Sunday, March 30, 2008
Michael J. Kussman M.D., Brigadier General (Retired), Under Secretary for Health, Department of Veterans Affairs commented at the opening session that the care that starts in DOD and moves forward is really providing a continuum of care as individuals go from DOD to the VA and sometimes go back and forth during their entire lifetime.
According to Dr. Kussman, the goal is to have a single integrated system and not to build two separate systems in a perfect world. Until that is possible, it is absolutely essential is to have interoperable systems that can talk to each other. For example, everyone today uses different phones but yet they still can talk to each other. We need to leverage what we have and not reinvent the wheel.
In the session on optimizing warrior care, Colonel David Gilbertson, Program Manager, Clinical Information Technology Program Office, Department of Defense Health Affairs told the audience that universities, federal agencies, and industry have to work together to move the right technology at the right time. We need strong senior leadership to make it work that will develop strategic ideas, identify challenges, determine what can be done in the near term, relate to the civilian community to explore new approaches, find ways to break down the barriers between IT people and providers, and invest in selecting the best people to be in charge.
“Tiger Teams” were formed to discuss four issues in a workshop format that included Longitudinal Health Records (LHR), Knowledge Discovery, Systems Architecture, and Interoperability. LTC Thomas Greig, MD, Program Director for Clinical Informatics and Accession Medical Policy within the Office of the Assistant Secretary of Defense for Health Affairs, speaking at the LHR workshop, reported that his team held discussions on a number of issues that need to be resolved before developing the future LHR.
He explained that the record is not just from cradle to grave but can be from the time that children are born if one or both parents are in the military. For example, if a child is born in a military hospital, also joins the military, and retires, that person could go through their lifetime being treating by the military health system and also the VA. This is why the LHR is so needed.
To start the process, the LHR team focused on the decisions that will need to be made in 5-10 years and focused on opportunities, challenges, and new approaches. The system needs to be adaptable, be able to deal with unintended uses, needs to be flexible, and needs to be able to take advantage of new technology as it comes along. The team realizes that it is necessary to learn from federal agencies, and the private sector. Also the issue of whether DOD and the VA should collaborate with RHIOs was discussed and it was thought that the LHR could provide valuable information to health information exchanges.
Nancy Staggers, PhD, RN, Associate Professor Informatics, College of Nursing, University of Utah, mentioned some of the specific problems within the DOD AHLTA system. She pointed out that the system sometimes presents excessive downtime along with slow response time and the software design works better for primary care than for specialists. Most importantly, usability precepts and tools are not a part of the DOD HIT processes, but it is important to know that usability issues are not just unique to AHLTA.
To discuss the health system from the industry point of view, David Parker, MD, Northrop Grumman Information Technology highlighted that AHLTA is the largest fully deployed EHR in the world and captures more detailed compatible clinical data in an outpatient setting than probably any other organization in the world. However, he is also concerned with slow speed, stressed the fact that the feedback hole has to be fixed, there is a need for improvements to be made to current tools, missing data must be addressed, and at this point, DOD is barely scratching the surface in using the data.
Rick Satava MD, University of Washington, speaking at the workshop presented a futuristic view of how medical records need to be enhanced with visual records. He wants to see the inclusion of total body scanning into the medical record. He envisions 3D images embedded in the lifelong military medical record system along with all of the data. Eventually the idea is to digitally recreate the soldier’s body and embed all of the medical data and visual information on a chip in the soldier’s dog tag.
DARPA was very involved in this idea, and created the Virtual Soldier program over a 4 year period. The goal was to use MRIs, CT scans, x-rays and ultrasound to create a holographic medical electronic representation of a person’s body. With this information the doctor would have a patient’s baseline picture to compare with the current situation. This would not be a static picture but would update information, provide automatic diagnosis, and have the ability to look into the body’s future.
Dr Satava also emphasized that we also need to do virtual autopsies because it is very important to have data on the causes of deaths. Currently, there is not always validity to death certificates and as a result, the information on the cause of death is not always accurate. New detailed information on how a soldier died can be very helpful especially if the death occurred from a blast injury. For example, if we have more data on this particular type of injury, this information could help in the design of better body protective equipment.
The Forum facilitated dialogue and the sharing of ideas at the many sessions and workshops, and to help plan for future health information systems, a report will be submitted to DOD and other agencies on the general sessions and workshops.
For more information, go to www.isis.georgetown.edu/ahlta or email alaoui@isis,georgetown.edu.
So far, HRSA is supporting:
· 42 New Access Point awards, worth about $25 million with more than 250 applications received
· 20 Expanded Medical Capacity grants, worth about $10 million with 220 applications received
· 160 grants worth $30 million for Service Expansion. The breakdown is 60 grants for Mental Health/Substance Abuse grants, 60 Oral Health grants, and 40 Pharmacy grants. 600 applications were received
· 25 planning grants worth $2 million with 100 planning grants received
In addition, HRSA will continue to implement health IT by awarding $20 million in grants to Health Center Controlled Networks. The agency expects to award more than $7 million to current grantees to continue ongoing projects with $13 million in new grants. The agency has already awarded HIT planning, implementation, and innovation grants worth $3 million. HRSA is going to make available $10 million on one time High Impact Grants to help health center networks or large health centers implement HIT systems.
According to Duke, the HRSA FY 2009 proposed budget would provide a $26 million increase to health centers to just over $2 billion. The increase would fund up to 40 new health centers in high poverty areas that currently have no health center sites and up to 25 planning grants to help community-based organization in these areas win grants in future competitions.
As for quality, the HRSA agenda is focusing on improving patient outcomes. HRSA has selected its first set of “Core Clinical Quality Performance and Improvement Measures”. The goal was to develop Core measure that could be reported on by all HRSA programs that deliver direct clinical care. The first set of six Core measures have been incorporated into the 2008 UDS reporting, and will be due in mid 2009.
HRSA’s Center for Quality and Office of Pharmacy Affairs is moving forward on the new “Patient Safety and Pharmacy Collaborative” to improve health outcomes, patient safety, and to increase clinical pharmacy services. The Collaborative was launched in 2007, and since then HRSA teams have been visiting high performing health centers, hospitals, and other healthcare organizations to see how they maintain good outcomes for their patients. This study process will conclude as the end of April.
In keeping with HRSA’s goal to help underserved populations, a new rule “Designation of Medically Underserved Populations and Health Professional Shortage Areas” was proposed in the February 29th issue of the Federal Register. Basically, the new rule will improve the way that underserved areas and populations are designated and target federal resources to the people and communities that need them the most. Comments on the rule will be accepted within the 60 day period following the Federal Register announcement.
As part of ongoing efforts to develop research tools that can help speed the delivery of life transforming treatments for Parkinson’s disease, the Michael J. Fox Foundation is launching the “Web-based Clinical Assessment Program.” Under this initiative, the Foundation is seeking test web-based tools so that any patient with a personal computer and an internet connection can participate in clinical research from the comfort of their home.
According to Katie Hood, CEO of the Foundation, a web-based clinical assessment can never entirely take the place of face-to-face interactions between patients and researchers, but if used as a supplemental measure, progress can move faster toward new treatments. Todd Sherer, PhD, Vice President for Research Programs said “web-based information can help to increase the participation of individuals who might otherwise not realistically be able to take part due to difficulties in traveling. A web-based clinical assessment could provide a more complete picture of symptoms by enabling individuals to test certain functions at home and throughout the day.”
Applicants for the funding need to focus on three deliverables:
- Development of an assessment tool that will be available via the internet
- Creation of a technological infrastructure where patients will be able to access this tool
- Design and implementation of a pilot study to test efficacy
Applicants may include both U.S. and non U.S. entities, public and private non-profits, such as universities, colleges, hospitals, laboratories, state and local governments, and eligible agencies of the Federal government, and for profit entities.
The program will provide up to $1 million in funding for web-based clinical assessments of various motor and/or non-motor symptoms of Parkinson’s disease. Pre-proposals will be reviewed and must be submitted online by May 14, 2008. Applicants selected to submit proposals will be invited by May 28, 2008 to submit full application proposals. Full proposals must be submitted by July 29, 2008. The anticipated award date is September 2008 with funding to begin in October 2008.
More information on submitting pre-proposals go to www.michaeljfox.org. For more information or inquiries, contact D. Erica Pascual at firstname.lastname@example.org or call (212) 509-0995 extension 261.
Monday, March 24, 2008
Speaking at the National Press Club in Washington D.C. on March 21st, Denis Cortese, MD, President and CEO of the Mayo Clinic, in Rochester Minnesota, stressed that this country needs to create a healthcare system that works. Some say the system is broken, but this is a fatal way to think because then you think that you can fix the system. A new healthcare system needs to be designed with reforms to ensure the future of quality patient care.
He said that people want their medical professionals to be able to predict risks for illnesses, prevent major illnesses, present wellness programs, diagnose illnesses accurately and timely, be able to control chronic illnesses, and people in general want to enjoy a good quality of life.
According to Dr. Cortese, one of the first steps is to come together to build learning systems. As the Institute of Medicine has pointed out, too many patients are subject to medical errors. In our system today, patients don’t always get the right advice 100% of the time. Learning systems are needed to connect information to enable the professionals to have best medical evidence available at all times to make the right decisions. With the right information and teamwork, medical care will be done right the first time.
Over the past two years, the Mayo Health Policy Center used an integrated approach to help find healthcare reform solutions. The Center over two years brought together more than 400 national thought leaders for discussions and to help guide the health reform process. The ideas discussed at these sessions concerned universal insurance coverage, coordinated care, providing high-value healthcare to patients, and payment reform.
Dr Cortese outlined some of the resulting Mayo Health Policy Center’s ideas on how to advance health reform:
- Health insurance and basic healthcare needs to be available to all Americans regardless of their ability to pay. Individual ownership of health insurance should be encouraged, with sliding scale subsidies provided for people with lower incomes
- The U.S. needs to move from employer-based insurance to portable, individual-based coverage. Employers could still help finance a portion of their workers healthcare expenses but they also need to promote employee wellness
- Create a mechanism similar to the Federal Employees Health Benefit Plan to offer private insurance packages to buyers, and appoint an independent health board to define essential healthcare services
- Coordinate patient care across people, functions, activities, sites, and time to increase value. This requires that information systems and process improvement techniques be put into place. This would help realign the health system toward improving health rather than just treating disease
- To further achieve value, a system needs to be developed based upon the needs and preferences of patients, provide measurable outcomes, and provide for safety and service. It is important to publicly display outcomes, patient satisfaction scores, and costs as a whole
- The payment system need to be designed to provide patients with no less than the care they need and no more than fully informed cost conscious patients would want. Create payment systems that provide incentives for colleagues to be able to coordinate care for patients and help support informed patient decision making
- Develop and test models of payment based on chronic care coordination, and shared decision making
However, there has never been a reported case of a patient with an implantable cardiac defibrillator or pacemaker being targeted by hackers, and the researchers emphasized that the study was designed to identify and prevent future problems.
The study was led by Kohno, Kevin Fu, an Assistant Professor of Computer Science at the University of Massachusetts Amherst, and Cardiologist Dr. William Maisel at the Beth Israel Deaconess Medical Center and Harvard Medical School. Their report will be presented and published at the IEEE Symposium on Security and Privacy in Oakland California on May 19, 2008.
Dr. Maisel notes that one of the purposes for the research is to encourage the medical device industry to think more carefully about the security and privacy of patient information, particularly as wireless communication becomes more common and operates over greater distances.
In the computer laboratory, the research team used an inexpensive software radio to intercept and capture signals sent from an implantable device. They were able to obtain detailed information about a hypothetical patient, including name, diagnosis, date of birth, and medical ID number. Researchers were able to determine the make and model of the device and access real-time electrocardiogram results as well as data on the hypothetical patient’s heart rate and cardiac activity.
Three prevention mechanisms have been developed that include a notification device to audibly alerts patients of security sensitive events, a device that authenticates requests for access from outside devices, and a vibrating device that patients can sense. All three mechanisms required no power from the battery.
The team only studied one common model of implantable cardiac defibrillator so the susceptibility of similar devices to privacy and security risks is uncertain. The researchers believe future studies are needed to assess potential risks for all of the implantable devices equipped with wireless technology.
According to the March 20th issue of the Federal Register, the FDA is requesting comments and information on technologies that can be used for the identification, validation, tracking and tracing, and authentication of prescription drugs.
Legislation was passed in 2007 to require standards to be developed and to identify effective technologies to protect against counterfeit, substandard, misbranded, or expired drugs. These technologies can include RFID, nanotechnology, encryption technologies, and other track and trace or authentication technologies.
The FDA wants further information on:
- The strengths and limitations for technologies to be able to identify, validate, track and trace, or authenticate drug transactions
- The costs to implement and use these technologies
- Benefits to the public health
- Feasibility for widespread use for these technologies
- Developing the standards necessary for the supply chain use of the technology
Comments must be submitted by May 19, 2008. Submit comment to the Division of Dockets Management (HFA305), FDA, 5630 Fishers Lane, Room 1061 Rockville MD, 20852, Room 1061. Submit electronic comments to http://www.Regulations.gov. For more information, phone 301-827-3360 or email email@example.com.
Each VA mobile pharmacy is housed in a 40 foot solid steel trailer built to withstand winds in a Category 3 storm. Each mobile pharmacy is divided into five compartments, including a work area for pharmacists, an entryway accessible to patients, and a sleeping area with a bath and shower for VA personnel.
Each mobile computerized automated state-of-the-art mail out pharmacy will be able to process more than 1,000 prescriptions hourly. The units will be connected via a satellite with the VA’s Consolidated Mail Outpatient Pharmacy system, so that the pharmacists can use the satellite system to dispense drugs on site.
The first mobile pharmacy was unveiled in 2007 in Washington D.C. A unit was displayed recently at a meeting of the American Society of Health System Pharmacists in Las Vegas. A second mobile pharmacy is expected to be delivered this spring.
To ensure rapid response to a wide range of emergencies, the mobile pharmacies will be strategically placed across the nation. Plans now call for one of the three mobile pharmacies to be stationed at Dallas Texas, Murfreesboro Tennessee, and Charleston South Carolina. The Department also expects to acquire a fourth unit to be placed in the western part of the country.
Wednesday, March 19, 2008
Providing for an electronic health information system was addressed in the plan since only 15% of physician practices use electronic medical records in the state. Some of the reasons for not using EMRs include costs, difficulty in using technology, constant changes in technology, and the need to protect patient privacy. Also, there is a lack of broadband in some parts of Maine but the recent FCC awards should address the problem in northern and western Maine.
HealthINfoNet (HIN) a new non-profit is working hard to build a health information superhighway. Starting in 2008, more than 2,000 healthcare providers, including 15 rural and urban hospitals across Maine and one-third of practicing physicians in Maine will join with the Maine Center for Disease Control and Prevention in a major 24 month demonstration of the new network. Hospital and physician practices in the pilot program, account for more than half of the state’s annual inpatient hospital admissions and nearly 40% of Maine’s outpatient visits each year.
Following the demonstration phase, plans call for HIN to expand to include providers who care for Maine’s 1.3 million residents. However, the completion of the final pilot requires some additional revenues and the state is challenged to find the resources needed to complete the work.
As of this date, the legislature’s HHS committee is deliberating whether to create a stakeholder workgroup to address the financing issue. If this does happen, the stakeholders would look into the options available to finance the expansion of electronic health information exchange in the state and work with the Governor’s office to explore additional financing in 2009. In addition, the workgroup would explore the offerings by several hardware and software EMR vendors to provide no cost or low cost equipment and software to physicians by December 2008.
The draft report makes several suggestions on dealing with healthcare acquired infections. Some of the suggestions are to improve the dissemination of information, make hospital specific data on health acquired infections viewable on the Maine Quality Forum website, develop a hospital infection control collaborative, share resources for infection control and outbreak analysis, develop standards for hospital infection control and prevention, and explore other reporting options such as the National Healthcare Safety Network supported by CDC.
Each year the Department of Health and Human Services has reported to the Maine State Legislature on progress being made in the state’s health facilities using the sentinel event reporting system. This year’s report concluded that the state significantly under reports sentinel events and recommends that changes be made to the statutory language to reduce ambiguity about what must be reported. Also, the DHHS Division of Licensing and Regulatory Services will convene a stakeholder workgroup to review the current system and provide a report by November 2008.
To download the draft health plan, go to www.maine.gov/governor/baldacci/cabinet/health_policy.html.
Dr. Walker feels that the internet can provide collaborative education for healthcare providers in resource poor settings. The HIV Online Provider for Education (HOPE) is a Harvard-developed internet platform used for training in HIV medicine and can play an important part in delivering information.
HOPE is a web-based voice-over internet protocol (VoIP) that requires only an internet connection, computer speakers, and perhaps microphones. Another advantage is that the conferences are automatically recorded and archived.
The technology is based on Centra, a web-based e-learning platform already commonly used to link businesses all over the world. During a HOPE conference, participants appear as microphone icons and can use a “raise-hand” function that simulates a real classroom, and at the same time, be able to look at power point slides
At the Partners AIDS Research Center, Aurora D. Kiviat is coordinating a HOPE related web site (www.hivconsult.org) to archive HOPE conferences, provide consultative email services, and present a core curriculum of lecture presentations, journal articles, guidelines, and web resources.
Researchers will build on effective clinical decision support tools and identify preferred methods and processes for incorporating these tools into electronic medical records with the goal to increase the use of EMRs in busy practice settings.
The research will assess potential benefits and drawbacks of clinical decision support services including effects on patient satisfaction, measures of efficiency, costs, and risks. Researchers will also evaluate methods for creating, storing, and replicating clinical decision support elements across multiple clinical sites and ambulatory practices.
Sunday, March 16, 2008
The first funding round will consider proposals in four topic areas that relate to latency in tuberculosis, ways to prevent or cure HIV infections, and finding new drugs and delivery systems. Another topic under consideration will look for new ways to protect against infectious diseases. The goal is to push past obstacles in vaccine discovery in order to expand the range of health interventions to protect against infectious diseases.
Several of the options within this category involve developing new computational or laboratory-based systems for rapidly testing vaccines and to be able to predict their efficacy. Another option is to discover new applications for new technologies for disease protection, such as the production of immunogens using synthetic biology or radical genetic engineering approaches.
The first application acceptance period will end May 30th 2008, with the first grants expected to be announced by the fall of 2008. For more information, go to www.gcgh.org/explorations?pf=1.
The “Grand Challenges Explorations” initiative is an expansion of the larger “Grand Challenges in Global Health” initiative that was launched in 2003 by the Gates Foundation in partnership with NIH. This initiative brings together science and technology to focus on adapting existing health tools like sophisticated laboratory tests, to be used for populations in developing countries. Many of the projects in this program are applying cutting-edge technologies that have never been used to advance global health.
One of the goals for the “Global Challenges in Global Health Initiative” is to develop technologies to assess the health status of populations in the developing world. For example, a grant was awarded in this program to Harvard University for $18.8 million to research how to wed epidemiology, biomedical research, and population health assessments. Researchers are hoping to produce new measurement tools that are science-based, standardized, and widely applicable across different resource-poor settings.
Another grant for $15.4 million was awarded to the University of Washington to develop a simple-to-use point-of-care device to bring sophisticated medical tests to remote areas of the developing world. The device being developed will be able to test blood for a range of diseases such as bacterial infections, nutritional status, and HIV related illnesses. The healthcare workers will be able to load a small blood sample into a disposable test card that contains all the necessary test reagents. To do the testing, the test card would be inserted into a device the size of a hand held computer with the results available in 10 minutes.
Use of the integrated record in dental care will support the early identification and documentation of oral symptoms which may indicate the presence of systemic health conditions. Through AHLTA, dental providers can document a patient’s screening results in the integrated record and make that information accessible to the patient’s primary care provider and even arrange a medical consultation when necessary.
The integrated system is the result of six years of a collaborative system design effort led by the Clinical Information Technology Program Office. Colonel Page McNall, DDS, CITPO’s AHLTA Dental Product Line Manager, reported that the final product fulfilled all of the requirements of the dental commands.
If the plan is approved this year, the Center will receive a four year $2.5 million Phase 2 grant to support the commercialization of new products and help companies expand in developing advanced medical technologies. The grant requires that COI be self supporting within five years.
“NCBIO believes that the CIO will help North Carolina leverage strengths in biotechnology, nanotechnology, information technology, and regenerative medicine and will become a leader in the advanced medical technologies industry,” said NCBIO president Sam Taylor.
In another funding initiative, the National Institute of General Medical Science within NIH has awarded Affinergy, a Duke University spinout, a Phase 2 SBIR grant for $2 million. Previously the company has been awarded multiple SBIR grants with the four grant awards awarded for Phase 1 programs exceeding $1 million.
The company develops coatings and medical devices for the orthopedic and cardiovascular markets. Examples of how the technology can be used would be to:
· Optimize the release of a protein growth factor from a device
· Attach drugs to a device at the point-of-care
· Deliver and attach adult stem cells to a specific device or tissue
“We are excited to initiate the Phase 2 activities and accelerate the pathway to commercialization”, said Shrikumar Nair, PhD., Affinergy’s Section Head for Discovery Chemistry and is the Principal Investigator for the Phase 2 program. “We have achieved great momentum and are excited by the potential to improve the clinical performance of a number of different products. This program could provide a significant clinical benefit for a large number of patients.”
Thursday, March 13, 2008
LMI Consulting and Brookings Institution with grant funding are establishing an independent and sustainable partnership between the government and the private sector. To make this a reality, over 200 stakeholders met on March 10th with stakeholders either in person, by webcast, or via teleconferencing. The stakeholders listened to comments and discussed how to best establish the AHIC Successor to be called AHIC 2.0. The Successor organization is scheduled to be in place within four months and transition to full operation after eleven months.
Mark McClellan, Brookings Institution, Engelberg Center for Health Care Reform, said the new organization selected to oversee this activity is working with a broad range of stakeholders and will examine management issues, define strategic directions, and determine key activities.
Stakeholders voiced numerous comments and suggestions on several issues and problems that need to be specifically addressed. Some of the issues that are open to further discussions include:
- Workshop redundancies
- Limited resources available to do the job
- Pace of expectations
- Drivers for adopting technology
- Business case needed to drive standards development
- Maintaining stakeholder support and commitment
- Tracking the marketplace
- Developing a roadmap for the project
- Impact on clinical decisions
- Role for the AHIC Successor in dealing with privacy and security
- Global considerations
- Coordination of current interoperable initiatives concerning standards harmonization and the Certification of health IT
- Working with Governors in states
The project is divided into two phases and key stakeholders from both the public and private sector will be invited to meet at two future meetings on April 8, and May 30, 2008. Four AHIC Successor Planning groups have been established on governance, membership, sustainability, and transition. Volunteers are needed to serve and need to apply by Friday March 14, 2008. For more information on volunteering for the planning groups, email Nate Gannon at firstname.lastname@example.org or go to www.ahicsuccessor.org/hhs/ahic.nsf/volunteer.htm.
Dr. Alexander Vo, Executive Director of the AT&T Center for Telehealth Research and Policy at UTMB, said, “It is a tremendous honor to receive this prestigious recognition and it speaks volumes to the wonderful work and support that UTMB has provided to the telemedicine program.”
The UTMB Electronic Health Network was created in 2004 to centralize all of UTMB’s resources into one entity. The EHN was charged with integrating all health technology components into a single system to deliver medical care to benefits providers, patients, and payers in the healthcare environment.
UTMB’s services comprise the largest telemedicine operation in the world, with more than 300 locations and more than 60,000 patients helped annually. The telemedicine program has been recognized as one of the top telemedicine programs in the U.S., and has been inducted into the Smithsonian Permanent Research Collection for Innovation in Information Technology.
James M. Turner, Acting Director, NIST appeared before the House Science and Technology Subcommittee on Technology and Innovation hearing held on March 11th to comment on the NIST FY 2009 budget request. He emphasized that NIST has an immediate need to invest in strategic and rapidly advancing technologies with the $42.8 million that is included in the budget request. According to Dr. Turner, inaccurate bioscience measurements sometimes make it hard to tell when treatments are healing or causing harm, and this can often increase costs and lower the quality of healthcare.
Dr. Turner also reported that a funding request for $10 million was submitted for further NIST research that is needed to improve measurements and standards in the biosciences field. He further said that the biosciences field funding for FY 2009 would focus on three intersecting research areas:
- Make biological data more reliable by establishing methods, standards, and benchmark data for the fundamental measurements needed in mass spectrometry and molecular imaging
- Devise new methods for simultaneously measuring hundreds to thousands of molecules at a time by developing and validating new technologies in areas such as micro-fluidics and live cell imaging
- Help laboratories to compare and combine their measurements and computer models with one another by developing standards for the exchange of biological data and information
He also commented on the budget funding for the NIST optical communications and computing program. The budget for FY 2009 requests $5.8 million to address the need for a new generation of transmission and networking technologies to produce innovation in many current and future industries including telemedicine, entertainment, and security.
Dr. Turner continued to say that NIST works closely with industry to expand research and development. The R&D goal is to produce new measurement capabilities to accommodate higher-speed and next generation communications networks, develop measurements to diagnose and locate transmission problems on data networks, develop new techniques to analyze computer circuits that transmit light instead of electricity, and develop ways to manipulate light within computer chips to interconnect very small electronic and optical devices.
Sunday, March 9, 2008
Senator Whitehouse (D-RI) plus representatives from leading health organizations were all in agreement that HIT can effectively deliver much needed critical healthcare to low income persons. The Capitol Hill Steering Committee on Telehealth and Healthcare Informatics briefing met on March 5th to focus on the challenges that exist in providing healthcare to this important population in our society today.
Senator Sheldon Whitehouse told the attendees that he is excited to be working with the Steering Committee to move HIT forward. He emphasized that our broken healthcare system is resulting in a tidal wave of health care costs, the number of uninsured Americans is rapidly climbing and will soon hit 50 million, and as many as 100,000 Americans are killed each year by unnecessary and avoidable medical errors.
The Senator mentioned his involvement in HIT and that he has introduced major health IT legislation. In a recent action on March 6, 2008, the Senate Budget Committee resolution that passed included a bipartisan Health IT amendment sponsored by both Senator Stabenow and by Senator Whitehouse. The amendment emphasizes the need for Iraq and Afghanistan veterans to have integrated medical records and would create a reserve fund supporting widespread adoption of health IT. The measure also examines the efforts by DOD and the VA to create seamless, interoperable electronic health records for service members transitioning from active duty service to veteran status.
The Senator was pleased to introduce Marcia Montanaro, MSW, President and CEO, Thundermist Health Center, located in Woonsocket, Rhode Island. She has worked hard to bring health IT into the health center and the use of technology in the center is now helping many patients that have few economic resources.
Thundermist a private, non-profit community health center provides comprehensive healthcare services to 26,000 patients in three communities in the state. Most of the patients come from poverty stricken areas and are able to receive primary medical care, dental care, behavioral health visits, plus they have access to a full in-house pharmacy.
Montanaro reports that the Rhode Island Department of Health is in the process of building a statewide health information data system. To start the initiative, $5 million in grants came from AHRQ. However, AHRQ does not fund interfaces with EMRs, decision support functionality, the creation of a Clinical Data Repository, pilot test sites, web-based patient portals, secure clinical messaging, laboratory orders, and e-prescribing. In addition to the AHRQ funding, HISPC contributed $507, 214 with funding ending in 2007, but $200,000 was contributed in new funding. Also, RWJF contributed $96, 317 for one year ending in 2006, Medicaid Transfer supplied another $2.2 million, and the state legislation provided $20 million for IT upgrades.
Montanaro is excited that Thundermist now in the process of switching from a paper to an electronic health record will be completed this year. The HIT project will reduce staff, redirect costs by not chasing paper, increase care management, and enable physicians to better communicate with patients, and downstream, the use of technology will produce more primary care savings. To accomplish technology goals, quality has to be maintained, the problem of the uninsured and underserved populations has to be solved, the payment system needs to be realigned, and financing for HIT needs to be made available through HRSA 330 grants.
JoAnn Webster, Senior Director, Access Leadership, Ascension Health, St. Louis, Missouri reports that Ascension Health as a private safety net provider is the largest Catholic non-profit health system serving patients through a network of hospitals and related health facilities. The healthcare provided is patient-centered paying particular attention to the poor and vulnerable while providing for acute, long term, community health, psychiatric, and rehabilitation care and services.
According to Webster, the goal in 2020 is to have 100% access and coverage to all of the people served in the communities but in the meantime, specific actions need to be taken to develop a community wide formal infrastructure, fill community services gaps, design care models to improve healthcare, engage private physicians in the system, and obtain sustainable funding.
Webster explained how $4 million invested in technology in Austin Texas provides IT for enrollment software and for pharmacy assistance software. The IT system is used by the Southern Arizona HIE, Primary Care Action Group, Escambia Health Information Network, and Healthcare Access San Antonia.
The system in Austin Texas provides care for an indigent coalition, and has community safety net providers in three central Texas counties. Data is now collected in 60 localities, 16 hospitals, and from 45 clinics. The Austin healthcare program serves 600,000 patients, has maintained 3.1 million encounters, and has filled 531,000 prescriptions.
However, as Webster sees the situation, there are many challenges to sharing information among safety net providers. Many in this group have little or no experience with existing technology, the patient population is very mobile and moves in and out of the system, there is little data available from payers since the majority of patients are uninsured, and in general, there are scarce resources.
According to Susan Stuard, Director, Technology Policy Development, New York Presbyterian Hospital (NYP), the hospital with 5 main facilities is the largest private employer in New York City, with over 5 thousand physicians and residents. The healthcare system serves poverty populations in Washington Heights, and Central and East Harlem. Today, there is 20% poverty in Manhattan with 51% foreign born comprising 22% of Manhattan and this can be as high at 37%.
Stuard stressed the importance for an HIE to enable patients to have direct access to healthcare data on line and be able to use a PHR. However, in order to use the PHR effectively, NYP will have to address socioeconomic barriers such as language, access to computers, and privacy concerns.
The NYCareConnect Project with three domains includes community hospitals, home care and skilled nursing, and referring physicians. The system provides emergency department alerts, discharge alerts, and access to medical records. However alerts are sent via fax, since many physicians do not have EHRs.
Stuard mentioned that there are some key hurdles such as dealing with patient privacy but it is also difficult to obtain physician contact information. Obtaining this information is difficult because many patients don’t have a physician or they simply can’t remember their doctor’s name. It has also been extremely difficult not only to track data on community physicians but also to confirm the information.
Fortunately for the community, a diabetes web registry has been developed that draws from hospitals, health plans, and community doctors to create an integrated view of patient care. The registry also includes an assessment for depression because there is a high rate of individuals with diabetes and depression.
Feygete Jacobs, Chief Operating Officer, RCHN Community Health Foundation, New York, NY, explained that the Foundation as a not-for-profit supports community health centers nationally and is the only foundation in the country devoted exclusively to CHCs. Through strategic investments and partnerships in research, education, and advocacy the foundation sustains the CHCs.
The Foundation has only been in existence for two years, but the addresses three key program areas to include healthcare access and center stability, affordable prescription drugs, and health IT.
According to Jacobs, the CHCs have the same basic operating needs as other ambulatory healthcare organizations but developing technology can present problems. Sometimes the program requirements for federal funded programs and FQHC reimbursement requirements can add further complications. Unique state specific PPS implementation requirements can also be added to the mix of complications. In addition, limited financial resource for many health centers restrict adequate financing to support technology.
Jacobs wants to see technology activities include strategic investments, joint program initiatives, policy influences through research, needed financing in terms of loans and grants, and collaborations developed to search and find financing vehicles. For example, the Foundation is developing a strategic partnership with NACHC affiliates, Community Health Advocates, and Community Health Ventures, to further develop business opportunities for CHCs.
Gary E. Michael, MD, Clinch River Health Services, in the small town of Dungannon, Virginia, explained that health services are provided to 400 individuals and includes 3,500 active users serviced by 3 providers. As Dr. Michael pointed out it is very important to follow an Implementation Plan as the EHR is developed. Following their implementation plan resulted in greater efficiency, more understanding of how the system should and will work, and the system was able to be put into place much sooner.
The implementation plan that was used was divided into seven phases:
- Phase 1 Strategic Planning—Develop a 5 year plan to improve performance. At the same time review finances and look at all funding opportunities
- Phase 2 Partnerships—Use partnerships to see where they can help in develop the EHR
- Phase 3 Staff Evaluations—Look at staff skills, organizational readiness, the process, patient flow, and then align personnel skills with what is needed
- Phase 4 Define measurable outcomes—Examine costs, efficiency, productivity and satisfaction. Interview the staff for job functions and concerns
- Phase 5 Review vendors—Select vendors, make purchases, and do on-site visits
- Phase 6 EHR Implementation—Designate a supervisor or an onsite IT person to work closely with the vendors before the “go live” date. Examine policies in terms of requests, orders, password protection, and routine charting system upkeep. Conduct weekly team meetings to share lessons learned
- Phase 7 Revisit the outcome measures—After one year reexamine all of the efforts to implement the plan and look for areas to improve
The EHR project captures more information, there are more total encounters, more daily recorded telephone messages, there is faster x-ray turnaround, and Rx refill time has been reduced. According to Dr. Michael, much of this is due to the implementation planning that was done beforehand resulting in an efficient EHR system.
Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).
The next lunch briefing session to be held at noon on Wednesday April 2nd, 2008, will discuss “Training a HIT-Enabled Healthcare Workforce: Addressing Shortages.” The briefing will take place in the Rayburn House Office Building, Room B-340. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email email@example.com.
An RFP has been issued to open new and innovative avenues for research and explore the improvements needed in health management that involves sharing between people, families, caregivers, doctors, and facilities. Eligible organizations include colleges and universities, and non-profit health institutions. Private sector organizations may partner with these institutions.
Proposals need to have the potential to advance the state-of-the-art in one or more areas of study and demonstrate the potential for expansion into a large scale program. The areas of study include primary and secondary prevention applications, acute care applications, juvenile disease management, women’s health management, and community and social health applications.
The total amount available under this RFP is $3,000,000. Microsoft Health Solutions
Group anticipates making approximately 20 awards averaging $250,000, with a maximum of $500,000 for any single award. The RFP closes on May 9, 2008 and the awards will be announced on July 1, 2008.
For more information, go to http://healthvault.com/fund.
Funding for $4 million is now available to help establish a M2D2 facility on the campus of the University of Massachusetts Lowell. The funding will come from a bond authorization and will be combined with private, federal, and local funds. According to Stephen McCarthy, co-director of M2D2, the funding will enable the Center to help medical device companies to develop viable products from proof of concept to commercialization.
Engineering and medical experts will be able to work with a steering committee of industry veterans and venture capital managers to guide companies through the pipeline from idea to production via M2D2. The Center will help in developing new medical instruments and products to improve the health and lives of citizens.
In addition, the Massachusetts Technology Collaborative has awarded a $500,000 grant to M2D2 to help entrepreneurs develop new medical device ideas, such as portable “jaws of life” that are easier for emergency responders to carry to accident scenes, and a dissolvable drug-coated stent to assist heart patients.
According to the Governor of Massachusetts Deval Patrick, M2D2 has the capability to service four to 5 times as many medical device concepts as it does right now. This could mean up to ten new companies per year could create medical breakthrough products. The Governor also said that last year, life sciences in Massachusetts grew 45% faster than the economy overall and one in every three products and services exported by the state are life sciences related and most are medical devices.
Looking for device development beyond the state, the Governor and members of the Massachusetts-China Partnership have reached an agreement with the Massachusetts Medical Device Industry Council and the Chinese Association for Medical Device Industry. The groups are going to promote economic and technical development collaborations and partnerships between the medical device clusters found in Massachusetts and in China.
Both organization will communicate and exchange information, as well as encourage professional and technology exchange, provide study, training and visiting opportunities for professionals, and provide for collaborations between research institutes, teaching hospitals, and development organizations.
The Annual Battlefield Healthcare Conference will feature top experts discussing advances in warfighter healthcare from the battlefield through to Level V care in CONUS. Technological advances from bandages to resuscitation techniques ongoing in military medicine will be highlighted at the Conference to be held March 31-April 2, 2008, at the Georgetown University Conference Hotel in Washington D.C.
Military, government, industry, and academia will gather to discuss goals and objectives, implementation strategies, enablers and barriers, and existing program initiatives to improve battlefield healthcare.
Some of the confirmed speakers are:
- Honorable Dr. Michael Kussman, Under Secretary for Health, Veterans Health Administration
- Vice Admiral Adam Robinson, MC, U.S Navy Surgeon General & Chief Bureau of Medicine and Surgery
- Lieutenant General James G. Roudebush, MC, CFS, Surgeon General of the Air Force
- Brigadier General Michael S. Tucker, Assistant Surgeon General for Warrior Care and Transition, U.S. Army Medical Command
- Colonel Charles R. Scoville (Ret), Chief Amputee Patient Care Service, Integrated Department of Orthopedics and Rehabilitation, Walter Reed Army Medical Center
- Captain William P. Nash, USN, MC, Combat and Operational Stress Coordinator Headquarters, Marine Corps
- Colonel Les Folio, USAF, MC, SFS, Assistant Professor, Radiology and Radiological Sciences, MS-IV Radiology Clerkship Director, Assistant Chair for Military Radiology, Uniformed Services University of the Health Sciences
- LTC Michael Jaffee, National Director, Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center
- Colonel Loree Sutton, MC, Special Assistant to the Secretary of Defense (Health Affairs) for Psychological Health, and Director, Defense Center of Excellence for Psychological Health and Traumatic Brain Injury
- Colonel Brian J. Eastridge, MC, Chief of Trauma, U.S Army Institute of Surgical Research, and Director 2007, Brooke Army Medical Center Joint Theater Trauma System
A pre-conference focus day on March 31, 2008 will present a series of in depth and interactive master classes to examine TBI from diagnosis to recovery. New approaches to treating TBI and PTSD, current state of military medicine, patient tracking and medical IT, advancements in amputee care and prosthetics, wound care and infection control, telehealth challenges and solutions, bridging the electronic gap, coordination with VA, R&D for battlefield healthcare, and much more will be discussed.
For more information and to register for the conference, go to www.battlefieldhealthcare.com or email TatianaPose@iqpc.com.
Tuesday, March 4, 2008
Not only will the programs help nursing students by providing them with more opportunities in nursing, but the funding will also be used to help communities by directing more services to medically underserved areas across the state. The grants range from $80,000 to go to small colleges and for $364,947 to go to California State University, Fresno.
The University of California at Davis has initiated a program called Rural-PRIME in the School of Medicine to expand the entering class size for medical students for the first time in a generation. With this plan, the students in their five years of medical school will have numerous opportunities to train, interact, and live in rural communities. The program will enable the students to use high speed broadband connections in rural learning labs that will provide video links connecting students to patients, physicians, faculty, and specialists at UC Davis in Sacramento.
Also to help increase and provide more access to medical professionals in remote areas, the $22 million grant recently awarded by the FCC will be used to establish a statewide communications network using broadband technology.
The California HealthCare Foundation recently awarded $350,000 in planning grants to seven provider coalitions operating in 16 rural counties. The grants are designed to help providers in rural areas work together to identify ways to improve timely access to specialty care. The purpose is to establish formalized referral relationships between primary care physicians and specialists, and also to use telemedicine to connect patients with doctors in other cities.
Several state efforts are now underway to increase broadband. The California Emerging Technology Fund has a commitment of $60 million for 5 years from SBC/AT&T and Verizon/MCI. At least $5 million will be earmarked to fund telemedicine applications to serve California’s underserved communities particularly in rural areas and to help facilities that have a large number of indigent patients.
The underserved communities include individuals, groups, and organizations that face telecommunications challenges or disadvantages due to physical disabilities, low incomes, inadequate telecommunications infrastructure, language and cultural differences, lack of technological understanding and/or equipment.
The California Advanced Services Fund a two year program will promote universal service in unserved and underserved areas in the state by funding qualified applicant carriers. The Fund collects a 0.25% surcharge from all end users to use to increase the use of broadband, but the money also goes to build facilities in underserved areas if the funds are available. The money will be available starting June 2, 2008.
Deborah Peel, a practicing physician and a national expert on health privacy founded the organization Patient Privacy Rights to help restore the individual’s right to decide on who can have access to health information. According to Dr. Peel, Americans want to control who can see and use their information. To make that point, an IOM Survey on Privacy conducted in October 2007, found that 99% of the public want to be able to give their consent if researchers want to use their personal medical and health information.
She continued say that in today’s world, personal health information is for sale along with Medicare and Medicaid data. One of the areas least protected information concerns prescriptions. As an example, Nex2 was sold to United Healthcare and built the largest near real time drug history database in the world. Releasing this information is HIPAA compliant because the insurance company always has the release signed by the individual applicant.
Dr Peel pointed out the need to use smart technology to protect privacy. In addition, smart certification could be given by a consumer-led organization offering a Good Housekeeping Privacy Seal of Approval for HIT systems and products.
According to John Rother, Director, Policy & Strategy, AARP, there are three positions being debated that deal with privacy. Some people insist that Congress must enact strong protections, however, the passage of legislation on health IT has been delayed in Congress due to privacy issues. Others say that opening HIPAA/codifying new protections would disrupt market forces that ensure that vendors protect privacy. Still others want new rules, but they favor breaking the gridlock by using a regulatory approach.
Rother explained that it is essential to break the gridlock because privacy is absolutely essential in order for patients to have confidence in HIT. We must have privacy rules that consumers can trust and individuals should not have to choose between privacy and using health technologies.
Six projects are being undertaken to evaluate:
· The effectiveness of using the telephone to ask outpatients whether they are experiencing specific adverse effects related to prescribed medications
· The impact of clinical decision support and automated telephone outreach on antihypertensive and lipid lowering therapy in ambulatory care
· Any new errors created when electronic prescribing is implemented
· The impact of a post discharge ambulatory medication intervention
· The 6 Regional Health Information Organizations in New York and their experience with medication safety
· Develop AMIA’s ONCHIT sponsored Clinical Decision Support Roadmap complete with a set of clinical decision support rules to be used in multiple settings.
Sunday, March 2, 2008
The key provisions of the Act would:
· Create a Indian Youth Telemental Health Demonstration Program
· Help Indian health professionals and expand the workforce
· Expand cancer screening
· Improve monitoring for infectious diseases
· Improve current diabetes screening
· Expand programs to prevent domestic violence
· Provides funds for construction and repair of facilities
· Provide funds for urban Indian youth treatment centers
· Protect privacy
· Encourage states to help Indians on or near reservations
Several sections in the Act (S 1200) refer to using telehealth technologies. Section #306 refers to Indian Health Care Delivery Demonstration Projects that includes provisions for providing urgent care services if necessary via telehealth. Section #708 refers to the Youth Telemental Health Demonstration Project that will test using telemental health services to prevent Indian youth suicides.
As for the IHS funding for FY 2009, the President’s budget request proposed $3.325 billion and prioritizes clinical and preventive healthcare services particularly in AI/AN communities on or near reservations. The budget requests an increase of $20 million over the IHS FY 2008 budget level to help operate hospitals and health clinics, and an increase of $2 million was requested for dental services with $2 million for preventive health services.
In addition, the FY 2009 budget requests $150 million for diabetes prevention and treatment grants. The IHS has awarded $850 million in grants over the past 6 years to over 300 tribes and Indian organizations to support diabetes prevention and disease management at the local level.
The budget proposal also asks for an increase of $9 million for a total of $588 million to use for contract health service funds. These funds would be used to purchase healthcare that the IHS cannot economically provide through their own network.
The Indian Health Service has announced plans to fund epidemiological development to help the AI/AN urban population in California. A competitive cooperative announcement published in the February 28th Federal Register (HHS-IHS—2008-EPI-0001) would help to establish a Tribal Epidemiology Center in California. Eventually, IHS intends to have Tribal Epidemiology Centers in all of the 12 IHS Administrative areas.
When the program is established, epidemiology activities at the TEC will include disease surveillance. In this capacity, the Center will be able to perform epidemiologic analysis, interpretation, and dissemination of surveillance data, investigate disease outbreaks, develop and implement epidemiologic studies, develop control and prevention programs, and work with other public health authorities.
Eligible applicants can be federally recognized Tribes, Tribal organizations and AI/AN populations. One award for FY 2008 will be made for $350,000. The application deadline is April 4, 2008 with the anticipated start date to be May 1, 2008 and to last until April 30, 2011.
The Federal TBI program awards State Infrastructure (Partnership) Grants and Protection and Advocacy Grants. Grantees from these programs need ongoing information and assistance with resource development and all of the factors specifically affecting the TBI community. In addition, the grantees need to be able to benefit from distance education efforts and from regional and national meetings. Previously these services were provided by the National Association of State Head Injury Administrators.
HRSA is looking for sources within the small business community that are familiar with many of the issues surrounding traumatic brain injuries. Specific capabilities are needed to develop databases for information collection, to track technical assistance and information, develop an interactive listserv, develop a web site for grantees and the public, address grantee training needs, identify funding opportunities for grantees, and be knowledgeable about product development.
This notice is for planning purposes only and does not constitute an Invitation for Bid, an RFP, or an RFQ, and therefore the government is not required to award a contract.
Responses to this notice must be received by March 12, 2008.
For more information, contact Christian Hager, at Chager1@hrsa.gov or Frank Murphy at firstname.lastname@example.org. For more details on the Sources Sought notice, go to www.fbo.gov.
The Medical Malpractice Mediation Program started at Rush in 1995 has been working to mediate malpractice disputes by acknowledging adverse events and then fairly compensate patients that may have been injured as a result. The program’s goal is to help resolve patient safety issues problems that might otherwise to court. In Rush’s newly grant funded mediation and patient safety project, the mediation process will not only work to amicably resolve disputes, but now the program will also move to take corrective actions to avoid adverse events in the future.
The new grant program will enable the mediation team to review a sampling of cases and not only select cases with critical safety issues but also select cases that hold promise to achieve lasting change in patient safety issues. Robert A. McNutt, MD., Chief of Medical Informatics and Patient Safety at Rush will serve as the medical advisor for the patient safety projects that result from these cases. In addition, patient safety officers from the Institute will become an integral part of the Rush Mediation Program offering clinical strategies to reduce the possibility that similar incidents will occur in the future.
The findings from the cases will be disseminated to senior executives within Rush and later to Chicago’s medical and legal communities and the hope is to increase awareness within these communities on the findings. Rush University sees the funding for this project contributing to a leading-edge approach for reducing future medical malpractice actions.
The Open e Health Foundation wants to create a worldwide community driven software development platform to speed up the digitization of the healthcare industry. The goal is to increase interoperability based on open standards to be accomplished with third party components and platforms. However, the Open eHealth Foundation will not develop new standards for interoperability but cooperate with existing standard developing organizations to implement the standards already in existence.
The Open eHealth Foundation is seeking additional members to participate in promoting an open based healthcare industry forum. There are three levels of membership available that includes contributing members to add their components to the Open Source code base of the foundation, participating members that can own projects, and promoting members who will be actively involved and be able to influence the direction of the foundation.
For more information, go to www.openehealth.org.