New York Supporting HIT

New York City’s next generation EHRs are now being used by more than 200 primary care providers and providing care for more than 200,000 New Yorkers. The City is on track to equip more than 1,000 local healthcare providers many of them practicing in the city’s poorest and sickest neighborhoods. The plans are to have EHR systems used by more than a million patients by the end of the year.

The Health Department’s Primary Care Information Project led by Assistant Health Commissioner Dr. Farzad Mostashart has developed the new electronic health records with the firm eClinicalWorks. The new software promotes prevention by giving doctors tools that no other commercially available health record now provides.

With $30 million, the Health Department developed the EHRs and offers eligible practices (primary care providers with over 30% Medicaid and uninsured patients) a subsidized package of EHR software and services including licenses, onsite training, data interfaces, and two years of maintenance and support. In return, eligible practices must bear the costs of hardware and network infrastructure and contribute $4,000 to the Fund for Public Health in N.Y. for ongoing technical support. The Health Department is also helping non-eligible practices integrate the new prevention tools into their own EHRs.

The initiative is being supported by a $3.2 million grant from the state and evaluated through $5 million in funding from CDC and AHRQ.

To further develop the use of health IT, (SB 6877) was introduced in the N.Y. state legislature on January 31, 2008 to establish two medical home demonstration programs to be located in Nassau and Onondaga counties. The bill’s purpose is to evaluate the effectiveness of the medical home concept, and Article 27-L S 2799 mandates the use of health information technology and other innovations to support the coordination of care.

The state is also looking for innovative ways to specifically improve the care for chronically ill Medicaid patients. The Department of Health on February 21st made $10 million available under the State’s Medicaid program, so that providers would be able to demonstrate innovative approaches to use to care for chronically ill beneficiaries.

As a result, the State has issued a Request for Proposal for chronic illness demonstration projects and the RFP can be found at www.nyhealth.gov/funding. Proposals are due on April 14, 2008.

CDC Needs Tool for Spina Bifida

The National Center on Birth Defects and Developmental Disabilities (NCBDDD) within CDC is looking at the development of a standardized registry tool to collect and enter patient data into a “National Spina Bifida Patient Registry”. According to the Spina Bifida Association, 70,000 people in the U.S. are currently living with the birth defect.

The care for these individuals is complex involving different organ systems and requiring different clinical specialists. As a result, there is the need for a national infrastructure to support both clinical research and to develop a systematic approach that would improve the quality of care.

NCBDDD will commit $320,000 in funds in FY 2008 to fund eight applications. The average award will be $40,000 for the first 12 month budget period. The total funding for the project is expected to be $960,000.

Eligible organization can include public and private nonprofits, for profits, small, minority, and women-owned businesses, universities, colleges, research institutions, hospitals, community-based and faith-based organizations, state and local governments, American Indian/Alaska Native tribal governments, Alaska Native health corporations, urban Indian Health organizations, and tribal epidemiology centers.

The letter of intent is due March 17, 2008 with the application due April 16, 2008. The start date for the project is September 30, 2008. For general questions email PGOTIM@cdc.gov or go to www.grants.gov.

New EHR Demonstration

A CMS demonstration project to use EHRs to improve the quality of healthcare and reduce errors was recently announced by HHS Secretary Mike Leavitt. The project will be open to small and medium-sized primary care physician practices in a dozen health markets across the country.

Over a five year period, financial incentives will be provided to as many as 1,200 physician practices that use certified EHRs to improve quality as measured by their performance on specific clinical quality measures.

In addition to the incentive payments, bonus payments may be awarded based on a standardized survey measuring the number of EHR functionalities that a physician group is able to incorporate into the practice. Total payments under the demonstration for all five years may be up to $58,000 per physician or $290,000 per practice.

The application period is open through mid May for communities interested in becoming one of the 12 sites. CMS expects to start with four communities in 2008, with the remainder beginning in 2009. One the communities have been selected, CMS will begin working with the communities to recruit physician practices for participation in the demonstration.

Recent State Efforts

The Florida Legislature is considering bill (SB 1998) to create the Florida eHealth Initiative Act with grants for health information organizations and to establish the Electronic Medical Records System Adoption Loan Program. The bill would also create the Florida Health Information Exchange Advisory Council to help implement a plan to promote participation in regional and statewide health information exchanges.

Recently, Florida’s Governor Charlie Crist unveiled the prototype of a handheld case management device to help child and adult protection investigators as well as case managers better document their visits to homes of foster children and vulnerable adults.

This prototype device would enable case workers to respond quickly to the needs of children, be able to access information obtained during visits and interviews in real time, track critical dates for follow-ups and referrals, receive alerts, and be able to prioritize care based upon the severity of need. The Governor has proposed $9.8 million in the budget for 2008-2009 to purchase the “all-in-one” devices.

The Connecticut legislature is considering (HB 5542) to encourage the use of telemedicine to deliver health care services. Section 5 of the proposed legislation would enable the Department of Public Health to establish one or more two year pilot programs to study using telemedicine to treat congestive heart failure, diabetes, and COPD.

The proposed bill would enable the Department of Public Health to issue a Request for Proposal for one or more entities to operate the pilot program. Each proposal submitted would need to include a plan for administering the pilot program and the methods to be used for data collection and reporting. The patient’s medical condition, the patient’s need for high frequency urgent care, the patient’s cognitive ability, if the patient resides in a medically underserved area, if the patient has support from a relative or caregiver, and the patient’s access to telecommunications technology services would need to be considered in the proposal development.

Two new pieces of legislation (HB 2301 and SB 3194) introduced in Iowa would establish an Electronic Health Information Commission to develop a plan for statewide health IT by January 2009. One piece of the plan will need to address how telemedicine can be used to address workforce needs that will be generated by the increased use of health IT.

In Pennsylvania, the December Patient Safety Advisory reported that medical errors can sometimes cause drug overdoses when Smart Infusion Pump Technology is used. Even when computerized systems are used to reduce drug overdoses they can still occur. For example, this can happen when using intravenous high-alert medications like Heparin. The most common reason for the overdose is due to programming the infusion pump incorrectly.

The Advisory also reported that CT scans may affect pacemakers and other implantable electronic devices. Patients can experience a shock during a CT scan if they have an implantable electronic device. This may be due to new more powerful scanners being used to obtain faster scans.

The state of Minnesota recently published the report “Adverse Health Events in Minnesota” with information on activities in education, promoting organizational changes, sharing knowledge, and how to strengthen the reporting system.

According to the report, the web-based registry was modified to collect additional information on where events occur, to better enable analysis of the trends in adverse events by location or specific settings. In addition, the Minnesota Department of Health worked with hospitals to develop a better process for collecting additional follow-up information about reported events.

The Governor of New Jersey’s Commission on Rationalizing Healthcare Resources has delivered their final report. The 13 member Commission was led by Uwe E. Reinhardt, Ph.D an internationally recognized healthcare economist and Princeton’s James Madison Professor of Political Economy.

One section discusses how a full fledged 21st Century Health Information System should operate and gives recommendations on developing and sustaining a health information system. The report recommends that the healthcare information infrastructure be supported with public subsidies, and the state take a leading role in developing the system and financing the R&D. The development and maintenance of the system’s common data base should be heavily government funded even if the actual development and maintenance is delegated to a private entity.

AF General Discusses Telehealth

According to Lieutenant General James G. Roudebush, MD., Air Force Surgeon General, appearing before the House Committee on Armed Services, using telehealth technologies to link radiologists has moved into the forefront with the development of the Air Force Radiology Network (RADNET) Project. The project provides Dynamic Workload Allocation by linking the military radiologists via a global enterprise system.

RADNET will provide access to studies across every radiology department throughout the AFMS on a continuous basis. The goal is to maximize physician availability to address workload regardless of location. The Air Force is aggressively targeting deployment of this capability in FY 2009 to all Air Force sites.

Lieutenant General Roudebush reported that the Telemental Health Project is scheduled to be operational in FY 2009. This project will provide video teleconference units at every Mental Health clinic for live patient consultations. Virtual Reality equipment will also be installed at six Air Force sites to use in a pilot project to help treat patients with PTSD. Using this equipment will enable desensitization therapy to be used by recreating sight, sound, and smell in a controlled environment.

He also mentioned that the joint electronic health record known as Theater Medical Information Program (TMIP) is now visible to all medical providers. Clinicians are now able access the data at every military and VA medical center world-wide using the joint Bidirectional Health Information Exchange (BHIE).

Technology for Neonatal Care

Researchers at the University of Iowa Children’s Hospital are studying how medication barcode scanning can be effectively used in a neonatal intensive care unit that does not include CPOE. This study is looking at not only the effectiveness of how the system could decrease the combined incidence of preventable and potential adverse drug events, but also how the system could be used to measure the reduction in all medication errors, and then determine if the safety gains achieved can be maintained. The hypothesis is that in this environment, barcode scanning may reduce preventable and potential adverse drug events by at least 45% and still be maintained.

In another research project, Moberg Research Inc in Ambler Pennsylvania with support from the National Institute of Neurological Disorders and Stroke is developing a neonatal EEG monitor that has the capability to use accurate analysis methods to enable earlier detection and management of brain injury in the neonatal population. The monitor could help make care decisions, measure treatment success, would enable more widespread monitoring of the brain status in newborns, and generally promote improved outcomes.

The monitor would have the capability to do complete EEG reviews with verification by clinicians. This would enable more accurate prognoses of neurologically at risk newborns to be done. Unlike adults, neonates cannot undergo traditional mental status testing. Presently, the use of EEG is well established as a means to characterize the health of the cerebral cortex in neonates. However, the availability of expert neonatal EEG interpretation is very limited and at present is available at relatively few specialized pediatric centers in the country.

HRSA Comments on HIT

HRSA in the September 2007 Federal Register had asked for comments on what strategies should be used to support HIT among safety net providers. Comments were requested on improving quality, collaborating, general network-related issues, HCCNs sustainability, and building HIT capacity. HRSA received 53 comments from a broad range of stakeholders, including state health departments, non-profit organizations, healthcare providers, and from the health information technology industry.

Some of HRSA’s responses to the many comments appeared in the January 25, 2008 Federal Register such as:

• HRSA is using the HCCN model for HIT adoption because of the HCCN business model in terms of cost efficiencies, the ability to attract competent staff, and the ability to strengthen health center operations in the marketplace

• OHIT will continue to foster collaboration among the telehealth network grantees and HCCN grantees. OHIT has interest in HCCNs with at three organizations, large multi-site health centers, and both urban and rural networks

• HRSA is addressing effectiveness, efficiency, and safety to measure the impact of HIT on quality and views HIT as a tool to use to improve the quality of care. While registries can provide quality improvement, two factors such medication error prevention and live clinical decision support may not improve quality with the use of registries. OHIT and the Center for Quality are working together on efforts for the adoption of HIT and for quality improvement

• HRSA is working internally across bureaus, programs, offices, and externally with other agencies, existing grantees, associations, networks, and other partners to develop new reporting requirements for clinical outcomes and other program data

• Over the coming year, OHIT will collaborate with BPHC to provide TA to health centers through OHIT’s Telehealth Resource Centers and BPHC’s State and National Technical Assistance Cooperative Agreements. The collaborations will address the challenges and opportunities for health centers to use telehealth services in underserved urban as well as rural communities. Also, HRSA has developed an internal HRSA HIT Policy Council to enhance communication and collaboration across all of its offices and bureaus

• Telehealth is a critical component in HRSA’s HIT strategy. OAT initially focused on rural communities but now a greater emphasis is placed on both urban and rural applications for telehealth technologies

• Some of OHIT’s activities include developing a Telehealth Technical Assistance toolbox available over the web to assist health centers in deploying telehealth services to their communities, and awarding 3 three year OAT grants to support telehealth based home services

• The telehealth networks are working to integrate EHRs into their services but this is difficult because of the lack of interoperability among the various health information systems

• HRSA has created a special portal for health centers as part of the AHRQ HIT Resource Center to share information on best practices, literature, and funding opportunities HRSA is including HIE within funding opportunity announcements to promote innovative practices. HRSA realizes that no one source of funding will be sufficient to pay for EHRs and other HIT initiatives. Sustainability after Federal funding will be expected, and grantees will need to move to self-sufficiency within the project period
  

Sensors to Measure Blast Impacts

While it may still be years away, military medical officials hope to place a sensor on every soldier to be able to measure the impact of a blast while alerting a combat medic to the possibility of a brain injury. According to Michael J. Leggieri Jr, Deputy Coordinator for DOD’s Blast Injury Research Program, fitting helmets with blast sensors that would be used in combat would be the first step to gathering needed data.

The sensor data would be recorded along with other operational data that is typically gathered after an event such as a bomb explosion. The data would be entered into the National Ground Intelligence Center already being used in the field. At the same time, if an injury occurs, the patient data already recorded in a trauma registry is in place.

“The helmet sensors are not medical devices, and the data is not medical data, so it will not be possible for anyone to take the raw sensor data and make any kinds of decisions about medical treatment, or injuries,” Leggieri said.

After the blast data is studied and if found reliable, then the event data will be matched with injury data. The medical community will have access to the data through the Joint Trauma Analysis and Prevention of Injury in Combat Program. Officials want to see if they can make a connection between what is seen on the sensor reading and any resulting injury.

Similar devices could be used in football player’s helmets and if the athletic is hurt, a doctor would be signaled to review the situation. If the devices are used in combat, leaders on the ground could use the data to refer the service member to medical officials who would then use diagnostic tools to determine if an injury occurred.

The Federal government is investing in traumatic brain injury research through DARPA, Office of Naval Research, and the congressionally mandated DOD Traumatic Brain Injury Multidisciplinary Research Consortium Award, which is run by the U.S. Army.

The John Hopkins University, Applied Physics Laboratory has been working on the blast effects on the body for several years. The Biomechanics Section at APL uses a sensor-laden, artificial torso to model how internal organs react to blasts, and the researchers are now developing a head and neck that will help model what goes on inside a skull when it is exposed to a blast.

The company Simbex through SBIR research and development funding was able to develop Head Impact Recording Technology for Field Applications. The system is able to measure head impacts in real-time, and has impact sensors, a processor and transmitter. This technology can transform any helmet or headgear into a head impact monitor.

A data collector receives impact data continuously from the encoders that can be a distance away and is able to monitor dozens of soldiers or helmeted team athletics simultaneously. The software analyzes the data and sends a pager warning if the impact is potentially serious.

Capitol Hill News

Robert T. Howard, Assistant Secretary for Information & Technology, Department of Veterans Affairs, appeared before the House Committee on Veterans Affairs on February 13th to focus on the VA IT program. According to the Secretary, the VA has faced challenges in the move toward a centralized IT Management System, but the IT capability within the VA has been reinvigorated. Now all IT staffing, equipment, and budgetary resources are under the VA Chief Information Officer with oversight across all IT activities in the Department.

The “veteran facing IT” systems and the “internal facing IT” systems comprise the VA system. The “veteran facing IT system” supports programs to provide medical care, deliver compensation benefits, pension benefits, educational opportunities, vocational rehabilitation, and employment services. This program accounts for $1,295 billion of the budget request.

The “internal facing IT” systems are those that require a more effective management of IT resources such in financial resources management, asset management, human capital management, IT infrastructure, and information protection. This budget request totals $418 million.

Some of the VA IT activities include:

• Standardization activities supporting VA/DOD sharing will establish a common architecture to eliminate redundancies in coding, support common terminology sources between applications, and promote software and data use

• The Scheduling Replacement project will improve access, decrease wait times for appointments, and increase provider availability. The first version will be in place at the VA Medical Center in Muskogee, Oklahoma during June 2008, and in FY 2011, the VA anticipates the national rollout to all VA sites

• The Laboratory System Reengineering will provide the VA with a modernized Laboratory Information Management System. In FY 2009, the system will undergo independent verification and validation, plus field tests. The FY 2009 funding is needed to acquire 20% of the equipment needed for the deployment. National deployment will begin in FY 2010 and will be phased in over five years

• The pharmacy suite of applications is undergoing modernization and pharmacy software modules will be replaced with new technology through reengineering, new development, and the purchase of commercial products. Plans are to deploy enhanced order checks in FY 2009, which will improve patient safety standards by reducing adverse drug events by 50%

Activation of new VA facilities will bring new requirements for IT and assets. Some of the needs will be for desktop computers, mobile devices, laptops, etc. By FY 2009, the VA will have 51 new community- based outpatient clinics available. In addition, there are currently 209 readjustment counseling vet centers with more projected to be opened during FY 2008. Both of these facility types will require additional IT equipment.

New legislation “Technologies for Restoring Users Security and Trust (TRUST) in Health Information Act, (H.R. 5442) was recently introduced by Representatives Edward J. Markey (D-MA) and Rahm Emanuel (D-IL). The TRUST Act would promote IT while protecting privacy and security. Specifically, the proposed legislation would enable patients to keep their medical records out of health IT systems unless they give their consent, would require notification if the patient’s health information is exposed, and mandates the use of encryption and other technologies to prevent unauthorized access.

The TRUST Act would also authorize grant funding to be used to purchase qualified health IT systems. The Act would establish a public-private partnership to make recommendations concerning health IT standards, and develop the criteria for the electronic exchange of personal health information to encourage a nationwide interoperable health information technology infrastructure.

Recent State Legislation

Several states have recently introduced legislation in New Mexico, Iowa, Oregon, and Oklahoma on topics related to health technology.

Bill Richardson Governor of New Mexico in his state’s Health Solutions Plan wants to see the use of electronic medical records ahead in the state. The plan in general has gained support from businesses, healthcare providers, the Women’s Health Advisory Council, the NM Medical Society, and other groups in the state.

The bill HB 37 was introduced in the NM House Health and Government Affairs Committee in January to help control costs in healthcare and to increase quality by implementing a plan to maintain, use, and protect electronic medical records. On January 22, 2008, HB 37 was unanimously passed by the House Committee.

In February two bills (HSB 636 and SSB 3140) were introduced in the state of Iowa to establish the Iowa Health Care Coverage Exchange. As part of the requirements for the Exchange, all participating healthcare providers would have to use electronic medical records. Information technology would be used to support optimal patient care, performance measures, patient education, and to enhance communications.

The state legislature of Oklahoma, is considering (SB 1719) to create the Task Force on Health Information Technology. The Task Force would study existing state and federal health information technology initiatives, identify health IT needs in the state, and examine strategies for integrating health IT into state public health systems.

The bill (S 1712) submitted to the Oklahoma state legislature would establish an online web site to help consumers find the most affordable prescription drugs. The online site would be called the Oklahoma Prescription Drug Retail Price Registry, otherwise to be known as the Consumer’s Choice Registry. The site would enable consumers to search retail prices at state pharmacies for the 150 most prescribed pharmaceuticals. All of the pharmacies in the state would be required to routinely submit retail prices to the site to be administered by the Oklahoma Department of Health.

UC Berkeley Researching Devices

The Center for Information Technology in the Interests of Society (CITRIS) at the University of California campuses (Berkeley, Davis, Merced, and Santa Cruz) is involved in health IT research. Studies on exchanging medical records and developing and using IT for telemedicine are ongoing.

John Canny at UC Berkeley and his researchers are working on integrating diagnostic medical devices with network technologies in an all-in-one device. A device developed in the current research program monitors EKGs, EMG (back muscle activation), GSR (galvanic skin response—a stress reducer), chest sounds, temperature, and movement.

The researchers want to see the all-in-one device provide longitudinal monitoring for the early warning of more serious conditions. As a Bluetooth device, the goal will be to gather data without network connectivity for daily upload to another Bluetooth device. But at the same time be able to communicate with specific cell phones from Bluetooth for real-time monitoring.

The next step for UC Berkeley is to find partners to explore home and clinical applications for the device by developing data analysis and visualization tools for these applications. The research program is specifically interested in home wellness monitoring, using telemedicine in developing regions, and crisis reporting and analysis.

Grant to Help the Disabled

The Department of Special Education within the Department of Education, seeks grant applications for Disability Rehabilitation Research Projects (DRRP). There is an important need to provide care coordination for individuals with physical disabilities. The DRRP program is working to develop methods and rehabilitation technologies to help individuals with the most severe disabilities.

Grant applicants must meet the DRRP priorities and applications for projects will be considered that would provide healthcare coordination, traumatic brain injury model systems, technology transfer, and supply technology to environments with limited resources.

Applicants are eligible to apply from states, public or private agencies and this includes for profit agencies, and public or private organizations including IHEs, Indian tribes and tribal organizations.

The funding will be $300,000 for one grant and cost sharing or matching is required but will be negotiated at the time of the grant award. A pre-application meeting on possible projects involving healthcare coordination, technology transfer, and supplying technology to environments with limited resources will be held via a conference call. The meeting on developing traumatic brain injury model systems will be held separately. The closing date for the applications is April 01, 2008.

Go to www.grants.gov for more information, or contact Donna Nangle at 202-245-7462, or by email Donna.Nangle@ed.gov.

Budget Discussed on the Hill

Key hill staffers, a leading HIT administration official, and the Vice President for eHI, spoke to a packed room at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics lunch session on February 6th. The speakers focused on the President’s FY 2009 HIT-related budget and future legislative possibilities.

According to P. Jon White, MD, Health IT Director, the health IT budget at AHRQ for FY 2009 is $44.8 million the same as FY 2008 with $7.5 million in grants. Dr. White explained that AHRQ’s four broad goals are to improve medical management, provide engineered clinical knowledge, deliver patient-centered care, and enable quality measurements.

Some of these goals are accomplished through grants and contracts. For example, the National Resource Centers for Health IT are helping the healthcare community deal with the information age. The Centers provide direct technical assistance and consulting services to AHRQ projects.

AHRQ awarded 5 contracts in 6 states to support State and Regional Demonstration projects. These projects are in place to support statewide data sharing and interoperability activities on a state or regional level.

AHRQ’s report to Congress included information on a joint CMS and AHRQ electronic pilot program to support the adoption of new electronic prescribing standards. The pilot was conducted in 5 sites in 8 states to test initial standards to see if the standards were ready to be adopted. As reported to Congress, the pilot program showed that the initial standards were already capable of supporting e-prescribing.

Christine Bechtel, Vice President of Public Policy, eHealth Initiative presented an overview of the FY 2009 Budget request. The request for $66 million for the Office of the National Coordinator for Health IT is an increase of $5 million over FY 2008 but still significantly less than last year’s administration request for $114 million. Overall, the HHS budget would decrease by 2.1% under the President’s budget proposal.

The proposed ONC budget would establish a successor to AHIC, develop standards and implementation for health IT through HITSP, make efforts to ensure appropriate Federal privacy and security protections for electronic health information, support state consensus efforts to address patient protections, develop the NHIN at $26 million, and certify Health IT products through CCHIT.

On the Senate side, Dana Halverson, Health Legislative Assistant for Senator Kent Conrad (D-ND) Chairman of the Senate Budget Committee, started by telling the attendees that the Senator wants to thank Neal Neuberger for the time and effort he has spent over the past 16 years to coordinate and develop the sessions and technology demonstrations for the Steering Committee.

Looking ahead, she said, although the legislation “Wired for Health Care Quality Act” to establish an interoperable health IT system did not pass in 2007, the goal in 2008 is to bring the legislation up again and to deal with the privacy issues.

Katie Oppenheim, Health Legislative Assistant for Senator Mike Crapo (R-ID,) said the Senator is very involved in telehealth and wants to see the program Telehealth Idaho broaden and expand resources to keep helping the people in the rural areas in the state to improve their access to healthcare.

Jordanna Levinson, Health Legislative Assistant for Senator Sheldon Whitehouse (D-RI), reported that DEA has made progress on regulations lifting the federal prohibition against electronic prescriptions for certain medications classified as scheduled drugs.

According information released by her office, the Senator is happy to see DEA acknowledge the need to move forward with new rules and is going to watch the situation closely over the next several months to make sure that this process stays on track. However, the officials at DEA report that they can’t predict how long the approval process will take since both OMB and the Department of Justice are required to review the proposed rule.

She also mentioned that the Senator is very actively involved in other HIT issues. Three bills (S 1451, S 1455, and S 1471) were introduced last year. The Senator wants to see the establishment of a public corporation to advance HIT that would spin off into the private sector, a bill to fund quality grants, and another bill to deal with reimbursement reform.

On February 7th, Senator Whitehouse (D-RI) spoke on the Senate floor concerning HIT issues and reported that the RAND Corporation estimates that a national interoperable HIT system could save $81 billion per year. He believes that we must not only develop a national interoperable secure HIT infrastructure, but we must also invest properly in quality and prevention, and at the same time, address how we will pay for this system.

He emphasized that health IT adoption alone will not stop our huge healthcare costs but we have to do something because more American families are bankrupted by healthcare, doctors are furious, and the paperwork is choking the system.

The Rhode Island Quality Institute has made a great effort to reduce the number of hospital-acquired infections. Similar efforts are ongoing in Washington State and in Utah. The Senator said “we need to get behind all of these state and local efforts.”

The Senator explained that when his state started the ICU reform, he talked to the Hospital Association. They estimated a $400,000 cost per intensive care unit but as much as $8 million could result in savings, a 20 to 1 payback. The Senator said the problem is that all the savings go to the insurers, so as a result, reform is very much an uphill battle.

On the House side, Mike Quear, Staff Director, House Science and Technology Subcommittee on Technology and Innovation, was very pleased to see the science workforce bill (HR 1467) pass the house but wants to see the bill move through the Senate. He said several changes have to be made to get healthcare professionals to embrace health IT. One of the barriers is the lack of trained workers in the field, and secondly, software developers work alone and don’t always design the appropriate needed healthcare systems. Quear emphasized that Congressman David Wu wants to see practitioners not only trained to use technology but also to develop products that fit the needs.

In another legislative effort, Chairman Bart Gordon (D-TN) of the House Science and Technology Committee introduced (HR 2406) on October 2007 to authorize NIST to increase efforts to support the integration of the healthcare information enterprise. Quear said, “NIST would still support AHIC and not circumvent AHIC 2.0.” Efforts are also underway to work on additional targeted bills to deal with privacy and the payment system.

Nandan Kenkeremath, Professional Staff, House Energy and Commerce Committee, raised some concerns as to how providers and patients should deal with specific information in electronic medical records. One of the questions is how will providers deal with genetic information in their actual practices? Will providers need prior patient consent in order to use genetic information in every case? Using genetic information is a very complicated issue. One of the solutions is to separate out specific medical information, but if the information is separated out and moved around in electronic records, then more medical errors may result.

Information in records that can help researchers also presents problems to providers. Medical researchers sometimes find that non-identifiable information can be vital for their use in their studies. However, is it always necessary to get a release for non-identifiable data? If the consent is needed, how do we inform patients on the need for the research so that they will give their consent?

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

The next session at noon on Wednesday March 5th, will discuss “HIT Projects to Improve Access for Low Income Persons and the Uninsured: Safety Net Providers Step up to the Plate”. The briefing will take place in the Senate Russell Building, Room 385. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email nealn@hlthtech.com.

VA FY 2009 Budget Request

The Secretary of Veterans Affairs, Dr. James B. Peake, reported that the President is seeking $93.7 billion in FY 2009 for the Department. The budget requests $2.4 billion for the Department’s IT program. This is $389 million (19% above the 2008 budget) and reflects the realignment of all IT operations under the control of the Chief Information Officer. The VA will expand the telehealth program to improve access to healthcare for veterans living in rural and remote areas. In 2009, the Department expects to treat 5.8 million patients which is an increase of 1.6% over 2008.

Highlights for the FY 2009 budget request include:

• $26,260 billion for acute care which includes inpatient acute hospital care, ambulatory care, and pharmacy services. The VA is expecting to fill 126 million prescriptions in 2009
• $3,861 billion for mental health to support inpatient and outpatient mental health programs
• $1,455 billion for the purchase and repair of prosthetics and sensory aids
• $4,820 billion for long term care to provide care in the least restrictive and clinically appropriate setting and to provide veterans with care closer to where they live. The VA is requesting $762 million or a 27.6% increase in non-institutional care
• $1 million for the Office of Rural Health to do studies on the current status of VA rural health programs and to develop policies and programs to meet the needs of rural health veterans
• $93 million to support the cyber security program to enhance data security
• $284 million to develop and implement the Veterans Health Information systems and Technology Architecture. This includes a health data repository, a patient scheduling system, and a reengineered pharmacy application. These applications are directly tied to programs which are intended to enhance or replace existing programs

HIT Planning Grants Available

HRSA, Office of Health Information Technology announced on February 06, 2008, that FY 2008 Health Center Controlled Networks funds are available. This funding will help the networks of health centers do planning activities to lead to HIT adoption. The estimated funding is expected to be $600,000 for 4 awards. The average size of each award is not to exceed more than $125,000. The grant application deadline is April 15, 2008. Public and non-profit organizations including faith-based and community-based organizations are eligible to apply.

Planning activities for EHR adoption can include:

· Conducting HIT readiness assessments
· Doing workflow analyses
· Using due diligence to select a vendor
· Doing business planning and market place assessments
· Determining specific network HIT functions
· Doing system upgrades to be able to join a network or to launch a HIT initiative
· Developing telehealth services
· Doing the initial stage of collaboration with partners

Some possible HRSA funding can include:

• If a network of health centers are ready to purchase an EHR system, but needs funds to help do an EHR readiness assessment and help with the procurement process, then funds may be available
• If funding is needed o upgrade systems to be able to join an existing network
• If an existing network of health centers wants to from a HIE with other state partners and needs funding to do a market assessment, establish a MOA with potential partners, or engage in marketplace and business planning, then funds might be available
• If an established network of health centers wants to develop clinical telehealth services to expand access to, coordinate, and improve the quality of healthcare services in the network

A pre application conference call will be held on March 12, 2008 at 2 pm. The call in number is 800-857-6258, and the pass code is 2058611. The replay number is 800-327-0221. For more information, go to www.grants.gov or contact Judy Oliver 301-594-4465, or email joliver@hrsa.gov.

FY 2009 Budget Request for HHS

On February 4th, Secretary Michael Leavitt detailed the President’s FY 2009 HHS budget request. The HHS FY 2009 budget request outlays $737 billion which is a net increase of $29 billion over the estimated outlays for FY 2008.

Key budget highlights are:

• $66 million for the Office of the National Coordinator for Health Information Technology, an increase of $6 million over FY 2008. The funding establishes the AHIC as an independent and sustainable public-private partnership, supports the development of health data standards, finds solutions for privacy and security in electronic health information exchange, and supports the testing of standards and services to exchange health information across geographic borders
• $40 million for the Office of Civil Rights an increase of $6 million over FY 2008. The budget includes an additional $2 million to improve critical HIPAA compliance and enforcement operations. OCR provides policy support to HHS and is an active participant in the development of standards for a national health information infrastructure. OCR is improving patient safety by establishing and enforcing confidentiality protections under the PSQI Act of 2005
• $29.5 billion for NIH. This is the same as FY 2008. These funds will enable NIH to continue to pursue cross-cutting research and continue to refocus programs for translating clinical research results into clinical practice. In FY 2009, NIH estimates it will support a total of 38,257 research project grants, including 9,757 new and competing awards which are approximately at the same level as FY 2008
• $5.9 billion for HRSA, a decrease of $992 million below the FY 2008 request. The HRSA budget request emphasizes direct medical care and expansion of the Health Centers program. In addition, HRSA will focus on placing health professionals in medically underserved areas. The budget request for HRSA reduces funding for rural programs by $87 million from FY 2008. A PART assessment found that there are programs similar to other HHS programs that provide resources to rural areas. The request for telehealth is $7 million
• $336 million for AHRQ a $9 million decrease from FY 2008. Funding is maintained for comparative effectiveness research, development of new research tools, and to provide transparency on healthcare quality and costs. The budget also supports patient safety by investing in health IT and includes $32 million to support a variety of patient safety activities such as developing a network of patient safety databases.
• $711.2 billion for CMS in mandatory and discretionary outlays, a net increase of $32.7 billion over the FY 2008 level. $3.8 million is included in the budget request to help to further adopt health IT by continuing a demonstration project. The demonstration project provides financial incentives for up to 1,200 physician practices to adopt certified EHR systems. Starting August 1, 2008, approximately $1.1 billion will be provided to Quality Improvement Organizations to start the next three year contract cycle. In the 9th SOW, clinical care efforts will focus on four major themes to include prevention, patient pathways, patient safety, and quality of care complaints.
• $8.8 billion for CDC and the Agency for Toxic Substances and Disease Registry, a decrease of $412 million from FY 2008. The request includes $50 million which is an increase of $16 million for BioSense the human health surveillance system. The funding would help CDC implement connections with emerging Regional Health Information Organization and Health Information Exchanges to implement case-based surveillance. The budget also includes $7 million for continued real-time lab reporting. The CDC budget for Health Information and Services includes $284 million for health statistics, health marketing, and public health informatics. The informatics program requests $71 million which is the same as FY 2008 to continue defining the needs for public health information systems, and to design information systems and software to expand the capabilities of public health
• $2.4 billion for FDA, a net increase of $130 million over FY 2008 with $291 million in the budget to ensure the safety of medical devices. This is an increase of $7 million over FY 2008
• $4.3 billion for the IHS. The budget request includes $58 million for Public Health Nursing to provide for health screenings, home visits, chronic disease care and case management. The budget targets funding for healthcare for Indian people living in isolated areas on or near reservations that do not have ready access to services outside the IHS system. The budget does not include funds for the Urban Indian Health Program
  

The Health Information Initiative promotes Federal efforts to implement health IT systems and products to meet recognized interoperability standards and to increase the transparency of healthcare costs and quality. HHS achieved a Green progress rating for the Initiative in FY 2007. This rating recognizes accomplishments such as developing recommendations for Federal agency health IT capital investment activities, and for providing draft contracting language requiring that as health IT systems are acquired, implemented, or upgraded, standards recognized by the Secretary be implemented.

Rural Health Research Studies Funding

HRSA announced funding for the “Targeted Rural Health Research Grant Program”. The funding will be used to support rural health research studies on a selected number of topics. Grant recipients will conduct policy-relevant research on rural health services as they relate to rural health clinics, public health workforce, oral health, and HIT implementation. HRSA will provide funding during FY 2008 for approximately $750,000 to fund up to 5 new awards. The maximum amount per award is $150,000, and the funding will be for an 18 month project and budget period.

Eligibility is open to any public, private, and non-profit organization. ORHP also funds a 5 year Rural Health Research Center Cooperative (RHRC) agreement which will be competitive again in FY 2008. While the applicant pools for RHRC and the Targeted Rural Health Research Grant program generally do not overlap, applicants may apply for both programs.

The rural health research areas to be funded include:

• Rural Health Clinics in terms of finance, utilization, and service mix
• Frontier Health Services Delivery
• Emergency Medical Services
• Rural Health Leadership
• Allied Health Workforce
• Public Health in terms of finance, HIT, and coordination

The application for the grant program became available on February 1, 2008 with the grant application due April 02, 2008. The projected award date is September 1, 2008 with the project end date to be August 31, 2010.

For more information, go to www.grants.gov or contact Erica C. Molliver at emolliver@hrsa.gov.

NRHA's Health Policy Institute

The attendees at the NRHA 19th Annual Rural Health Policy Institute 2008 held on January 28th and 29th came to Washington D.C. to learn about Federal agency initiatives and to meet with Senators and Representatives to discuss critical health needs in rural areas. According to Tim Fry, Government Affairs Manager, National Rural Health Association, healthcare issues are not at the top of the agenda due to all of the other issues our country faces such as the war, energy policies, and the economy.

Marcia Brand PhD, Associate Administrator, Bureau of Health Professions, announced that Tom Morris is now the Acting Director for the Office of Rural Health Policy. She recounted how ORHP worked on several programs with several agencies. For example, the ORHP staff discussed interpretive guidelines with CMS, communicated with SAMHSA on mental health research, collaborated on a special project with the HIV/AIDS Bureau to coordinate care, and worked with the VA to help rural veterans. In addition, the staff at ORHP worked on quality issues and opportunities, focused on HIT models, highlighted workforce needs, and expanded research on rural pharmacy issues.

Dr. Brand mentioned several meetings that will take place in the next few months. The National Advisory Committee on Rural Health and Health Services will meet February 20-22, 2008 in Washington D.C. to discuss new programs. The Bureau of Health Professions will hold a meeting February 25-27, 2008 to bring grantees together to discuss national health professions education and workforce needs, plus an All Advisory Committee meeting will be held in May.

The major NRHA 2008 Policy Institute goals are to have Medicare provide key rural provisions, achieve proportional representation on MedPAC, protect the physician fee schedule from devastating cuts, provide adequate funding for the rural health safety net, and provide the means to train future rural health professionals.

NRHA Policy Institute presented their 2008 legislative and regulatory agenda at the meeting so that Congress, Federal regulatory agencies, the White House, States, and the healthcare industry will be able to address the issues.

The NRHA legislative and regulatory agenda includes areas related to telemedicine and telehealth include:

• Reimbursement for telehealth should be made based upon medical effectiveness and utilization and not upon particular delivery programs or locations. The NRHA supports Medicare reimbursement for telehealth consults using store-and-forward technology


• Medicare should reimburse telehealth when it is provided by licensed or credentialed provider otherwise eligible for Medicare reimbursement


• Telemedicine payments should provide for delivered services including a technical fee to help facilities cover costs associated with the technology used


• Regional and National Telehealth Resources funded by the Office for the Advancement of Telehealth should be supported and expanded


• Federal and state funding needs to address strengthening and integrating emergency medical services with rural healthcare services and providers. Federal funding needs to support innovative demonstrations, improved training, research activities, telehealth, address preventive health, and provide personnel recruitment for rural and frontier areas


• NRHA supports expanding the Universal Service Program to more appropriately fund telehealth


• The NRHA supports the VA’s efforts to increase care for rural veterans through telehealth systems especially for sub-specialty care as in the case of mental health services. NRHA supports full funding for the Office of Rural Health in the VA

NRHA supports other technology issues related to rural health:

• Federal agencies should support providers, state EMS, and state offices of rural health through policy development, data systems, appropriate curricula, and access to grans


• Congress should require vendors of information systems used in rural communities to incorporate national standards for HIT into their systems


• Federal and state government should provide for the infrastructure and policy framework needed to allow for regional networks


• Liberalization of the Stark Laws should be considered to allow rural hospitals to serve as the hub for a rural network


• Existing and new funding mechanisms need to be put into place. Funding should be provided to support the expansion, upgrading and/or renovation of rural health facilities, including HIT and ambulance services


• A strong public health infrastructure should be developed with access to advanced communications systems and technologies to serve rural communities in the event of a bioterrorism event, for disease surveillance, and to better manage public health emergencies.


• NRHA wants to see proportional rural representation on all federal healthcare related commissions, task forces, and advisory groups


• Funding needs to be provided to support demonstrations, and to perform comprehensive evaluations of state efforts to expand access to oral health services to rural and frontier populations
  
  For more information, go to http://www.nrharural.org/ or email Tim Fry at fry@nrharural.org.

SBIR PHS 2008 Solicitation Available

The PHS 2008-2 Omnibus Solicitation for SBIR/STTR grant applications for NIH, CDC, and FDA recently opened. NIH is interested in numerous topics addressing new technologies. In general, there is interest for small research companies to develop software and hardware, biosensors, monitoring systems to be used at the point-of-care, telehealth and ehealth technologies, medical devices, to do research in biomedical informatics, new tools to analyze clinical trial results and transmit the data, new imaging capabilities, virtual reality applications, assistive technologies to use for the disabled, effective databases to collect extensive medical information, plus develop other technologies for other applications.

These SBIR/STTR topics focus on telehealth, ehealth, health IT and other closely related technologies:

• The National Institute of Biomedical Imaging and Bioengineering seeks telehealth software and hardware to use in situations with broad applications as well as in specific focus areas


• The National Institute on Drug Abuse wants to see the development of ehealth software and hardware to promote the efficacy and safety of clinical trials being done to study substance abuse. NIDA wants to see ways that telemedicine can be used to disseminate drug addiction research findings to primary healthcare providers. NIDA is also interested in the development of an electronic drug abuse treatment referral system


• The National Institute of Nursing Research seeks telehealth technologies to improve patient outcomes. NINR wants to be able to assess traumatic injury severity at remote sites and transmit this information to acute care settings, be able to communicate vital signs and symptoms for home-based clients to healthcare providers in distant locations, and be able to tailor care for diverse patients in a wide variety of settings. The NINR is seeking biological and behavioral monitoring devices for patients at-risk living in underserved populations in rural and frontier areas


• The National Institute of Mental Health seeks technology to enable neuroscientists to electronically interact with colleagues and provide data at a distance. NIMH is also interested in developing capabilities to monitor and analyze the behavior of children using video or telemetry systems


• The National Cancer Institute is looking for ways to better use telemedicine and remote imaging for early cancer detection, screening, and diagnosis in underserved communities. NCI’s Center to Reduce Cancer Disparities is looking for communication technologies to help professionals deal with health literacy


• The National Heart, Lung, and Blood Institute is interested in health IT to be able to adopt and implement asthma clinical practice guidelines. NHLBI wants to see research done to better develop information systems to coordinate patient management, use point-of-care devices to monitor patients, plus help patients adhere to medical regimens

Go to http://grants.nih.gov/grants/funding/sbirsttr1/2008-2_SBIR-STTR-topics.doc for complete information on all of the topics. The closing dates for 2008 submissions are April 5, August 5, and December 5. For more information on the program, go to http://grants.nih.gov/grants/funding/sbir.htm (NIH Office of Extramural Research).