Wednesday, April 30, 2008

Use for eICUs Advancing

The use of eICU systems are moving forward and more and more military and civilian hospitals are finding that being able to electronically monitor intensive care patients can provide more efficient care. For example, the Tripler Army Medical Center located in Hawaii is the first military medical center to use telemedicine technology for long distance ICU care.

The system’s high resolution cameras feed data into a bank of computers using real-time transmissions. Critical Care specialists are then able to examine, diagnose, and monitor intensive care unit patients in conjunction with local doctors at U.S. military installations in Guam and Korea.

The critical patients at both the Naval Hospital in Guam and the Army Hospital Yongsan in Korea can be stabilized under the direction of intensivists at Tripler. Dr. Benjamin Berg , an intensivist at the University of Hawaii’s Telehealth Research Institute said, “patients can be treated and many times the need for air evacuation can be eliminated or delayed at a cost of more than $100,000. If they need to be, stabilized patients can be brought to Tripler on a regularly scheduled medical flight mission when they are in better condition to fly.

The fiber optic internet-based technology was used during a boiler room explosion on the Guam-based submarine tender USS Frank Cable in December 2006. The ability of surgical and critical care specialists to remotely examine and triage the sailors helped the initial stabilization and evacuation of the severely burned sailors from the hospital in Guam to Brooke Army Medical Center in San Antonio, Texas.

The program provides that physicians in the intensive care unit have immediate access to critical care specialists, such as cardiologists and pulmonologists available 24/7. The consulting doctors at Tripler are able to quickly view a patient’s chart, labs, and other data as well as directly see the patient using a video camera. In the future, the telemedicine technology may be used for patients aboard ships at sea, or in forward deployed locations such as field hospitals.

In the civilian sector, rural Maryland hospitals facing emergency room physician shortages now have doctors in Delaware electronically monitoring their ICU patients. The Christiana Care Health System in Delaware has been using the eICU program for emergency care since 2005 and was the first health system in the country to adapt the program to monitor critically ill patients in their emergency departments and post anesthesia care units.

The Christiana eCare services are now expanding to hospitals in rural communities in Maryland using the program known as “Maryland eCare”. The six rural Maryland hospitals collectively admit more than 66,000 patients per year.

Marc T. Zubrow, MD, Director, Critical Care Medicine at Christian Care serves as the medical director overseeing the “Maryland eCare” project along with a team of critical care nurses and physicians, said “using this technology in rural Maryland will mean that patients and families will have better care close to home.”

The system enables patients to be remotely monitored through video and audio technology combined with intelligent monitoring plus alarm systems. The eICUs remote center closely monitors patients for any physical change, and then immediately alerts local caregivers and recommends corrective action.

The system was developed at VISICU located in Baltimore by two former Johns Hopkins critical care physicians. More than 200 hospitals across the country are now using the system.

Tufts Helps with Major Decision

James Roosevelt Jr., CEO, Tufts Health Plan, said “34% of adults in America are overweight and an additional 32% are obese. Obesity and the number of severely obese individuals in our country cost the U.S. economy in excess of $100 billion annually and results in 400,000 deaths”. He made his remarks at the 5th Annual World Health Care Congress held in April in Washington D.C.

To address the obesity problem, Tufts Health Plan is providing a specialized modification program to help the members that are interested in their controversial bariatric surgery program. The health plan has identified evidenced-based criteria for the coverage of bariatric surgery, including BMI limits. For an individual to be considered for bariatric surgery, they have to complete a six month lifestyle modification program before the surgery will be done.

Roosevelt emphasized that this is very important since the patients selected have to be right for the program and the surgery has a very high complication rate. If surgeons do the surgery without the patient making changes in their behavior and lifestyle, then the surgery may be less safe.

The participants in the 6 month life style modification program have one-on-one calls with a dedicated health coach, access to web tools, communications with their primary care physician, and access to a variety of informed decision making tools. The participants must set two behavior goals that are meaningful for them, and they must complete informed decision-making modules regarding bariatric surgery options.

After the 6 month program is completed, members can opt to continue their lifestyle changes without further program intervention, or they can enroll in the program for up to an additional 12 months, or at this point, consider bariatric surgery options.

The program currently has 229 members enrolled and 119 members have graduated from the program with a combined weight loss of 997 pounds. Early results show that 17% of the people graduating from the modification program have deferred surgery and have modified their behavior. Overall there is a reduced surgical trend due to the acceptance and success of non-surgical strategies with an estimated annual cost savings resulting in more than $4 million.

Nursing Homes and IT

AHRQ is funding a study (K08HS016862-01) to assess the relationship between IT sophistication and nursing home quality. The Sinclair School of Nursing, University of Missouri at Columbia with lead investigator Professor Greg Alexander, has two specific goals. One goal is to compare pressure ulcer quality measures in nursing homes with high IT sophistication versus nursing homes with low IT sophistication. The second goal is to explore strategies to communicate pressure ulcer preventions used in highly sophisticated nursing homes versus nursing homes with low IT sophistication.

According to an April press release by Emily Smith of the MU News Bureau, current levels of IT sophistication in U.S. nursing homes are unknown and the use of IT is minimal. Greg Alexander further reports that while some homes have advanced systems to aid nurses in making treatment decisions, the majority of other nursing homes have minimal levels of technology in place. These nursing facilities need wireless technology to support administrative and financial matters and inpatient self-management.

Alexander wants to see the creation of a national infrastructure for healthcare providers. There is an immediate need to enable the exchange of information between short-term care and long-term care facilities and if technology is used, providers and others will be able to coordinate and transfer work between settings.

The first study “IT Sophistication in Nursing Homes will be published in “Long Term Care Interface”. The second study “Measuring IT Sophistication in Nursing Homes” will be published in AHRQ’s “Advances in Patient Safety.”

For more information, contact Greg Alexander at (573) 882-0277 or email

Sunday, April 27, 2008

RADAR Detects Adverse Events

According to Charles Bennett MD, PhD, Buehler Professor of Geriatrics and Economics at the Feinberg School of Medicine at Northwestern University, the RADAR project has helped healthcare professionals and patients find knowledge to avoid potentially adverse drug and device events. He explained how effectively and thoroughly the “Research on Adverse Drug Events and Reports (RADAR) project is able to detect adverse reactions. His comments were made at the “Consumer Connectivity—Social Networking and Health Searches” session held at April’s 5th Annual World Health Care Congress in Washington D.C.

RADAR a monitoring program and project was developed at Northwestern University. RADAR has proven to be very valuable in identifying serious and often-fatal drug reactions. Adverse drug and device reactions account for as many as 100,000 deaths annually, In general, more than half of the most serious adverse drug reactions have been discovered seven or more years after a drug has been marketed.

Dr. Bennett said “In one case, a patient at Northwestern Memorial Hospital had a potentially fatal toxicity termed TTP. The patient’s life was saved with plasmapheresis (dialysis of the blood). Additional investigation indicated that the patient had received 14 days of the anti-platelet agent ticlopidine. Questions were posed as to whether it was possible that this commonly used drug could occasionally result in potentially fatal drug toxicity.

This is where querying the social network proved to be invaluable. The first step was to contact Directors of Centers providing therapeutic plasma exchange services. Next, a list of all therapeutic plasma exchange centers was obtained from the supplier of the equipment used in this procedure.

From there, medical directors were queried on whether they had seen patients with an almost fatal drug reaction. Surprisingly, almost every medical director had seen such a case. In total, 60 cases of TTP following ticlopidine administration were identified but unfortunately, 20 of these patients had died. The end result was that a safety report was prepared and the drug was basically removed from the market.

RADAR is performing a number of valuable social networking services in the internet age. In another situation, RADAR raised concern that some patients were allergic to polymers that coat drug eluting stents placed in coronary arteries. An allergic reaction to the polymers can be potentially fatal.

The background on this situation was placed on Interested patients responded and expressed interest in the need to evaluate this concern. In doing further investigation, patients had to undergo a formal evaluation for the possibility of an allergic reaction. Patients that had adverse drug reactions reported this information to the RADAR project. This was followed up with more investigation and the information was fed back not only to the patient but also to relevant safety officials.

Dr. Bennett stressed that all in all, RADAR has proved to be a powerful new instrument that supplements existing FDA surveillance systems and has helped save hundreds to thousands of patient lives

For information on the World Health Care Congress, go to

CDC Issues Grant Opportunity

CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, have FY 2008 funds available to help national organizations establish national programs to promote healthy communities and prevent chronic diseases.

In order to achieve these goals, the grants will be awarded for two general categories. Category A will provide funding and technical assistance to local affiliates/chapters in local community settings. Category B will promote electronic communication, technical assistance, disseminate tools and resources, develop policy-related products, and create training opportunities focusing on disease prevention related to arthritis, cardiovascular disease, cancer, diabetes, obesity, poor nutrition, physical inactivity, and tobacco use.

The grantees in Category B will create, update, publicize, and maintain electronic services and other communication venues to inform the targeted constituency, relevant stakeholders, and the general public on systems and current chronic disease and health promotion activities.

Eligible applicants include national organizations with state health departments and their affiliates that serve city and county health departments or community affiliates, and others that operate nationally within the U.S. and have offices in the U.S.

Applicants can propose activities in either Category A or Category B or both. If applying for both categories, a separate application must be submitted for each category. There will be 2-5 awards in Category A and 1-3 awards in Category B.

The closing date for the applications is June 16, 2008 with the award anticipated to be made on September 30, 2008. Approximate current fiscal year funding range will be from $3,400,000 to $5,750,000. The approximate total project period funding range will be $9,300,000 to $20,000,000 based on funds available.

For more information on CDC-RFA-DP08-812, go to or go to

Governor Issues New Order

New Hampshire Governor John Lynch on April 23, 2008 issued an Executive Order directing the Citizens Health Initiative to further develop the state’s health IT infrastructure. The Executive Order directs the group to bring together lawmakers, state government officials, business leaders, healthcare providers, workers, and insurance experts to address healthcare challenges in the state. The goal is to develop a strategic plan and deliver the plan to the Governor by December 1, 2008.

The Citizens Health Initiative wants to see New Hampshire become the first state to ensure that all physicians can prescribe medications electronically. The group has worked with insurance companies to develop criteria for “pay-for-performance” standards and the group has developed a web site so that employers are able to get the information that they need.

The Citizens Health Initiative has a working group in place with representatives from hospitals, physicians, home care and hospice providers, clinical providers, health plans, employers, state health related offices, security and privacy content experts, and consumer advocates. To meet the requirements of the Executive Order, the working group is going to consider the following:

  • How to facilitate the statewide adoption of standards and interoperability requirements to provide information between providers, patients and payers, and how to provide for regional and national exchange of data
  • Identify where state laws and regulations hinder rather than facilitate the adoption of HIT and HIE and recommend strategies to remove the barriers
  • Identify and develop strategies for the continued protection of confidentiality and privacy of health information
  • Identify opportunities and strategies for a public/private partnership approach to create financially viable and sustainable business models for HIT projects in the state
  • Develop options for advancing the implementation of HIT through the state’s role as a major purchaser, provider, and regulator of healthcare services
  • Develop performance metrics to measure the success of HIT implementation throughout the state

2008 Health IT Week Coming

From June 9-13, National Health IT Week 2008 will take place in Washington D.C. Recognized by Senate Resolutions in 2006 and 2007, the National Health IT Week is the leading forum for developing common ground to advance the adoption of HIT to transform health and care in the U.S. Public and private sector organizations with diverse perspectives on health and care will gather to work together under one banner. The goal is to improve healthcare efficiency, quality, cost-effectiveness, and patient safety through HIT.

Health IT week is geared towards partner organizations and key healthcare constituents including information technology and interconnectivity vendors, hospital and provider organizations, payers, pharmaceutical/biotech companies, government agencies, industry and professional associations, and consumer protection groups.

National Health IT Week 2008 will have several partner events:

  • The HIMSS Summit will be held on June 9-10, 2008 to focus on health IT leadership. Register Now
  • HIMSS Advocacy Day will be held on June 10-11, 2008 to provide training so that more than 300 individuals will be able to visit hundreds of members of Congress on June 11, 2008. Register Now
  • National Health IT Week Advocacy Day Networking Reception and Awards Ceremony will be held in the evening on June 11 at the Capitol Hill Club
  • The Capitol Hill Steering Committee on Telehealth and Healthcare Informatics Technology Showcase will be held on June 12, 2008. An exhibition of health IT solutions and innovations will be presented
  • A Capitol Hill Press Conference to be held on June 12, 2008 will be the cornerstone of National Health IT Week 2008 media events
  • The Center for Information Therapy Seventh Annual Conference will be held on June 12-13, 2008 at the Newseum in Washington D.C.

For more details and to register, visit for event updates and details. For other questions or information, contact Alyssa Willard at (919) 791-0012, extension 112, or email

Wednesday, April 23, 2008

Connecticut Receives Funding

On April 22, 2008, Governor M. Jodi Rell reported that a CMS grant for nearly $800,000 will be used to promote community-based health centers. Although more than 217,000 state residents used community health centers last year, patients tend to go to hospital emergency rooms for routine medical needs which then clog the urgent care system.

The CMS grant will fund the state Department of Social Services for the next two years to connect the state’s network of 13 federally qualified health centers and 10 hospitals. The Community Health Center Association of Connecticut, the membership association for federally qualified health centers, will lead the project under contract with the Department of Social Services.

The system will connect the centers and the hospitals via a computerized appointment system for non-emergency Medicaid beneficiaries. The system will help to search and schedule appointments for Medicaid enrollees, and thus encouraging people to obtain routine medical care at community-based health centers.

The web-based application was created by Global Health Direct, Inc. and enables patients to be scheduled for appointments 365 days a year 24/7. Now each referred patient will leave the emergency department with a written confirmation of their primary care appointment. The confirmations are printed in the patient’s language of choice and contain the day and time of the appointment along with the name, address, and telephone number of the clinic. Patients are also given information on the bus lines that operate near the center.

The Governor’s mid-term budget recommendation for the next fiscal year also includes $100,000 for the Department of Social Services to conduct outreach to Medicaid and provide Healthcare to Uninsured Kids and Youth (HUSKY) clients so that they can use appropriate primary care providers, rather than turn to hospital emergency departments for primary medical care.

On April 14, 2008, the Governor released a report submitted by the state’s Federally Qualified Health Care Centers that provide services statewide to more than 80 locations. The report outlines efforts to expand community health center hours, increase services for non-emergency transportation, and perform more cancer screening, tobacco cessation programs, primary care case management, and prenatal care.

HHS Tracking Infections

HHS’s role in reducing the rates of Healthcare-associated Infections (HAI) was discussed at the House Oversight and Government Reform Committee hearing held on April 16, 2008 on Capitol Hill. Don Wright, M.D., M.P.H., Principal Deputy Assistant Secretary for Health at HHS, Office of Public Health and Science within the Office of the Secretary, outlined the various surveillance and monitoring systems now in place within the agency.

CDC is leading in several activities to track and prevent healthcare-associated infections. For example the National Healthcare Safety Network (NHSN) formerly the National Nosocomial Infection Surveillance System, is a web-based tool used by hospitals and state health departments to measure healthcare-associated infections. The system is maintained using the Public Health Information Network (PHIN) components and standards.

According to Dr. Wright, additional options for NHSN will be released in 2008 to help the states participating in NHSN measure MRSA among both inpatients and outpatients. Participation in NHSN has increased in the past few years, and the Network is expected to continue to expand to accommodate local, state, and federal reporting initiatives for healthcare-associated infections. CDC currently supports more than 1300 hospitals in 16 states using NHSN to fulfill state reporting requirements.

Dr. Wright explained that there are several other healthcare systems tracking infections by CMS, and AHRQ, plus joint efforts are taking place. For example, CMS is using several systems to report infection data. The Medicare Patient Safety Monitoring System identifies the rates of specific adverse events within the Medicare population using inpatient medical records and administrative data.

The CMS Reporting Hospital Quality Data for Annual Payment Update System has participating hospitals reporting on infection related measures with the data currently reported and available on the CMS Hospital Compare website. The data promotes value-driven healthcare and quality transparency by providing information from individual hospitals to the public.

CMS is currently evaluating replacing the current coding system ICD-9-CM with an updated system ICD-10 that should improve the collection of healthcare-associated infections data. Plans are for ICD-10 to be ready by 2011.

AHRQ is also involved in tracking infection data. The agency is able to obtain information on potential in-hospital complications and adverse events and can track variations in healthcare-associated infections across regions using Patient Safety Indicators (PSI). Through AHRQ partnership’s with 39 states in the Healthcare Cost and Utilization Project, data is now reported on 90% of the hospital discharges in the country. AHRQ can then track variations in healthcare-associated infections across regions and over time using PSIs.

Within the joint efforts taking place between CDC and CMS, the agencies are collaboratively working on a common set of data requirements for monitoring infections and adhering to prevention guidelines. CDC and CMS are working on data requirements to measure MRSA as part of CMS’s Ninth SOW for the QIO program. This should result in the wider use of NHSN by hospitals participating in the QIO program. Also, CDC and CMS are working on an agreement concerning monitoring surgical procedures that should be monitored as part of public reporting of surgical site infection rates.

GAO recently published the report “Health-Care-Associated Infections in Hospitals” that criticizes HHS efforts for having multiple programs collecting data on healthcare-associated infections. GAO reports that each of the databases that collect the information present only a partial view of the extent of the problem. GAO also reports that there are limitations on the scope of information that they collect plus there is a lack of integration across the databases. GAO wants to see linkages across the healthcare-associated infections databases to better understand where and how infections occur.

DOD SBIR Seeks System

On April 21, 2008, DOD issued their pre-released FY 2008.2 SBIR solicitation with topics from the Air Force, Army, Navy, DARPA, CBD, OSD, and DTRA. One of the Army topics seeks SBIR research to provide automated reality systems to use for training healthcare providers. The training needs to be geared to combat medics and combat life savers in the military, civilian counterparts including EMTs, and other first responders. Proposals will be accepted starting May 19, 2008 with a closing date of June 18, 2008.

The SBIR research needs to focus on the three main causes of trauma death which are hemorrhage, improper airway management, and tension pneumothorax. The Army is looking for innovative ideas that will use recent advances in immersive reality technologies with those of mannequin or actor-based systems. The technology developed needs to be able to superimpose virtual or real images of external or internal trauma injuries onto either a mannequin or an individual acting as a patient.

The tools developed must:

  • Engage the user in a compelling realistic simulation experience
  • Register the visual image on the mannequin or patient actor
  • Allow for the interaction between the caregiver and the mannequin/actor
  • Rapidly convert MRI or other source data into visual formats that can run on standard Image Generator (IG) systems
  • Explore the capabilities of intelligent tutoring systems
  • Identify the metrics needed to base trainee performance
  • Be able to monitor patient/casualty vital signs along with the caregiver’s performance.

In Phase I, the feasibility study, analysis, and concept definition for the system will be developed, Phase II will develop the prototype, and Phase III will focus on commercializing the training system in both the military and civilian sectors.

For more information, go to click on new solicitations, click on topic search and enter OSD08-H08 to see the details. Or contact Gene Wiehagen (301) 619-3258 or by email for more details.

Behavioral Telehealth Summit Coming

The Second Annual Summit on “Behavioral Telehealth: Technology for Behavior Change & Disease Management” to be held in Boston on June 2-3, 2008 will be an exciting and innovative meeting. The Summit will focus on integrating behavioral health into primary care and chronic condition management in an effective and efficient way.

The Summit will feature presentations by academic thought leaders, clinical informatics experts, product developers, health services researchers, and business leaders.

Participants will learn:

  • How to use telemedicine and other emerging information technologies to support the integration of behavioral health into primary care and chronic disease management
  • How to empower health consumers through the design, use, and evaluation of technology assisted self care
  • How to identify the barriers to using telehealth and telemedicine as well as the strategies needed to overcome these barriers
  • How depression impacts the workplace productivity and how to solve the problem

The Summit is geared to senior executives, clinical leaders, clinicians, IT staff from behavioral health companies, disease management companies hospitals, health plans, employers, home care agencies, long term care facilities, academic institutions, government agencies, IT vendors, telemedicine companies, remote monitoring companies, psycho physiological monitoring companies, biofeedback and neurofeedback companies, behavioral test publishers and vendors, medical device companies, pharmaceutical companies, ehealth companies, consumer health portals, consulting and health law firms, and clinicians in private practice.

Steven Locke MD, Research Psychiatrist, Beth Israel Deaconess Medical Center, Associate Professor of Psychiatry, Harvard Medical School, Associate Professor of Health Science and Technology, at MIT, and Program Chairperson will be a keynote speaker.

Other impressive keynoters will include Ronald C. Kessler, PhD, Professor of Healthcare Policy, Harvard Medical Center, Joseph C. Kvedar, MD, Partners HealthCare Systems Inc., and Associate Professor of Dermatology at Harvard Medical, Victor J. Strecher, PhD, MPH, Professor and Director of the Center for Health Communications Research Department of Health, Behavior, and Health Education, University of Michigan School of Public Health, and Chairman and Founder Health Media, Inc.

Some of the other notable keynote speakers will be from Duke University Medical Center, Tufts University, School of Medicine, Continua Health Alliance, and the Feinberg School of Medicine, Northwestern University.

There will be two Post Summit workshops that will delve more deeply into topics covered in the main body of the Summit. Workshop I to be co-chaired by David Ahern and Bruce Rollman will focus on technology tools for patient self-management and shared decision making. Workshop II to be co-chaired by Bryan Bergeron and Debra Lieberman will cover emerging technologies, gaming, simulation, and social media in behavioral health and disease management.

Some of the topics for the many sessions and panel discussions include Behavioral Health and Disease Management Integration, Serious Games and Health Improvement, Progress in Computer-based Treatment of Behavioral Disorders, Behavioral Informatics Interventions for the Workplace and Primary Care Settings, Telepsychiatry, and Legal Regulations and Policy Issues in Behavioral Health.

For more information or to register, contact Satish Kavirajan, Managing Director, TCBI, (310) 265-2570 or email

Sunday, April 20, 2008

Worforce Shortages Hill Topic

Leaders in the health workforce field speaking at the April 17th Steering Committee on Telehealth and Healthcare Informatics session on Capitol Hill, examined the problems and solutions needed to cope with the huge healthcare workforce shortages facing this country. The experts were in agreement that the solutions involve legislation being passed, federal agencies tackling some of the issues, and for universities, colleges, and associations to lead the way with new innovative ideas and programs.

Representative David Wu (D-OR), Chairman, House Committee on Science, Subcommittee on Technology, and Honorary Steering Committee Co-Chair, stopped by the briefing to say that since the House has passed the “10,000 Trained by 2010 Act”, it is now time for the Senate to act on the legislation.

The legislation would enable the National Science Foundation to award grants to improve healthcare informatics curricula, would create multidisciplinary Health and Medical Informatics Centers, and invest in healthcare informatics research to find hardware or software solutions.

Since the legislation is still in the Senate, Representative Wu would like to talk to Congressional leaders on how to proceed and move the legislation forward. Also, Representative Wu realizes that the HIT community needs to contact the Senate to champion the legislation. It may be that the legislation will have to be incorporated into a larger legislative package in order to get passed. His hopes are to see the legislation passed in the Senate while there is still a window of opportunity in this session of Congress.

Karen Bell, MD, MMS, Technology Coordinator, HHS Office of the National Coordinator for Health Information Technology, told the audience that her office has been working on developing and prioritizing what needs to be accomplished to provide for an effective and efficient workforce. Her office has been following a number of work groups in the HIT field that are discussing issues such as how to make the HIT business case, how to deal with privacy and security, and how to get the right technology in place so that HIT can move forward.

Dr. Bell pointed out that the technology itself is not really the problem as we have many devices that can be used to remotely monitor patients, and we also have the technology and the ability to communicate that is not too expensive. However, if we don’t solve the workforce shortage problem right now, then the adoption and use of technology by providers and consumers will be affected.

William Hersh, MD, Professor and Chair, Department of Medical Informatics, Oregon Health & Science University, feels that there is a bright future for HIT and for the people that work in the field. He sees biomedical informatics, health information management, and health information technology playing an important role. However, as Dr. Hersh noted, we really know surprisingly little about the HIT workforce as most of the research available only looks at specific settings or professional groups.

The study “Characterizing the Health Information Technology Workforce: Analysis from the HIMSS Analytics Database” was released on April 17th. Both the authors Dr. Hersh and Adam Wright, PhD, Senior, Medical Informatician at the Clinical Informatics Research & Development Group at Partners HealthCare concluded that the need for professional IT workers will greatly increase in the future.

The data from the report was extracted from the HIMSS Analytics Database with information mainly limited to IT professionals in 5,000 hospitals. While doing the research for the report, they found that there are about 108,390 full time employees working as IT professionals in healthcare, but to move the entire country to higher levels of adoption will require an additional 40,784 full time IT professionals. The report notes it is very important to pay attention to the future workforce that will develop, implement, and evaluate HIT applications.

Dr. Hersh pointed out that the OHSU educational program is growing. Today, 160 alumni have been awarded 168 degrees with over 500 enrolled in graduate certificate programs, the NLM training grant was recently renewed through 2012, and the university is involved in international collaborations in Egypt, Argentina and elsewhere. The university is making outreach efforts to other academic institutions, industry, and healthcare organizations to develop Oregon into an academia-industry hub in HIT.

Speaking from the Community College vantage point, Brian P. Foley, M.Ed., MHA, Interim Provost, Northern Virginia Community College, said “50% of the nurses in this country and the majority of allied healthcare workers in hospitals are community college graduates with approximately 80% of firefighters, law enforcement officers, and emergency medical technicians credentialed at community colleges.

The 2008 updated PricewaterhouseCoopers study on the Northern Virginia healthcare workforce shortage points out the crucial need to address the problem. The study found that if workforce shortages aren’t addressed by 2020, there will be 17,651 allied health and nursing workforce vacancies with the shortage expected to grow to 36%.

Northern Virginia has established a long term, business-driven sustainable strategy to address the healthcare worker shortage. Because of this strategy, the “NoVaHealthFORCE” was formed with a coalition of private sector, business, government, community, healthcare and educational leaders coming together to develop comprehensive strategies and to develop an action plan.

One of the goals is to increase capacity within the healthcare education and training system by addressing the lack of nursing and allied health faculty, and look for additional clinical training sites and faculty.

To further address the problem, the first CEO roundtable consisting of the region’s healthcare CEOs and college and university presidents was formed. In addition, the first regional meetings of the College and University Deans of Nursing were held to discuss how to meet the shortage of clinical training. In the funding area, the General Assembly provided nursing grants for $1.5 million, and the Department of Labor provided a diagnostic imaging grant for $1.2 million.

Another goal is to develop and sustain an ongoing supply of persons interested in entering healthcare career fields by improving healthcare career preparedness in the school systems, provide upward mobility opportunities, and help foreign trained healthcare personnel get the skills needed to enter the workforce. Fortunately, a MetLife Grant is funding a Bridge Program.

This goal will require developing innovative approaches in healthcare human resource management. This means institutions and organizations will need to nurture the career fields of tomorrow, develop a forum to share best practices, and designate an organization to coordinate the implementation of these actions.

The “NoVAHealth” leadership is working on several innovative collaborations and projects:

· Collaborating with the Commonwealth’s Secretary of Technology on the workforce issue
· Collaborating with GMU for the development of academic pathways in HIM and developing an EHR program
· Collaborating with the Northern Virginia Technology Council to form a Health Technology Committee
· Collaborating with a healthcare informatics solutions company to develop the new career field of Clinical Trials Specialist.
· Helping students find opportunities in the Civil Service HIM workforce
· Providing training to wounded warriors in HIM

Speaking on how to take action to educate and expand the HIM professional workforce, Claire Dixon-Lee, PhD, RHIA, Vice President for Education and Accreditation, American Health Information Management Association (AHIMA), said “in spite of the fact that there are 255 academic programs accredited in the field, in general, there still aren’t enough academic programs available in this country and most of these programs are small.”

Also, in the near future, serious faculty shortages will result as the current faculty begins to retire. In addition, college programs often are not selling the curricula in a competitive education environment. Most importantly, baby boomers are going to retire without providing knowledge transfer to the next generation.

AHIMA has several action priorities for 2008. This includes commissioning employer surveys on marketability and the types of jobs available for individuals with associate baccalaureate degrees, and masters’ degrees, plus information is needed on what jobs are available for HIM professionals. Examining new and existing certification programs is also on the agenda.

In 2005, AHIMA launched an internet based learning lab called “e-HIM Virtual Lab” for HIM students with an array of healthcare technology software, lessons for student practice, along with instructor training support, and a learning management system. The lab supports online and traditional students with self paced, instructor led training. Today 115 colleges have signed on plus there is much company participation. Expansion is planned for other disciplines but funding will be needed to accomplish these expansions.

AHIMA and AMIA have worked on several projects together. The Work Force Summit was held in 2006 to bring together 48 stakeholders to discuss the steps needed to build the work force to support electronic health information transformation. The publication “Building the Work Force for Health Information Transformation” was published as a result of the Summit.

In 2007, the two associations worked on a project together to develop core competencies for the health workforce. A task force was called together to decide on key areas and the competencies needed in four key areas. As a result, the task force developed the 2007 AHIMA/AMIA Core Competencies Workbook.

Meryl Bloomrosen, Associate Vice President of the American Medical Informatics Association (AMIA), emphasized how effectively AMIA is transforming informatics from a serious avocation to a formally recognized health profession.

AMIA has been very actively involved with their signature “10x10 program”. The goal for the program is to train 10,000 healthcare professionals in applied clinical informatics by the year 2010. Right now, there are several university programs now underway at Oregon Health Sciences University, University of Illinois, Chicago, Stanford University, and at the University of Alabama

According to Bloomrosen, AMIA initiated an academic forum with informatics program directors to find ways to integrate and track ways to improve formal education and training in the field. In addition, an academic strategic leadership forum was formed to support informatics at the highest levels within academic health centers.

AMIA has also formed partnerships with professional societies, clinics, foundations, and institutes to promote education outreach. In addition, AMIA is actively involved in public health informatics and working with CDC to advance public health informatics training by developing web based distance learning tutorials.

To address specific workforce issues, AMIA is taking part in several activities with the National Library of Medicine and the Robert Wood Johnson Foundation (RWJF). A grant from RWJF is going to help AMIA develop clinical informatics as a medical specialty. AMIA is also working to integrate the science and practice of clinical informatics into mainstream clinical care. A grant from NLM will provide for an upcoming consensus conference on developing biomedical and health informatics competencies.

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 on Wednesday May 7, 2008, will discuss “Ensuring the Integrity and Reliability of HIE Among Multiple Stakeholders: A Look at Successful Partnerships between Industry, Academia and Government”. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email


On April 14, 2008, HRSA announced that a new competition (HRSA-08-124) will fund $10,000,000 for twelve awards to implement high impact HIT for Health Center Controlled Networks and Large Multi-Site Health Centers. The funding will support sustainable business models to deploy HIT in HCCNs as well as help health centers form strategic partnerships for other HIT initiatives and to participate in pay-for-performance programs. The closing date for applications is May 30, 2008.

There are several categories announced in the competition. The “Electronic Health Record Implementations” category will use the funding to implement EHRs in health center networks or in large multi-site health centers that have a need for an EHR.

The second category called “Innovative HIT Implementations” has two sub-categories. (Sub-Category 1) referred to as Early HIT Implementation” will provide funding ($150,000) for HCCNs or large multi-site health centers that do not currently have an HIT system in place but want to work in HIT but are not ready to move into EHR. This category will fund up to two organizations to implement the early stages of HIT adoption but is not limited to e-prescribing, disease registries, physician order entry, bar coding, using PDAs, and clinical messaging.

The “Advanced HIT Implementation” (Sub Category 2) will fund $555,000 for up to five organizations to implement advanced HIT innovations to build upon previous investments in HIT. The funding is not limited to community health records, personal health records, health information exchanges, smart cards, and integrating electronic oral health records into existing electronic health records. The funding can also be used to create interoperability with outside partners horizontally or vertically. Applicants may propose projects that build upon or enhance existing HIT systems that would create interoperable information systems to provide for telehealth.

Cost sharing and matching are not required. However, applicants are encouraged to demonstrate cost participation to show community and organization support. It is also necessary to indicate how the project will continue after Federal grants support has ended.

HRSA’s Office of Health Information Technology will oversee the projects. A pre-application conference call for potential applicants will be held at 2 pm ET on May 5, 2008. The call in number is 888-469-1929 and the pass code is HRSA. For more information, go to

ATA Supports Telehealth Bill

The American Telemedicine Association (ATA) is actively supporting the Medicare Telehealth Improvement Act of 2008 (S.2812) introduced by Senator Kent Conrad (D-ND) and co-sponsored by Senators Debbie Stabenow (D-MI) and John Thune (R-SD). The Senators introduced the legislation to help make important and needed improvements to the Medicare telehealth program.

Fortunately, the bill announcement was timed to coincide with the ATA 2008 Annual Meeting held in April 6-8 in Seattle. “The timing of the bill was excellent, coming on the eve of our annual meeting with 2400 in attendance” said Jonathan D. Linkous, ATA’s Executive Director.

S 2812 would expand Medicare reimbursement for telemedicine in several ways:

· The bill would add skilled nursing facilities, dialysis centers, and community mental health centers to the list or originating sites so the benefits of telemedicine could be provided

· The bill would make additional healthcare providers eligible to provide telemedicine care under Medicare. The new providers would include physical therapists, occupational therapists, speech-language pathologists, audiologists, and diabetes educators

The proposed bill would also create an advisory committee to help CMS assess what telemedicine services would be eligible for Medicare reimbursement. Dr. Elizabeth A. Krupinski, and President of ATA, said “We believe that having an advisory committee of telemedicine providers to assist CMS in making these determinations will improve the process and ensure that patients have access to appropriate care.”

For more information on the bill or ATA, contact Reed Franklin at (202) 223-3333 or email

Tuesday, April 15, 2008

Telemedicine for Audiologists

HRSA has issued a Sources Sought/Market Survey to locate (small business, Veteran Owned, HUBZone, and 8 (a) firms) with the capability to develop a model infant audiology diagnostic protocol using telemedicine. This will help professionals provide diagnostic services in rural areas. Audiology as a profession has been slow to adopt telemedicine, but it is now becoming necessary and more feasible to use telemedicine since inexpensive interactive video systems are now available.

Preliminary research suggests that telemedicine models might prove to be effective for audiologists to use to deliver hearing services to locations where no services now exist. This is vital because diagnostic audiology needs to occur between the ages of one to three months after a baby fails to pass a follow-up screening. However, only half of the infants referred are generally evaluated due to the shortage of pediatric audiologists and equipment. Data shows that an infant with a significant hearing impairment who receives intervention by six months of age will perform significantly better in language development than the infant who is identified after six months of age.

The goal is to place diagnostic equipment in a spoke site of an existing telemedicine network. Audiologists at the hub site would then observe the correct use of the equipment, interpret the results, and interact with the families.

The methodology, once demonstrated could be spread through the National Center for Hearing Assessment and Management. NCHAM has a regional network of pediatric audiologists operating throughout the U.S.

The contractor needs to be able to provide:

  • A toolkit containing training materials for both hub and spoke sites so that teleaudiology diagnostic services could be adopted throughout the existing telemedicine sites
  • Technical assistance to state grantees and the Federal Newborn Hearing Screening and Intervention Program and provide telephone and in person consultations as needed
  • Quarterly progress reports

This Sources Sought notice is for information and planning purposes only and is not a solicitation announcement for proposals. The response to this announcement must be received by April 21, 2008 by delivery, mail, or fax. Send to HHS/HRSA/DPM, attn: Daniel Matusiewicz, 5600 Fisher Lane, Room 13A-19, Rockville, MD 20857, or call (301) 443-4703, or fax (301) 443-5462. This Sources Sought announcement was posted on on April 11, 2008.

Texas TETF Investing

The State of Texas helps companies attract new talent to the state and helps commercialize university research through the Texas Emerging Technology Fund (TETF). The Fund financed by the state helps to boost companies financially so that they can launch their companies and products into the marketplace. So far TETF has awarded more than $108.5 million to Texas companies.

In 2005, the legislature created TETF, a $200 million initiative to increase research collaboration through the new Regional Centers of Innovation and Commercialization. A 17 member advisory committee of high tech leaders, entrepreneurs, and research experts review potential TETF projects and make recommendations for funding projects to the Governor, Lieutenant Governor, and the Speaker of the House.

For example, Seno Medical Inc. in San Antonio received funding to further develop medical devices for cancer. The company is commercializing imaging technology that will produce real-time color images that can differentiate benign and malignant tumors for all solid tumors, such as in breast cancer.

Another company Resonant Senors Inc. in Arlington received funding to develop a new class of optical, biological, and chemical sensors to do high volume, highly accurate screening in drug development and homeland security applications.

In another move, the state is investing $6 million in building the Texas Institute for Preclinical Studies at Texas A&M University which will train physicians, scientists, technicians, and engineers to meet the growing needs of the biomedical industry. The TETF funding will be used to help recruit biotechnology researchers to the Institute.

The Institute will conduct research in medical devices and combination product safety studies in large animals, pre-clinical studies, and biomedical imaging to support pharmaceutical and medical equipment development.

An additional $40 million allocated for the Institute came from Texas A&M University and $2.5 million came from the local community through the Research Valley Partnership. The Texas A&M Office of Technology Commercialization will provide intellectual property protection and business start-up support to spin-out companies that emerge from the Institute.

For more information, go to

Collaborating on Global Health

Open Health Tools (OHT) has announced that there is now a way to collaborate on Global Health IT solutions. A collaborative effort has been put into place where national health agencies, government-funded organizations and agencies, major healthcare providers, international standards organizations, and companies from Australia, Canada, the UK, and the U.S. can now work together to develop common healthcare IT products and services.

The global health IT community will focus on the requirements, design, and development of enabling tools and components. The results will be available under an open source agreement to enable interoperable healthcare platforms to link clinics, hospitals, pharmacies, and other points of care.

“Every day lives are lost and people are at risk because of the lack of integrated and interoperable health IT networks, despite the existence of similar networks in almost every other industry. We believe that collaborative open source communities like OHT are the key to driving the evolution of emerging health IT standards” according to Ciaran DellaFera, IBM Engineer and CTO of Healthcare & Industry Software Standards for IBM Software Group.

OHT is a membership organization comprised of standards organizations, academia, national health systems, the open source community, vendors, and IT professionals. The results of the members’ efforts will be made available under a commercially-friendly open source license.

The inaugural vendors and open source organizations providing medical software services and equipment include IBM, Inpriva, Eclipse, Ocean Informatics, CollabNet Oracle, Red Hat, Kestral, BT, JP Systems, Palamida, B2 International, NexJ Systems, Innoopract, and Ozmosis. The academia and research groups contributing include Linkoping University, Oregon State University Open Source Lab, and Mohawk College.

“The need to exchange patient health information across healthcare organization boundaries creates complex privacy challenges,” said Don Jorgenson, CEO, Inpriva. “We expect that the availability of standards-based security/privacy components in the Open Health Tools framework will help accelerate deployment of interoperable healthcare systems and health information networks.”

For more information, go to or contact Barbara Stewart at (480) 488-6909 or email

Sunday, April 13, 2008

Alaska's Healthcare Efforts

Governor Sarah Palin is leading Alaska’s efforts to have affordable healthcare and to make certain that the Alaskan healthcare system is responsive to changing demographics and market conditions. In January 2008, with recommendations from the Health Care Strategies Planning Council and the Health and Social Services Certificate of Need Negotiated Rule Making Committee, the Governor introduced the “Alaska Health Care Transparency Act.”

The Act would establish the Alaska Health Care Commission to do further healthcare planning from a statewide perspective. A healthcare information office would be established to give consumers factual information on quality, costs, and other matters to help them make better informed decisions about healthcare.

The recommendations made to the Governor were recently released in the “Health Care Action Plan: “Making Alaskans the Healthiest people in the Nation.” The plan details long term goals and strategic directions for the years 2008-2014. The final report complete with summaries and recommendations was released in December 2007.

Several goals are listed in the plan but one goal would make quality healthcare accessible to all Alaskans by:

  • Expanding telehealth and electronic health record systems and taking the lead in pursuing matching FCC grant funds in the short term
  • Increasing the presence of the public health system particularly public health nurses in rural communities
  • Enabling Alaskans to have access to a primary care provider and behavioral health provider when needed
  • Helping Alaskans to not use emergency rooms for primary care
    Exploring private enterprise incentives
  • Improving primary and long term healthcare options for elders, particularly with regard to Medicaid and Medicare

The Governor is also proposing a repeal of the “Certificate of Need Program”. CON is a regulatory process requiring certain healthcare providers to obtain state approval before offering certain new or expanded services. According to Health and Social Services Commissioner Karleen Jackson, the CON program does not benefit the citizens of Alaska because of the litigious environment surrounding it.

According to the Mukluk Telegraph newsletter published by the Alaska Native Tribal Health Consortium (ANTHC), as many know, residents in remote Alaska areas are faced with difficulties getting healthcare. Transportation to providers can mean driving long distances, taking boat rides, or even flying to the doctor. Today, some patients in Adak, Akutan, Nelson Lagoon, King Cove, St. George, and Cold Bay have been able to monitor their care at home using technology.
However, as with many groups, ANTHC is facing several challenges all directly or indirectly related to funding. IHS annual funding increases from 1 to 2 percent are not keeping up with medical care costs and population growth. Added to this, there are substantial cost increases for utilities employee benefits, construction, pharmaceuticals, surgical implants, and travel.

To further help deliver home healthcare, the Alaska Federal Health Care Partnership (AFHCP) is partnering with the Eastern Aleutian Tribes to provide VitelNet Home Telehealth Monitors also known as “Turtles” to deliver care in some of the most remote homes. Already success has been seen in treating diabetics and also the population that needs to be on the prescription medication coumadin. “In a state where access to care is a major issue, home telehealth monitoring profoundly impacts healthcare delivery in Alaska,” said Mark Anaruk, project manager for AFHCP.

The Alaska Federal Health Care Access Network (AFHCAN) provides access to healthcare using telehealth technologies, and helps beneficiaries of IHS and tribal organizations, the Department of Defense, U.S. Coast Guard, the VA, and provides benefits to state Public Health Nursing offices.

AFHCAN is promoting telehealth by sending traveling specialists to remote healthcare facilities to educate end users on how to use VTC technology. This technology is used for dermatology, otolaryngology, and podiatry to provide continuing education. AFHCAN is evaluating the data from these VTC sessions to see if it helps increase the use of telemedicine in distant sites. In addition, AFHCAN provides the Traveling Audiology Program to provide audiology services in remote areas.

AFHCAN in recent years has been using telemedicine carts, but now the carts have been improved and come equipped with additional monitoring and diagnostic equipment. The use of telemedicine is expanding and ANTHC is now forming a subsidiary company that will distribute the telehealth carts nationally and internationally.

According to the newletter “Alaska Rural Health Notes” published by the Alaska Center for Rural Health, besides the actual hardships in delivering good healthcare, another problem has to do with the enormity of the health workforce crisis. However, Alaska is not alone in the struggle to recruit and retain a competent health workforce.

The University of Alaska, Fairbanks will receive a grant to help train healthcare workers in rural Alaska through the Rural Alaska Health Education and Training Project. The Alaska Congressional Delegation announced that the university would receive a $1,858,528 grant through the Department of Labor’s Community-Based Job Training Grant Competition. According to Senator Ted Stevens, “the lack of healthcare workers in Alaska, particularly in our most remote areas is alarming.”

For example, Alaska faces a staggering shortage of behavioral health professionals at every level of training. Also, Tribal Alaska’s vacancy rate is over 40% for dentists and over 50% for pharmacists. In addition, shortages for physical therapists, occupational therapists, and speech pathologists are also dire.

Addressing mental illness is an enormous undertaking in the state. In an effort to improve suicide prevention outcomes, the goal is to better utilize the state’s telemedicine capabilities. Many Alaskan Native Health Corporations have signed telemedicine agreements to help increase early intervention, screening, and treatment capacity in rural areas. There are also plans to link with developing rural health clinics to improve service delivery, provide gatekeeper training, and analyze recommendations from the Alaska Follow-Back Study to be able to identify new strategies to use for earlier intervention with identified high-risk individuals.

The TeleBehavioral Health Project has been piloted in Alaska with AMHTA, DHSS, and Federal grant funds. This program provides access to services via technology to remote hub villages so that Alaskans with psychiatric issues do not have to leave their home community to obtain services or deteriorate to an emergency status as this could mean that they would have to be transferred to the Alaska Psychiatric Institute.

The Alaska Psychiatric Institute has been working on an automation project that could enhance their electronic medical record system and at the same time help expand the TeleBehavioral Health Project. As with many projects, additional funding is needed to help continue the automation work.

None of the above issues can be addressed and work if broadband isn’t established throughout the state. Through the FCC Rural Health Pilot Program, a grant for $10.5 million is going to help develop an Alaska e-health network for telehealth and health information exchange and provide for the design and development of a statewide broadband network.

To help with the project, ANTHC has been designated to act as interim project manager to design and develop the network. ANTHC envisions the eventual creation of a public private partnership to manage the Alaska e-health network for the long term.

The specific objectives for the network are to unify the separate electronic healthcare networks that are being developed throughout the state, and supply rural health providers with connectivity to providers both in Alaska and the lower 48 states. The network will provide for the exchange of health information, support telemedicine services, transfer high resolution images, provide for videoconferencing, and for voice-over-internet applications.

Research Funding for PTSD

The National Institute of Mental Health (NIMH) and the Department of Veterans Affairs released a Request for Applications (RFA-MH-09-060) on April 7, 2008 to find ways to differentiate trauma survivors who will recover naturally from their injuries as opposed to those survivors of trauma who will develop PTSD. There are some problems in approaching the solution to this problem, due to the need to recruit very large symptomatic samples to know whether any given intervention is working.

If researchers are successful in developing effective early interventions, then these methods can become part of routine emergency triage and follow-up care. If this research project produces the intended results, there will then be a clear need for decision tools to be developed to guide clinicians and patients.

The grant funding will enable researchers to look at PTSD risk predictors including family and patient history of mental illness, early adversity, cognitive biases, gender, education, and the nature, severity, and exposure to causes for mental illness.

NIMH is committing $600,000 in fiscal year 2009 to fund 3 awards. Eligible applicants can be public/state/private institutions of higher education, non profits, for profits, small businesses, state, county, city governments, regional organizations, eligible agencies of the federal government, and faith-based organizations. Applications from underrepresented racial and ethnic groups as well as individuals with disabilities are encouraged to apply.

The closing date for applications is August 29, 2008 with the earliest anticipated state date of July 2009.

For more information, go to or for the link to the full announcement, go to

Technology Empowering Patients

According to Joseph C. Kvedar, MD, Founder and Director of the Center for Connected Health, and Past President of the American Telemedicine Association (ATA), connected health technologies empower patients to take a more active role in managing their health. Dr. Kvedar presented his findings at the 13th annual ATA Conference and Exhibition held in Seattle, Washington on April 6th through April 9th.

He said, “Eleven research studies are being conducted by the Center for Connected Health that demonstrate how successful patients can manage their care and in general improve their overall health. Through a number of ongoing programs, the Center is finding more evidence demonstrating the benefits of connected health for patients, healthcare providers, employers, and payers, as well as for the person who simple wants to stay healthy”.

The Center a division of Partners HealthCare has developed and deployed the Remote Monitoring Data Repository (RMDR) system that is able to store remotely measured and reported patient data in a single scalable data repository. This has resulted in a single integration point for the connected health programs. RMDR also provides a single integration point to the health information systems at Partners. So far, three connected health programs are storing data into the system with more coming online.

The Center is involved in a several studies and projects using remote monitoring:

  • Non-homebound heart failure patients participating in the Connected Cardiac Care program participants were given home telemonitoring equipment to transmit daily vital signs and symptom reports to a telemonitoring nurse. Initial feedback from participants have been overwhelmingly positive with 100% of the patients reporting that the program has helped them stay out of the hospital
  • Patients being monitored for diabetes reported that blood sugar monitoring was most valuable when newly diagnosed, or for patients trying to regain control of their diabetes
  • A reminder system used to improve medication adherences using an electronic pill bottle and desk lamp linked to a pager system showed significant acceptance among participants
  • A randomized controlled trial comparing asynchronous e-visits consisting of online surveys and digital images to manage mild to moderate acne reported that 100 trial subjects were satisfied
  • Three studies have looked at how consumer technology such as the telephone, a pager system, and the internet can help patients adhere to their prescribed medications and maintain an exercise regimen

To see how remote monitoring can help in industry, the Center for Connected Health and EMC Corporation recently launched a new web-based remote monitoring program to help employees fight hypertension. EMC is the first company to participate in using “SmartBeat” which was designed by the Center. The program uses a wireless blood pressure cuff and communicator, and an internet-based feedback system to aid the employees in self managing their high blood pressure.

“Employers are increasingly looking for innovative, consumer-centric approaches to create and maintain a healthy workforce and manage healthcare costs,” said Dr. Kvedar. “Our partnership with EMC is evaluating how simple technologies can help employees manage a chronic condition, such as high blood pressure, and will demonstrate how a web-based remote monitoring program can empower patients to improve their own health.”

The program will also study how a web-based hypertension wellness program can impact health care costs and utilization, such as the number of doctor visits required or the use of prescription medications to manage the condition.

Monday, April 7, 2008

Surgeon Generals Speak at Conference

Vice Admiral Adam M. Robinson Jr, MC, U.S. Navy Surgeon General & Chief, Bureau of Medicine and Surgery, said “the Navy not only deals with the consequences of war and the wounded, but the Navy also helps family members acting as caregivers with emotional issues. Taking care of the wounded warrior and the family at the same time has never been done before. The Surgeon General made these remarks at the 6th Annual Battlefield Healthcare Conference held at Georgetown University on April 1-2, 2008.

According to the Vice Admiral, when wounded warriors enter the Navy medical system, they are assigned a team that may have physicians, nurses, case managers, social workers, therapists, chaplains, and others to help.

The Navy not only has to sustain the care for the wounded, but also care for soldiers that will have debilitating chronic illnesses in their lifetime. Many of the injured soldiers will be in the military health system for the next 40 to 50 years. That is why it is so important for the Navy to provide patient and family centered care and to partner with the VA.

Today, mental health professionals need to deal with many problems with military personnel that may be common, potentially disabling, and possibly preventable. Some of the problems that they see have to do with drug and alcohol abuse, depression leading to suicides, and abuse to family members in the home.

Many developments have helped combat casualty care. For example, resuscitative teams have been able to stop and stabilize injuries before the wounded go to the hospital. Great success occurs because the right medical teams are at the front lines and able to provide the correct care en route to the hospital. Some of the advances in military medicine have resulted in vacuum-assisted wound closure devices, advanced clotting sponges, advanced prosthetics, and advances in imaging that provide information on both hard and soft tissue and provide limited radiation exposure.

There are new ways to handle blast injuries that result in brain swelling. Today, the surgeons are able to remove large brain plates, do 3-D imaging and obtain a description of what has been lost. This enables the surgeons to do complex planning for the next step that involves implanting a prosthesis that fits precisely in the skull. After the healing process, reconstruction of the brain is then performed.

Lt. General James G. Roudebush, MC, Surgeon General of the Air Force, also addressing the attendees at the Battlefield Healthcare Conference, is proud that the Air Force’s air evacuation and en route care provides critical care at the right place and at the right time by getting the wounded rapidly to their first damage control surgery. Although getting the wounded to the right medical facility quickly is critical, the Air Force Medical Service not only takes care of the patient’s medical needs, but at the same time is able to make the patient comfortable while in flight.

As the Air Force Surgeon General explained, the wounded are stabilized and transported to Landstuhl Regional Medical Center in Germany, to Andrews Air Force Base, or to wherever necessary for treatment usually within 36 hours. Transporting the wounded is helped by using TRAC2ES, a system put in place to monitor and track patients leaving theater via Air Force aero medical evacuation.

According to General Roudebush, the Air Force currently has new techniques and devices available to better care for wounds, control infection, and to help control pain. Medical personnel are now better able to monitor the wounded during flights using devices that are lightweight, small, mobile, and rugged.

In addition, CT scanners and handheld blood analyzers have helped enormously in getting the wounded to the operating room with the right information at the right time. This is particularly important in trauma injury cases because the vast majority of trauma patients require multiple procedures done by a team of surgeons in the operating room. This means that all of the surgeons on the team must have immediate data to proceed.

For more information on the Battlefield Conference and on future meetings, go to

E-Prescribing Standards Published

CMS has published a new regulation establishing Part D e-prescribing standards for four types of information. The new rule will go into effect on April 1, 2009. According to HHS Secretary Mike Leavitt, establishing standards for e-prescribing under Medicare’s prescription drug program will help pave the way for the widespread adoption of e-prescribing throughout the medical community.

This regulation applies to:

  • Formulary and benefits: This standard will enable doctors and other prescribers to find out information on what drugs are covered by a Medicare eligible individual’s prescription drug benefit plan
  • Medication history: This standard will enable doctors, other providers, as well as dispensers to communicate about prescribed medications a beneficiary has taken or is taking including those prescribed by other providers
  • Fill status notification: This standard will enable doctors and other providers to receive an electronic notice from the pharmacy or other dispenser telling them that a patient’s prescription has been picked up, not picked up, or has been partially filled
  • Provider identifier: The final rule requires providers, dispensers, and Part D sponsors to use the NPI to identify individual healthcare providers in Part D e-prescribing transactions

For more information, go to

DOD Trauma System Discussed

Colonel Brian J. Eastridge, MC, Chief of Trauma, US Army Institute of Surgical Research, and Brooke Army Medical Center, speaking at the Battlefield Healthcare Conference at Georgetown University on April 1, 2008, discussed the effectiveness of the Joint Theater Trauma System. The system provides for an organized approach to providing improved trauma care across the continuum of care.

According to Colonel Eastridge, the Joint Theater Trauma Registry (JTTR) is the data repository collecting all of the DOD trauma related data. The system contains records on both pre-hospital care and subsequent care in CONUS along with the most comprehensive and historical picture of war wounds ever assembled. The vision is to improve the delivery of care, improve communications for clinicians in the evaluation chain, ensure the continuity of care, and provide improved access to data.

The registry has data on injury prevention, trauma care, hospital care, acute care, rehabilitation and where injuries are located on the soldier. The information helps researchers develop and make improvements in both soldier personal protective equipment and vehicle design.

There are 14,000 patients with injuries listed in the database with data on level two, level three, and level four patients. Presently the system is adding level five data. The database can be separated with Iraq injuries versus injuries endured in Afghanistan.

The soldiers in this highly injured population in the war zone may sustain wounds requiring massive transfusions. The system is able to track massive transfusions and provide data to prevent deaths and complications. Today, the survival rate for these soldiers is high at 80% to 90%. The system also provides data on casualty trends and provides pre deployment education.

The system provides information that helps researchers deal with hypothermia on the battlefield. With the data provided, the Army is looking at ways to prevent hypothermia such as using body bags and temperature monitors. Researchers are studying how to best do burn resuscitation and now they are developing standard burn flow sheets to track input and output after incidents of over or under hydration.

Wednesday, April 2, 2008

Technology Advances in NY

Grants for $105 million were awarded to 19 community-based health information technology projects in New York State and range from $1 million to $10 million. The grants will link Medicaid data to interoperable electronic health records, link electronic health records to the New York State Immunization Registry, connect patients and clinicians through personal health records and other patient focused tools, and implement quality measurement and reporting capabilities.

Also last February, Mayor Michael Bloomberg and the Health Commissioner announced that New York City’s next generation electronic health records are already in use at more than 200 primary care providers across the city to care for more than 200,000 New Yorkers. New York is equipping more than 1,000 local healthcare providers with EHR systems to benefit more than a million patients.

The Health Department’s Primary Care Information Project developed the EHR system with the firm eClinicalWorks. With $30 million, the Health Department developed the system and offers eligible practices a subsidized package of EHR software and services. The practices must pay for hardware and network infrastructure and contribute $4,000 to the Fund for Public Health in New York for technical support. The initiative is supported by a $3.2 million grant from the State and will be evaluated using $5 million in funding from CDC and AHRQ.

In the academic community, SUNY Downstate Medical Center has begun a multi-year project to deploy electronic health records to help the University Hospital of Brooklyn and the community. Recently, the hospital went live with Phase One.

SUNY HealthBridge is using the Eclipsys Sunrise clinical suite of applications that includes a CPOE system and is able to track medical orders and medication records. Using flow sheets, practitioners will be able to electronically document patient care including clinical laboratory and radiology results.

In addition, the SUNY Downstate Medical Center now has the capability to email electronic slides. After nearly ten years of research, scientists at the Medical Center in Brooklyn and Peking University in Beijing were awarded a U.S. patent for their virtual telemicroscope. This patented software permits off-site pathologists to diagnose cancer or other diseases in remote locations around the world. The device is being tested as a diagnosis instrument in China at 600 hospitals without on-site pathologists.

To further increase the use of health technologies in the state, it was announced in March that nine public/private sector partnerships will receive funds to support innovative solutions and help to build high speed broadband access networks so that affordable broadband internet access will be available for underserved urban and rural communities.

In 2007, the New York State Legislature appropriated $5 million to provide seed money to be awarded through the Council. To leverage the funds, the Council required a minimum dollar for dollar match in the form of cash, in-kind goods and services, or a combination of the two. The value of the matching cash and in-kind services from the nine award recipients totals more than $15.1 million. More than 50 applications were received for the first year of funding and the proposed 2008-2009 budget includes $15 million to continue the program.

VR Helping PTSD

Mark Wiederhold, MD, PhD, President, Virtual Reality Medical Center, appeared before the House Committee on Veterans Affairs on April 1, to explain how his company tests virtual reality therapy to treat PTSD. According to Dr. Wiederhold, his company is now testing virtual reality therapy to treat PTSD in five VA hospitals with requests from six additional facilities, plus the technology is also being tested in Navy facilities.

Virtual reality technology has been used to treat patients for the past 12 years with an overall success rate of 92%. The success rate is defined as a reduction in symptoms, improved work performance or the successful completion of a task which was previously impossible.

He continued to say that the research protocol works by allowing the therapist to gradually expose the combat veteran to distressing stimuli in the virtual scenarios, while teaching the study participant to regulate breathing and physiological arousal. After a number of sessions, the “fight or flight” response to distressing stimuli is extinguished. The advantage of virtual reality is that it helps make it safe for the veteran to engage emotionally, therefore allowing the fear structure to be accessed and the abnormal response to be extinguished.

Dr. Wiederhold suggested the need to correlate the progress of virtual reality therapy not only with psychophysiology, but also with brain imaging. His researchers have been collaborating with other researchers, and have postulated that an “fMRI signature” or functional brain imaging signature for PTSD could possibly lead to more targeted treatments.

Secondly, VR can be used both alone and in combination with neuroprotective agents such as antioxidants, to conduct stress inoculation training pre-deployment. Lastly, virtual reality therapy may be an important piece of the puzzle as tools are developed that can assess and treat the many co-morbid conditions that accompany PTSD. For example, VR can be useful in both cognitive rehabilitation for TBI and in physical rehabilitation for veterans with amputations.

Examining Emergency Errors

Researchers at the University of Texas Health Science Center in Houston are examining the complexities of emergency medicine and the resulting medical errors. The first phase of the five year project funded by a $4.7 million grant to Arizona State University from the James S. McDonnell Foundation will study underlying critical care decision making for inefficiencies and weaknesses.

The second phase will examine how to correct problems within the healthcare delivery system to reduce and prevent medical errors, reduce healthcare costs, and increase healthcare quality. The research is being conducted with partners at Arizona State University and with Banner Health System in Phoenix, and Washington University in St. Louis.

The researchers will shadow healthcare provides in the emergency center at Memorial Hermann Texas Medical Center. They will make observations and look at how frequently physicians access medical records, how they communicate with the nurses and pharmacists, and how they prioritize the order in which patients should receive treatment. The researchers will also look at data from the electronic medical records systems, and create a computer model of activities and human though processes and behaviors in the emergency centers.

Researcher David Robinson MD said “it is an enormous task to identify and map the processes behind emergency medicine and patient care. We are going to take an analytical look at how the system operates so that we’ll have a better understanding of where errors come from so that we can make changes in the way we provide patient care.”