Sunday, June 29, 2008

Capitol Hill News

As reported by the Center for Telehealth & E-Health Law, the Senate and House spending bills boost telehealth funding. Both the Senate and House appropriations committees released FY 2009 spending bills that will increase funding for the Office for the Advancement of Telehealth to $7,100,000 from a FY 2008 level of $6,700,000, while the Senate bill would increase OAT funding to a full $8,000,000.

In other actions, the “PRO(TECH) T Act of 2008 introduced on June 24, 2008 by John D. Dingel (D-MI), Chairman of the House Energy and Commerce Committee and Joe L. Barton of Texas was forwarded to the full Committee by voice vote. The Act encourages the adoption of HIT and protects the privacy and security of health information. The bill would help by authorizing funds over five years for grants and loans so that health providers would be able to buy hardware and software for health IT systems.

The Act provides for the adoption of standards to allow providers to exchange health information on their patients. Advisory panels would be established to advise on technical standards and once the advisory committee decides on these standards, then the government would be required to adopt the technology.

In addition, the legislation makes ONCHIT permanent and encourages the use of health information technology for each patient by 2014. It would further protect the security and privacy of an individual’s health information by requiring notification when a patient’s personal health information is breached.

On June 23, 2008, Representative Charles W. Boustany, Jr, MD, (R-LA) introduced the “Patient Controlled HealthIT Act (HR 6345) to establish a demonstration project to provide financial incentives to encourage the adoption of interactive PHRs and to encourage HIE networks to link the clinical data to the PHRs. Representative Boustany a former cardiothoracic surgeon introduced the bill to spur investment in health IT. The bill was referred to the House Committee on Energy and Commerce.

The “Promoting Health Information Technology Act of 2008” (HR 6179) introduced on June 4th by Representatives Dave Camp from Michigan and Sam Johnson from Texas seeks to utilize public private partnerships and tax incentives to help the adoption of HIT.

A practice of five physicians could easily spend upwards of $200,000 to implement an electronic health record. To speed adoption, the PHIT Act would allow physicians who purchase HIT to deduct a larger portion of this business expense more quickly. The Act would also eliminate the arbitrary 2013 sunset HHS has placed on hospitals providing physicians with software for electronic health records.

The Act makes recommendation for HIT standards, and requires the HHS Secretary to develop a strategic plan for implementing technology and privacy standards among all federal entities involved in the development of HIT. The legislation would also establish an expedited process to approve modifications for existing standards.

The legislation would strengthen telehealth in several ways. Section 303 in the legislation would help to provide telehealth services across state lines, calls for a study on expanding home health and related telehealth services, examine how to pay for home health telehealth services, and look at ways to expand the list of sites to include county or public mental health clinics.

The legislation requests a study done by the Office for the Advancement of Telehealth to report on the use of store and forward technology for telehealth. This study needs to include an assessment of the feasibility and the costs for expanding the use of these technologies.

WI Moving Ahead on Tech

On June 24, the Governor of Wisconsin Jim Doyle made the announcement that nearly $1 million in grants from Wisconsin’s Universal Service Fund Telemedicine program will be awarded to several non-profit health organizations around the state. The grants will help clinics purchase telecommunications equipment to promote advanced medical services especially to underserved areas.

The non-profits are going to use the funding to provide education and training, purchase telehealth units to use in emergency rooms, purchase AEDs and cell phones to communicate with the AEDs, use funding to expand psychiatric services, to establish remote pharmaceutical dispensing, to purchase home health monitoring systems, videoconferencing equipment, point of sale systems, pharmacy workstations, and computed radiology systems.

In March 2008, the Public Service Commission awarded $450,820 in grants to 23 nonprofit organizations in Wisconsin to facilitate affordable access to telecommunication and information services.

Also in March 2008, the Commission made an application package available for the Telemedicine Equipment Grant Program for FY 2008 and 2009. Due to budget uncertainties, the Commission decided to solicit grant applications for both the current fiscal year and the next fiscal year. Available grant dollars to award for the combined years are likely to range between $500,000 and $1,000,000.

In another move to help the state, the Governor announced that Ministry Health Care will begin using an electronic health record software suite developed by Marshfield Clinic. Karl Ulrich M.D., President and CEO Marshfield Clinic said “I am gratified that the agreement extends our “CattailsMD” system to Ministry Medical Group facilities.”

As part of the agreement, Marshfield Clinic will provide planning, project management, implementation, training, customer service and technical support services to facilitate the installation of the clinical software applications.

“CattailsMD” is the first provider-developed ambulatory EHR in the nation to achieve CCHIT certification and the system is used daily by more than 13,000 providers and support staff to provide integrated applications, work flow management tools, care management capabilities, and a shared data repository. Now more than 1,000 providers in the Marshfield Clinic system at Ministry Medical Group and Ministry hospital locations will be able to share access to 2.5 million patient records.

Telehealth Network to Expand

Nearly 400 clinics have expressed interest in participating in the California Telehealth Network to provide broadband connections for rural telehealth. The $30 million project was the second largest project funded by the FCC under their $417 million initiative launched last November. The FCC awarded $22 million to CTN which is also receiving funds from the California Emerging Technology Fund and UnitedHealth Group Inc.

Over the next three years, the CTN will begin to connect primarily rural clinics to a telehealth network with a goal of connecting 100 clinics in the first year. The project is to be co-managed by the University of California Office of the President and the UC Davis Health System and is working in partnership with a coalition of government agencies, healthcare providers, and others.

The CTN is available to both for profit and non-profit facilities in the state. In addition to receiving a free connection to the broadband network, participating facilities will receive technical support and may have some capital equipment costs offset as well.

Healthcare facilities interested in participating must take two initial steps. They must complete an online readiness survey and submit a brief Letter of Agency (LOA) document that expresses interest in participating. The deadline for submitting the LOA is July 30. Most of the clinics have already completed the readiness survey, but many have not yet submitted a LOA. “It is important for the project to have as many LOAs as possible in order to secure the maximum available federal funding”, said Cathryn Nation, MD, Associate Vice President for Health Sciences with the UC Office of the President and co-director for the project.

For more information, go to or call the hotline number (916) 734-3008.

Wednesday, June 25, 2008

Robot Helps Stroke Patients

Neurologists at the University of Virginia Health System are learning to maneuver a robot over a wireless network using a laptop and a control stick. The robot known as the Remote Presence Robotic System (RP-7) will allow the doctors at UVA to communicate with doctors at the rural 25 bed Bath Community Hospital in Hot Springs to help stroke patients.

Dr. Nina Solenski, a Neurologist in the Primary Stroke Center at the UVA Health System and UVA’s Project Officer for the newly launched Virginia Acute Stroke Tele-Health Network (VAST) initiative is testing the effectiveness of the robot to help.

RP-7 is five feet six inches tall and has a flat panel head and camera lens eyes. As the robot moves and does the work, the face of the person at the controls is projected on the flat panel display. The robot’s camera and speakers function as eyes and ears, notes Dr. Solenski.

The project was funded by a $1.3 million grant from the National Office of Rural Health Policy. The program is testing a variety of health information technologies to see if they give rural critical access hospitals quicker and improved access to stroke experts at the regional hospitals and to other healthcare providers. Implementation of VAST was made possible by a partnership of the Virginia Department of Health, the Virginia Stroke System Task Force and the Virginia Telehealth Network.

The robot is also being used in Kentucky. A physician at the University of Louisville Hospitals is now connecting to the robot via the internet and consulting and interacting with a patient and their family at T.J Sampson Community Hospital in Glasgow. Bill Edwards, Director of T.J. Samson’s emergency room said “it allows us to have services that would otherwise not be available here. It’s not likely that we would have a world famous stroke neurologist move to Glasgow and be able to practice here, so this gives us a service that otherwise wouldn’t be possible.”

Just recently to update the robot, InTouch Health signed an agreement with Neurostar Solutions Inc. to integrate NSI’s clinical imaging management application into the RP-7 robotic system. This clinical imaging management application now enables consulting physicians to have up-to-the-minute information plus access to the patient’s imaging information.

Tracking Radiation in Tumors

According to Purdue University, researchers are creating a wireless device that can be injected into tumors to let doctors know the precise dose of radiation received and be able to locate the exact position of tumors during treatment. Because organs and tumors shift inside the body during treatment, a new technology is needed to tell doctors the exact dosage of radiation received by a tumor.

The information obtained could more effectively kill tumors, said Babak Ziaie, an Associate Professor in the School of Electrical and Computer Engineering and a researcher at Purdue’s Birck Nanotechnology Center. Ziaie leading the team testing the prototype wireless implantable passive micro-dosimeter said “the device could be in clinical trials in 2010.”

Conventional imaging systems can provide a three dimensional fix on a tumor’s shifting position during therapy. However, these methods are difficult to use during radiation therapy, are costly, and sometimes require x-rays, which can damage tissues when used repeatedly.

The new device uses RFID technology which does not emit damaging x-rays. The device does not have batteries and is activated with electrical coils containing a miniature version of dosimeters worn by workers in occupations involving radioactivity. The tiny dosimeter provides up-to-date information about the cumulative dose a tumor is receiving over time. Since the technology does not require intricate circuitry, the device can be easier and less expensive to manufacture than more complex designs.

The device has a diameter of about 2.5 millimeters and is about 2 centimeters long so that it is small enough to fit inside a large-diameter needle for injection with a syringe. The current size is small enough to be used in tumors, but researchers are working to shrink the device to about half a millimeter in diameter and to half of its current length.

The researchers were funded by NSF and recently received a two year grant from NIH to continue the work. The researchers are working to simplify the fabrication process so that the devices can be manufactured inexpensively. In addition the researchers are working with the University of Texas Southwest Medical Center at Dallas.

For more information, email Babak Ziaie

HRSA Funding Center

HRSA’s Bureau of Health Professions has announced the availability of funds to help increase access to healthcare workforce information. The June 19th FOA (HRSA-08-157) HHHsolicits grant applications for the Health Workforce Assistance Center (HWAC) cooperative agreement program. The closing date for applications is July 21, 2008, and one award will be made for $750,000 to be awarded for a 5 year project period.

Some of the grantee’s responsibilities would include:

· Operating an information center to provide a full range of information and respond to general public inquiries on health workforce issues
· Planning, acquiring, and processing health workforce materials plus searching for appropriate databases for information
· Developing ways to provide information and assist in navigating the complex web of Federal agencies, foundations, and technical assistance providers
· Tracking and electronically posting policy documents and federal regulations that affect the health workforce
· Collecting and disseminating best practices in health workforce education and key research findings
· Preparing a continually updated web version and linking to with information on state and federal funding opportunities
· Producing a general interest newsletter to be published electronically

Eligible applicants include state or local governments, health professions schools, schools of nursing, academic health centers, and community based health facilities.

For more information, go to

Legislation Moves on the Hill

On Tuesday June 24, 2008, Jonathan Linkous, CEO, American Telemedicine Association, sent out a Special Notice that the House passed H.R. 6331 by a landslide vote of 355-59. Section 149 in the bill contains provisions adding skilled nursing facilities, hospital-based dialysis centers, and community mental health centers as originating sites for Medicare telehealth reimbursement.

As reported by ATA, Senators Max Baucus (D-MT) and Charles Grassley (R-IA), the Chairman and Ranking Republican on the Senate Finance Committee announced that they have reached a compromise in their negotiations on the Medicare legislation but according to ATA, a written copy of the compromise has not yet been release.

However, ATA has learned from sources on the Hill that at least the skilled nursing facility provision and the hospital-based dialysis provision are in the compromise bill. ATA also thinks that by including the telemedicine language in both the House and Senate versions of the Medicare bill, it is likely that the telemedicine language will be included in the final legislation.

Jonathan Linkous wants to thank the many organizations and the ATA members that worked hard to see the passage of the legislation plus he wants to thank the many people that signed personal letters to get the legislation passed. He also wants to give his personal thanks to Reed Franklin, ATA’s Policy Director, for his perseverance and the countless hours that he spent on the Hill personally shepherding the provisions through the legislative process.

Sunday, June 22, 2008

Studies on EHRs Available

The Creighton University Health Services Research Program along with the South Dakota State Medical Association conducted a survey to learn what factors are influencing HIT adoption in the state. The report “Status of Health Information Technology in South Dakota: Focus on Electronic Health Records in Physician Offices” released June 2008, summarizes the state of EHR adoption of physician practices in South Dakota as of November 2007.

The results in the report will be used to design education practices to help in EHR adoption for health professionals and policy makers in the state. Patterns of adoption may also help policy makers further advance educational efforts and resource decisions involving health information exchange and infrastructure development. The findings may also help health professionals in their decision-making processes on the adoption of HIT.

The cross sectional survey was distributed to South Dakota physicians in October and November 2007 using the state licensure database as the primary record source to identify physicians. Surveys were distributed to 2,217 South Dakota licensed physicians who had a mailing address in the state or in an adjacent state. Three hundred forty three physicians maintaining ambulatory care practices in the state completed the survey.

The physicians using HIT tended to be located in larger populations across the state. Those physicians in the planning stage of EHR implementation represented the largest group of reporting physicians in the state and were mainly located in the eastern half of the state.

Some of the highlights are:

  • Nearly all physicians would like to use desktop computers laptop/notebook computers, tablet PCs and PDAs in their future practice.
  • In today’s environment nearly all physicians are using desktop computers while use of other technologies is not as prevalent
  • EHR users represented 29% of physicians in office practices, planners represented 55% of physicians in office practices, and non-planners represented 16% of physicians in office practices
  • Administrative computer applications are used equally by physician practices regardless of the stage of EHR adoption
  • Most prescriptions are still generated using a handwritten prescription pad for all stages of EHR adoptions. EHR users tend to use laptop or desktop computers more than nonusers to generate prescriptions. However, traditional methods of prescription delivery to pharmacies still predominates
  • The main barriers to EHR adoption are financial and lack of interoperability

The survey found that EHR users directly observing or experiencing patient safety incidents was higher for EHR users as compared to nonusers. This was a surprise and the explanation may be that there are substantial problems in information management and exchange related to the interoperability requirements of an EHR. Additional research is needed in this area.

According to a new study “Electronic Health Record Adoption in the Ambulatory Setting: Findings from a National Survey of Physicians” made available on-line appeared in the New England Journal of Medicine. The study shows that only 4% of physicians from a survey of 2,758 physicians have a fully functional EHR system and only 13% have a basic system.

The study was conducted between September 2007 and March 2008 by lead study author Catherine DesRoches, David Blumenthal, MD., and a team at MGH, Weill Cornell Medical College, and the George Washington University School of Public Health and Health Services.

The survey found that cost and complexity are key barriers. Two thirds of physicians without EHRs cited affordability as the reason they don’t have an EHR. Other reasons included finding the right EHR, concern about return on investment, and that the system will become obsolete. One in five physicians expressed reservations about the ease of use and reliability of their systems.

Another study “Health Information Technology in the United States: Where We Stand in 2008”, funded by RWJF and co-authored by the Institute for Health Policy at MGH and George Washington University will be available in July.

To see the South Dakota report, go to For copies of the study “Electronic Health Record Adoption in the Ambulatory Setting, Findings from a National Survey of Physicians”, contact Isha Mehmood at or call 301-652-1558.

Tech to Help Diabetics and Doctors

The University of Vermont is developing a meter to help diabetics measure the amount of glucose in an exhaled sample of their breath. This will enable patients to do frequent and painless monitoring and avoid collecting blood samples.

The meter consists of a mouth piece for the patient to use to exhale, a one-way valve that prevents backflow of the vapor, a pre-chilled collecting cartridge to condense the vapor and expose it to a biochemical assay for glucose, and a digital display. A second cartridge with a different biochemical assay can be used to measure levels of beta-hydroxybutyrate which is a biomarker for ketoacidosis.

In developing the device, it might be developed and be similar in form to a traditional handheld glucose meter. The device might also take the shape of a pen with the mouthpiece at one end and a cartridge at the opposite end. Kits could be marketed that include the meter and one or both types of cartridges with additional cartridges sold separately.

In another venture to help clinicians, the Joslin Diabetes Center and Epocrates Inc. are helping clinicians use a handheld so that they can keep current on information and opinions from experts in the field. The new Epocrates diabetes mobile resource center is able to provide an intelligent and editorially independent summary of the most important clinical news and research in diabetes.

The mobile resource center’s content includes scientific articles, research findings, and breaking news. Comments are provided by Richard Jackson MD., Director of Medical Affairs Healthcare Services at the Joslin Diabetes Center where he identifies the clinical significance of the information. He presents recommendations from various governing bodies clearly and distills it in a way that clinicians can digest and apply the information to their practices.

CDC Issues Grant Notice

CDC issued a grants notice (CDC-RFA-HK08-802) on June 19th to plan, develop, and evaluate the concept for a regional surveillance collaborative using technology. According to the announcement, monitoring the entire U.S. and then following up on any aberrations in patterns of health using syndromic surveillance is simply too large to be centralized in one agency such as CDC.

Regions will be defined as groups of public health agencies (or authorized organizations) that represent populations in multiple geo-political areas (e.g. multiple states within a contiguous geographic area of the U.S., multiple localities with a geographic area that crosses state borders).

Eligibility is limited to nonprofit and for profit organizations (other than small business), universities, colleges, research institutions, state and local governments or their bona fide agents.

The closing date for applications is July 21, 2008 and the estimated total program funding is $500,000 with one award. For more information, go to or call 1-770-488-2700.

Wednesday, June 18, 2008

Legislation in Colorado

The Colorado Department of Health Care Policy and Financing held a meeting to discuss how the new telemedicine project authorized and funded by SB-196 would work. The use of telemedicine included in the legislation is to be implemented in the home health program. Diana Huerta and Sean-Casey King are both leading the telemedicine project for the Department and at the meeting reported on the progress being made to meet the spirit of the legislation. According to Huerta and King, the next step after conducting discussions and listening to comments is for the Department to draft rules for the program.

According to King, the goals are to roll out the program quickly, enable providers to have freedom in determining telemedicine needs, ensure cost savings by closely monitoring claims data and the clinical process, and make certain that the program maintains quality of care. The project will not pay for technology equipment, but home care providers will be compensated on a flat-fee monthly basis to use technology in their own way in treating clients.

The program will be implemented in two phases. Phase 1 will be put into place to benefit clients in acute home health and at the beginning of the acute period, the provider would determine as to whether the client should receive telemedicine. During the acute period, the provider does not need to assess whether the need for telemedicine is at Level 1 of Level 2.

At the end of the acute phase, if the client is expected to go or return to long term home health, a telemedicine level determination must be made. So at this point, the agency will need to document whether they believe the client will benefit from the use of telemedicine in long term home health.

The agency will also determine if the client should receive Level 1 or Level 2 telemedicine, based on the amount of nursing interaction needed. The agency will need to document their reason in the client’s medical record. Most importantly, clients in Phase 1 can only receive telemedicine during the long term home health period if they received care during an acute home health period.

Once the telemedicine level is determined, the provider may bill Medicaid once per calendar month and must assess the client’s need and level for telemedicine at the beginning of each home health plan of care period.

The information, determination, and the patient’s records will be reviewed by a third party vendor to learn how different providers are making these decisions. At this point, the department may develop a standard tool for all providers to use in determining telemedicine needs and levels. The third party vendor also will have the responsibility to ensure that claims are submitted appropriately and the third party vendor is to be chosen through the Request for Proposal process.

Phase 2 of the plan does not include telemedicine for clients who have not had an acute episode. However, if cost savings and need can be established, the Phase 2 roll-out may include the option for providing telemedicine to long term home health clients who have not had an acute episode.

In other legislative actions, the Governor of Colorado signed legislation in June on healthcare. One of the new pieces of legislation SB 135 will streamline healthcare and make it easier for doctors, nurses, and patients to get information from insurance companies. The legislation created a standardized health plan ID card for patients will use 21st century technology for the electronic exchange of information.

Colorado’s Blue Ribbon Commission for Healthcare Reform was formed to study and to establish healthcare reform models in the state. A report released in 2008 by the Commission made a number of recommendations to increase the adoption of health information technology. The Commission’s report recommends that a statewide health information network focusing on interoperability be established and supports creating an electronic health record to work across systems for every person in the state with protections for privacy. In addition, the Commission supports a statewide data system to provide specific care guidelines and performance measures.

To help support some of the Commission’s suggestions for healthcare reform, SB 217 was introduced in March 2008 to develop the Centennial Care Choices program. The bill encourages the use of health information technology and telemedicine including health information exchanges, electronic health records, and e-prescribing. The bill would encourage establishing pay-for-performance programs and would provide consumers with educational materials on how to access internet-based healthcare tools.

Army Improves IT Management

According to the newsletter “The Point” published by the Army Medical Research and Materiel Command, the Army Medical Information Technology Center (USAMITC) at Fort Sam Houston, Texas has improved their IT service management processes. USAMITC provides information management and information technology products and services to support the Army Medical Department, the military health system, DOD, and other government clients worldwide.

Improving their IT service management processes provides for better, faster, and cheaper services for their customers and their users to help others provide high quality healthcare. The system is built on the information technology infrastructure library or ITIL, standards that Terry Hessler, USAMITC configuration manager considers to be the most widely accepted approach to IT service management in the world. The ITIL framework promotes process improvements through standardization, common language, and “common sense” changes.

This year, the Southeast Regional Medical Command, USAMITC deployed the ESD which is a consolidated, standard, stable and secure service desk. ESD was deployed throughout the entire Army Medical Command infrastructure, a move to reduce redundancies and achieve significant efficiency improvements and cost savings for the command. The ESD deployment is scheduled for completion my March 2010.

When users from the healthcare provider in the hospital to the medical logistician in theater are impacted by an IT problem, the ESD will be the single point of contact. If an IT issue arises, one number is called or an email sent to one address. This will result in the same level of service no matter the location.

Technicians assist users with a broad range of issues and by using a shared knowledge database, a technician can fix the problem and share that knowledge by putting it on the global database. This helps other technicians at other sites having the same issue so that they can find the solution to resolving the incident.

All Army medical treatment facilities will work together and have access to that shared knowledge database. With technicians looking for new fixes and better ways to do things, efficiency stands to continually increase.

Funds for Forecasting Model

NIH’s National Institute of Aging has posted Funding Opportunity Announcement (RFA-AG-09-007) for researchers to develop models that will forecast Medicare expenditures and provide insight into cost growth and population aging. According to the announcement, measuring future Medicare expenditures requires more than just understanding factors beyond cost growth and needs to take into consideration other factors such as disabilities and life expectancy.

In addition, changes in population health may also impact productivity and affect the tax base that serves as a revenue stream for the Medicare program. Increases in Medicare premiums under current law may lead to less consumption of healthcare leading to changes in population health.

Eligible applicants can include private institutions of higher education, small businesses, Native American tribal governments, and for profit and non-profit organizations. Applicants are to develop the next generation of innovative models to use to forecast Medicare expenditures.

The grant opportunity will support up to $800,000 per year in total costs over five years for all projects awarded. NIA anticipates making 2 to 3 awards under this FOA.

The funding opportunity was posted June 13, 2008 at . Letters of intent must be received by September 9, 2008, and the FOA application is due October 29, 2008. For more information, contact John W.R. Phillips at 301-496-3138 or email

Sunday, June 15, 2008

Showcase Promotes HIT

The latest advances were highlighted at the highly successful Capitol Hill Technology Showcase and briefing held on June 12, 2008 in conjunction with Health IT week. Each year, the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics devotes a day in June to highlight the progress and the steps taken to deliver better and more effective healthcare.

Senator Kent Conrad (D-ND) one of the Co-Chairs of the Steering Committee thanked Neal for his excellent leadership in organizing the Capitol Hill briefings since 1993. The sessions enable many people to have the opportunity to hear from leaders in the field on how to move the health IT movement forward.

The Senator said that dealing with the telehealth issues in Medicare is a slow process but he emphasized how telehealth is needed to save money, produce a more effective healthcare system, and save lives.

Representative Patrick Kennedy (D-RI) said he doesn’t see much happening to move HIT forward before the election but he does want to take part in healthcare discussions at the Democratic Convention. He sees the next President putting healthcare on the forefront of the agenda and is hopeful that HIT will make some progress next year.

The Senator from Rhode Island Sheldon Whitehouse told the attendees that the healthcare system is screaming out for reform. According to the Senator, the country needs a national HIT infrastructure, a focus on quality improvement, and a major change in the reimbursement system.

Senator Debbie Stabenow (D-MI) along with Olympia Snowe (R-ME) introduced S 1408 to improve quality in healthcare and the bill would provide incentives to adopt technology. Senator Stabenow wants to see support for the bill and is proud that her state is a leader in using technology.

For example, the South East Michigan e-prescribing group has been active since 2005 and so far, 25,000 doctors have used the system with incredible results especially in finding drug interactions. Also, the Upper Peninsula a very rural area in the state has been using telehealth for some time which has made a big difference for the residents.

Speaking from the administration viewpoint, Robert Kolodner MD, National Coordinator for Health Information Technology, discussed how the 5 year Strategic Plan recently released provides information on all of the HIT efforts that have taken place in the last four years.

Dr. Kolodner said that in the fall of 2008, 19 trial implementation awardees will participate in a collaborative effort to find the common interfaces that NHIN Health Information Exchanges need to operate. Awardees will work together on a cooperative interoperability testing event to effectively demonstrate real time information exchange.

According to Donald A. Lindberg, MD, Director, National Library of Medicine two new standards are under review. One standard applies to functional MRIs and the other standard applies to genetic testing if the data is to be included in the electronic medical record.

According to Dr. Lindberg, communications with others in disasters is failing and a solution needs to be put in place. The Wireless Information System for Emergency Responders (WISER) developed by NLM has been used very successfully and fire departments really like to use the handheld. WISER a mobile application designed to assist first responders in hazardous material incidents provides a wide range of information on hazardous substances including chemical identification support, physical characteristics, and human health.

Colonel Jonathan H. Jaffin, MD, Deputy Commander Medical Research and Materiel Command, Ft. Detrick, MD, said MRMC provides full spectrum support for warfighters. MRMC has many technologies under development and is working with a number of university and industry partners to support programs such as:

  • An automated clinical decision support and disease management system to help mostly patients with diabetes and heart problems. The goal is to provide telemedicine, home care, and monitoring involving biosensor development, plus provide for advanced immunologic testing
  • Robots to help the injured warriors in the battlefield and in surgery
  • Biosurveillance capabilities capable of doing threat analyses using computational methods
  • Medical modeling and simulation programs using digitally enhanced mannequins for training, interactive multimedia, and total immersion virtual reality systems
  • Advanced imaging and brain mapping technologies to provide portable imaging equipment
  • Pharmaco-vigilance systems to perform active monitoring to reduce adverse pharmaceutical related events
  • Mobile and remote computing to provide medical care immediately on the battle field using wireless information and sensor technology
  • Neurosciences to be better able to diagnose head injuries to improve the outcome
  • Regenerative medicine to provide cutting edge technology to help returning warriors

Adam Darkins, MD, Chief Consultant, Office of Care Coordination, Veterans Health Administration, reported that the VA is now providing telehealth care in the home and is taking care of 33,400 patients living independently in their homes. The program started in 2003 with 1,500 patients, and in the future expects to have 75,000 patients using the home-based technology in their homes.

Dr. Darkin pointed out that the VA is using video conferencing that is proving to be very effective and veterans are able to get help in 1,000 locations. The use of video conferencing is especially helpful in treating patients with mental health issues. Presently, there are 35,000 patients involved in the program and this is projected to rise to 80,000 patients.

VHA has training ongoing in home telehealth, general telehealth, and store and forward telehealth. Training on screening for diabetic retinopathy using store and forward technology is high on the agenda for the 20% of veterans with diabetes. Also important is the ability to use store and forward for teledermatology.

Another important issue brought up during the day concerned the development of the Legal Electronic Health Record. Michelle Dougherty, AHIMA, explained that it is very important for the Legal Electronic Health Record to be put in place. She told the attendees, that no matter whether the format is paper or whether a fully electronic system is used, the health record needs to and must meet the requirements of the official legal business record for the organization.

She continued to say “given today’s urgency to begin deploying EHR systems, healthcare entities, vendors, and others sometimes neglect to build in the record management processes and system capabilities needed to ensure that the electronic rather than the paper version can stand as the legal business record.”

The Technology Showcase featured federal agencies, associations, leading research organizations, and companies demonstrating their latest advances toward an “E-enabled healthcare system. Participating organizations included ATA, AT&T, Inc., Continua Health Alliance and Partners, eHealth Initiative and Partners, Encite, Himss and Partners, Department of Defense Military Health System, VHA, Greenway Medical Technologies, INRange Systems, Inland Northwest Health Services, Lehigh Valley Hospital and Health Network, SAIC, Siemens Medical, RCHN Community Health Foundation, National Association of Public Health Information Technology, iMDsoft, Eye Controls, NLM, and RTI International.

Many of the products and services displayed at the Showcase involved ongoing work in biosurveillance, battlefield medical information systems, robotic systems, chronic care and disease management tools, electronic health records, handheld devices, imaging, patient identification and tracking systems, and rural telemedicine technology.

It was announced that Neal Neuberger President of Health Tech Strategies, LLC has been selected to lead the newly launched HIMSS Institute for e-Health Policy and will also continue to head the Steering Committee. The Institute will provide educational opportunities in the Washington D.C area for public and private sector stakeholders impacted by e-health policy decisions. The Institute with have an Executive in Residence Program and will have government relations undergraduate and graduate level internship programs to support two college interns for three semesters each year.

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), Allyson Y. Schwartz (D-PA), 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).

Be sure to attend the next session on July 16th on “Achieving Interoperability, Connectivity, and Continuous Availability among Systems: Is there a light at the end of the HIT Tunnel?” For more information on future Capitol Hill sessions, contact Neal Neuberger, at (703) 790-4933 or email

Mannequin Delivers for Doctors

Noelle the Military Health System’s $20,000 mechanical mom is a mobile obstetrics emergency simulator used to improve emergency delivery skills. Noelle delivers an infant-sized mannequin baby once or twice a month for the labor and delivery personnel at Madigan Army Medical Center in Fort Lewis Washington. Nine military treatment facilities currently use the simulator and 20 more are going to be delivered throughout the world to locations that include Korea and Japan.

Before Noelle, doctors and nurses in labor and delivery wards around the country dealt with child-birth emergencies as they arose in the clinical setting based on whether they had encountered similar situations in the past. “Even though these events are rare, we need to practice for them” according to Dr. Shad Deering, Director of the Anderson Simulation Center at the Madigan Medical Center.

Gaumard Scientific created Noelle in 1999 but it was Dr. Deering who created the mobile obstetrics emergencies simulator. He took the Noelle model and added modifications to simulate eclampsia, integrated the simulator with the DOD Teams STEPPS response system, and added a mobile cart to display maternal and fetal vital signs. This system is now referred to as the Mobile Obstetrics Emergency Simulator (MOES).

The final product MOES is capable of presenting a number of different emergencies that can range from full body seizures to post-partum hemorrhaging and gives the doctors and nurses hands-on experience to deal with emergency situations such when an infant’s shoulder gets stuck inside the womb and eclampsia. Now the team can practice each of these emergency scenarios.

Recently, the Anderson Simulation Center received $2.8 million in funding through the Office of the Surgeon General to establish the Army Central Simulation Committee with Dr. Deering named as the Chairman. The funding will be used to create a standardized simulation curriculum for 10 different specialties at all 10 Army training hospitals.

Evaluating Medical ID Theft

ONC has awarded $450,000 to Booz Allen Hamilton to assess and evaluate the scope of the medical identity theft problem in the U.S. The purpose of the project is to examine how health IT can be used to detect and prevent medical identity theft.

Medical identity theft is a specific type of identity theft which occurs when someone uses another person’s identifiable health information, such as insurance information or medical records, without the individual’s knowledge or consent to obtain medical goods or services or to submit false claims for medical services.

Dr. Robert Kolodner, National Coordinator for Health Information Technology, has noted that medical identity theft stories are being documented at an increasing rate, bringing to light serious financial, fraud, and patient care issues. Health IT can be an important tool to combat the threat of medical identity theft.

The first phase of the project will include developing an environmental scan to assess the scope of the problem that will serve as the baseline for developing prevention, detection, and remediation strategies. This phase will examine the stakeholders who are affected by medical identity theft and their issues, the impact on the healthcare industry, and examine the gaps where there are no reliable measures

A one day town hall meeting will be held in October 2008 in the Washington D.C., area during the second phase of the project. The meeting will bring together approximately 100 participants from both public and private healthcare stakeholders to share knowledge and experience with experts from other economic sectors that deal with medical identity theft. The meeting will explore how medical identify theft should be considered and addressed in a health IT environment.

The third phase of the project will result in a final report and roadmap scheduled to be released next winter summarizing key issues and possible next steps for the Federal government and other stakeholders.

Still Time to Register

The 5th Annual Healthcare Unbound Conference and Exhibition will focus on new ideas dealing with the convergence of consumer and healthcare technologies. The Conference on July 7-8, 2008 at the Marriott San Francisco is co-sponsored by the American Association of Homes and Services for the Aging and the Center for Aging Services Technologies.

The Conference is geared to help HIT companies, healthcare providers, consumer technology companies, pharmaceutical, medical device and diagnostics companies, health plans, and financial and consulting firms.

The high level attendees include “C” and senior level executives whose responsibilities include business development, operations, technology, marketing, information technology, R&D, and medical management.

The Conference will stress how innovative technologies can drive opportunities to serve health consumers in new ways and in new settings. The program will have a strong focus on the use of remote monitoring, home telehealth technologies for wellness promotion and disease management, with a special emphasis on baby boomers and the elderly.

The agenda will cover topics on the emerging role of mobile/wireless technologies, legal/regulatory developments, reimbursement issues, strategies for success for vendors and much more. The program will feature keynote presentations from many of the nation’s thought leaders in the field, and present leading edge case studies.

Some of the leading keynote presenters include:

  • Vince Kuraitis, JD, Principal and Founder of Better Health Technologies, LLC
  • David C. Kibbe, MD, MBA, Principal, The Kibbe Group
  • Liz Boehm, Principal Analyst, Customer Experience for Healthcare and Life Sciences, Forrester Research
  • Michael J. Barrett, Managing Partner, Critical Mass Consulting
  • Gordon K. Norman, MD, MBA, Executive VP, Chief Scientific Officer, Alere Medical, Inc.
  • Eric Dishman, General Manager and Global Director, for the Product Research and Innovation Group, Intel Corporation
  • David L. Whitlinger, President and Board Chairman, Continua Health Alliance
  • David Ceino, General Manager, Consumer Engineering, Health Solutions Group, Microsoft
  • Donald Jones, Vice President, Business Development Qualcomm
  • Jerry Lin, Product Manager, Google
  • Anaud K. Iyer, PhD, President & Chief Operating Officer, Welldoc Communications
  • Larry Leisure, President, North America iMetrikus, Inc

Many additional panels will discuss connected health developments not only nationally but also globally, state of aging services technology, wireless technology, from PHR to consumer health products, health 2.0 current state and future directions, developing potential collaborations between payers, providers, and manufacturers, telehomecare and remote monitoring, piloting tomorrow’s technology, interoperability vision for Kaiser Permanente, how the network effect impacts adoption, expanding telehealth programs through collaborative policy initiatives, transformative home healthcare, disease management applications, and networking drugs, devices and consumer products with intelligent medicine,

Three additional post conference workshops will be held to discuss technology enabled patient self management, securing reimbursement from payers for healthcare unbound products and services, and effectively using consumer electronics to deliver clinical services.

The event builds on the strength of last year’s conference and exhibition that attracted over 400 high-level attendees. The Conference has proven to be a great networking event attracting executives and clinicians from across the U.S. and abroad.

For more information, contact Satish Kavirajan, Managing Director TCBI, (310) 265-2570, email, or go to for information on the conference and to register.

Wednesday, June 11, 2008

Robots to Help in Homecare

The Center for Healthcare Robotics within the Health Systems Institute at Georgia Institute of Technology and Emory University are looking at ways that robots can be used to help when providing homecare for patients. The research team led by Charlie Kemp, Director of the Center has found a way to instruct a robot named El-E to find and deliver items it may have never seen before by using a laser pointer. The researchers are now gathering input from ALS patients and their doctors to use to prepare the robot to assist patients with severe mobility challenges.

The verbal instructions a person gives to help find an object are very difficult for a robot to use. These commands require the robot to understand everyday human language and a description of the object at a level well beyond the state-of-the-art in language recognition and object perception. According to Wallace H. Coulter, Department of Biomedical Engineering at Georgia Tech and Emory, “Robots have some ability to retrieve specific predefined objects but retrieving generic everyday objects is a challenge for robots.”

The laser pointer interface and methods developed by Kemp’s team is overcoming this challenge by providing a direct way for people to communicate the location of interest to El-E and ways that will enable the robot to pick up an object found at this location. Through these innovations, the robot can retrieve objects without understanding what the object is or what it is called.

The researchers see fetching as a core capability for future robots in healthcare settings such as the home. In the home, El-E is able to find objects since there are common structures found indoors. In the home, most objects are found on smooth flat surfaces that have a uniform appearance such as floors, table, and shelves. Regardless of height, the robot is able to localize and pick up objects by elevating the arm and sensors to match the height of the object’s location.

The robot uses a custom-built camera that is omni-directional to see most of the room. After the robot detects that a selection has been made with the laser pointer, the robot moves two cameras to look at the laser spot and triangulate its position in three dimensional space.

Next the robot estimates where the item is located. If the location is above the floor, the robot finds the edge of the surface on which the object is sitting, such as on the edge of a table. The robot then uses the laser range finder to scan across the surface to locate the object. Then the robot moves its hand above the object, uses a camera in its hand to visually distinguish the object from the texture of the floor or table. After refining the hand’s position, the robot descends upon the object while using sensors to decide when to stop moving down and closes upon the object with a secure grip.

Once the robot has picked up the item, the laser pointer can be used to guide the robot to another location to deposit the item or direct the robot to take the item to a person. El-E is able to distinguish between these two situations by looking for a face near the selected location and then is able to present the item.

The researchers are now working to help El-E expand capabilities that will include switching lights on and off when the user selects a light switch and opening and closing doors when the user selects a door knob.

Preventing Birth Injuries

A national collaborative called the Premier Perinatal Safety Initiative is comprised of 16 hospitals in 12 states where nearly 115,000 babies will be delivered. According to Representative Shelley Moore Capito (R-WVA), “Infants in the U.S. experience close to three birth injuries for every 1,000 births many of which are preventable." She is the co-founder and co-chair of the Congressional Caucus on Infant Health and Safety.

There are five recurring clinical issues such as failure to recognize an infant in distress, failure to initiate a timely cesarean birth, failure to properly resuscitate a depressed baby, inappropriate use of labor-inducing drugs, and inappropriate use of vacuum or forceps are responsible for the majority of perinatal harm and associated costs.

Perinatal team members at participating hospitals in the collaborative will conduct simulations for certain high risk protocols. The data will be collected and the results will be measured against benchmarks from similar hospitals. Customized harm measures that have been developed will be analyzed with the assistance of the National Perinatal Information Center. Expertise in team building and simulations and data analysis will be provided to the group by the University Of Minnesota School Of Public Health.

In Maryland, Governor O’Malley has just announced the availability of a perinatal safety grant for $469,000 to be awarded to the Perinatal Collaborative operating in 25 hospitals by the Maryland Patient Safety Center. The Perinatal Collaborative is one part of a comprehensive public health initiative called “Babies Born Healthy” that was launched in 2006 by the Maryland Department of Health and Mental Hygiene.

Activities to be undertaken will help participating hospitals learn best practices for electronic fetal monitoring, improved communications training, emergency simulation, and safe delivery techniques. The program also provides hospitals with the tools necessary to measure outcomes and improve safety.

WHO Supports Research Grants

The Small Research Grants project is a new initiative of the World Health Organization’s World Alliance for Patient Safety. The aim is to stimulate research studies on patient safety priority areas by providing seed funding for 20 to 30 small research projects

The WHO World Alliance is looking for research proposals that focus on identifying, developing and/or testing local improvement interventions for patient safety, as well as studies on cost-effectiveness of risk reducing strategies. Other priorities that have been identified at global, regional, or local levels with the potential for translation into policy and practice will also be considered.

All researchers affiliated with a recognized institution located in the country where the research project will be conducted are eligible. Research can be done in any healthcare setting. Collaboration is strongly encouraged, both between institutions and between countries. Applicants may wish to consider submitting collaborative research projects with colleagues in different countries, including those with well-developed patient safety research programs.

The Call for Proposal applications will be available July 1, 2008 with applications due September 30, 2008. Projects are scheduled to begin in the spring of 2009. Funding of $500,000 will be available with $10,000 to 25,000 to be awarded for each grant.

For more information, email or The address for the project is World Alliance for Patient Safety, Information, Evidence and Research (IER/PSP), WHO, Avenue Apia 20, CH-1211 Geneva 27, Switzerland.

Sunday, June 8, 2008

$300 Million to Improve Quality

“Across America, there are serious gaps between the healthcare that people should receive and the care they actually receive,” according to Risa Lavizzo-Mourey, M.D, President and CEO, Robert Wood Johnson Foundation. “Despite having the most expensive healthcare system in the world, patients are subject to too many mistakes, too much miscommunication and too much inequity. As a result, too many Americans aren’t receiving the care they need and deserve.”

At the RWJF briefing held at the National Press Club on June 5th, the Foundation released information on new research conducted by the Dartmouth Atlas Project at the Dartmouth Institute for Health Policy and Clinical Practice. The initiative analyzed Medicare claims and found staggering variations in healthcare quality across the country. The report notes that African Americans lost legs to amputations at a rate nearly five times that of whites, and there were a number of differences in the population in receiving basic recommended care.

To improve the quality of healthcare in this country, RWJF has just initiated a $300 million program known as “Aligning Forces for Quality”. The 2008 program was launched to improve healthcare in 14 communities in the U.S. The communities selected are going to make fundamental and cutting-edge changes needed to rebuild their healthcare systems.

The communities are located in Cincinnati and Cleveland Ohio, Detroit and Western Michigan, Humboldt County California, Kansas City Missouri, Maine, Memphis Tennessee, Minnesota, Seattle Washington, South Central Pennsylvania, Western New York, Willamette Valley Oregon, and Wisconsin.

RWJF launched the first phase of the project the “Aligning Forces for Quality” program in 2006 as an effort to help communities build healthcare systems where none existed. The first phase of the program provided community leadership teams with grants and expert assistance to help physicians improve quality of care and help consumers make informed healthcare decisions.

Now the program in 2008 is expanding and geared to improve the quality of care, provide people with information on how to be better partners with their doctors, improve care inside hospitals, and reduce inequality in caring for patients of different races and ethnicities.

Speaking at the briefing and emphasizing the point that receiving the right healthcare at the right time can make a big difference, Cynthia Nunnally, M.P.H, from the Shelby County Health Department in Memphis, talked about her history with diabetes. She is a 43 year old African American and has had diabetes since early childhood, but fortunately, she has received excellent care so far.

She has endured complications and been hospitalized maybe 50 or 60 times and as a result has some renal and vision loss. She has had access to dieticians and has been an active participant in her healthcare. However, as she said “many people in communities are not encouraged or are unable to take an active role in handing health problems and medical issues and therefore do not always receive the best care.”

VA Names Rural Health Members

The Secretary of the VA, Dr. James B. Peake has appointed 13 members to the new Veterans Rural Health Advisory Committee to advise on rural healthcare issues. James F. Ahrens, former head of the Montana Hospital Association and former member of the Montana governor’s task force on healthcare will chair the committee.

Other members include:

  • Dr. Robert Moser a practicing physician in rural Kansas and Colorado
  • Cynthia Barrigan Acting Director of the Virginia Telehealth Network
  • Charles Abramson Air Force veteran who served on the medical staff ethics committee at St. Patrick Hospital
  • Major General John W. Libby Adjutant General of the Maine National Guard
  • Hilda Heady a social worker and Associate Vice President for the West Virginia Rural Health Association
  • Dr. Ronald Franks a psychiatrist and Vice President of the College of Medicine at the University of South Alabama
  • Bruce Behringer Assistant Vice President at East Tennessee State University for Rural and Community Health
  • Rachael Gonzales Hanson member of the National Association of Community Health Centers
  • Tom Ricketts, PhD, Director of North Carolina Rural Health Research Program
  • Michael Dobmeier National Judge Advocate of the Disabled American Veterans and President of the North Dakota Veterans Home Foundation
  • Terry Schow Executive Director of the Utah Division of Veterans Affairs
  • James Floyd, Native American and Director of the Salt Lake City VA Medical Center

Recently, the VA created the Travel Nurse Corps to enable VA nurses to travel and work throughout the department’s medical system to help stem nursing shortages. The nurses in addition to their nursing duties will be working very closely with the rural health advisory panel.

VCU Develops Database

Patient recruitment is an increasing challenge and it is often difficult to quickly recruit patients eligible to participate in each clinical trial. Pharmaceutical and biotechnology companies, clinical research organizations, and community physician practices, and hospitals all want to participate and enroll patients in clinical trials.

Physicians would like to introduce their patients to relevant trials and educate patients on the merits of participating in the trial. However, only 14% of patients participating in clinical trials were first informed of their trial by their doctor. The high patient volume, limited visit time, and the large number of clinical trials that are available make it difficult for clinicians to identify and discuss appropriate trials with their patients. Also, the clinical inclusion and exclusion criteria for each trial is very specific and make it complicated for clinicians to match a patient to a trial.

To address these issues, Virginia Commonwealth University researchers developed the Clinical Trials Eligibility Database (CTED) so that the clinical staff is able to prescreen patients before their office visit for eligibility to participate in clinical trials. Information is obtained from multiple electronic in-house sources including historical billing and clinical test results to build an eligibility profile for each patient.

As a visit is scheduled, the patient’s eligibility profile is automatically screened against the selection criteria for each clinical trial in CTED. When a match occurs, the clinician is informed prior to the patient’s visit, so that the trial can be discussed with the patient, and the physician is able to increase participation in clinical trials. The system enables costs to be reduced, improves efficiency, can evaluate all patients, and the system can be adapted and used with many different electronic data formats.

Within the VCU’s Massey Cancer Center, the CTED is incorporated in their Cancer Research Informatics and Services Shared Resource system. The other components in the system include the Massey Cancer Center Information System, the Automated Cancer Extraction Application, and now the Clinical Research Database System.

For more information on the system, contact the VCU Technology Transfer office at (804) 828-5188, or contact Allen Morris, Licensing Manager or call (804) 827-2211.

Wednesday, June 4, 2008

ONC Releases Strategic Plan

On June 3, 2008, the Office of the National Coordinator for Health Information Technology released the Federal Health IT Strategic Plan 2008-2012 to advance HIT. The ONC coordinated plan identifies the federal activities needed to implement the technology infrastructure in both the public and private sectors.

The two primary goals are to help Patient Focused Health Care and Population Health. The first goal envisions a transformation to higher quality, more cost efficient care, and meeting patients needs with electronic health information. The second goal relates to population health, and envisions the appropriate use of electronic health information to benefit public health, biomedical research, quality improvement, and emergency preparedness.

Objectives, strategies, and milestones have been established for each goal. They portray the totality of what must be done across the federal government to address privacy and security, achieve an interoperable health IT architecture, accelerate IT adoption, and foster collaborative governance.

The strategic plan describes 43 strategies needed to achieve each objective. Each strategy is associated with a milestone against which progress can be assessed plus a set of illustrative actions to implement each strategy.

The ONC worked with 12 agencies and staff divisions within HHS, and also with the Departments of Commerce, Defense, and Veterans Affairs, and the FCC. Two federal advisory bodies such as the National Committee on Vital and Health Statistics and AHIC also contributed to some of the strategies and milestones as cited in the plan.

To see the full report and the synopsis, go to

Research to Help Stroke Patients

The Robert Wood Johnson Foundation just recently awarded the first round of grants through the “Health Games Research” national program. More than $2 million in grants will help research teams support the use of digital interactive games to improve player’s health behaviors and outcomes. One funded research project was awarded to the University of South Carolina Research Foundation to explore how motion-based games may be able to help stroke patients progress faster in physical therapy.

A total of 112 research proposals were submitted by universities, medical centers, and industry in the U.S. In January 2009, Health Games Research located at the University of California in Santa Barbara will issue their next call for proposals expecting to award an additional $2 million in grants.

The University Of Maryland School Of Medicine has received NIH funding to do research to further develop a new in-home stroke rehabilitation device called “Tailwind”. The device works by activating new brain pathways that can improve arm function in stoke patients. In addition, through a licensing partnership with the university, the funding will enable Encore Path, a Baltimore-based medical device company, to market the patented invention in a compact, retractable and portable design.

“What I truly find exciting is that we have a tremendous partnering opportunity with the university to invent, develop, and research, practical and cost-effective rehabilitation technologies to advance the recovery of stroke survivors,” said Encore Path CEO Kristen Appel.

The funding will also enable Encore Path to create additional software to allow therapists to be able to measure their patient’s progress. So far, the device has been tested only in patients for 6 to 8 months after their first stroke but the funding will now be used to test the upgraded device in the sub-acute hospital setting on patients who recently have had a stroke.

NIH Expands Consortium

Fourteen academic health centers in 11 states are the latest members to become a part of the Clinical and Translational Science Award (CTSA) consortium. The Centers will receive $533 million over 5 years to help researchers turn laboratory discoveries into treatments for patients, to engage communities in clinical research efforts, and to train the next generation of clinical and translational researchers. The consortium is led by the National Center for Research Resources a part of NIH.

The institutions receiving the new CTSA funding include Albert Einstein College of Medicine of Yeshiva University, Boston University, Harvard University, Indiana University School of Medicine, Northwestern University, Ohio State University, Scripps Research Institute, Stanford University, Tufts University, University of Alabama at Birmingham, University of Colorado Denver, University of North Carolina, University of Texas Health Science Center at San Antonio, and the University of Utah.

Since the launch in 2006, the consortium has:

  • Leveraged CTSA resources to expand research and training opportunities in underserved states and communities
  • Assembled interdisciplinary teams of biologists, clinical researchers, nurses, pharmacists, biomedical engineers and geneticists
  • Partnered with researchers at minority institutions to enhance outreach to underserved populations, local community and advocacy organizations, and healthcare providers
  • Created best practices to improve clinical research informatics tools to analyze research data and manage clinical trials
  • Designated technologies for marketing and licensing purposes that will increase global access to research tools
  • Forged new partnerships with private and public healthcare organization, including pharmaceutical companies, VA hospitals, health maintenance organizations, as well as state health agencies

Most of the funding will come from terminating grants to General Clinical Research Centers supplemented by NIH Roadmap funds. In 2012, when the program is fully implemented approximately 60 CTSAs will be connected with an annual budget of $500 million.

A fourth funding opportunity announcement for CTSAs is now available, and the next round of applications need to be submitted by June 17, 2008 with the awards expected in March 2009. For more information, concerning this funding announcement go to For more information, on the academic health centers go to

Sunday, June 1, 2008

Monitoring Helps HF Patients

The American Heart Association’s 9th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke reported on a study that showed that a remote monitoring program can improve the condition of heart failure patients who are mobile and may also decrease hospital readmissions.

The study conducted by the Center for Connected Health, a Division of Partners HealthCare, included 150 heart failure patients admitted to Massachusetts General Hospital in Boston. Sixty eight patients averaging age 70 were randomized to receive usual care for heart failure. The remaining 82 patients were offered remote monitoring. Forty two patients accepted the monitoring program but the remaining 40 patients declined to participate.

The goal for the Connected Cardiac Care program was to reduce hospital readmissions, provide timely intervention and help patients understand their condition by using home telemonitoring, said Ambar Kulshreshtha, MD, M.P.H, the lead author of the study and a research fellow at Harvard Medical School and Massachusetts General Hospital. The study was co-authored by Joseph Kvedar, MD, Alice Watson, MD, M.P.H, and Regina Nieves, R.N.

Patients in the remote monitoring group experienced lower average hospital readmission rates (31 readmissions per 100 people) compared to patients in usual care (38 readmissions per 100 people) and non-participants (45 readmissions per 100 people). Patients in the remote monitoring group also had fewer heart failure related readmissions and emergency room visits than usual care and non-participating patients. Researchers said the results show a positive trend but are based on only three months of follow-up and did not reach statistical significance.

Patients received telemonitoring equipment to monitor vital signs such as heart rate, pulse and blood pressure. They also weighed themselves daily and answered a set of questions about symptoms every day. That information was transmitted through the telemonitoring device to a nurse who would call weekly or more often if a patient’s vitals indicated problems, if the patient hadn’t taken their medications, or if the patient wasn’t eating right or exercising.

Post study surveys show:

  • 95% believed they were able to manage their heart failure better and an equal number had overall program satisfaction
  • All participants said their health improved and they received adequate interactions with a homecare nurse

The researchers said they plan to expand the program to target 350 ambulatory patients by summer of 2008 and are currently developing a method to stratify high risk patients.

Voice Recognition Used in Iraq

According to MC4 Public Affairs, Lt. Colonel, MD, John Mansfield, Urologist at the Air Force Theater Hospital at Balad Air Base in Iraq, voice recognition technology is successfully being used in clinics and operating rooms. The technology is being used to record patient care and capture surgical procedures electronically by using DOD’s Medical Communications for Combat Casualty Care (MC4) System via a laptop.

Dr. Mansfield has been the only urologist on staff in Balad since January and sees about 150 patients per month with both outpatient and inpatient visits involving mostly trauma and kidney stone ailments. Like most doctors in the combat zone, he doesn’t have time to stop and type everything he does, so he has to improvise.

By synching the newly deployed voice recognition software known as Dragon Naturally Speaking Medical Version 9.5 with his MC4 system, the doctor is able to cut his documentation time in half by talking at about 120 words per minute. The system is able to handle up to 140 words per minute.

Not only is Dr. Mansfield the first to use the software with MC4, he is also the first doctor to implement a voice recognition roaming medical network in a medical treatment facility on the battlefield.

To use the system, users of the software must customize the speech engine to their voice and style of speech. This is called creating a speech file. With the new network or roaming capability that MC4 has set up, Dr. Mansfield’s speech file is maintained on a server and can be accessed from any of his laptops if the voice recognition software is loaded on it. This technology allows physicians to roam from place to place while dictating at any of the current 10 MC4 laptops.

Major Michael Matchette, a radiologist at the hospital, finds that the voice recognition set up with the MC4 system really helps radiologists because they dictate more than any other specialty in the hospital. The software saves time especially when there are mass casualties.

According to Major Matchette, he can get a more complete report in the computer and do it in less than half of the time. By using voice recognition technology, doctors can have full trauma scan reports in the computer, often by the time that the patient goes to the operating room.

In five weeks, Dr. Mansfield and the MC4 personnel have trained 16 surgeons from various disciplines on the system which includes surgeons, ear, nose, and throat specialists to neurosurgeons. Dr. Mansfield’s experiences have motivated him and the MC4 technical support staff to extend their training outreach efforts and they have plans for more voice recognition training sessions Reviews have been mixed but the doctor hopes that after the system has proven to be successful, everyone will come on

MN Legislative Accomplishments

The Governor of Minnesota, Tim Pawlenty recently reported on the progress that was made in healthcare reform in the state’s 2008 legislative session. In addition, the state has established a high speed Broadband Task Force to identify the areas in the state that lack the infrastructure to support broadband services. The task force will develop a comprehensive plan to achieve statewide broadband goals.

Some of the health reform measures and accomplishments as a result of the 2008 legislative session include:

  • Minnesota consumers are able to access information on web sites concerning healthcare prices and quality information
  • The state is going to be require all healthcare providers to use e-prescribing
  • Patient-centered health care homes will be developed to provide comprehensive primary care. Medical homes will help patients coordinate care, especially for chronic diseases
  • Work is progressing towards healthcare payment reform based on financial incentives and more market competition among healthcare providers and health plans is encouraged
  • The uninsured in the state who are eligible for a pre-tax medical account and purchase insurance in the private market will be eligible for a new 20% insurance premium tax credit
  • There is an additional $500,000 to meet current County Veterans Service Office grant requests to improve benefits, and programs
  • There is $720,000 a year allotted to continue the operation of LinkVet, the toll free customer service line to provide veterans with information referrals on handling an immediate crisis situation and how to find psychological counseling 24/7.
  • LinkVet case workers will now be available to coordinate benefits and the needs of veterans, military members, and their families
  • Courts must not inquire about a defendant’s military status and history at sentencing. If a defendant convicted of a crime is a veteran and has been diagnosed with a mental illness, the court may consider local treatment options

Public Health Care Congress Coming

Leaders from hospitals, health systems, and federal, state, and county health officials will meet to exchange ideas and experiences at the 2nd Annual Public Health Congress. This event will be held at the Mandarin Oriental Hotel in Washington D.C. on July 23-25 2008. Strategies for optimizing emergency preparedness and prevention will be key topics along with information on the tools and technologies that can be used to help support public health programs and services.

National experts and innovators will share case studies and strategies for:

  • Controlling the spread and incidence of infectious diseases from nosocomial infections to avian flu
  • Ensuring the effectiveness of emergency preparedness and rapid response efforts
  • Updating information management systems to improve data driven decision making and resource allocation
  • Leveraging NHIN capabilities to ensure interoperability across organizations
  • Establishing and managing effective public and private sector partnerships
  • Improving patient safety and quality outcomes through innovative technologies and evidence-based care protocols

Sessions will be held on community and hospital surge capacity, optimizing multi-agency coordination in pandemic preparedness for hospitals and public health agencies, hazards preparedness, building an IT Infrastructure to support medical emergencies, strategies to align military and public health emergency preparedness activities, and developing comprehensive and actionable plans.

A partial list of speakers includes:

  • Bradley Perkins, MD, Capt USPHS, Chief, Officer of Strategy and Innovation, Office of the Director, CDC
  • Thomas R. Frieden, MD, MPH, Commissioner, NY City Department of Health and Mental Hygiene
  • Ahmed Calvo, MD, MPH, Acting Deputy Director, Center for Quality, Office of the Administrator, HRSA
  • Denice Cora-Bramble, MD, Executive Director, Goldberg Center for Community Pediatric Health
  • Michael L. Cowan, MD, Chief Medical Officer, Bearing Point and former Surgeon General, U.S Navy
  • Garth Graham, Deputy Assistant Secretary for Minority Health, HHS
  • RADM Ali D. Kahn, MD, MPH, USPHS, Assistant Surgeon General, Deputy Director, National Center for Zoonotic, Vector-Borne, and Enteric diseases, CDC
  • Patrick M. Libbey, Executive Director, National Association of County and City Health Officials
  • Evelyn Meserve, Executive Director, International Association for Healthcare Security and Safety
  • Alan F. Morgan, CEO, National Rural Health Association
  • Maime H. Rivera, MD, Director Division of Public Health, Delaware Department of Health and Social Services
  • Bradley Perkins, MD, Capt, USPHS, Chief, Officer of Strategy and Innovation, Office of the Director, CDC

For more information, and to register go to Call 1-800-767-9499 or email