is on achieving interoperability and really achieving reliable,
secure, trusted interoperability of health information nationwide. Now,
you\'ve heard us use some different terms, talk about technical
standards. The technical standards are all in support of achieving the
interoperability, and in the documents that we have, in the documents
that were discussed at the AHIC, we talk about this, and explored this.

Secretary Leavitt, when he talks about technical standards, talks about
them in a broad sense, not a narrow sense. And that\'s why you need to
look at what\'s in the document and what\'s described, because that
really is what we mean when we\'re talking about technical standards.
It\'s all the things that are necessary to achieve this nationwide
interoperability.

The initial operating period between spring of 2008 and late fall of
2008, will be a critical time for establishing that this new entity can,
in fact, provide direction and is fully supported by the government. The
exact activities during that part of the grant period will be better to
find, once the design activities are under way.

With a cooperative agreement, there are responsibilities that are
outlined for the grantee or collaborative, for HHS, as well as there are
shared responsibilities. The collaborators collectively play a convening
and managing role, and again, you heard us describing that \-- are you
looking for a George Washington who is trusted as a single individual or
entity that can bring it together, or is it a collaboration that among
them is able to identify who should step forward and who engenders that
trust, who might be the one that we actually provide the money to.
Because we have to have an entity that we provide the money to, but
whether it comes because a visionary kind of convener draws in their
colleagues, or whether it\'s because in a self-organizing fashion, those
of you who are interested call your other colleagues who are your
esteemed, trusted people from other sectors, and organize that, and then
say well, who is ready to step up and accept the money? It could follow
any number of paths, and we\'re not trying to prescribe that.

So the collaboratives do play this convening and managing role that
require, at a minimum, strong facilitation of the planning board. So
you\'re going to have to have an individual who can do that. It needs to
have good executive oversight of the design process to make sure that it
actually moves forward, because we\'re trying to do this in a very short
period of time.

What we\'re hoping is a lot of the concepts that are there, a lot of the
materials that we\'ll be discussing on September 5^th^ can be used as a
starting point, so you don\'t have to create everything from scratch,
because that would be impossible to do in a four month period, but that
you can look at those. If you have a better idea, you can replace that
component or that solution with another, and bring together the best and
most creative ideas possible.

So in addition to that oversight of the design process, we have to have
management of the staff, the deliverables, and thought leadership of a
stature that will bring people together and encourage them to coalesce
around this common cause. There is also a need for domain expertise, and
a deep understanding of a national health IT agenda, of HITSP, as again
was discussed in the Q & A period, and CCHIT, and what those
relationships might be, which probably will not be defined ahead of
time, but may be under discussion between the entity, legal entity
that\'s formed, and those organizations, themselves, to determine what
sort of relationship they might have. We would be looking at the moneys
that we are using to contract with HITSP and CCHIT, and possibly working
with the legal entity to give them the oversight of that in conjunction
with us in whatever fashion it is legally doable.

They also need to understand those competing interests, and again, we
had a number of questions that were about that, and a deep understanding
of organizational design related to public-private partnerships. And
finally, there is need for really sharp business acumen, and strategic
planning and execution.

On this slide, you see the responsibilities that are listed here for HHS
are specifically for my office, which span the entire two-year duration
of the grant period. My office will provide consultation and assistance
to the grantee and evaluate the design activities, and will be a part of
that design process. We will be making sure that the grantee has all the
information required regarding the work done through the Office of the
National Coordinator, and will act as a focal point for collaboration
with other government agencies and departments.

We\'ll also be reviewing activities to ensure that the objectives and
award conditions are being met and coordinating with AHIC, and to the
extent relevant, to support good use of everyone\'s time.

I mentioned they\'re joint responsibilities, and so jointly, the
collaborative or grantee and HHS will identify a planning board for this
Stage 1. And if the collaborative consists of a large number of
collaborators which, as you\'ve heard, is what we\'d like to see occur,
then the board would consist of a subset of that group of collaborators.
And we\'d expect that those on the board would be the most esteemed and
trusted leaders in the collaborative who can commit the time needed to
provide the guidance and make the key design decisions regarding the
AHIC Successor that\'s being established.

Now, who is likely to receive the grant? And you heard actually at the
AHIC meeting in \-- on July 31^st^, the Secretary put it out there that
if we don\'t get an acceptable grant, we won\'t be making the award. So
we\'re not over a barrel, if we have to go a different path, we will.
But we really believe that the expertise and the interest is out there,
and the good will to come together, and apply with a balanced group of
organizations and individuals. So in an ideal world, we might get only
one application for the grant where all the stakeholders self organized
and developed a single approach.

More realistically, we understand that there may be different groupings
of organizations that will come together to collaboratively prepare a
grant proposal, and in order to select from among multiple applicants,
if we need to do that, we will evaluate the proposal based on several
criteria.

For example, the applicant will need to demonstrate an understanding of
the national health IT agenda, as it has unfolded over the past few
years, and again, we've talked in the Q & A session about we\'ve made
progress. It\'s not as fast as any of us would like it to be, but at
least now we\'re making progress and we\'ve got momentum, and we need to
continue and speed that up.

The applicant should also describe an approach for designing the
governance that\'s fair and balanced, and allows for cooperation of ONC,
and are experts in the design process. And again, in answer to one of
the questions as to how it would honor and respect and include the
interests of the vulnerable, or those who have less capital and yet
represent important stakeholders in this process.

And the process that\'s put forth should also support and encourage
participation from many different industry sectors. The applicants
should also demonstrate that in addition to the grant money, they will
be able to secure additional funds if needed, and that they have the
staff resources needed to convene and disseminate information.

The proposed staff to work on the design will also be reviewed to
identify the best fit for this unique and unprecedented responsibility.
The proposed thought leaders for this effort will be a key discriminator
among different proposals for the grant, should we receive multiple
ones.

And lastly, we will most likely select the applicant that demonstrates a
willingness to combine forces after the award with others, with other
applicants, so that we might, in fact, say you\'ve got the award, but
you need to include these others and be working with them to get that
full balance, if it\'s not there, in order to get the work of designing
and establishing completed in a timely manner.

Our process and timeline for awarding the grant is simple. The notice of
available funds is posted, you can download the forms that must be
completed, and prepare a narrative describing how you would accomplish
the work. We will conduct another public meeting, as you\'ve heard me
mention, on September 5^th^, to provide more detail about what we
envisioned. And that\'s also some of the things that we\'ve learned from
Visa and others, and the kind of ways of \-- some ways of achieving
those attributes, and discuss some of the more complex issues
surrounding the work of setting up the AHIC Successor.

If you intend to apply, we would like to hear from you by September
15^th^, with a letter of intent, and that will allow my office to be
prepared to review your submissions, and for us to be able to gauge the
interest that is out there moving forward. Your proposals for the grants
are due to us by October 5^th^, and we expect to award the grant on or
before mid November.

At this point, we\'re going to transition to the second Q & A period.
You see on the screen, for those who are on the web, the number to call,
and actually after you call that 877 number, you need to press star 1 to
get into the queue. Or you can also email questions in on the website
where you are getting the Videocast, using the event feedback form.

So at this point, let me start in the room, and we\'ll see whether
questions come in from the web. First up.

MR. EISENSTEIN: Hi, I\'m Howard Eisenstein, Federation of American
Hospitals. I\'m sure you\'re going to be informing the AHIC members,
throughout this entire process what\'s going on, but what role will they
play, if any, in the selection process? Or once that\'s awarded in
providing advice, guidance, or vetoing, whatever it might be, as it goes
forward through 2008?

DR. KOLODNER: Great question, Howard. In terms of the selection of the
\-- of the grantee, because of the way that process goes and the fact
that it\'s a government granting process, the AHIC 1.0 won\'t be
directly involved in that part of the process. On the other hand, as
that group starts putting together its proposals of the design for that
organization, one of the things that we mentioned at the July 31^st^
meeting was we expect to have those designs and some of those key
concepts brought forward for the current AHIC to consider. And what that
may mean, and we\'re looking at that right now, is we may actually
frontload some of our AHIC meetings in that first few months of calendar
year 2008 so that we can iterate and have enough time to see that a few
times before we reach the point where that entity is actually
incorporated, and we are at a point where we would be making the Stage 2
decision.

Other questions here in the room? There is one question that came over
from the people watching on the web. Let me read it to you. This is from
John Madden from Duke University. \"Technology standards are extremely
dynamic. Many excellent IT standards exhibit a relevant marketplace
lifetime of only under five years before becoming obsolete due to the
pace of technological innovation, and it\'s critical that standards
govern and operates so as to assist rather than impede technology
process \-- progress, excuse me. Yet top down standard setting tends to
trail behind the marketplace. How can we ensure that the AHIC 2.0 has a
sufficiently nimble process that on balance it helps rather than impedes
the adoption of best technologies?\"

Reasonable question. I think it echoes one from the first session, first
Q & A session as well, and I think the answer is that we believe that
the AHIC 2.0 can, in fact, act much more nimbly than the current AHIC.

As with the current AHIC, which isn\'t setting standards, it\'s
recognizing standards, it\'s working with HITSP, which, again, is not
\-- HITSP is not a standards setting, it\'s a standards harmonization
process. We expect those standards to continue to evolve and be updated,
and what we\'re wanting to do is to learn from these first processes, in
terms of how to continue to improve and move forward, and, in fact, as I
mentioned at the last AHIC meeting, we actually have a contract with the
Institute of Medicine to evaluate our first cycle of standards from the
identification of priorities through to the recognition, to see how we
might improve that and what we can learn.

And I expect that because we see the AHIC 2.0 as being a learning
organization, and one where being balanced, and knowing that we want the
progress to be made, it will be able to find and react as well to the
improvements that are proposed, either by members or by the SDOs
themselves, or by HITSP. And that we see this actually as one that\'s
going to be very important for us to succeed at.

Other questions in the room? There was a question also from earlier that
I wanted to address.

Any other questions that are coming in? Okay. If you have more
questions, if you can get to the microphone, we\'ll use the queuing up
method right now. Please.

MR. SCHOENBAUM: Steve Schoenbaum from the Commonwealth Fund. Just a
question. I\'m somewhat confused about the role of the grantee versus
what happens prior to the grantee, and at times, I thought I had heard
that there might be a process prior to the awarding of the grant, and
then I\'m not \-- but at other times, I\'m not clear that either your
Stage 1 or clearly not Stage 2 occur until the grant is awarded.

DR. KOLODNER: So, the \-- I\'ll answer a little bit \-- I also have some
members of my staff here who have the in-depth knowledge of some things,
so I\'ll give you an answer, and then they\'ll elaborate and course
correct me if I\'m off target.

The grantee is the person who wins the award with that November
timeframe for actually providing the funds. And they are drawn from the
applicants, which we\'ve also talked about as being collaborative. What
we\'re doing between now and then is providing information interacting,
but it\'s the collaborative that comes together and one member of that
collaborative who actually is the applicant to receive the funds.

We would, then, be evaluating those applications, making an award, and
working \-- as we make that award, if there are some changes that we
want before making the award, we\'ll interact with that awardee, and
then we\'ll be continuing to work with them in the government role as
part of that planning process moving forward. Mark, anything more about
that?

MARC WEISMAN: I\'ll just add that at the technical assistance conference
planned in September, I think in depth will address more that nuance of
transferring the grant from the convener to the new legal entity.

DR. KOLODNER: Which is a Stage 1 to Stage 2 change. Yes.

MR. CHEN: Stanley Chen from Altarum. These are more administration
questions. You may not have the answers to them today; they may wait
until September. The first is whether or not the three contractors, who
had helped build the White Paper on the AHIC transition, the AHIC
successor group, would they be eligible to bid on this grant? I don\'t
know if there is a restriction on that \--

DR. KOLODNER: There is no restriction. It\'s open to any.

MR. CHEN: Terrific. And the second question is just a timing issue.
There is a question and answer, or public response period associated
with that Paper, and I\'m wondering how you plan on incorporating what
responses you get into the definition, then, for what the successor
organization will do.

DR. KOLODNER: Great question, and one where we\'re looking at how to
both use the White Paper to inform individuals as to what we had in
mind, but also recognize, as you heard from the Secretary, that we
don\'t think we'd have all the answers. And so if there are improvements
on that, we wanted to hear what they might be. So the responses to that
\-- to that white paper and the attributes that are there, actually will
be gathered together to be provided to the awardee, for them to then use
as they do their design process. Other questions? Anything from the
Internet? Okay, Marc, you have one.

MARC WEISMAN: Well, there is a question from Mark Leavitt at CCHIT.
We\'re wrestling a little bit with the question, but I\'ll read it.
"What are the guidelines governing possible relationships or
partnerships between CCHIT and the applicants for this grant during the
application process?"

And the intention is that, you know, the applicants self form. We like
to see the merger of ideas and proposals come forward from organizations
that sort of work with one another. So in reading this question, where I
give pause is that it uses the word relationship, and that\'s what this
event is trying to foster, the beginning of those relationships. So I
would encourage the reaching out to organizations like CCHIT and see
what their intentions are. But this is, I think, a question that we\'ll
take under advisement and have more detail on in September.

DR. KOLODNER: One of the things is that the relationship that ONC has to
CCHIT is that we fund the development of the certification criteria, but
the certification itself is funded by the entities, themselves, so we
expect \-- and Steve Lieber\'s question earlier had to do with what\'s
that tie between the standards and the certification and the option
driving that out. That needs to be a tight link, and the degree to which
the identification of the standards, and the inclusion in certification
criteria, and the requirements when connecting into a network are the
reason that you see all three of those aspects as part of the scope of
this entity, when we mean interoperability.

We actually believe that that can be tighter in a \-- in this
public-private entity, than we\'re able to do, necessarily, within the
government. And so what we expect is that the legal entity will be \--
will be stood up, and it will be working with CCHIT regarding the
certification criteria, and how those are aligned. And what that
ultimate relationship is, and we \-- you know, brainstormed a variety of
those relationships.

I think we \-- what we\'ve said is we don\'t know what the right answer
is. That\'s for CCHIT and the AHIC 2.0 to decide, just like with HITSP,
and AHIC 2.0, that those discussions need to occur, and find those right
relationships. It\'s also very possible, depending on the membership
structure, that CCHIT and HITSP will become members of it, so that there
is relationships that are fairly complex types of relationships that
will develop, that we expect in a well functioning system, or as the
Secretary talked about, this network of collaboration that needs to
form.

And that brought Steve to the microphone.

MR. LIEBER: Actually a different subject. You've mentioned several times
the \-- Steve Lieber from HIMSS. The issue of sustainability. As far as
you said so far, that this is a two-year grant, would you like to
speculate on any government funding role beyond two years?

DR. KOLODNER: The first answer, of course, is I don\'t know. Still to be
determined. But part of this is that we don\'t see this organization as
being sustained for very long by handouts from the government. Now, we
said that the government\'s going to be at the table, and part of what
will need to be decided, and you saw some of the key decisions about how
is it going to sustain funding for the entity \-- that\'s part of the
plan that will need to be done during the design period. It may be a
membership start, and that membership also has to be balanced and we
mentioned this in the funding availability.

That membership has to be structured so that it doesn\'t keep
organizations or individuals from being at the table, if they can\'t
afford it. And that addresses something earlier. But it may be that \--
and again, this is speculation of many things that could occur. It could
be that the NHIN, the Nationwide Health Information Network, needs a
governance entity, and that this could serve as the governance entity.

And if, for example, the business model is that there is a small service
fee for using the network, then that may be how the organization
ultimately sustains its costs. And this is where we look, for example,
to Visa as an exemplar of how things could work. Visa, which is made up
of member banks, and it\'s that same structure that if you meet the
criteria, you can\'t be kept out. So if you\'re in \-- and we expect
that to be the same thing for AHIC 2.0. And if you\'re in, you can\'t be
kept in, if you want out. So you\'re not forced in there. It\'s a
voluntary joining.

Visa, which has a much simpler number of data elements, I\'m told that
in the financial arena, there is about 128 standard data fields. They
move data around the world. By the way, they\'re the largest financial
institution in the world now. They move data around the world, translate
languages, translate currency, for less than a penny a transaction.

So maybe in healthcare it\'s five cents or 10 cents or 15 cents for the
more complex things, but it\'s still a whole lot less than what it takes
to fill out the paper, or key things across, or have the incompatible
standards and the data moved, and having to be normalized now.

So we expect that there are ways that the NHIN might be able to provide
income, if that\'s the direction that the organization goes. But again,
I\'ve not given you the answer. I\'ve just said here is one example. And
we expect that the first start is the grant money. The next may be
membership fees, may be loans, may be other kinds of \-- may be other
funds and organizations that donate moneys to them that are recruited.
So there can be a number of ways that it goes, but it does ultimately
need to be self-sustaining.

MR. GORDON: Stuart Gordon, NACDS. The world continues to move while
you\'re in transition, and there is an issue out there that at moment
\-- at the moment is in infancy, but I can perceive gaining real force
during this transitional period. Ohio has started taxing pharmacy
electronic transactions, and as legislators go to NCSL conferences or
CSG conferences, and they discover that there is this great idea in
another state, ideas like that tend to mushroom.

Which entity will be addressing those kinds of issues during the
transitional period? Will 1.0 continue to address those issues, and
attempt to formulate whatever legislative or negotiating type tactics
have to be undertaken, or will the 2.0 be expected to ramp up quickly
enough to address those issues?

DR. KOLODNER: I would expect that 1.0, because of the urgency of that,
that 1.0 may be the one that addresses that or looks at that, if that is
within the purview of what either AHIC 1 or AHIC 2 decide they want to
take on.

I think one of the things to be aware of is that when we say government
participation, we\'re also taking about state governments. So we expect
state governments to be members and join this AHIC 2.0 as well. And the
issue of charging for the e-prescribing, right now, there isn\'t an
NHIN. So the way that e-prescribing is done is either done on a private
network or on a point to point, and as the networks and the NHIN start
to form \-- and by the way, just for those who aren\'t aware, the NHIN
is not a single national top down type of solution. We actually work
with the local health information exchanges, and probably next month
we\'ll be announcing the awards for the next round of NHIN funding,
which goes to various health information exchanges that are maybe
regionally based or locally based or whatever. Some are state based.

And so those types of things, I think, will ultimately come together
rather than something being forced by either AHIC 1.0 or AHIC 2.0. But
my anticipation is that AHIC 2.0, from the first part in the spring, to
the mid summer, will be concentrating on coming up into speed and
beginning to take over a few, or transition a few of the
responsibilities, and we don\'t expect AHIC 1.0 to completely sundown
until the fall of 2008, at which point we expect 2.0 to take over all
those nongovernmental, as you heard, nongovernmental roles of AHIC 1.0,
and complete the transition.

MS. KLOSS: Linda Kloss, AHIMA. You said earlier that the White Paper was
really put forth as a prototype or \-- I can\'t exactly remember the
word you used. But there is quite a lot of specificity about the
governance model, and even down to details about, you know, staffing for
the entity. To what extent is the collaborative really being called upon
to do another round of creative thinking about the design model?

DR. KOLODNER: Excellent question, Linda, and one that we\'ve wrestled
with, because we\'ve gone from having a model that had great specificity
to rather than putting out a model and saying this is the answer,
although we think it has a lot of strong, and strengths within it, but
we\'ve recognized that we don\'t necessarily have all the answers.

So what we did is we actually took that model, or aspects of that model,
and extracted attributes. And what you see in the White Paper are the
attributes, with a few small diagrams that are used for illustrative
purposes. We\'ll be going over that more on September 5^th^. But if a
collaborative comes up and says we have a better way of doing it, and
you heard Secretary Leavitt\'s anecdotes about the incredible innovation
and creativity that we believe can be out there.

The key is to achieve the goal. The goal is how do you create an entity
that has all of this at the table? That is balanced and fair in its
governance, so that the trust can build, and so the groups that normally
can\'t work together and sit at the table, because of the lack of trust,
can work on some of these very tough issues, and step by step, work
through those. If there are better ways of doing that, if there are
better ways of achieving those attributes, or if there are different
attributes that will help to achieve it, or attributes there that you
think are needed, we need to hear that. Nothing is off the table. But
you need to make the case for why that\'s a better way.

And we\'re looking for the best ideas. We\'re not looking to simply
implement the things that we have there. We want you to bring your best
ideas to the table, bring the best people to the table, bring the most
trusted, esteemed organizations and individuals to the table so that we
can work at this together.

Any other questions from the Internet? We have a phone call. Okay. So
we\'ve got one phone call in the queue. Anybody else here while we\'re
waiting for that question to come in from the phone? Okay. So we\'ll
give just a moment for us to process that question from the phone call.

FEMALE SPEAKER: Brian, could you ahead and unmute Gary
\[unintelligible\]. Mr. Dickenson, go ahead.

MR. DICKENSON: Thank you. My name is Gary Dickenson. I\'m representing
CENTRI Health \[spelled phonetically\]. The root of succession or
successor is success. Promoting succession without solid evidence of
success is a fool\'s errand. AHIC has no track record of success. HITSP
has no track record of success. Much has been proposed but
\[unintelligible\] little has been validated through real world
implementations.

So the question is, why not take the next 17 months to validate these
myriad recommendations through implementation? Specifically focused on
the HITSP interoperability specification, and without taking on
additional use cases. If success is evident through this implementation
and validation process, succession will be the obvious path forward.
Otherwise, succession seems moot.

DR. KOLODNER: Okay, thank you, Gary. And I think the point that you make
is whether or not we pursue the AHIC Successor. I think that\'s not up
for discussion at this point; that\'s actually something that the AHIC
1.0 would need to consider, and when it did consider it, when the
Secretary considered it, that was not the path that they wanted to
pursue. They wanted to move forward in establishing the AHIC 2.0, so
that there would be something that occurs 18 months from now instead of
reaching the kind of transition that Secretary Leavitt mentioned
previously.

Any other questions on the Internet or in the room? If not, we\'ll
conclude today\'s session. Thank you very, very much for your time and
your participation. We hope that what you\'ve heard here has caught your
interest, and that you are energized to reach out to your colleagues and
join as part of a collaborative that can apply. Thank you very, very
much.

\[applause\]

[\[Whereupon, the meeting was adjourned at 12:45 pm EST\]]{.underline}