Telemedicine Improves Outcomes

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

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

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

The TEMPiS program is to:

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

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

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

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

Helping Small Tech Companies

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

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

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

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

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

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

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

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

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

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

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

VC Used to Treat Dementia

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

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

The specific aims for the study are to:

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

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

ePrescribing Today

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

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

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

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

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

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

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

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

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

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

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

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

For more information on the Summit, go to www.worldcongress.com/eprescribing.

Board Releases Plan

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

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

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

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

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

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

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

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

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

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

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

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

DOD Releases SBIR Notice

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

Basically, the DOD OSD SBIR program is interested in:

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

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

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

The solicitation was issued November 12, 2008 and proposals can be accepted on December 8, 2008. Final proposals are due January 14, 2009. For questions and more information, go to www.dodsbir.net/solicitation/sbir091/osd091.htm

TX Fund Invests Millions

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

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

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

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

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

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

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

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

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

"LA Health First" Details

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

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

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

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

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

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

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

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

IHS Addressing Quality

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

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

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

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

For more information, go to www.ihs.gov/NonMedicalPrograms/quality.

Computers Investigate Cells

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

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

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

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

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

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

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

Medical Technology Issues

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nursing and Technology

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

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

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

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

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

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

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

NASA Licensing Technology

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

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

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

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

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

For more information about the Innovative Partnerships Program at NASA Glenn go to http://technology.grc.nasa.gov.

CMS Seeks IT Solution

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

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

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

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

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

Emergency Care Research

A new CDC grant was awarded to help health departments, providers, and communities select the right communication mode for the right situation when an emergency strikes. The goal is to strengthen public health systems communication and their response to a variety of emergencies.

The grant for $6 million was awarded to the Preparedness and Emergency Response Research Center. The Center, one of seven centers in the U.S. to receive these grants will be led by Dr. Mark Oberle, Associate Dean for Public Health Practice at the University of Washington School of Public Health and Community Medicine, and Dr. Susan Allan, Director, Northwest Center for Public Health Practice.

The researchers will look at 911 and public health call centers to improve managing non-English speaking callers, improve emergency health alerts between public health and providers, and will examine cellular technologies needed to reach vulnerable populations in times of emergencies.

Collaboration between the University of Washington and other state and local health jurisdictions in Washington and Montana will be formed to do the study. The research will integrate the work of public health practitioners and the academic research center to ensure that the work is not only grounded in practice but also provides an evidence base that can be used to improve public health communications nationwide.

The Emergency Medicine Foundation (EMF) an organization to promote the delivery of quality emergency medical care funds research grants. The EMF Health Policy Research Grant Program funds research projects in health policy or health services research topics. The seed grants help researchers develop applications for further funding. EMF awarded 18 grants totaling $385,750 from July 1, 2007 to June 30, 2008 with projects ranging from laboratory research, health policy research, and research on adverse medical events resulting from ED crowding.

For example, a grant for $24,978 awarded in 2007 helps researchers at the University of California, San Francisco study how to help 911 dispatchers recognize strokes in a timelier manner for patients that call 911. The Cincinnati Prehospital Stroke Scale (CPSS) takes less than a minute to administer so a baseline assessment will be conducted as to how 911 dispatchers using CPSS can do a better job to accurately detect strokes.

Another 2007 grant award for $50,000 went to Beth Israel Deaconess Medical Center to investigate ED crowding which is one of the most important issues facing emergency medicine today. The study looks at the contributors to ED crowding, the practice of boarding admitted patients, and examines profitability by building a model comparing actual and estimated revenues and costs. The data used will come from a large inner-city academic hospital that serves as a regional referral center, experiences high levels of ED boarding, but is also highly profitable.

Now in 2008, applicants for the EMF awards may apply for current grants available up to $50,000 in a one year period. To be eligible, the principal investigator must have a primary faculty appointment in Emergency Medicine and be able to demonstrate that the project will be successfully completed at their institution. While any proposal relating to health policy or health services topics will be considered, special consideration will be given to proposals discussing outcomes, cost effectiveness, and quality of care. The proposal deadline for current proposals is December 22, 2008. For more information, go to www.emfoundation.org.

Developing Device Prototype

The Center for Integration of Medicine & Innovative Technology (CMIT) and Sensor Technology-Devices (ST+D) are collaborating on a monitoring device. ST+D transferred a prototype of a miniaturized wearable wireless device to monitor vital signs in traditionally unmonitored low-acuity settings to CMIT.

ST&D is a Belfast spin-out of the University of Ulster with experience in developing medical sensors and wireless systems to monitor patients’ vital sign. The company recently teamed with CMIT investigators led by Dr. Nat Sims, of Massachusetts General Hospital.

ST-D and CMIT are developing the device to provide information on heart, respiration, temperature, and movement. The device will use existing hospital wireless networks to immediately notify clinical teams if there is a change in the patient’s health. The device will be called “Guardian Aingeal” which is the Irish word for angel.

Members forming the consortium include Beth Israel Deaconess Medical, Center, Boston Medical Center, Boston University, Brigham and Women’s Hospital, the Charles Stark Draper Laboratory, Children’s Hospital Boston, Harvard Medical School, Massachusetts General Hospital, MIT, Newton-Wellesley Hospital, Partners HealthCare, and VA Boston Healthcare System.

ST&D’s latest funding round has been led by Belfast-based Clarendon fund managers and supported by existing investors including Enterprise Equity. Wellcome Trust has also provided research funding plus Invest Northern Ireland supports the initiative with CIMIT with financial support.

Tracking Metal Fragments

A Department of Defense registry is helping officials gather data to be sure that the long accepted practice of leaving embedded metal fragments in the wounded soldier’s body as long as vital organs aren’t threatened is valid. “In general, we’ve always felt that metal fragments in a body, if they are smaller than a certain size and not in a vital area of the body, it is ok to leave them in”, said Dr. Michael Kilpatrick, DOD’s Deputy Director for the Force Health Protection and Readiness Group that created the “Embedded Metal Fragment Registry.”

The registry has the potential to help the military spot trends and track down potential causes of illnesses and perhaps lead to new tests that would determine the type of metal and its concentration in an individual.

It is important to know what the enemy may be shooting at our military and what type of enemy roadside devices are being used. So far, the fragments are not of a dangerous type of mental, but consist of iron, aluminum, or copper, or brass.

Those veterans that have had fragments removed and have had their fragments sent to the registry but still live with unrecoverable fragments, are now part of the database. Administrators will use medical records created when service members were injured in blasts and have the subsequent medical records added to that database.

Service members with electronic records are being covered. This information will be shared with the Veterans Affairs Health Care System and will follow veterans for the rest of their lives. So far, the registry has looked at 400 to 500 fragments to determine their makeup.

Innovation in Michigan

The University of Michigan established the Medical Innovation Center to encourage new ideas in the state. The Center was formed to help clinicians overcome a number of barriers, help others navigate the complexities of commercialization, improve public health, develop an effective education curriculum, and provide introductions to collaborators, funding sources, and industry partners.

Once the Innovation Center has sufficient funds, a Global Innovation Alliance Program will be established. This program will provide international fellows the opportunity to be trained at UM and the university will support innovative programs to develop low-cost biomedical technologies. These technologies will be used to help emerging countries and for individuals suffering from rare or orphan diseases.

Recently, the University of Michigan’s C.S. Mott Children’s Hospital received a $100,000 Grand Challenges Explorations Grant from the Bill & Melinda Gates Foundation. Matthew M. Davis, M.D., Associate Professor of General Pediatrics and Internal Medicine at the UM Medical School will lead the project.

This project is one of 104 grants announced by the Gates Foundation for the first funding round of Grand Challenges Explorations, a five year $100 million initiative to help scientists around the world explore bold new solutions for health challenges in developing countries.

Davis will work with other UM experts in vaccines and economics on the project. The idea is to link biotech companies and researchers in the industrialized world with vaccine manufacturers in developing countries to enable the transfer of new vaccine technologies from one phase and place of vaccine development to another. Priority will be given to vaccines against HIV/AIDS, tuberculosis, malaria, diarrheal diseases, and pneumonia.

In another advance, the University of Michigan Health System implemented the UM-CareLink computerized provider order entry system in the University Hospital and the Cardiovascular Center. Even before the system was completed, there had been a 29 percent reduction in medication errors and a 40 percent cut in time between ordering and administrating urgent medications.

In addition, UMHS received a grant from the William and Flora Hewlett Foundation to provide comprehensive pre-clinical health curricula worldwide via the Internet. The University of Michigan, the Open Society Institute, and the Foundation for Advancement of International Medical Education and Research are providing financial support.

The UM Medical School is leading the project and working with the UMHS schools and partner institutions in Africa at the University of Cape Town and the University of Ghana. A key part of this effort will be to convert existing educational materials into Open Educational Resources available online. The Medical School and the Schools of Public Health and Dentistry will provide materials for the pilot.

In the state and federal government sector, Michigan’s Department of Community Health’s (MDCH) Office of Public Health Preparedness is overseeing projects through CDC’s funding of $24 million made available for pandemic influenza preparedness. The state of Michigan received more than $2 million for projects.

MDCH will provide the oversight to three projects. The first project involves expanding the Michigan Care Improvement Registry (MCIR). The MCIR All Hazards Enhancement Project developed through MDCH’s Bureau of Epidemiology will expand the registry to achieve timely reporting, data aggregation, and data exchange in the event of an influenza pandemic.

The second project is using a new electronic PHIN compliant electronic mortality reporting system developed through MDCH’s Bureau of Local Health and Administrative Services to exchange mortality data with federal partners and then integrate this data into existing disease reporting systems.

The final MDCH project developed through Spectrum Health of Grand Rapids is working on a set of planning and operations guidelines to identify and provide essential healthcare if it becomes necessary to care for large numbers of hospitalized and home bound patients during a pandemic.

The Michigan Institute for Clinical and Health Research part of the NIH Roadmap Clinical and Translational Science Award created the Pilot and Collaborative Grant Program with $5 million in funds. The program looks for proposals promoting the development of novel solutions to improve patient and community health outcomes. In addition to clinical and translational research, proposals are accepted on health services studies, outcomes or policies that test new interventions, and proposals relevant to developing new methods or best practices.

The types of grants available in this program include seed grants, pilot grants, collaborative grants, clinical trial planning grants community-university research partnerships, health disparities research, and research on ethics projects.

CMS Releases Final Rules

CMS released a final rule pertaining to telehealth services for services furnished on or after January 1, 2009. CMS added three new facility types to the list of authorized telehealth originating sites that now includes hospital-based or CAH-based renal dialysis centers including satellites, skilled nursing facilities, and community mental health centers.

Further, in a request from the American Telemedicine Association (ATA), CMS even though there has been no immediate approval has agreed to evaluate the use of a number of additional codes related to skilled nursing facilities in its review for 2010. The ATA outlined codes in their request for initial nursing facility care, subsequent nursing facility care, nursing facility discharge services, and other nursing facility services.

CMS decided not to add diabetes self-management training and critical care services to the final rule but CMS did add new codes specific to the telehealth delivery of follow-up inpatient consultations. The new codes will enable practitioners to bill for follow-up inpatient consultations delivered via telehealth. These codes are intended for use by physicians or NPPs when an inpatient consultation is requested from an appropriate source such as the patient’s attending physician.

Requests to change approved telehealth services must be made by December 31st of every calendar year. The requests are then reviewed for placement in the proposed rule for the next rulemaking cycle.

Also, CMS released their final 2009 physician payment rule for e-prescribing. Physicians and other eligible professionals who adopt and use qualified e-prescribing systems may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009. The National ePrescribing Patient Safety Initiative is offering free ePrescribing software to all physicians and medication prescribers. For more information, go to www.nationalerx.com.

This incentive is in addition to a 2.0 percent incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative (PQRI). Therefore, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1 percent pay boost for 2009.

HRSA to Fund Center

HRSA released a grant announcement (HRSA-09-177) on November 4th to fund a Data Resource Center to provide access to the Maternal and Child Health Bureau’s user-friendly national, state, and regional data available from surveys and other data resources. The surveys focus on the “National Survey of Children with Special Health Needs” and the “National Survey of Children’s Health”. The goal is to use these two resources to provide an evidence base for state, local maternal, and child health programming information.

Specifically the grantee’s responsibilities include:

• Developing and maintaining data use support features for the website
• Developing easy to understand resource materials and training modules
• Providing technical assistance to respond to national, state, community and family
  constituencies, and particularly for the State Title V programs
• Incorporating new data sets from the latest information as it becomes available
• Consulting and providing technical assistance to MCHB and the National Center for Health Statistics

Any public or private entity including an Indian Tribe, tribal organization, faith-based or community organization is eligible to apply for the grant.

Approximately $575,000 is expected to be available annually to fund one grantee and will provide funding for FY 2009-2011 depending on the availability of appropriated funds. The application deadline is January 07, 2009. The project is estimated to start May 01, 2009.
For more information, go to www.grants.gov or contact Michael Kogan at mkogan@hrsa.gov or call 301-443-3145.

Consumers Need to Take Charge

Regina Herzlinger, Professor of Business Administration at the Harvard Business School, and author of “Market Driven Health Care: Who Wins, Who Loses in the Transformation of America’s Largest Service Industry”, discussed issues affecting healthcare in the U.S. The keynote presentation via video took place at the Partner’s Center for Connected-Health Symposium held October 27-28, 2008 at the Harvard Medical Conference Center.

Professor Herzlinger posed the question as to why employers are in charge of our healthcare. Health insurance in the hands of the employers means that people sometimes stay in big companies simply because of the availability of health insurance. As a result, small innovative companies don’t have access to all the people that they might hire and therefore, new positions aren’t expanding. Also, limited insurance choices result in fewer physicians, fewer innovations, uneven quality, high costs, and leaves millions of individual’s uninsured and underinsured.

Consumers if they could would like the choice of remaining with the employer’s insurance or buying their own insurance. Making choices is good for everyone and would produce a competitive, more personalized, and innovative society. Consumers would like to seek health insurance policies that would provide long term care, high deductibles if desired, and rewards for lifestyle if the individual is taking care of themselves and staying healthy. In other words, consumers are looking for more control and a customized healthcare plan.

Herzlinger emphasized that in a single payer system, innovations aren’t likely to happen especially when the government controls the money. Having a single payer system controlled healthcare system results in rationing healthcare is simply not acceptable in this country. In a consumer controlled system, individuals would be able to buy their own health insurance, healthcare services, and technology. Also, in a consumer driven system there would be a heavy IT system of care with information provided from all connected providers.

According to Herzlinger, Switzerland is a good example of a country that is consumer driven. Consumers buy their own health insurance and are able to demand information on costs and the quality of insurance plans. The defining feature of the consumer driven system is that when consumers make choices, the system becomes competitive, innovative, and provides many more choices.

A consumer driven system would also help entrepreneurs develop innovations in medical devices. For example, some of these innovations may include implantable devices such as continuous glucose sensor systems and the further development of real-time wireless systems. Plus a consumer driven system would also encourage scientists to make further advances in genetic testing. Healthcare entrepreneurs starting companies have a deep knowledge of how underlying technologies work and if they were helped by a consumer driven system, this alone could take healthcare innovations to a new level.

Cutting Costs by $197 Billion

Remote monitoring alone could reduce healthcare expenditures by a net of $197 billion over the next 25 years by using remote monitoring to track the vital signs of patients. This will only occur if policies are adopted to reduce barriers and if the use of remote monitoring technologies is accelerated, according Robert Litan, PhD, Study Author, Vice President, Research & Policy, Kauffman Foundation and a Senior Fellow in the Economic and Global Economics Programs at the Brookings Institution. At the same time broadband-based applications can improve care for chronic disease.

Litan spoke at a briefing sponsored by Better Health Care Together held at the National Press Club in Washington D.C. where his study “Vital Signs Via Broadband: How Technology Can Cut Health Care Costs and Improve Patient Care” was released on October 24, 2008.

He pointed out “remote monitoring can spot health problems sooner, reduce hospitalizations, improve life quality, and save money.” The Litan study looked at estimated baseline savings tied to four specific conditions such as congestive heart failure, diabetes, chronic obstruction pulmonary disease, and chronic skin ulcers and wounds.

Litan warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the U.S. does a better job of reimbursing healthcare organizations for remote care. The country also needs to encourage continued investment in broadband infrastructure tailored to meet the privacy, security, and reliability requirements for telemedicine applications. Litan estimates that the failure to make the right policy adjustments will cut estimated healthcare savings by almost $44 billion over the 25 year period.

He continued to say that while broader broadband penetration is desirable, the right kind of broadband is just as important. Effective remote monitoring requires “smart networks” that will ensure that the patient’s critical data and the communication of that data is not disrupted or interrupted.

Jody Hoffman, Executive Director , Better Health Care Together, a partnership of leaders from business, labor, and public policy organizations said “Litan’s study illustrates how new directions in health care can enable the U.S. to deliver quality care at lower costs. Our first priority is to make sure every American has quality, and affordable health coverage. In order to do this, we need to develop and use information technologies in a big way.”

Neal Neuberger, Executive Director, Institute for e-Health Policy and President of Health Tech Strategies, LLC said “remote healthcare monitoring sits at the intersection of traditional telemedicine and new healthcare information technologies.”

Neuberger noted that we must acknowledge the nature of our complex and rapidly evolving healthcare delivery system given the diversity and pace of proposed reform efforts. There are several issues to deal with involving reimbursement, changes in telecommunications law, workforce shortages, and licensing. He continued to say we need to do remote monitoring, develop the medical home to meet the needs, build out networks so they will affordably reach into homes, and set up rural and remote clinics and health centers.

He continued to say that from the provider’s perspective, the integrity and reliability of data is critically important since clinicians will not accept questionable data because it poses quality and liability concerns. Patients on the other hand are concerned about their access to healthcare, concerned about the cost and quality of healthcare, expectations for privacy and security, but most importantly, patients today want to be involved in the decision making process.

The Litan study is available at http://betterhealthcaretogether.org/news.

Funding Available for Grants

UnitedHealthcare is funding $1.3 million in new grants to help healthcare consumers and improve healthcare delivery in Arizona. The grants will fund projects involving technology improvements for safety-net providers, initiating medical education programs in underserved communities, and providing population-based preventive health strategies. In addition, cash or in-kind contributions will be made to help establish and support healthcare information technology initiatives.

The present grants are going to be awarded in the second grant cycle. In the first grant cycle, UnitedHealthcare contributed more than $1.4 million to several local organizations, including $700,000 to Arizona State University Foundation to refurbish a mobile healthcare van and $200,000 to El Rio community Health Center in Tucson to help build an interface for electronic medical records and a health information exchange. A third UnitedHealthcare cycle of grants is planned for the fall of 2009.

UnitedHealthcare will begin to accept applications on November 1, 2008 with all applications due by December 15th. For more information contact Deborah Chambers at 602-954-3381 or email dchamber@suhc.com.

The California HealthCare Foundation seeks proposals that will help provide high quality chronic disease care in California since there are fourteen million Californians with at least one chronic condition.

The grants range from $50,000 to $500,000 each with grants to be awarded for $25,000 per coalition of multiple key stakeholders. The funding is dependent on community size, scope of work, and the potential for impact.

CHCF is going to fund up to $250,000 to support local cross-sector activities to:

• Address the creation of cross sector partnerships to lead quality improvement efforts
• Spur the sharing of ideas, practices, resources, and tools for improving the quality and patient-centered chronic disease care across provider organizations
• Advance the knowledge and skills of clinical staff across organizations to provide better chronic disease care such as in team care and panel management

The CHCF proposals are due December 12, 2008. For more information, contact Nandi Brown at nbrown@chcf.org or call 510-238-1040.

Senator Kerry Opens Symposium

Senator John Kerry (D-MA) spoke to a packed audience at the Partners Center for Connected-Health Symposium held at the Conference Center at Harvard Medical School on October 27-28, 2008. The Senator told the audience that although the economy is facing difficult times, technology especially health IT is set to play an important role in the future.

The Senator pointed out that the country spends two trillion on healthcare every year which represents one out of every six dollars in the economy but this simply can’t continue. In order for the economy to forge ahead with new technologies and to keep our technological advantage, the country as a whole needs to be innovative, productive, creative, and competitive plus the right incentives need to be in place.

However, to move health IT forward, the first job is to move reforms through Congress which must include more funding for IT along with reforms for Medicare reimbursement. Senator Kerry has confidence that legislation will get passed perhaps as part of a comprehensive package that may include direct grants, tax incentives, and tax credits. A big problem is that on a good day in the current Congress, only about fifty one Senators vote but 60 votes are needed to get legislation passed. However, many changes are possible with the election and hopefully Congress will produce legislation with new investments in health IT.

The recent passage of the requirement for e-prescribing included in the Medicare legislation is a very good example of how e-prescribing will help to move health IT forward, according to Kerry. The state of Massachusetts is actively involved in e-prescribing and this means that pharmacists will no longer need to use two thirds of their time to check on prescriptions. Kerry foresees that many doctors in Massachusetts will be transitioning over to e-prescribing systems within the near future.

UVA Adding Sites

The Office of Telemedicine at the University of Virginia Health System has received a $227,613 grant from HRSA to add three new telemedicine sites in far Southwest Virginia. These sites will provide screenings for breast and cervical cancer and also a broad range of specialty and sub specialty medical services. The new locations will increase the UVA telemedicine sites in far Southwest Virginia to 27. More than three dozen other sites in the state belong to the UVA telemedicine network.

The grant funding will purchase video conferencing equipment, computers, monitors, electronic stethoscopes, a standard documents camera and a high resolution camera for all three sites. The funding will also be used to purchase a video colposcope, an innovative telehealth tool used in the diagnosis of cervical cancer. The equipment will be linked to all Southwest Virginia Community Health System telemedicine facilities and should be in service by the end of November. In addition, the grant will enable UVA’s digital mammography van to provide screening.

According to Karen S. Rheuban, M.D., Medical Director, UVA Office of Telemedicine, “more than 300 live interactive patient consultations were provided in 35 clinical specialties in the region last year and we are gratified by the partnerships that have made this expansion possible.”

Representative Rick Boucher of Virginia noted “Southwest Virginia now has more than 50 broadband-connected telemedicine sites, more than any other Congressional district in the nation.”

In coming months UVA telemedicine will add several more sites in far Southwest Virginia to the network. The USDA funding will enable Johnston Memorial Hospital Cancer Center in Abingdon and the Mountain Laurel Cancer Support and Resource Center in Norton to become telemedicine sites. By the end of 2008, the JMH and UVA Cancer Centers will begin conducting shared tumor boards via telemedicine links to evaluate patients and to discuss a multidisciplinary approach to treating these patients.

Another future site for telemedicine is the Appalachia University College of Pharmacy in Grundy, which has received an allocation from the Tobacco Indemnification and Community Revitalization Commission to create a telemedicine link with UVA.

1st Device/Solution Demo

With close to a quarter of the world’s population overweight, more than 600 million people with some form of chronic disease and millions more reaching retirement age, the time for greater personal health management is now, said Dave Whitlinger, Continua Health Alliance President.

He emphasized that Continua member companies are working on real solutions to empower consumers and healthcare professionals to access and share information quickly and easily through connected products and solutions. “Together, we can create a new marketplace, improve health and quality of life, and advance personal telehealth worldwide” said Whitlinger.

The first public device and solution demo to show interoperability among pre-certified products and services was presented on October 27th at the Partners Center for Connected Health Annual Connected Health Symposium held in Boston Massachusetts. Continua members A&D, Cambridge Consultants, Cypak, FitLinxx, Google, IBM, Intel, NHS, Nonin, Oracle, Partners, Philips, Roche, Stollman, and University Health Network provided the devices and software solutions.

The demos showed how data can be shared seamlessly across a variety of environments both in the home and professional settings to help consumers and professionals better manage personal health and wellness. The attendees were able to see the benefits of real-time information sharing that improves data for diagnostics and treatment, results in savings in time and costs, and improves patient experiences.

Google and Dossia are now part of the Continua membership and will help to ensure that current and future PHR/PHS applications can be used across a wide array of Continua-certified devices.
Both organizations are focused on creating richer consumer healthcare experiences through tools and applications to allow for secure information storage and retrieval.

In other news, Continua has selected AT4 as its Test Tool vendor, released the first edition of “Vendor Assisted Source Code” to the membership, delivered a database of all peer-reviewed remote patient monitoring literature conducted in the last 5 years in Europe and the U.S., now researching a White Paper “U.S. Policy Environment for Remote Chronic Disease Management”, and Continua and IHE have signed a Memorandum of Agreement to promote interoperability of healthcare devices.

The Continua Health Alliance helps members and non-members seeking appropriate vendors for new health and chronic disease management programs through Continua’s Matchmaking program (www.continuaallliance.org/match_program). The program helps healthcare providers find world class vendors that have developed the next generation of personal telehealth devices and services.

Support for Nursing Education

HRSA’s Bureau of Health Professions in partnership with the Office of Health Information Technology is funding technologies to use to educate nursing students at collegiate Schools of Nursing. Nursing collaboratives will be formed to establish healthcare information systems for use in nursing education and practice, to optimize patient safety, and drive improvements in healthcare quality.

The grant notice “Faculty Development: Integrated Technology into Nursing Education and Practice Initiative” (HRSA-09-119) seeks ways to enhance nursing education and practice in informatics by using telehealth, mannequin-based and patient simulators, computer-based instructions, virtual simulation, interactive simulated case studies, advanced 3D graphics, e-learning technology, and any other simulated or virtual methods.

Since no institution or organization currently offers the full spectrum of technologies, nursing collaboratives will need to develop linkages and partnerships to undertake this initiative. State-of-the-art training sites will be established so that nursing faculty can be fully trained using virtual reality and real-time training in a full range of relevant technologies.

The program will provide funding for FY 2009-2013. Approximately $600,000 is expected to be available annually to fund two cooperative agreements. It is estimated that there will be two awards with the project to begin July 2009. The proposals are due December 4, 2008.

For more information, go to www.grants.gov or call Nancy Douglas Kersellius at 301-443-6333.