Sunday, December 21, 2008

VA Telehealth in the Spotlight

Telehealth and health IT are used by the Veterans Health Administration to treat veterans in more than 30,000 homes, according to Adam Darkins M.D., Chief Consultant for Care Coordination at the Department of Veterans Affairs. Appearing at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics Briefing held on December 17th, he said “the VA has made a remarkable transformation in delivering care in recent years and 5.6 million veteran patients are served annually.”

Even though veterans and their healthcare needs are growing, the number of hospital beds is going down today with most of the care taking place in local clinics and ambulatory settings. Dr. Darkins pointed out that before 1900, care took place mainly in the home but starting in the 20th century, more of that care took place in hospitals. However, care in the 21st century, can be given wherever it is safe to do so, feasible, and cost effective.

As Dr Darkins explained, the VHA in 2003 started the national home telehealth program called Care Coordination/Home Telehealth (CCHT) to take care of patients with chronic conditions. The program uses home telehealth and disease management techniques plus uses health IT. The program treats patients with single and multiple conditions and treats patients with diabetes, CHF, hypertension, PTSD, COPD, and depression. The program in 2003 had 2,000 patients, by 2007, the VA treated 31,570, and by December 2008, the VA treated 36,000 patients.

When treating patients at home, devices are used to send information on the patient such as vital signs, disease management data, and e-health information that goes to the National VHA Care Coordination Infrastructure where it then can go via the Internet or the Intranet and then be sent to VistA and to hospitals.

According to Steve Pirzchalski, Director of Enterprise Network Services for the Department of Veterans Affairs, in recent months, the VA joined Internet2 as an affiliate member and is connected to the nationwide network. Now it will be possible to deliver next generation medical services, provide for faster delivery of services, extend the reach for information, decrease costs of service, and so now data is able to move faster, better, and cheaper.

The medical services can provide include high resolution imaging, telepresence, telepathology, and mental health counseling. Also Internet 2 opens numerous opportunities for tele-teaching, training, and distance learning with universities, DOD, other government agencies, hospital health networks, rural communities, research organizations, and in the corporate setting.

In addition, the VA is working to enhance current partnerships and build whole new relationships through the Internet2 system by partnering with universities, medical schools, and research institutions all over the world, plus the VA is working on IPv6 technology for telehealth use in the home. Pirzchalski, said however, there are still challenges in developing the right infrastructure and bandwidth, dealing with security issues, and developing new applications.

Gail Graham, Director of Health Data and Informatics, reports that the VA program is trying to reach the 32% of the veteran population living in rural areas.VA is now opening 31 new outpatient clinics in 16 states located in Alabama, Arkansas, California, Florida, Georgia, Hawaii, Illinois, Iowa, Maryland, Michigan Minnesota, Mississippi, Missouri, North Carolina, Pennsylvania, and Vermont. The plans are for all the clinics to be operational by late 2010.

Graham said that Electronic Health Record System, Personal Health Record System, on line prescription refills, quick access to records, and being able to schedule appointments is really valued by the veterans. However, one of the primary goals is to move the delivery of care forward with the focus more on patient-centered care delivered separately from the geographical location but it has to be done in a seamless manner. The VA is going to expand health information exchanges to provide information at the point of care, do more work in the field of genomic medicine, nanotechnology, and medical devices.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI), John Thune, R-SD), and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), Allyson Y. Schwartz (D-PA), and David Wu (D-OR).

The Steering Committee also coordinates activities with the “House 21st Century Health Care Causcus”, Co-Chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

The Steering Committee briefings are now being produced by the HIMSS Foundation’s Institute for e-Health Policy. For more information on future briefings, contact Neal Neuberger, Executive Director for the Institute at or go to the web site at

HIMSS Releases HIT Blueprint

The HIMSS report “A Call for Action: Enabling Healthcare Reform Using Information Technology” outlines specific priorities and recommendations for the Obama Administration and the 111th Congress. The report explains how to harness information technology’s power to reform healthcare and stimulate the economy.

Stephen Lieber, HIMSS President and CEO appeared last week at a press conference on Capitol Hill to announce the publication of the report. He said, “The HIMSS report gives direction to dealing with the healthcare issues facing this country and can help lead the Obama Administration and Congress to get the U.S. on the road to adopting HIT in the immediate future.”

Speaking at the briefing, Representative Patrick Kennedy (D-RI) who has been instrumental in providing House leadership for healthcare IT sees promising opportunities for the passage of health IT legislation in the next session of Congress. Letters from leaders on the Hill have been written to President Elect Obama to express how important it is to invest in healthcare reform now. He stressed that the golden opportunity for health IT legislation to pass is here in the next administration.

Representative Kennedy said he also knows that the next Secretary of HHS and Director of the White House Office on Healthcare Reform Tom Daschle, is very informed on the issues and understands the enormous problems that the country faces in delivering healthcare. Right now, the incoming HHS Secretary is working hard to put together a strong Health Technology office.

Specific recommendations in the report include:

  • Investing a minimum of $25 billion in health IT to help non-governmental hospitals and physician practices adopt electronic medical records
  • Applying recognized standards and certified health IT products among all federally funded health programs by requiring that federal funding used to assist providers and payers be used to purchase or upgrade new Health IT products that apply HITSP interoperability specifications and have CCHIT certification
  • Expanding Stark Exemptions and Anti-Kickback Safe Harbors for EMRs to cover additional healthcare software and related devices that apply HITSP interoperability specifications and are CCHIT certified
  • Authorizing and codifying HITSP as the National Standards Harmonization Body, a Senior Level Health IT Leader within the Administration, and authorizing a Federal Advisory and coordinating body for Health IT
  • Conducting a White House Summit on Healthcare Reform through Information Technology

To sum up the importance for the HIMSS report, Harry Greenspun, M.D., Chief Medical Officer, Perot Systems Corporation and HIMSS Government Relations Roundtable Co-Chair, said “The recommendations in the report can help lay the foundation to build a more accessible healthcare system that could improve patients’ quality of life, help prevent disease and increase affordability of care. Implementing these changes would also put us on the path toward ensuring that our healthcare system will be able to meet the needs of future generations.

The full report is available online at

AHRQ Releases Presolicitation

On December 18th, AHRQ published a presolicitation with the goal to release a solicitation in early January. The solicitation will seek proposals for multiple IDIQ/Task Order contracts through which individual Task Orders will be awarded to support the AHRQ National Resource Center for Health Information Technology.

AHRQ anticipates awarding multiple contracts for four separate domain areas:

  • Health IT Program Management, Guidance, Assessment and Planning
  • Health IT Technical Assistance, Content Development, Program Related Projects and Studies
  • Health IT Dissemination, Communication, and Marketing
  • Health IT Portal Infrastructure Management, Website Design, and Usability Support

Multiple master contracts are expected to be awarded by the end of May 2009, and multiple individual task orders are expected to be awarded by August 2009. AHRQ anticipates awarding approximately 3-6 contracts per domain with no more than 10 contracts per domain area.

Through the issuance of task orders, AHRQ expects to award approximately $25 million, contingent on available funds over the course of the one year base and the four option year periods. The program has the potential to award $50 million if the program expands and gains federal partners.

AHRQ plans to award contracts to a mixture of large and small businesses. While the solicitation is an open competition, AHRQ’s intent is to reserve some awards in some of the domains for small business.

For more information, go to or contact Sharon L. Williams Contracting Officer at or call 301-427-1781.

Informatics Course Online

Business and healthcare professionals with a Bachelor’s degree are drawn to the healthcare informatics field since informatics is now considered one of the core competencies needed by all clinicians. At the same time, the field has evolved into a specialty area within nursing, pharmacy, medical imaging, biotech, medicine, plus informatics has many applications in other clinical fields.

To meet the ongoing needs in the expanding informatics field, the MGH Institute of Health Professions in Boston is offering an online course from January 12, 2009 to April 28, 2009 that will examine healthcare informatics from an interdisciplinary perspective and prepare students for the national informatics exam. The MGH Institute of Health Professions an interdisciplinary graduate school is an affiliate of the Massachusetts General Hospital and a member of the Partners HealthCare System.

This course is set up as a survey course to provide students from all clinical fields an overview of the healthcare informatics field. Specifically, online students will learn all about the history of healthcare informatics, concepts, theories, and applications within the healthcare industry, the information system life cycle, human factor issues in healthcare informatics, enabling information systems technologies, knowledge management principles, and professional practice trends and issues.

The students will be able to go out into the real informatics world and find jobs with companies within all segments of the healthcare industry from healthcare providers such as Partners Healthcare, insurance companies, perhaps with vendors that market software applications to the industry, and or work for many other individuals and organizations involved in evidenced-based practices. The salary range can span from $50,000 to over $100,000 based on an individual’s qualifications and expertise.

This course is the first of the six course sequence. The faculty is now researching the possibility of offering a CAGS in Applied Healthcare Informatics. They are further exploring the potential of offering a graduate degree in this area as well.

For more information on the course or other courses, or to download a registration form, go to

Tuesday, December 16, 2008

Center to Coordinate Telehealth

The California HealthCare Foundation (CHCF) has established the California Center for Connected Health (CCCH), a strategy and planning body to lead and coordinate telehealth adoption throughout the state. CCCH will be led by Sandra Shewry, Former Director of the California Department of Health Care Services.

Millions of dollars in new federal and state funds are going to be used to support the expansion of California’s telehealth infrastructure. This includes approximately $30 million investment in broadband and connectivity through the FCC pilot program—the California Telehealth Network, and $200 million in Prop 1D infrastructure financing available to expand telehealth and medical education through the University of California. The Prop 1D funding includes $10 million for a community investment fund to help equip community healthcare sites partner with the University of California to provide for medical services through telehealth.

The FCC and Prop 1D grant funds will expand the telehealth infrastructure, but CCCH will be the coordinating body that will link together many groups and individuals to make telehealth a reality. The CCCH will connect stakeholders, including state agencies, provider groups, and public and private sector organizations, and set the strategy and vision for a sustainable telehealth model in the state. “Working together, we can realize telehealth’s potential to improve access and quality for underserved populations,” said Shewry.

Developing the Medical Home

The Medical Home System Advisory Council in Iowa recently discussed how to advance the medical home concept in the state. The purpose of the Council is to advise and assist the Iowa Department of Public Health (IDPH) on developing a statewide patient-centered medical home system as outlined in the state legislation (HF 2539).

The initial phase as entailed in the legislation will focus on providing a patient-centered medical home for children who are eligible for Medicaid. The second phase will focus on providing a patient-centered medical home for adults covered by the IowaCare Program and for adults eligible for Medicaid. The third phase will focus on providing a patient-centered medical home for children covered by the “hawk-i” program, adults covered by private insurance, and self insured adults. Plus state employees will be allowed to use the system.

Specifically, the legislation calls for IDPH to:

  • Develop a plan and an organization structure to implement the system
  • Develop standards and a process to certify medical homes
  • Recommend a reimbursement methodology and incentives for participation
  • Coordinate the requirements of the medical home system with the dental home for children
  • Integrate the recommendations and policies developed by the Prevention and Chronic Care Management Advisory Council into the medical home system
  • Provide oversight for all certified medical homes
  • Evaluate the medical home system annually

Some other states are looking at developing the medical home concept. For example, Idaho, is studying the “Target for a Healthy Idaho” initiative that would provide each person access to a medical home. Other states such as Minnesota and Louisiana are gearing the medical home program to Medicaid enrollees and uninsured populations. New Hampshire’s Multi-Payer Medical Home Project however is a pilot involving all payers, including Medicaid and Medicare providers, and subject experts.

In another state legislative action, (SB 2394) was introduced in New Jersey. The bill calls for the State Medicaid program to establish a three year medical home demonstration project. The demonstration program would support primary care practices that use a medical home model and reward the practices for improved quality and improved patient outcomes. The primary care practices at a minimum will need to have a multi-specialty team available to provide patient-centered care coordination by using health IT and chronic care registries.

Remote Monitoring for ICD Patients

Implantable Cardioverter Defibrillators (ICD) can be an important and effective treatment for patients at risk for sudden cardiac death. To enable patients to have more continuous follow-up along with reduced complication rates, new devices such as home remote monitoring equipment geared to patients with ICD are now available.

Biotronik Home Monitoring an automatic wireless system used for patients with cardiac devices was used in a study with 1,443 patients to test if home remote monitoring would reduce the number of scheduled office visits in a prospective randomized trial. The data demonstrated that the home monitoring system reduced the number of office visits while maintaining patient safety, plus using the system led to earlier detection of arrhythmic events.

Eighty nine percent of remote monitoring alerts were managed remotely and required no follow-up office visits. About 30 percent of unscheduled office visits among patients in both the control and study groups required physician interaction and were considered actionable. However, unscheduled office visits triggered by the remote monitoring system nearly doubled the rate of treatment. More than 51 percent led to some action by the clinician and at the same time made better use of the clinician’s time.

In another ongoing clinical trial taking place in Germany, Charite University and Biotronik GmbH & Co. are currently recruiting participants to study remote monitoring after ICDs are implanted. The goal is to look at how effective remote monitoring does as compared to standard care in patients. All study participants will receive an ICD in the Biotronik Lumax family.

All of the patients in the study will have Ventricular Arrhythmias that need treatment. One group of the patients participating in this home monitoring experiment will not only receive a home monitoring device but will also receive an additional home monitoring device called the CardioMessengerII following the ICD implantation. Follow up appointments for this group will be done in outpatient clinics for the first month, for the first year, and for 24 months after the implantation.

Remote visits will be done for this group of patients for the third month, six month, and for 18 months after the ICD implantation. Doctors will be able to follow up on their patients with fewer in clinic consultations and hopefully the study will show that home monitoring results in more efficient and effective follow up along with cost savings.

The patients in the group that will receive standard care will also receive a home monitoring device but will have scheduled follow-up appointments at the outpatient clinics at 1,3,6,12,18, and 24 months.

Sunday, December 14, 2008

UC Launches Loan Program

The University of California Davis Health System in Sacramento has just launched a program to help community hospitals and primary care clinics obtain video conferencing and related telehealth equipment. The program called the “UC Davis Proposition ID Telemedicine Equipment Loan Program” provides not only for the loan of video conferencing units but also for peripheral medical equipment, such as specialized cameras, to be used in healthcare sites located within the health system’s 33 county service areas.

The loaned equipment will be available to healthcare sites and the communities they serve for an extended period of time. If, for some reason, a site no longer uses or needs telemedicine equipment, or if the site’s status as a healthcare provider changes, the equipment loan program would enable UC Davis to redistribute the equipment to other appropriate sites.

The telemedicine program at UC Davis Medical Center in Sacramento provides direct clinical care to patients at a distance, giving clinics and hospitals throughout the state access to more than 40 medical specialties not readily available in most smaller communities. So far, the UC Davis Telemedicine program has conducted more than 20,000 telehealth consultations.

To be eligible, partner sites must be a public or non-profit entity and provide care to underserved populations. Interested healthcare providers should submit a letter of interest and complete an online informational survey at between December 9, 2008 and January 6, 2009.

UC Davis plans to review each submission and make recommendations to the UC Office of the President. It is anticipated that by the end of 2009 as many as 25 sites will receive a telemedicine equipment loan along with installation support and training from UC Davis technical experts.

A Vision for the Future

George Halvorson Chairman and CEO Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, joined healthcare executives, legislators, and business leaders at the Fourth Annual World Healthcare Innovation & Technology Congress on December 8th, 2008 in Washington D.C. He said “the vision for the future is to provide all of the information about all of the patients, all of the time, anywhere.

Halverson reported that right now KP produces 30,000 lab reports for patients every day, and patients can use their computers to set up their office visit appointments, physicians can look at digital x-rays, e-prescribing is available, and electronic care counseling is provided daily.

Halvorson envisions a new model for healthcare where:

  • Data and connectivity will enable patient-centered care and make it easier for caregivers to deliver the best evidence-based care to every individual, and at the same time, manage serious illnesses and chronic conditions more efficiently and effectively
  • Systems will link patients to doctors, doctors, to doctors, doctors to nurses, doctors/nurses and patients to care team members, and laboratories and imaging centers to data bases
  • Patients will be able to do e-scheduling, e-visits, e-referrals, e-test results, and do secure electronic messaging with their care givers
  • Home bound patients will be able to have telemedicine consults and have instant responses to in-home crisis situations and potential problems

Halvorson went on to explain that the big spenders in healthcare are not acute care, cancer treatments, broken limbs, or births. Today, the major cost driver for healthcare is for chronic care. Eighty percent of costs treating chronic care deal with co-morbidities which also means that more than one doctor may be needed to treat to treat each patient.

Today, the reason that doctors tend not to coordinate care for patients with multiple diseases is simply because they are not reimbursed for linking care. Chronic care will not get better until the care is linked and to create the linkage, Halvorson stressed that chronic care needs to operate as a team sport. Operating as a team means that we need to put in place devices, mechanisms, financial incentives, and financial penalties so that a cooperative team is created involving caregivers.

Broadband Key Issue in NY

Developing and implementing New York’s broadband initiative is a key and complex issue in the state. Edward Reinfurt, NYSTAR Executive Director and Chair of the State’s Governmental Initiatives Action Team, spoke on December 10th before the NY Assembly Standing Committee on Governmental Operations.

Reinfurt told the Committee how detailed mapping plays an important role and is critical to expanding broadband capabilities to meet the state’s objectives. He explained that mapping is the first crucial step needed to increase service because you need to know exactly where the underserved and unserved communities and regions are located in the state. However, mapping has proven to be very difficult, complicated, and a frustrating exercise for the state and almost every other state. Due to FCC regulations, the state lacks the authority to compel the broadband industry to provide the data it desires.

Even on a voluntary basis, the state has been unable to demonstrate that it has the mechanisms in place to gather the needed information from the private sector and meet the private sector concerns on releasing proprietary information.

However, recently the NYS Office of Cyber Security & Critical Infrastructure Coordination and other agencies such as the Public Service Commission are making progress in this direction. At a meeting in November, information was presented on a model that can be used to map a single county which may serve as an example of what can be done on a larger statewide scale. In addition, the Office of Cyber Security has a database of infrastructure assets which can help in mapping efforts.

Mapping is a large undertaking but to do the work, the state needs additional data and resources. Even with more information and help, the state will only be able to estimate where coverage is, and even these techniques will not apply to New York City. According to Reinfurt, a model which may not be 100% precise is still far superior to no model and would help to identify and build a priority list of underserved areas.

In addition to the discussion on mapping, Reinfurt presented three recommendations to the NY Assembly Committee to help meet broadband objectives. These include:

  • Designating a single state entity with responsibility for managing the various aspects for expanding broadband coverage. Up to now, collaboration has been voluntary and responsibility needs to be formally established
  • Allowing the state to use all of the state assets to enhance broadband coverage throughout the state. The state’s underserved area do not have broadband because the return on investment is not seen as attractive for broadband companies
  • Laying conduit or putting fiber in makes sense when construction is already taking place. When roads are being dug up or buildings being built, agencies need to consider laying conduit down or putting fiber in at this time

Wednesday, December 10, 2008

Funds to Advance Ideas

The University of Texas, School of Health Information Sciences at Houston, received grant funding from AHRQ to train future scientists. The goal is to train scientists on how to design, implement, select, and evaluate health IT. Scientists today need to be able to develop and apply human-centered methods and techniques to HIT.

To accomplish these goals, scientists must be given training in two different training areas. First a solid foundation in informatics, research design and evaluation, human-centered design, and quality improvement must be given. Secondly, trainees need firsthand experience through research programs that give them the opportunity to put their didactic training to practice by working on HIT.

The overall program will be managed by the W.M Keck Center and trainees may be enrolled at the University of Texas Health Science Center at Houston, the University of Texas MD Anderson Cancer Center, Baylor College of Medicine, Rice University, and the University of Texas Medical Branch at Galveston.

In other developments at the university, the Department of Defense awarded the UTHSC at Houston a $9.2 million grant to conduct a clinical trial that could lead to an improved survival rate for trauma patients who require massive blood transfusions.

To do this, the university’s Center for Clinical and Translational Sciences has contracted with the Army Institute of Surgical Research to serve as the Data Coordination Center for the “Prospective, Observational, Multi-Center Massive Transfusion Trial”. Clinical trial sites for the two year study will include several trauma centers.

From the time a trauma patient is admitted to the hospital, healthcare providers are processing data on the patient’s condition such as vital signs, medications, and other healthcare information. All of this information needs to be collected, coordinated, and managed. The idea is to design a secure, web-based informatics system to make it possible to collect vital data by the patient’s bedside in order to make point-of-care decisions. The system will also allow for subsequent data management and analysis for clinical and translational research.

“The first few hours after the trauma injury are critical and what happens minute-to-minute determines whether these patients live or die” according to Colonel John Holcomb, M.D., Co-Investigator, Director for the Center for Translational Injury Research.

In the commercial sector, the Texas Austin based company NanoMedical Systems (NMS), Inc., a startup co-founded by Mauro Ferrari Ph.D., from UTHSC at Houston, received a $3.5 million Commercialization award through the Texas Emerging Technology Fund. The era of personalized medicine will require products for individuals that depend on many sophisticated technologies. The funding awarded to NMS will be used to accelerate completion and pre-clinical testing of the company’s Personalized Molecular Drug-Delivery System, a small drug delivery device that is implanted under the skin.

The device delivers medication into the bloodstream using 100,000 nano channels each the size of a drug molecule. This enables controlled doses of medication to be released in the bloodstream over weeks or months. The company is developing the device so that anti-cancer drugs will be easier to use in long term therapy. As research goes on, the device will be made smaller and more useable and make a difference in cancer care with other future applications possible in space and military medicine.

New Materials Research

A team of researchers at North Carolina State University as reported in “Biomedical Materials” have made a breakthrough that can lead to new dialysis devices and a host of other revolutionary medical implants. The researchers have found that a nanoporuous ceramic membrane can be used to create new devices that can be implanted into the human body. This includes blood glucose sensors for diabetics and artificial hemo-dialysis membranes that can scrub impurities from the blood.

Researchers have been looking for ways to develop medical devices that can be implanted into patients for a variety of purposes but existing materials used today present significant problems. For example, devices need to be made of a material that prevents the body’s proteins from building up on sensors and therefore preventing the sensors from working properly. Also implanted devices must not provoke an inflammatory response from the body that could result in the body’s walling off the device or rejecting it completely.

Dr. Roger Narayan, Associate Professor in the Joint Biomedical Engineering Department at North Carolina State and the University of North Carolina At Chapel Hill, led the research and is hopeful that the nanoporous membranes could be used to create an interface between human tissues and medical devices that will be free of protein buildup.
In another effort, the National Science Foundation (NSF) through an Engineering Research Center grant in collaboration with the University of Pittsburgh and the University of Cincinnati, has recently funded a five year $18.5 million grant to develop implantable devices made from biodegradable metals.

North Carolina Agricultural and Technical State University will lead the research. The research focuses on producing biodegradable self adapting devices and smart constructs for craniofacial and orthopedic reconstructive procedures and for similarly behaving cardiovascular devices such as stents and miniaturized sensing systems. The devices will be able to monitor and control the safety and effectiveness of biodegradable metals inside the body. In the future, this technology could lead to responsive biosensors to help doctors determine when and where diseases occur in the body.

The biodegradable devices and smart structures could reduce complications and spare patients with conditions ranging from cleft palate and bone fractures to coronary heart disease from undergoing multiple surgeries. For example, children born with a cleft palate are fitted with hard medal devices that must be removed and refitted over time. These new devices if crafted from magnesium alloys and other biodegradable metals would adapt to the body without refitting plus the magnesium alloys would dissolve after their work is done with no clinical side effects. Magnesium stents and other supports would restore cardiovascular function without having to remove the device and without exposing the patient to the potential complications of leaving the device inside the body.

Nearly 30 product development and industrial partners in the nano and biotechnology market will form a consortium with ERC to provide input on the direction of the research and work to help transfer the developed technology to patients.

Policy Analyst Position Open

A policy analyst position (GS 12/13/14) for the Office of Policy and Research in the Office of the National Coordinator for Health IT at HHS has been posted. The position entails responsibility for research, evaluating, analyzing, and coordinating activities related to policy, including privacy and security policy with other component office of ONC and other relevant Federal agencies.

The salary range for the full time position located in Washington D.C. is $69,764 to $127,442.00 per year.

The position was posted on USAJOBS. The Job Announcement Number is HHS-OS-2009-0144. The USAJOBS Control Number is 1416252. The period for application is from December 05, 2008 to Wednesday December 24, 2008.

For questions concerning the position go to Rockville Center Help Desk, Phone 888-478-4340, Fax 571-258-4052, or email For mail, send to Department of HHS, DHHS Rockville HR Center, 5600 Fishers Lane, Rockville, MD 20867 or Fax 571-258-4052.

Sunday, December 7, 2008

Telemedicine Helps TBI Patients

Today, there is a growing critical need to assess and treat Traumatic Brain Injuries (TBI) and although DOD, the VA, and rehabilitation hospitals are trying to address the problem, there can be shortages of TBI specialists at any one location. At this point, telemedicine technologies have the opportunity and the need to step in and play an important role in TBI patient care.

Several of the challenges involved in managing TBI require the cooperation of many disciplines. First of all, severe TBI frequently occurs with other traumatic injuries that can complicate emergency treatment, recovery, and rehabilitation. Secondly, mild and moderate TBI particularly for those patients where the head is not penetrated may not immediately know that they have TBI. Thirdly, if symptoms are subtle and occur in isolation as in a remote region, the patient may not be aware of any brain problems.

There are several ways that telemedicine can be used to help patients with TBI and can be used to:

  • Identify concussion and mild TBI by using electronic cognitive assessment systems
  • Provide information so that clinical teams are able to collaborate on TBI care
  • Provide teletherapy and encouragement for patients with TBI receiving long term rehabilitation services
  • Provide real-time video visits with family members
  • Provide video nursing supervision of patients with TBI in their home
  • Manage medication and provide for an online response system
  • Provide cognitive therapy, speech, and physical therapy in distance or rural areas
  • Provide interactive video programs and web courses to train medics, physician assistants, nurses, and other providers in civilian and military settings

According to the newsletter “Brainwaves” published by the Defense and Veterans Brain Injury Center (DVBIC) located at the Walter Reed Medical Center, a telemedicine program has been established to help healthcare providers assess and treat TBI in deployed settings or in remote locations. The program includes specialty experts in a variety of disciplines such as neurologists, neuropsychologists, occupational and physical therapists, and others who are able to offer expert advice related to TBI.

The DVBIC telemedicine program specialists make recommendations on when and how to screen for TBI, strategies for symptom management, return to duty considerations, and provide advice in areas where neurological and psychological health concerns overlap. The specialists are able to work with 16 other specialty groups such as dermatologists, ophthalmologists to help thousands of patients each year by making specialty email consultations available in remote locations. Questions generated in theater are expedited through an email network which allows expert clinical responses to be given within five hours.

One of the problems in treating TBI concerns the limited time and resources available at forward medical commands. To deal with this problem, DVBIC’s remote cognitive assessment system identifies TBI using a web-based program containing evaluation questionnaires and brief cognitive screening tests. It has been found that computerized cognitive assessment becomes even more useful when baseline test data is available.

Also, the Biomedical Technology Defense Program is helping with TBI by developing PC or web-based video game applications to improve cognitive, motor, and sensory performance. A portable system has been used on the battlefield to monitor TBI, along with a virtual reality based assessment tool to determine return to duty status of patients.

The Veterans Health Administration is also very involved in helping patients with TBI. Currently, the Polytrauma Telehealth Network using state-of-the-art video conferencing connects clinicians at Polytrauma Centers and VA medical centers across the country to help coordinate national trauma rehabilitation and educational services and to provide for direct patient evaluations.

Recently, the National Rehabilitation Hospital (NRH) in Washington tested a web-based system for assessing cognitive and emotional functions on a group of patients with TBI who were receiving outpatient rehabilitation services at NRH. The patients participating in the study took a series of cognitive tests through an intranet connection. All communication with the examiner was conducted via video conferencing.

Commercialization on the Rise

The University of Pittsburgh is moving ahead on a number of technology commercialization projects. A number of these innovations are highlighted in the University of Pittsburgh, Office of Technology Management’s 2008 Annual Report. According to Marc S. Malandro Associate Vice Chancellor for Technology Management and Commercialization, the university received $642 million in research funding last year.

Over 400 Pitt innovators have participated in the commercialization of the university research. There was a 36 percent in FY 2008 increase in patents awarded to Pitt innovators and a $9 million increase in revenue generated from licensed and optioned innovations in FY 2008.This has kept the staff of both the Office of Technology Management and the Office of Enterprise Development, Health Sciences working at full capacity to manage the flow of ideas and move technology through the commercialization process.

Cardiorobotics, a start-up company spun off of university innovations in FY 2008 is developing highly articulated robotic probes designed for use in minimally invasive surgeries. The probes are teleoperated and are able to steer a self-supported non-linear path. The company is in the pre-clinical stage and expects to begin human clinical trials in 2009. Marco Zenati, Professor of Surgery at the university is co-founder of the company.

Another innovation mentioned in the report reports the development of tiny carbon nanotube-based sensors to help asthmatics fend off attacks. Asthma sufferers need to be able to predict accurately oncoming attacks, and Professor Star, a researcher at the university has developed a sensor to allow asthmatics to measure nitric oxide early. The wires used in the device, are 100,000 times smaller than a human hair and since the wires are so tiny, the measurement device can be both disposable and small making it ideal for home use.

Another university professor Andrew Schwartz is making breakthroughs in robotic arm research by studying the ways in which the brain and the central nervous system control motor movement. This research enables the researchers to know how many variables that are forming the reaching movement are represented in the motor cortex section of the brain. This will be a breakthrough if perfected, and could change the lives of people afflicted with paralysis or the loss of a limb. So far, Schwartz’s team has been able to train monkeys with restrained limbs to use the robotic arm to reach successfully for a piece of food.

Schwartz is working with funding from NIH, DARPA, and the Whitaker Foundation. Although the team needs to overcome a number of hurdles before they are able to produce a practical medical device, however, human trials for a simplified version are now under way.

Grant Report Released

A report just released by Commerce’s NTIA and FEMA at DHS provides an in depth analyzes on the nearly $1 billion Public Safety Interoperable Communications (PSIC) Grant Program funded in September 2007. The awards were awarded to help state and local first responders improve public safety communications and coordination during disasters.

The report “Improving Interoperable Communications Nationwide: Overview of Initial State and Territory Investments”, discusses findings from the agencies and their analyses of state, territory, and local communications initiatives. The agencies also established a baseline for measuring each program’s anticipated impact on interoperable communications across the nation.

The report serves as a foundational document against which PSIC grantees and their progress will be examined. The findings will be periodically updated, as additional states are approved for the release of funds and as states modify their projects to respond to changing needs.

Some of the key findings were:

  • More than one half of the investments were for new initiatives not previously funded
  • More than 90 percent ($811 million) of PSIC funds were designated by State and local agencies for the acquisition and deployment of equipment to increase emergency communications interoperability
  • Forty seven states and territories will allocate $75 million of their PSIC funds to establish equipment reserves that are prepositioned, deployable, and able to re-establish communications
  • PSIC was the first grant program to require states and territories to align their investments to a DHS approved Statewide Communications Interoperability Plan. This ensures that investments were coordinated across multiple jurisdictions and disciplines

Florida ($42,888,266), Illinois ($36,414,263, Texas ($65,069,247), New York ($60,734,783), New Jersey ($30,806,646), and California ($94,034,510 were awarded the most funding.

Details on PSIC projects by states and territories are available at

Wednesday, December 3, 2008

VITL Making Progress

The Vermont Information Technology Leaders, Inc. (VITL) has developed a comprehensive work plan for the remainder of 2008 and the first half of 2009. The work plan is included in the application to go to the state to receive funding from the Vermont Health IT Fund.

Under the work plan, VITL will establish interfaces with up to six hospitals and the Vermont health information exchange will begin clinical data sharing. The work will occur in stages, beginning with the delivery of lab test results and radiology reports from hospitals to physician electronic health records systems.

The second stage will enable physicians to place electronic orders for tests at hospitals. The third stage will develop a bi-directional health information exchange, including sending and receiving the Continuity of Care Document, which is a standardized clinical summary. Additional hospitals will be connected to the exchange under future work plans.

An assessment of specialist physicians needs for HIT and HIE is also proposed as part of the work plan. The assessment would identify existing technology use among specialists, and look at the demand for connecting specialists to the HIE. The plan would also establish a way to evaluate the impact of connectivity, such as decreasing expenditures related to document faxing, courier services, and repeat diagnostic tests.

VITL is also requesting funds to deploy an interface to enable the submission of immunization data messages from physicians with EHRs systems to VITL. These messages would then be sent from VITL’s data center to the Vermont Department of Health’s Immunization Registry.

The biggest component of VITL’s application is the Clinical Transformation Project, which would educate physician practices on clinical process improvement and provide grants to independent primary care physicians for acquiring electronic health records systems. Under the project, training will be provided to help build a network of end-users to serve as resources to other physician practices.

In addition, VITL is making progress on a day-to- day basis and reported in September and October that hospital lab results are now being transmitted to electronic health records systems in physician practices. This live interface now enables Northwestern Medical Center in St. Albans to send lab test results to VITL’s data center in South Burlington. Once the results are received, they are translated in real-time to LOINC, an industry wide standard supported by major electronic health records systems. The lab results are then immediately transmitted via a secure interface to the electronic health records system of the physician who ordered the test.

Primary Care Health Partners the largest independent primary care practice in the state, has contracted with VITL to be the first EHR Connectivity Service customer and will implement the EHR in physician practices in 5 locations throughout the state.

VITL has plans to expand the service to send radiology results electronically from the hospital to physician practices using VITL’s HIE infrastructure. The capability for the physician practice to send electronic orders for tests to the hospital will be added.

In another new development, VITL has added another hospital emergency department to their electronic medication history service. Brattleboro Memorial Hospital is the third customer within
VITLs Medication History Service and service is now provided between VITL and the hospital’s emergency department. Rutland Regional Medical Center and Northeastern Vermont Regional Hospital were the first emergency departments to go live in 2007.

The system begins operating when VITL forwards the request to RxHub. The PBMs databases of pharmacy claims are queried in real-time and then lists all of the patient’s pharmacy claims paid in the last six months. The information is assembled and transmitted to the hospital emergency department via the VITL data center. Clinicians can then go over the list with the patient to verify each medication and add any drugs the patient is taking which may not be on the list. The medication list is then placed in the patient’s medical chart.

Efforts to Connect Globally

Indiana University is leading a project to connect Pakistan to the global research community via a new high speed network. The university, the National Science Foundation, the Pakistan Higher Education Commission, and the European Commission are partners and will extend the NSF-funded TransPAC2 network managed by IU to connect scientists.

The network connection will enable Pakistani scientists from 60 universities and institutes, to be linked via the Pakistan Education Research Network to work with international peers on research projects that require fast data transfers across the globe.

The Committee agreed to aggressively pursue the linkage of institutions in Pakistan with counterpart institutions in the U.S. in such focus areas as genomics, scientific and industrial research, electronics, training in measurement science and standards, molecular medicine and information technology. Other areas for scientific cooperation include remote sensing and ways to stimulate and enable innovative entrepreneurial partnerships. Nanotechnology and advanced light source science were also identified as areas for possible cooperation.

The U.S. and Pakistan will also seek opportunities to cooperate in strengthening the existing disease surveillance program in Pakistan and have agreed to develop cooperation in distance learning including the expansion of a digital library program.

In another move to further promote understanding with international programs, Cisco gave a $650,000 gift including three years of networking and support costs, to install their TelePresence video conferencing room complete with a 65 inch high definition screen to create a virtual meeting space at Purdue University in their Department of Computer Science.

Aditya Mathur, Department Head, reports that Purdue is a global university with students from over 100 countries in over 100 universities outside of the U.S. He is sure that the Cisco TelePresence University Connection Program will greatly improve the quality of interactions with global students, researchers, and partners.

Doug Comer, Vice President of Cisco Research and Distinguished Professor of Computer Science at Purdue said “we believe this is an important step in fostering an open, more collaborative research environment for innovation in the 21st century and beyond.”

Reducing Malpractice Settlements

A new study shows that using EHRs may help to reduce paid malpractice settlements for physicians. Results from a study appearing in the November 24th issue of Archives of Internal Medicine, show a trend toward lower paid malpractice claims for physicians who are active users of EHR technology. The study based at the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care was funded by AHRQ and the Massachusetts e-Health Collaborative.

The study examined survey responses from 1140 practicing physicians in Massachusetts during 2005 and looked at their demographic characteristics and the length and extent of their EHR use. The physicians’ malpractice history was then accessed using data available from the Commonwealth of Massachusetts Board of Registration in Medicine. The study team compared the presence or absence of malpractice claims among physicians with and without EHRs, including only claims that had been settled and paid.

Overall 6.1% of physicians with EHRs and 10.8% of physicians without EHRs had paid malpractice settlements in the preceding ten years. It was found that 5.7% of more active users of their systems had paid malpractice settlements, as compared with 12.1% of less active users.

The investigators speculate that EHRs may decrease paid malpractice claims for a number of reasons. EHRs offer easy access to patient histories which may result in fewer diagnostic errors, improved follow-up of abnormal test results, and better adherence to clinical guidelines. In addition, the clear documentation care available by using EHRs can bolster legal defenses if a malpractice claim is filed.

If the link between EHR use and lower malpractice payments is confirmed in further studies, malpractice insurers may offer lower premiums for practices that use EHRs. The Federal government might also decide to offer subsidies for EHR adoptions if it is shown that healthcare costs are reduced due to a decrease in medical malpractice payments.

HIT Workgroup Formed

The American National Standards Institute (ANSI) just formed a new public and private-sector group called the “EHR Clinical Research Value Case Workgroup” to promote the convergence of global clinical research and healthcare.

The goal will be to pioneer a new “value case” approach that will assign priorities based on the potential for delivering value to stakeholders. The priorities identified by the work group will than go to the Healthcare Information Technology Standards Panel (HITSP) for harmonization and development of HITSP Interoperability Specifications.

ANSI has named Dr. Rebecca Kush, President and CEO of the Clinical Data Interchange Standards Consortium, and Dr. Gregory Downing, Director of the Initiative on Personalized health Care at HHS as co-Chairs.

The work group’s members include a cross section of experts representing healthcare systems and technology providers, as well as researchers, academicians, patients, and others to advise on the content areas and processes where standards harmonization with healthcare will bring the greatest value to clinical research.

At an initial meeting in Washington D.C. in November, the work group identified the need for a clinical research core dataset as an initial priority. Members also agreed to develop a consensus vision statement for better use of EHRs and secure data exchange in support of clinical research. Eventually patient recruitment, clinical research findings for patients and practitioners, and the improved use of EHR based clinical data for research purposes will be included.

Unlike previous work within HITSP, the clinical research value case has not received funding from the federal government. An initiative is currently underway to solicit funding from stakeholders in both the private and public sectors as this financial support is needed before standards harmonization can begin.

Sunday, November 30, 2008

Telemedicine Improves Outcomes

Stroke patients have a better chance of surviving and living independently when they receive specialized stroke care in community hospitals using telecommunications to communicate with major stroke centers. This has been reported in a study appearing in “Stroke: Journal of the American Heart Association”.

Most community hospitals don’t have dedicated stroke units because of a shortage of experienced physicians and lack of access to stroke related clinical expertise at major medical centers. Rural areas in particular often have inadequate resources to provide specialized stroke care.

In Germany, the Telemedical Project for Integrative Stroke Care (TEMPiS) funded by the German Federal Ministry of Research, examined the feasibility and potential value for extending specialized stroke care to a large area of the Bavarian region of Southeastern Germany. TEMPiS, is a collaborative effort between two academic stroke centers and community hospitals in Bavaria.

The TEMPiS program is to:

  • Establish stroke units at community hospitals along with multidisciplinary stroke teams to provide care
  • Install and monitor equipment and facilities
  • Train and educate the stroke team plus have specialist physicians, nurse, and therapists provide continuous bedside teaching
  • Implement standard treatment protocols
  • Provide for 24 hour telemedicine consultations by academic stroke centers

The outcomes for the stroke patients treated at five TEMPiS hospitals with patient outcomes at five non TEMPiS hospitals in the same geographic region were compared. The study included 3,060 stroke patients with 1,938 treated at TEMPiS hospitals and 1,122 treated at other hospitals.

The patients treated at the TEMPiS hospitals had a 35 percent lower probability of death and dependency at 12 months and almost a 20 percent reduced probability for a poor outcome at 30 months as compared with non TEMPiS patients.

Initial results showed that specialized stroke care improved with the use of telemedicine. Factors such as making high quality stroke care available, providing for rapid brain imaging, providing patients with clot dissolving drugs on a frequent basis, having the ability to assess stroke related swallowing disorders, initiating early stroke rehabilitation, and using telemedicine was shown to contribute to this improvement in stroke care.

Helping Small Tech Companies

The State of Maryland is actively supporting ongoing initiatives to help small biodefense, biotechnology, and life science companies. According to the FLC NewsLink publication, the Fort Detrick Technology Transfer Initiative (FDTTI) located in Frederick Maryland, provides awards to help for-profit small businesses support technology development projects. The goal is to develop technologies in the medical field as well to commercialize the technologies developed in Fort Detrick’s research laboratories.

With funding from Congress, a partnership was formed between the Maryland Technology Development Corporation (TEDCO), the Frederick County Office of Economic Development, and the Army Medical Research and Materiel Command headquartered at Fort Detrick. Through the FDTTI, companies can receive awards of up to $50,000 for eligible projects, and since 2005, 16 companies have received awards totaling $800,000.

Several of the businesses are housed at the Frederick Innovative Technology Center (FITCI) which is Frederick County’s business incubator. FITCI provides Maryland entrepreneurs a low cost space for startup companies to share resources.

Akonni Biosystems a small Maryland life science company and a graduate of the FITCI incubator won a FDTTI award for $50,000 to develop and sell genetic-based diagnostic and disease surveillance products for infectious and other human health diseases.

Akonnai’s technology is based on a microarray technique developed at the Argonne National Laboratory. The company’s diagnostic TruArray ™ system includes a portable reader device and credit card sized disposable tests where a small blood, urine or saliva sample may be placed. The card is then placed in the reader to process the sample by just pushing a button. The caregiver is able to print out a clinical result in a fraction of the time over current tests and at a significantly reduced cost.

Although the underlying microarray and microfluidic technology has been well tested and proven, this is the first time these patented technologies have been combined to produce an integrated diagnostic device capable of performing a battery of complex medical tests at the push of a button with results available in minutes.

In the spring of 2008, Akonnai received a $200,000 investment from the Maryland Department of Business and Economic Development (DBED). According to Governor O’Malley, “Akonni’s cutting edge work with disease detection has global implications and offers hope to millions of people in the world to receive quicker diagnostic answers.

Dr. Charles Daitch, Akonni Biosystems CEO, “With the increasing threat to human health from highly infectious diseases, it is important to note that by using the Akonni’s TruDiagnosis® system, lower disease transmission rates result and healthcare expenditures are reduced through more efficient patient isolation, triage, and more timely and proper prescription of therapeutics.”

Currently, Akonnai is working with the Army Medical Research Institute for Infectious Diseases to evaluate its microchip identification system in identifying possible biodefense threats.

In other Maryland news, in October 2008, five growing Maryland technology and life sciences companies, all of which previously received Maryland venture funds were awarded an additional $350,000 to assist with the development, sales, and marketing of a number of cutting-edge technologies, medical, and disease detection products.

This additional funding was provided through DBED’s Challenge and Enterprise Investment Funds program to provide financing to small start-up technology companies for a portion of the initial costs associated with bringing new products to market, but companies are required to provide matching funds. The funding went to Neodiagnostix, Aguru Images, Encore Path Inc., Neuronascent Inc., and Sirnamoics Inc. all located in Maryland.

VC Used to Treat Dementia

Video Conferencing (VC) technology has been used to extend care in psychiatry and other specialties in rural areas, but long distance assessment of dementia has received little attention. A research project supported by the National Institute on Aging at the University of Texas Southwest Medical Center in Dallas, is studying how to use telemedicine technology to conduct neurocognitive testing. The testing will be compared to traditional face-to-face examinations in older Native American and non-Native American adults with or without cognitive impairment.

The oldest segment of our population is the most rapidly growing age group and with advancing age comes the increased risk of Alzheimer’s disease and other forms of cognitive impairment. A portion of the U.S. population lives in rural areas, where access to medical specialties may be limited. Unlike other ethnic groups in the U.S., more than half of the 2.5 million Native Americans live outside of metropolitan areas, and the percentage of elderly Native Americans is predicted to more than double by the year 2050.

The specific aims for the study are to:

  • Assemble a battery of neurocognitive tests to be administered using VC technology to detect cognitive impairment
  • Conduct traditional face-to-fact testing and compare this information to VC based testing among older healthy controls and patients with mild to moderate Alzheimer’s disease as seen at the UT Southwestern Memory Disorders Unit
  • Field test these procedures in a rural Native American Population at the Choctaw Nation Healthcare Center in Southeastern Oklahoma where VC based psychiatric interviews and face-to-face neurocognitive examinations are conducted
  • Expand AD samples and acquire data from healthy controls to explore the psychometric properties of the tests administered and assess the ability of telecognitive evaluations to distinguish cognitively intact and impaired groups.

The research project titled “Telecognitive Assessment: Extending Neuropsychology to Underserved Elders” (1R01AG027776-01A2) was initiated in August 2008 and will continue to May 31, 2011. The principal investigator is Munro Cullum at

Sunday, November 23, 2008

ePrescribing Today

The World Health Care Congress Leadership Summit on ePrescribing and Medication Management presented speakers from CMS, the state of Massachusetts, and associations. In addition, many other outstanding speakers from a variety of other organizations invested in the field, gathered to discuss their ideas on this important topic at the Summit held on November 17th at the Westin Hotel just outside of Washington D.C.

According to speakers from CMS, Medicare is uniquely positioned to spur the broader adoption of electronic prescribing and able to link physician reimbursement to ePrescribing. Medicare is using the “carrot stick” approach by providing 2 percent bonus payment for 2009 and 2010 with 1 percent for 2011 and 2012, and 0.5% for 2012. The key to broad adoption is to have sufficient reimbursement for physicians, develop standards consist with Part D, and secure the full adoption by all eligible physicians.

Concerning standards, Tony Trenkle, Director, Office of e-Health Standards and Services, at CMS, reported that the goal of his agency is to seek mature standards with a track record and then to work with industry to develop other standards as needed. In 2006, pilot tests were conducted to look at standards for formulary and benefits, and as a result, three standards were eligible for adoption with the final rule expected to be published in 2009. Future standards will be developed as identified.

He added that CMS helped to move ePrescribing forward by awarding Transformation Grants for $150 million to states to improve effectiveness and efficiency under Medicaid. The funds can be used to find ways to reduce patient error rates, for electronic health records, electronic clinical decision support tools, and ePrescribing programs.

Trenkle noted that using ePrescribing for controlled substances is an issue still being debated. However, a proposed rulemaking was issued in July 2008 with DEA receiving over 200 comments. DEA is very concerned with the integrity of the issue and will work with HHS to develop a final rule. They are optimistic that the rule can be published next year.

Massachusetts House of Representative Peter J. Koutoujian, (D-MA), House Chair, Joint Committee on Public Health, talked specifically about his state’s efforts to increase the use of ePrescribing. He explained how his state is in a good position to move ahead with technology since the state is the hub for healthcare, biotechnology, and life sciences. The state also has a number of premier medical centers, schools, and hospitals, plus the state’s legislative environment is very open to innovation, and in addition, the private sector has been very cooperative.

Specific groups have also been very helpful and active in the state such as the Mass Tech Leadership Council established to help software and technology-enabled companies, and the eRx Collaborative resulting from individual ePrescribing pilots.

Mark Merritt, President and CEO for the Pharmaceutical Care Management Association, pointed out that physicians are trying hard to implement the eRx system, but the real problem is there is no sense of urgency to do this from physicians or from the physician community as a whole.

Merritt specifically talked about the Southeast Michigan ePrescribing Initiative (SEMI) where he reported that 60% of physicians have switched prescriptions due to drug alerts, generic utilization has increased from 56.7 percent to 66.6 percent and 75 percent of the physicians are saying that ePrescribing improves care.

Emmanuel Curry, MPH, Senior Health Care Analyst at the Ford Motor Company, also discussed SEMI. According to Curry, as of June 2008, there are over three thousand physicians enrolled in the program with 9.5 million ePrescriptions written, and 448,100 dispensed medical histories downloaded. The aggressive mail program really impacts the SEMI bottom line. The total number of mail prescriptions written by SEMI prescribers during the analysis period totaled $219,133 and produced a cost savings of $1,630.349.

As David Gans, MSHA, FACMPE, Vice President, Practice Management Resources, for the Medical Group Management Association, noted in a survey done this year, one of the biggest problem affecting electronic transmission of prescriptions is that not all pharmacies are able to accept ePrescribing, For example independent pharmacies can’t always afford the technology to pay for the connectivity especially in rural areas. Today, these pharmacies are struggling to exist and just trying to keep up with the big chains. They really need financial help and assistance to put electronic prescribing in place.

Gans commented on how the workflow can be disruptive when initiating ePrescribing, but the staff will find that by sending prescriptions electronically to the pharmacies, their work will be a lot easier with less paperwork, fewer calls for refills, and fewer calls from pharmacies. He emphasized that it is important to have the support of the nursing staff so that coordinating the job is easier. He went on to say that vendors need to work with the staff to develop a hands-on approach and then work the tools needed to operate the system into the work flow of the office.

For more information on the Summit, go to

Board Releases Plan

The Oregon Health Fund Board established by the Oregon legislature released their November 2008 Blueprint to reform Oregon’s healthcare system. The plan “Aim High: Building a Healthy Oregon” stresses that Oregon needs to have a healthy population, provide extraordinary patient care, and provide for reasonable per capita costs to be shared in an equitable way by the entire population.

The overreaching strategy for the State is to establish partnerships with communities, to provide health insurance to all the children, ensure transparency for information on costs and health outcomes, unify purchasing power, stimulate innovation, ensure health equity for all, train a new healthcare workforce, and advocate for Federal changes.

An important goal of the plan is to provide the strategies to stimulate system innovation. One of the prime strategies would be to develop Integrated Health Homes (IHH) to guide primary care practice transformation across the state. While this model allows for many different care settings to serve as integrated health homes, they all share common features.

For example, IHHs would establish personal and continuous relationships with patients, provide team-based care, provide culturally competent care for all of a patient’s healthcare needs, coordinate and integrate care with the care received from other providers and organizations, focus on quality and safety, and provide patients with enhanced access to care.

While integrated health homes are just starting to be implemented in the U.S. on a large scale, there have been a number of local demonstration projects that have shown some tangible results. For instance, the South Central Foundation in Alaska implemented an IHH model at the Alaska Native Medical Center. This IHH model has improved care measures over a five year period, decreased disease-specific hospitalizations, improved childhood immunization rates, and decreased emergency room, specialists, and provider visits.

A care-management based integrated health home model was also implemented at the Intermountain Health Care in Salt Lake City resulting in significant health improvements, including improved glucose control. As a result, hospitalization and death rates have decreased in elderly patients with diabetes as compared to patients at control clinics.

However, the plan points out some of the action steps that need to take place. First of all, a system needs to be created where IHHs report requirements on process, outcomes, and quality metrics, standards need to be established for reimbursing designated IHHs, and standards need to be developed with contracted health plans. Additionally, IHHs need to be incorporated into the Oregon Health Plan (OHP) with incentives for OHP participants, and learning collaboratives need to be established for IHHs.

The plan also addresses changes needed in payment reform to encourage high quality healthcare delivery in the state. The state’s role as both the integrator and instigator of system change can be the key to improving the payment system to pay for the quality of care rather than the quantity of care.

The first action step should be to establish a Payment Reform Council to explore new payment models to reward providers for the quality of care they provide in coordination with providing incentives for innovative models of care that ensure care coordination and efficiency, such as an IHH. Secondly, there is the need to promote evidence-based practice under clearly articulated state policies and active supervision.

Another step in the right direction would be to continue to support community-based collaboratives to develop innovative programs and relationships to better integrate healthcare across multiple local organizations, and one of the ways that this can happen would be for the state to establish challenge grants. The grants could be in the form of direct financial or technical assistance and would require local matching funds and specific performance objectives and measures.

The plan also addresses Federal actions that are needed. Today, the most critical federal barrier to health reform in Oregon relates to the low Medicare reimbursement rates paid to Oregon’s providers as compared to other states and regions. Congress needs to reform the process for setting Medicare rates to more equitably align reimbursement across the country, preserve the option of Medicare Advantage HMO and PPO plans, provide for additional Medicaid waivers and expand the program, enhance tax benefits for self-employed individuals and other individuals buying health insurance on the open market, address healthcare provider workforce issues, and provide for open dialogue among provider organizations concerning delivery system changes.

The plan will be sent to the Governor and the Oregon Legislative Assembly for consideration beginning January 2009. To view the entire report, go to

DOD Releases SBIR Notice

The Department of Defense Office of the Secretary has just released the SBIR FY 2009.1 Solicitation. One of the important goals is to be able to integrate assessments from health databases and other intelligence assessments such as incidents from land mines and safety incidents so the data can be used to help identify future medical technology capabilities.

Basically, the DOD OSD SBIR program is interested in:

  • Health surveillance planning and decision support tools. These can include targeted software applications, decision support tools, data and knowledge management information visualization technologies including geospatial tools and artificial intelligence-based applications for analyses purposes
  • New methods to monitor health status and clinical laboratory data. Data and information analysis tools are needed to collect and harmonize disparate data and information sources
    to provide health status surveillance pre or post injury, Projects are required to have a strong biological basis and be sensitive to changes in health status based on real-time measurements, clinical laboratory data sources, or recorded inpatient, outpatient, or trauma registry data
  • Medical training and learning tools. Advanced distributed learning simulation-based training and other computer based training technology is needed to enable all healthcare personnel to plan, respond and manage future medical situations

Specific Defense Health Program Biomedical Technology topics with an emphasis on TBI are:

  • Army (OSD09-H01) to develop a highly interactive PC or web-based videogame application using a videogame console platform to improve cognitive, motor, and sensory performance following traumatic brain injury
  • Army (OSD09-H02) to prototype or refine and test a portable system to provide battlefield triage and monitoring of traumatic brain injuries. The system needs to provide complete diagnostic data
  • Army (OSD09-H03) to develop a highly interactive PC or web-based application to allow family members to verbally interact with virtually with deployed service members
  • Army (OSD09-H04) to design, prototype, and provide preliminary validation data for a virtual reality based assessment tool to use to determine return-to-duty status of patients diagnosed with mild traumatic brain injury
  • Army (OSD09-H05) to develop a computing interface to be used for cognitive and physical rehabilitation of victims with traumatic brain injuries. The interface needs to be interoperable with new and existing cognitive and physical rehabilitation tools

The solicitation was issued November 12, 2008 and proposals can be accepted on December 8, 2008. Final proposals are due January 14, 2009. For questions and more information, go to

Wednesday, November 19, 2008

TX Fund Invests Millions

The Governor of Texas Rick Perry announced that the Texas Emerging Technology Fund (TETF) a $200 million initiative created by the Texas legislature has invested $2 million in CryoPen LLC of Corpus Christi. The funding will be used to develop and commercialize their innovative cryosurgical device called CryoPen. To date TETF has allocated $115 million in funds to Texas companies and universities.

CyroPen provides a simple non-invasive and effective means to perform cryosurgery a surgical technique that implements freezing to destroy unwanted or harmful tissue, most often related to skin lesions removal.

Unlike other existing methods, CryoPen eliminates the need for storage and handling of hazardous cryogenic liquids and gases, plus the patient’s results are not highly dependent on operator technique. Therefore, CryoPen’s operational simplicity limits the amount of training needed to operate the device.

Because the CyroPen is safe and easy to use, the device makes cryosurgery more easily available to primary care physicians especially physicians in small communities eliminating the need for patients to travel to larger towns to see a doctor.

Skin lesion removal is a $3 billion market in the U.S. and a $6 billion market worldwide. CryoPen began selling the device in 2006 and in its regional phase 1 rollout, more than 50 CryoPen units were sold to help with lesion removals averaging six device sales per month. The units currently sell for $8000 per unit. The device has been selling to family and general practitioners, podiatrists, internists, general surgeons, pediatricians, gynecologists, and dermatologists.

Recently, the Tech Fund announced an investment of $1.5 million in Codekko Software Inc. of Dallas, and $250,000 to DentLight of Richardson to work on:

  • Codekko is working to improve the function and performance of computer servers by improving performance, scalability, and delivery speed by up to 10 times in the delivery of web-based applications. Codekko is partnering with the Jonnsson School of Engineering, the Computer Science Department, and the School of Management in the Marketing Department at the University of Texas at Dallas
  • DentLight’s dental diagnostic technology integrates LEDs, lasers, optics, and digital electronics into its next generation treatment devices. The company has partnered with the University of Texas Health Science Center at San Antonio’s dental school to research and evaluate the technology’s effectiveness at diagnosing dental disease

In a move earlier this year, TETF invested $5 million to use to recruit scientists and surgeons in trauma care and next generation medical technologies to the UTHSC-H for their newly created Center for Transitional Injury Research (CeTIR) program. In Texas alone, 85,000 Texans are hospitalized as a result of traumatic injury and more than 13,000 die.

In addition to the TETF investment, UTHSC-H, Memorial Hermann Hospital System and the University of Texas System Medical Foundation have pledged nearly $13 million to establish the CeTIR to attract a team of experts in medical research and trauma care.

"LA Health First" Details

New details on the “Louisiana Health First” initiative were just announced by Governor Bobby Jindal. The Governor stressed that the state is last in healthcare outcomes and has far too many people with no health insurance at all, so it is very important for the state to take action. The initiative focuses on expanding health insurance, providing coverage for the working poor and offering Medicaid consumers choices on insurance coverage rather than have a government one-size-fits-all system. Governor Jindal added “the state’s rapid growth in spending with continued poor outcomes is not acceptable and is not financially sustainable for the state.”

According to state DHH Secretary Alan Levine, Louisiana is 42 in per capita income, but the state’s total state spending on Medicaid and the uninsured is very high. In the last two years, the Medicaid budget has grown by more than $1.6 billion resulting in a 28 percent growth. Medicaid spending has grown from 8.5 percent of the state’s general fund two years ago to more than 16 percent today. It is expected that this spending will consume nearly 22 percent of available discretionary dollars by 2011.

DHH and HHS have been having ongoing discussions to resolve the issue of the $771 million potentially owed by the state for alleged overspending in Medicaid in the past. The state should invest this money instead to expand access to health insurance, according to Levine. The state has also asked the federal government to freeze the interest on this money which would allow Louisiana to invest this additional $100 million savings in expanded access to insurance, and to provide for the repayment over a five year period rather than pay it back over the traditional 15 to 21 months.

The state is proposing to expand Medicaid by transforming Medicaid into a system where the beneficiaries will not only have insurance but also transparency. The system needs to have incentives aligned for better health outcomes at a more reasonable rate of growth in cost.

In addition, the state is planning to change the governance of Charity Hospital in New Orleans to create a state-of-the-art teaching facility that can invest properly in research and training and compete head to head with the most prestigious teaching hospitals in the country. The Academic Medical Center would provide for payments and care for the uninsured and residency programs with LSU and Tulane.

One of the Initiative’s goals is to develop the medical home system. The Health Care Reform Act passed in 2007 was put into place to develop and implement a healthcare delivery system providing a continuum of evidence-based and quality driven healthcare services. These services are to be provided based on the medical home system of care using successful managed care reimbursement principles.

To meet these goals, the medical home system of care would need to:

  • Coordinate and provide access to healthcare including convenient and comprehensive primary care plus access to appropriate specialty care and inpatient services
  • Provide for strong and effective medical management
  • Use health outcome data to ensure that patients and providers improve outcomes
  • Require the use of electronic medical records
  • Provide quality of care and cost efficiency through performance measures
  • Provide for adequate reimbursement levels to ensure quality providers

IHS Addressing Quality

The Indian Health Service (IHS) launched a new website to report on the quality of care provided to American Indian and Alaska Native patients. The VA and the Department of Defense along with IHS have identified a set of clinical performance measures to be made available through the site.

Each performance measure has been synchronized within the three agencies to the extent possible given the differences of the patient populations served. For 2008, the IHS is reporting on seven measures concerning diabetes, immunizations, pneumonia, asthma, and stroke. In 2009, two other immunizations and three cardiovascular disease-related measures will be added.

The website allows IHS patients to compare the performance of the IHS facility where they receive care to the performance of other IHS facilities within their geographical area. The site also includes 24 performance measures that the IHS reports annually to the Office of Management and Budget and to Congress. Currently, these measures are reported only at the national level and are not comparable at the facility level.

In addition to the IHS performance measures, the website provides information to help patients advocate for their own healthcare. A checklist is available containing important items such as family history of disease, current medications, and immunizations and procedures that are received at other healthcare facilities. This information can then be discussed with the patient’s healthcare provider.

For more information, go to

Computers Investigate Cells

A team of MIT researchers have found new ways in which cells process chemical information that could help maximize the effectiveness of disease treatments such as chemotherapy. In essence, the researchers have changed the computational model with the results announced in the Journal “Cell”.

A few years ago, a research team reported on a data driven computational model that allowed the team to simultaneously investigate the relationships between several cell signaling pathways. These pathways control the cell’s response to inflammation, growth factors, DNA damage, and other events. This model can be used to help figure out how cells will respond to growth factors and treatments like chemotherapy and therefore enable treatments to be tailored to individual patients.

As explained in “Cell”, the team is going one step further to obtain more information from the computer model. They looked at what happens to cells where the model fails catastrophically which is called the “model breakpoint analysis”. This form of analysis is an extension of more traditional failure analysis methods used by engineers to find out flaws and changes needed to help the situation.

To reach the “model breakpoint”, the researchers entered data to the model that resulted in the data becoming more progressively worse and worse with more and more biologically inaccuracies. According to Michael Yaffe, MIT faculty member, the model would work fine, and then when the model reached a certain threshold called the “breakpoint”, the model suddenly wouldn’t predict anymore.

Dr. Yaffe added that by looking at what happed in the model when the predictions failed, we discovered a surprising amount of new biology that was actually happening in the living cell. The computer modeling approach offers the chance to learn about biological phenomena that might take thousands of hours in the laboratory to uncover.

One significant unexpected finding was that both overactive and underactive mutations within a particular gene, such as those found in cancer, reduce cell death compared to the normal gene. This suggests that normal cells are poised to die whenever there is trouble, but perhaps not tumor cells. This means that the dynamic range of cell signaling may be a greater determinant of what cells do than the absolute level of a particular signal. This research enables researchers to not only look at one pathway in the cell in isolation, but they can also look at five pathways or eight pathways simultaneously,

The research was funded by NIH, the Deutsche Forschungsgemeinschaft, the David H. Koch Fund, the Edgerly Innovation Fund, and the American Cancer Society.

Sunday, November 16, 2008

Medical Technology Issues

The Journal “Health Affairs” on November 10th at the National Press Club brought together panelists to explore some of the challenges the medical technology market faces especially for diagnostic imaging technologies. The briefing addressed whether unnecessary scans have resulted from the physicians’ desire to make good on their investments in office-based scanning equipment, the need for the mandatory disclosure of prices, and should Congress legislate greater transparency for medical devices.

Susan Dentzer, Editor-Chief, Health Affairs, and moderator for the event, poses an idea in the current “Health Affairs” thematic issue as to whether medical technology and spending is going to be the next market bubble. She points out that we shouldn’t carry the analogy too far but maybe there are similarities between the boom brought about by subprime mortgage lending and the very different boom in medical technology.

Between 1995 and 2004, the number of CT and MRI units more than doubled. Using Medicare claims data, Stanford University’s Laurence C. Baker, PhD, Professor of Health Services Research, and colleagues from Stanford and Harvard University found that the number of MRI procedures per 1,000 Medicare beneficiaries increased from 0.3 in 1985 to 50 in 1995. By 2003, that number reached 173. CT procedures more than doubled from 1995 to 2005 from 235 per 1,000 beneficiaries to 547.

Dr. Baker thinks that we need to look at how many of these scans were value added and the medical community needs to really look at technology in terms of costs and benefits. He pointed out that quicker and more precise diagnoses are clearly more beneficial if more effective treatments are used more quickly, and this in turn, leads to improved outcomes.

Dr. Baker and his colleagues in their article in the current “Health Affairs” issue, agree that if the base of cost-effectiveness information could be expanded, this data would help assess the value for expanding imaging. This is important particularly when data is studied on the availability of imaging along with how this availability affects the way imaging is used.

The consequences of secret prices and transparency issues were discussed by several on the panel. Jeffry Lerner, President, and CEO, ECRI Institute in his “Health Affairs” article told the audience that today’s manufacturers enforce price confidentiality clauses in contracts with hospitals for purchases of physician preference items such as implantable medical devices. Also, secrecy clauses prevent hospitals from revealing prices to third parties that would help them in the negotiation process and to surgeons who specify which device brands and models hospitals purchase.

Lerner thinks that transparency even if the information is incomplete could assist hospitals to make better informed judgments about the cost and effectiveness of PPIs and would help to negotiate lower prices for them. In addition, it could also increase pressure to align the incentives of hospitals and physicians.

Lerner mentioned legislation introduced last year referred to as the “Transparency in Medical Device Pricing Act of 2007”. The Act introduced by Senators Grassley and Specter would bring transparency to medical device pricing so that there will be sufficient information available for the market forces to work.

Hal J. Singer, President and Managing Partner, Empiris LLC, refutes the idea of mandatory price disclosures and pointed out that it is important to know whether the alleged benefits are likely to succeed the costs. Singer and his colleagues are the first to provide an economic framework for analyzing the likely benefits and the costs of mandatory price disclosures.

According to the Singer, recent analyses have shown that mandatory price disclosures in other segments of the medical industry can adversely affect consumers and in some cases mandatory disclosure rules have generated unexpected consequences in several other industries.

Price disclosure also depends on the structure of the medical device industry and it is not likely that mandatory price disclosure would be beneficial to consumers. For one thing the costs are likely to be large, substitution of related products is severely limited in the medical device industry, GPO contracts tend to be rebid every three to five years, and many types of implantable medical devices are specialized. Also, firms do not already know each other’s prices as GPO transaction prices are not publicized and therefore, contract pricing is a closely guarded secret.

Singer in considering the 2007 Transparency legislation is concerned that the external flow of price information contemplated in the proposed legislation would make price information available to rival medical device manufacturers.

Panelist David Nexon, Senior Executive Vice President, AdvaMed, pointed out that confidential contracts are not unique to the medical device industry. His association advocates for greater transparency so that consumers can know value and costs. He also pointed out that it has been shown that medical technology is not driving hospital costs.

For more information, go to or call Chris Fleming 301-347-3944 or Caroline Broder at 301-652-1558.

Nursing and Technology

With future demands for healthcare increasing, it is estimated that the nursing shortage will range anywhere from 400,000 to over one million nurses needed in the U.S. by 2020. Pamela F, Cipriano, Chief Clinical Officer and Chief Nursing Officer at the University of Virginia Medical Center, speaking at the AMIA 2008 Conference held in Washington D.C. on November 11th, pointed out that in order to attract more nurses to the hospital setting, the hospital environment needs to be safe, efficient, automated, and operate with improved communications.

She continued to tell the AMIA attendees that if hospitals were adequately staffed, complications would be reduced, and in the end, hospitals would be able to operate more efficiently and profitably. For example, if a nurse in an acute care setting has eight patients instead of four, the risk of death for the patients’ increases by 31 percent. By adding just one full time RN per patient per day can help to eliminate deaths.

According to Cipriano, nurses today work in hospitals that can be extremely complex, chaotic, and generally operate with partial electronic and paper systems. Added to this environment, many hospitals are using non-compatible technology. The facts are that most hospitals are not able to provide for the rapid retrieval of data at the point-of-care. Today’s lack of technology in hospitals contributes to nurse burnout, retention issues, plus creates safety and quality issues.

Capiriano explained that the Robert Wood Johnson Foundation’s 2005 funding helped the American Academy of Nursing study the issue of using technology in hospitals and how this technology can help nurses in the field and avoid nurse burnout. The project called “Technology Drill Down” looked at how to improve efficiency and find the technological solutions to help improve workflow inefficiencies in the hospital setting. The project initiated discussions at 25 acute care centers representing over 200 sites, and at patient care units involving 1000 participants.

Group participants in the study identified major work categories and at the same time, analyzed their current work environment and process within each work category. The participants envisioned how the work should flow under ideal circumstances. Then the participants identified gaps between the current situation and the ideal environment. Processes that needed to be changed to reach the ideal state were identified and at that point, available technologies were discussed that could fill the gaps.

The nurses were in agreement that technology is absolutely essential to be able to retain nurses and to generally help the workforce. However specifically, they want to see the rapid retrieval of data at the point-of-care, the use of smart voice activated devices—especially wireless devices, the use of technology to do accurate tracking and scheduling, improved interoperable, integrated, and globally accessible communication systems, functionality that eliminates “work arounds”, and more robots used in hospitals.

Nurses would like to see hospital executives and technology vendors listen to the staff when designing and installing equipment. Essentially nurses want to be partners up front in the design of the technology and demand that the vendor’s products be thoroughly developed, tested, and affordable.

NASA Licensing Technology

NASA’s Glenn Research Center has licensed technology to Endotronix, Inc. of Peoria Illinois to help thousands of individuals avoid potentially life threatening complications of hypertension, abdominal aortic aneurysms, and congestive heart failure.

Space communications technology has made it possible to create extremely small antennas for Bio-Microelectromechanical Systems (Bio MEMS). These sensors can be implanted in the body and wirelessly transmit findings to a hand-held device that can power the implanted sensor, retrieve the data, and then transmit the data wirelessly to a computer for assessment and analysis.

The inventors of the technology, Glenn researchers Dr. Felix Miranda and Dr. Rainee Simons, were the first to identify the potential to apply radiofrequency technology to Bio-MEMS sensors. According to the researchers, the technology has the potential to meet NASA’s need to provide non-invasive monitoring for the astronauts health needs such as blood pressure, heart rate, and oxygen during spaceflight.

“The technology enables frequent and accurate monitoring of patient health data in both the home and hospital. Wireless patient health monitoring has the potential to improve healthcare by enhancing treatment paradigms and reducing the overall cost of care,” stated Dr. Anthony Nunez, Co-Founder and CEO of Endotronix.

Endotronix, Inc. is expanding operations in Cleveland, Ohio with the assistance of BioEnterprise and TechLift.

For more information about the Innovative Partnerships Program at NASA Glenn go to

CMS Seeks IT Solution

CMS on November 14, 2008, issued a Sources Sought Notice for Small Businesses to help CMS develop requirements for an IT solution. The main purpose for the notice is to find companies that can eliminate redundant data entry tasks for similar information that goes between two disparate applications. The specific applications include the Audit Racking and Reporting System (ATARS) and the Clarity Priority Project Tracker (CLARITY PPT).

CMS uses ATARS as the primary system for end-to-end audit tracking and reporting. The application is based on PowerBuilder technology software. In the future ATARS may potentially be a Java-based application on a Sun platform but as of yet a decision has not been reached.

CMS uses the CLARITY PPT system to track detailed information about each audit recommendation contained in ATARS where a corrective action plan and related milestones are required.

The specific task is to manually extract, clean, and reformat ATARS data for manual entry into the CLARITY system for tracking and updates. Once the tracking is completed in CLARITY, status information would then be manually transferred back to ATARS.

The Sources Sought response date is December 4, 2008. This Sources Sought Notice is to be used for information and planning purposes only and is not a solicitation announcement for proposals. For more information, go to or contact Renee Wallace Abney, Contract Specialist at, or Christopher Hagepanos, Contracting Officer at