Thursday, August 28, 2008
The 2008 grant awardees are Benson Hospital, Cochise Health Network, Marana Health Center, Regional Center for Border Health, Verde Valley Guidance Center, and Yuma Regional Medical Center.
In addition, the RHITA program provided $298,663 in consulting and educational services to healthcare organizations in rural communities. This funding is being used to hold community meetings statewide to raise the awareness of the benefits of e-health and to enable active RHIO participation.
Also in Arizona, a project called AZ3D is being developed to produce a statewide visualization platform to help improve public safety in the state. The project in conjunction with the Arizona Department of Homeland Security and other state agencies will use imagery and numerous datasets and then incorporate this data into a non-technical internet-based viewing environment. Using these datasets will allow the information to be shared with state and local government emergency planners, first responders, and other decision makers in order to upgrade public safety efforts in the state.
In addition, medical personnel now have more information sources available in the theatre according to an article appearing in the July 2008 MC4 “Gateway Online Newsletter”. Since deployed personnel have fewer hardcopy materials onsite available and bandwidth restrictions can reduce the accessibility to search most web sites, several databases are now provided in the field to help medics obtain information.
One database Micromedex has information on medications and poisons, and the other database MEDIC has information on worldwide diseases and environmental health risks. Both of these databases are located on MC4 systems.
Another source available to medical personnel is the Army Medical Department’s Virtual Library. This source is a central location for databases, online text books, and links to clinical communities. “While accessing online resources in theater can be cumbersome compared to stateside access, one of my favorite sources for information is www.uptodate.com ,” said Captain William Sanders, Physician Assistant with the 744th Military Police Battalion, Baghdad, Iraq.
LTC Edward C. Michaud, Division Surgeon, 3rd Infantry Division, Ft Steward Georgia, notes that providing input is a challenge in communicating electronically. He reports that the biggest issue continues to be connectivity in theatre and development of agile user-friendly software.
LTC Michaud says that one approach to overcoming the connectivity problem would be to continue to work with the Signal community and the larger Army to coordinate bandwidth. He also suggests that to further develop the software, it would help to use a regulated open architecture system. This would allow for different types of software to be integrated faster and meet the growing demands of the providers.
For more information, go to www.mc4.army.mil.
As part of the program, funding for $8.5 million was awarded to the doctors, scientists and engineers who are part of a team from the University of California Davis Health System and the Lawrence Livermore National Laboratory (LLNL). The researchers will focus on Point-of-Care (POC) testing to develop two prototype instruments that can simultaneously detect five bacterial and fungal pathogens, plus develop other exploratory diagnostic technologies.
“The specific goal for the Center is to improve the accessibility, portability and field robustness of POC instruments for critical emergency disaster care in community hospitals, rural areas, and disaster response sites,” said Gerald Kost, Professor of Pathology and Laboratory Medicine and Director of the POCT-CTR at UC Davis. Dr. Kost stressed that when the Katrina disaster happened, if POC diagnostic devices had been used in the field, then triage and other mobilization efforts would have been greatly helped.
In April 2008, the UC Davis-LLNL Point-of-Care Technologies Center released the program announcement (UCD-POCTC-08) looking for exploratory projects in new POC technologies. The technologies need to specifically address clinical needs in critical emergency disaster care with the focus on multiplex pathogen detection in human whole blood for use in situations of disaster triaging, decision making, management, and treatment. The applications were due July 11, 2009 with the awards to be announced on or before October 1, 2008.
The award amount will be approximately $600,000 with two subcontracts to be awarded. After the announcement of the awards, UC Davis will begin to process the first subcontract in October 2008, and the subcontract for the second project will begin in 2009.
Dr. Charlotte Gaydos, Principal Investigator of the Center for POC Technologies for Sexually Transmitted Diseases at Johns Hopkins University and her colleagues are collecting data from patients seen in the John Hopkins Hospital and at Cincinnati Children’s Hospital Medical Center emergency rooms if the patients are willing to give permission to use the POC STD testing.
The POC Center for Emerging Neurotechnologies led by Dr. Fred Beyette of the University of Cincinnati is focusing on bringing POC testing to the ER doctor with rapid and reliable information related to a neurologic emergency. According to Dr. Joseph Clark, co-principal investigator of the Center, “one million brain cells die every minute during a stroke so an initial correct diagnosis results in a 91% likelihood of a good outcome.”
Dr. Bernhard Weigi Principal Investigator of the Center to Advance POC Diagnostics for Global Health at the University of Washington noted that many settings may need to provide immediate healthcare but may be considered low resource areas. Therefore new POC devices must be stable to be useful.
Sunday, August 24, 2008
Two Foundations located in the Northwest recently awarded grants and issued an RFP. One of the organizations, the Regence Foundation awarded three technology grants for $195,000 to help nonprofits improve healthcare quality in Portland and Seattle.
One technology grant went to the Virginia Garda Memorial Foundation for $100,000 to help fund an electronic version of a medical home for thousands of Oregon residents. This foundation emphasizes providing high quality and culturally appropriate primary healthcare especially for migrant and seasonal farm workers.
The funding will help purchase hardware and software to support the electronic medical records of patients at the Virginia Garda clinics which can then be accessed by any clinic in the Community Health Information Network.
The two other awards will deliver healthcare information via the internet. The first award went to the Oregon Health Care Quality Corporation in Portland for $45,000 to help build a consumer oriented web site on healthcare quality to be operated by Partner for Quality Care. The site will provide the public with resources on healthcare quality, hospitals and nursing homes quality data, and provide links to other credible health resources along with tips on evaluating the online health information.
The second award went to the Puget Sound Health Alliance in Seattle for $50,000 to create a web-based portal to deliver performance results to Puget Sound area clinics and will include data on individual providers. The funding will enable the performance reports to be valuable tools to refine clinical improvement processes, identify and start new patient support programs, and guide overall quality improvements.
As for the RFP, the Northwest Health Foundation on behalf of the Oregon Department of Human Services issued an RFP that is due by September 2, 2008 to find innovative ways to improve access and provide effective healthcare delivery for families. The goal is to improve preventive health services, increase access to better primary care for families, explore alternative models for reimbursement, and collect information to be able to evaluate each grant funded project.
Specifically, the Northwest Health Foundation and the Oregon DHS are interested in projects to:
- Bring diverse stakeholders together to coordinate, communicate, and improve access to care
- Provide patient-centered care that uses patient driven goals and evidence-based practices
- Provide for team-based care that takes advantage of nursing services
- Provide for coordinated care to link patients to comprehensive services in the community
- Provide accessibility through the telephone and email and remove other barriers to timely care
- Collaborate with the community to ensure that health related interests and services are coordinated, along with psychosocial services. Assessments need to be conducted on health status, disparities, and effectiveness of services
The DHHS will award grants for two projects in the amount of $250,000 and will cover a two year grant period. For more information, contact Chris DeMars at the Northwest Health Foundation at firstname.lastname@example.org or telephone (971) 230-1292, or for further information, go to www.ohsu.edu/ohsuedu/outreach/oregonruralhealth/news/nwhf-rfp.cfm
The Institute for Alternative Futures (IAF) has launched a new project to look at the changes needed for future healthcare needs in this country. In 2009, the new administration will face the challenge to change healthcare in America. In looking ahead, IAF is working on a series of nine papers covering the 10 year change process necessary to stimulate the ideas that are needed to begin this process.
The project “Healthcare That Works for All”, when completed will discuss nine interrelated aspects of healthcare to occur by the year 2019. The papers in the series that are currently available cover values for healthcare, health economics, and the changes needed in the payment and delivery systems. Future papers will relate to healthcare issues such as science and technology, political changes, policy, infrastructure, and social and economic conditions.
The paper on healthcare payment systems in 2019 envisions a redesigned healthcare payment system that would require:
- A combination of private and public options covering the population, but with limits on third party obligations that define a basic tier of care that is constrained by value-based purchasing
- Government funding of an open source network to assess the comparative efficacy of treatments, and how this would shape reimbursement policy
- A new Independent Health Board that would propose annual national health budgets that would only be increased by Congress through higher taxes or designated shifts from other parts of the federal budget. The board would first conduct a public referendum with randomized surveys so that the priorities represented by healthcare are democratically reinforced
- Regulators would continually monitor for unanticipated rises in costs that would lead to swift adjustments in policy or recommendations to CMS for regulatory action. As spending trends move upward, the Health Independent Board would propose changes
Futurists envision sufficient incentives and protections being offered to encourage the widespread use of electronic medical records and personal health records. The infrastructure will support a host of incentives for provider teams to coordinate care and improve quality. Procedures and information will be communicated so that it will be possible to readily navigate payment systems with the help of continuously improving software aids. Also evaluation tools to link healthcare inputs to health outcomes would need to be developed.
Most Americans would continue to get their healthcare insurance through employers. Others would have the option of buying insurance from other organizations using regional risk pools that cover people with pre-existing conditions with transportable covers. By 2019, all individuals would be mandated to have healthcare insurance so that the basic tier is available to all. The cost of this basic tier would only be allowed to increase at the rate of growth of the GDP. Individuals, who want more than the basic tier of care, would be able to pay out of pocket or buy supplemental insurance. However, tax incentives would only support the basic tier.
For questions and comments on the papers, contact email@example.com. To download the papers, go to www.altfutures.com/2019_Healthcare_That_Works_For_All.
AHRQ has plans to award a contract that will assess the effectiveness and safety of patient safety practices (PSP). The agency anticipates that the results of this work will benefit researchers and others that want to evaluate the results when implementing patient safety practices. One contract will be awarded with a maximum budget of $1 million with a cost plus fixed fee contract contemplated for a 12 month period of performance.
The contractor is expected to:
- Form an interdisciplinary panel of experts in patient safety, frontline healthcare delivery, clinical and health services research, behavioral and social sciences research, evaluation design and methodology, systems engineering management science, and other disciplines as necessary
- Identify a diverse and representative set of PSPs to be used to help develop the criteria for the systematic assessment of the safety of PSPs
- Identify research and evaluation models, methods, and designs that could be used to evaluate the PSPs
Proposals are due October 13, 2008. The date for the webex only Conference is September 5, 2008, and Notice of Intent is due September 13, 2008.
Questions regarding this RFP need to be emailed to Linda.Simpson@ahrq.hhs.gov by August 29, 2008. The subject line should be marked “Proposal Questions RFP No. AHRQ-09-10001.” The answers to the questions will be provided in the form of an amendment to this solicitation and will be posted on www.ahrq.gov/fund/contraix.htm and on the Federal Business Opportunities web page at www.fbo.gov.
Wednesday, August 20, 2008
HRSA’s National Advisory Committee on Rural Health and Human Services just released their 2008 Report to the Secretary of HHS with a section in the report targeting healthcare workforce challenges in rural areas. Although the Committee is aware that Federal programs have been created to help reduce rural physician shortages, the Committee is very concerned that several recent trends may undermine attracting the next generation of physicians to rural areas.
Such trends as:
- The continued cuts in the HHS title VII primary care training grants and the declining match rates for family practice residencies
- The decline in applicants for the J-1 Visa Waiver program
- Not having enough federal assistance to train nurses, physical therapists, and radiation technologists
- The shortage and lack of rural dentists in rural areas. Wisconsin and North Carolina are considering opening new dental schools to focus more directly on public health dentistry and on the needs of underserved areas
- Primary care doctors in rural areas may not have adequate training in mental healthcare, yet they are providing the majority of mental health services in these areas. There is often stigma associated with receiving help in rural areas since confidentiality can’t always be assured in close knit rural communities
According to the “Chronicle of Higher Education”, the nation will need at least 20,000 more physicians over the next decade to care for elderly patients, through fewer than 8,000 geriatricians are in practice today. High caseloads, long hours, isolation from colleagues, lack of easily accessible continuing education, limited professional opportunities for spouses, and heavy school debt deter medical students and residents from practicing in rural areas.
The Committee’s report argues that solutions will require long range planning. The Committee suggests that not only must HHS play a major role in addressing the workforce challenges, but also other cabinet-level departments need to play key roles. The Department of Education with links to community colleges, and the Department of Labor through the Workforce Investment Act program needs to become more involved.
Massachusetts is also addressing healthcare workforce shortages. According to AAFP News, the state has just enacted a sweeping healthcare measure to address primary care workforce shortages. The legislation calls for creating a robust primary care workforce particularly in rural areas, and calls for the establishment of the patient-centered medical home.
The state now has the authority to establish a medical home demonstration project. However, certain provisions of the law still need to be flushed out. For example, the legislation authorizes MassHealth to develop a medical home pilot project in conjunction with the state’s Health Care Workforce and the Massachusetts AFP, but it is not clear how the medical home pilot will be structured, how many practices it will involve, or how long it will last. Most importantly, the project itself is subject to appropriations.
State Senator Richard Moore a sponsor of the legislation, said “the pilot will go forward and the focus will be on the medical home particularly for chronic illnesses where it will be used to better manage a patient’s care.”
Most importantly, the legislation establishes a statewide goal of adopting electronic health records by 2015. Hospitals will be required to use an interoperable health record system after 2015 to receive their license. The legislation authorizes $25 million for the new Massachusetts e-Health Institute to facilitate the financing and deployment of a statewide compatible system of EHRs. The institute which is part of the state’s technology collaborative will award grants to physician practices to help facilitate the adoption of EHRs.
The Duke Endowment a private foundation established to serve the people of North and South Carolina has a program that supports healthcare. In the fall of 2006, Duke Endowment sent some representatives to pay a courtesy call to meet with Mr. Magill to discuss the Duke Endowment’s growing interest in mental health issues in the state.
Mr. Magill was very interested in talking to the representatives from Duke Endowment about the possibility of easing problems in the state and being able to provide adequate mental health care without crowding the emergency rooms. DMH already had a successful record of using telemedicine to serve clients with mental illness that were deaf. The representatives liked what they heard about using telemedicine and were interested in pursuing the matter to help in the emergency rooms.
As Duke Endowment was learning more about the possibility of the DMH proposal, Mr. Magill expanded his team to find others with a stake in finding an effective solution that could bring assets to the table. He approached the South Carolina Hospital Association, South Carolina Office of Research and Statistics, and the South Carolina Department of Health and Human Services to get on board with the project. Discussions were also held with the heads of the Departments of Psychiatry at the University of South Carolina, School of Medicine, the Medical University of South Carolina, and the Medical College of Georgia.
In June 2007, DMH submitted an application to Duke Endowment, and in November 2007, received a letter saying that the agency had been awarded a $3.7 million grant to develop and implement the telepsychiatry consultation network in all emergency rooms around South Carolina.
By using telemedicine in the emergency rooms, psychiatrists can now provide better mental health care to smaller rural communities by using state-of-the-art video and voice equipment placed in all participating emergency rooms. The equipment is capable of providing direct links to DMH where psychiatrists can be available 24/7 to conduct face-to-face behavioral health consultations with the patient, the family, and the ER staff. Participating hospitals can also contact each other for other medical consultations.
Also, Mr. Magill formed the Connectivity Committee, a group comprised of DMH’s business partners, leadership from other state agencies and universities, and other principals to serve in an advisory capacity. The idea is for the group to review the status of DMH’s telemedicine project in light of other advanced technological initiatives taking place in and around South Carolina.
That was not all that was accomplished. In addition to the use of telemedicine in the emergency rooms, electronic medical records were installed in mental health centers in the state. Since, the South Carolina Office of Research and Statistics was developing a multi-agency electronic health record, the South Carolina Department of Health and Human Services awarded South Carolina DMH a $1 million grant to design and implement an electronic health record system.
In 2007, the Electronic Medical Record was ready to move beyond the pilot stage, so the system was installed it in three mental health centers and now has expanded to all of the satellite offices. The system includes client and individual treatment plans and progress summaries, plus the scheduler has all of the client’s appointments.
Most clinical documentation placed in the clinical notes section includes psychiatric medical assessments, medication monitoring plans, and clinical service notes. The initial clinical assessment section is in development and will be added later this year, followed closely by the psycho-social rehabilitative service notes. New documentation will be added in the order of what is most widely used.
The state will reimburse actual costs of $3,500 per Tennessee licensed physician or DO, and $2,500 for mid level prescribers including advance practice nurses, physician assistants as well as physician specialists.
Additionally, the awardees in the 67 counties designated as rural by the FCC will be eligible for up to $7,500 per site to cover the cost of connectivity and authentication. The goal is to cover the cost of a T1 connection in its entirety for rural practices that will really benefit from the use of health IT.
The funding awarded per physician can be used for equipment, and the software and services needed to connect to the eHealth Exchange Zone via TNII, the state’s private and secure broadband network. All grantees are required to participate in ePrescribing for 2 years.
All grants are one time funding available on a first come first served basis. For information on the grants, go to www.TennesseeAnytime.gov/ehealth and for information on the TNII network, go to www.TNII.net/ehealth.
AHRQ wants to see research ideas that have the potential for high impact. The research needs to be novel and span a diverse array of disciplines that have the potential to lead to highly innovative solutions and reflect ideas substantially different from those already being pursued by AHRQ. The idea is for the portfolio to fund transformative research to solve pressing healthcare problems.
The comments and ideas need to be submitted no later than October 14, 2008. For more information, contact Francis D. Chesley, Jr., M.D., (301) 427-1449 or email firstname.lastname@example.org.
Sunday, August 17, 2008
Top engineers, physicians, and scientists are joining forces to conceptualize and develop future tools and treatments for 21st century healthcare at the University of California, San Diego. The goal is to accelerate innovation in unconventional ways by establishing the Institute of Engineering in Medicine.
The Institute will intersect broad areas of research and focus on new approaches to disease identification, genomic medicine, clinical testing and monitoring, and the discovery of new drugs and therapies. Davis Brenner, MD, Vice Chancellor for Health Sciences and Dean of the School of Medicine sees the Institute as a leader in designing next generation therapies and new medical technologies.
“The next giant leap in patient care is going to happen through the joint efforts of engineering, medicine, and pharmacy specialists, by applying their expertise to expand the tool box for preventing, diagnosing, and treating disease, and injury”, said Dr. Brenner.
Examples of projects currently underway at UC San Diego:
- Cells have been identified that may be capable of regenerating damaged or lost heart muscle in patients with cardiovascular disease
- A nanoparticle drug delivery system to fight cancer is underway that will use tiny smart bombs capable of specifically targeting spreading cancer while delivering cancer-killing drugs and sparing healthy tissues
- Visualization technologies and other minimally invasive devices are being developed to make scarless surgery a reality
- State-of-the-art stroke care is being delivered to remote sites using wireless telemedicine applications developed in collaboration with the California Institute for Telecommunications and Information Technology
- Development of therapies to promote vascular remodeling and repair
The project “TeleWatch Patient Monitoring System” was developed to do home monitoring and disease management for high risk outpatients suffering from congestive heart failure. The Home Link system provides for communication and recording of patient’s data.
A U.S. patent (7056289) was issued and JHU/APL is seeking a licensee for the technology. For more information, contact Dr. T.A. Collella, (443) 778-3782. Reference number PO1598.
Another project to help treat heart and lung ailments called the “Cardiac Auscultatory Recording Database” (CARD) available via the internet provides for a database containing patient demographics, relevant health information, physical exam results, ECG traces, echocardiograph diagnoses, and auscultatory findings obtained with a traditional stethoscope. The data is all linked together with digitized recordings of patient data and includes recordings from five standard auscultatory areas.
The initial prototype device provides two acoustic channels and one ECG channel which can be stored, digitized, and processed on a laptop computer. CARD collected digitized heart sound recording from patients at the Pediatric Cardiology Echocardiography Laboratory at the Johns Hopkins Outpatient Center and contains over 2500 individual recordings from over 350 patients.
This device is exclusively licensed to Zargis Medical with a U.S. patent issued and international patents pending. For more information, contact T.A. Collella at (443) 778-3782. Reference number is PO1720.
The researchers working on the project “Wireless Wearable Electronic Tags for Patient Triage” have developed an electronic triage system to provide collaborative and time critical patient care in multiple levels of the medical response community. Electronic triage tags or e-tags were developed with the ability to track vital signs and locations and are able to support mobile stations available at mass casualty sites. Web portals and handheld devices can provide real-time information to emergency response teams, incident Command Posts, and Public Health Departments.
JHU/APL is seeking an exclusive licensee and development partner for this technology. If interested, contact H.L. Curran (443) 778-7262. Reference number PO2272.
The research project “Transdermal Optical Communication System” has developed a medical device to provide telemedicine and provide for wireless diagnostics. Researchers have developed a method to communicate with such devices implanted in the human body and came up with a way to communicate via an optical link through the skin. The researchers developed an information modulated two-way optical link that stays inactivated until activated by a “wake-up” transmission to the data exchange circuitry. Specific data is then transmitted to and from the implanted device.
This device is available for licensing opportunities. If interested, contact H.L. Curran (443) 778-7282. Reference number is PO1649.
All ten participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers. Five of the groups, Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John’s Health System, and the University of Michigan Faculty Group Practice achieved benchmark quality performance on all 27 quality measures.
The Physician Quality Reporting Initiative (PQRI) a related CMS VBP effort uses a pay-for-reporting approach. Under the PQRI, physicians and other healthcare professionals can earn incentive payments for reporting measurement data about the quality of care that they provide to Medicare patients.
CMS is developing a Physician VBP Plan to move from the PQRI pay-for-reporting approach to a performance-based approach for Medicare physician payments. The experience that CMS has gained from the PGP Demonstration will be considered in developing the performance-based payment plan.
Also in August, CMS awarded contracts for the 9th Statement of Work for the 53 contractors participating in Medicare’s Quality Improvement Organization (QIO) Program. The contracts extend from August 1, 2008 through July 31, 2011. The new contracts also provide additional tools for CMS and the QIOs themselves to track, monitor, and report on the impact that QIOs have on the healthcare provided in their states and jurisdictions.
The 9th SOW will initiate some changes such as working on projects that span the entire spectrum, focus on quality improvement resources where they are needed the most, develop a more robust monitoring framework, and address disparities issues across the continuum of care.
Wednesday, August 13, 2008
The idea is for the two schools to work together and focus on the changes needed to implement information technology, achieve quality and safety management, deal with chronic disease management, address clinical change initiatives, and develop other evidence-based management approaches.
“Healthcare organizations need continual innovation in management and clinical practices to address critical issues related to care that is safe, effective, patient-centered, timely, and equitable in addition to offering the latest clinical technologies to remain competitive”, said Dr. Rathindra DasGupta, NSF Program Director for CHOT.
Larry Gamm, PhD, Professor and Head of Health Policy and Management at the Texas A&M School of Rural Public Health will serve as the CHOT director and will be joined by CHOT co-director, Eva K. Lee, PhD., Associate Professor and Director for the Center for Operations Research in Medicine and HealthCare at the Georgia Tech.
The Center’s budget will be funded by NSF and the Center will work together on approaches to solving healthcare issues with a number of technology companies and progressive health-focused organizations. These organizations will include health systems with multiple hospitals and outpatient clinics in Georgia, Texas, and several other states. The health system leaders and their staff will collaborate with the universities in guiding and conducting the center’s research.
A listing of the health systems participating in CHOT will be online beginning September 4, 2008, at www.isye.gatech.edu/NSF-CHOT.
Patient records that are shared with the research community must have any identifying information removed, according to HIPAA. However, manual removal of identifying information is prohibitively expensive, time consuming, and prone to error constraints. This has prompted considerable research toward developing automated techniques for “de-identifying” medical records.
The principal investigator Roger G. Mark, a professor in HST and MIT’s Department of Electrical Engineering and Computer Science and his colleagues tested their censoring software on 1,836 nursing notes. Using multiple experts and additional algorithms, they were able to replace all personal information with fake data.
The researchers have reported that the software successfully deleted more than 94% of the confidential information while wrongly deleting only 0.2% of the useful content. This is significantly better than one expert working alone and at least as efficient as two trained medical professionals checking the work. It is also many times faster.
The researchers are providing other researchers with access to the evaluation dataset together with the software to allow others to improve their systems, and to allow the software to be adapted to other data types that may exhibit different qualities.
The DOD Military Health System is working to determine what is best for AHLTA and the VA’s VistA electronic health record system. Currently, there is a strong feeling that the best approach would be for the two systems to converge. Questions arose at the AHLTA web hall held in June with the Defense Department responding to inquiries.
Some of the questions and answers were:
- When will AHLTA 3.3 rollout? The new AHLTA 3.3 application is currently in field beta testing. The goal is to have 3.3 deployed to all sites by the end of 2008. A site by site specific schedule will be developed between the Program Office and the Services and released once the software is available
- What causes the demographic inconsistencies across CHCS and AHLTA? AHLTA pulls the data from DEERS while CHCS allows for individual local input, which may cause discrepancies. The MHS plans to replace or modernize legacy systems to help to address these issues
- For duplicate patient records, how can one unique SSN possess more than one record? The DOD system has family members sharing the sponsor’s SSN for benefits. CHCS uses the sponsor’s SSN therefore it is not a unique identifier. AHLTA has developed a unique identifier that will be used across the board when legacy systems are modernized or replaced
- Is there a way to arrange clinical notes by time as well as by date and can specialties be added to the list of entries for clinical notes? The current AHLTA application arranges clinical notes by date but does not arrange clinical notes by time or allow specialties to be added to the list of entries for clinical notes. This is under discussion for the AHLTA release after AHLTA 3.3.
- How are mental health records being protected against unauthorized access? Currently, these notes are being marked as sensitive and in order for users to gain access they must “break the glass” and are subject to auditing.
- Why is AHLTA so slow? DHIMS is working to improve the speed, reliability, and usability issues and will address those issues in AHLTA 3.3. Work is ongoing to standardize desktops, add additional memory and processing, optimize workflow, reduce the amount of clicks, optimize queries to the database, and work with local base operations on network issues.
For more information and to see the entire list of questions and answers, go to www.health.mil/Press/Releease.aspx?ID=284.
Medicare’s administrative contractor, Noridian Administrative Services released a solicitation to potential PHR vendors on August 8th. The program is scheduled to begin in January 2009 and will offer Medicare beneficiaries in the two states a choice of several PHR options.
Beneficiaries who select one of the participating PHR vendors can add other personal health information if they choose. Depending on the specific product, they may be able to authorize links to other personal electronic information such as pharmacy data. PHRs can link to tools to help consumers manage their health such as to wellness programs for tracking diet and exercise, link to information on medical devices and health education, plus provide links to tools to detect potential medication interactions.
Letters of intent are due August 18, 2008. The PHR vendors have until September 8, 2008 to submit applications to participate in the pilot. On October 20, 2008, PHR vendors will be announced. For more information, go to www.NoridianMedicare.com/phr or email email@example.com.
Sunday, August 10, 2008
Currently doctors typically depend on radiology specialists to create and show them 3D images based on CT or other scans on high end imaging workstations. Since doctors are unable to view the images on their own computers, they need to study the images and essentially memorize them. Dr Soetikno envisions a system where doctors won’t have to memorize the images but have a system that works like a futuristic 3D GPS map.
The system at Palo Alto relies on low cost software and hardware. Computers are linked together via an existing data network and physicians are able to view the images on any computer in the secure VA network. The software also provides for real-time web-based videoconferencing where a medical team, the patient, and family members can all look together at the same 3D image and manipulate the view in any number of ways as they discuss treatment options.
The system also enables any physician with an Apple computer to not only view 3D images but also to create or customize them independently. One click can render a set of two-dimensional images into a 3D image.
Dr. Soetikno hopes that the system can be replicated through the VA system and even meshed with the VA’s electronic medical record system. He stresses that doctors with the ability to use the 3D system could really help improve care for rural veterans.
The grant was awarded through HRSA’s “Faculty Development: Integrated Technology into Nursing Education and Practice Initiative” The grants fund collaboratives or partnerships formed with collegiate schools of nursing, academic health centers, accredited public or private institutions, and other organizations. The goal is to help the nursing faculty integrate technologies related to simulated learning, informatics, and telehealth into the nursing curriculum.
The nursing students at Drexel’s College of Nursing and Health Professions use PDAs complete with reference tools for the classroom and bedside. The students are also able to learn clinical procedures in a controlled environment at the “Center for Interdisciplinary Clinical Simulation and Practice Simulation Lab” where they use simulators such as SimMan and the Noelle Birthing simulator. In addition, more than 20 online courses and programs are available on the web.
With the HRSA funding, Drexel will now be able to use these technologies throughout the Pennsylvania/District of Columbia Nursing Education Technology Collaborative. The Community College of Philadelphia, Bloomsburg University of Pennsylvania, and Howard University are part of the Collaborative.
As the lead school in the program, Drexel will train 45 partner-school faculty members at its facilities. The partner schools will then share their results throughout the State University and Community College System, and among Historically Black Colleges and Universities.
In a major move on August 1, 2008, HRSA awarded $12 million in grants to academic institutions and several hospital organizations not only for the “Faculty Development: Integrated Technology into Nursing Education and Practice Initiative” but grants were also awarded for HRSA’s “Nursing Workforce Diversity Program.” HRSA’s Bureau of Health Professions administers most of the agency’s nursing grant programs.
With this funding, nine Nursing Workforce Diversity Program awards totaling $2.8 million were made to seven universities and two community colleges. Funds will help educate and support pre-nursing and nursing students from disadvantaged backgrounds, including racial and ethnic minorities underrepresented among registered nurses.
Recently, researchers analyzed data on patients from 46 hospitals enrolled in the North Carolina Stroke Registry (NCCSR) from January 2005 to April 2008 for a study. The NCCR is one of four registries originally funded by CDC with a mandate to measure, track, and improve the quality of acute stroke care.
NCCSR as part of a pilot program gathers data on each step of emergency and hospital care for stroke patients from the time of the emergency response to the patient’s discharge from a hospital. The NCCSR differs from most quality improvement efforts because it encourages the collection of patient data to be concurrent with care as opposed to latter collecting the data from medical records.
At the end of the three year pilot, the results showed that large gaps existed between generally recommended guidelines for treating stroke patients and actual hospital practices. Intensive quality improvement efforts are needed to close the gap.
Gathering data on stroke patients is vital in order to provide appropriate emergency treatment, but another study at the University of California San Diego Medical Center, reported that that the UCSD telemedicine program enables stroke specialists to play an important role in the treatment of stroke patients.
The team at UCSD uses the “Stroke Team Remote Evaluation Using a Digital Observation Camera” system referred to as “STRokE DOC”. The system connects stroke experts located at a hub site to the patient at a remote but connected spoke site via the internet. The audio/video teleconsultation system enables the stroke expert real-time visual and audio access not only to the patient, but also to the emergency medicine practitioner, to the medical team, nurses, attending physicians, and perhaps family members.
The researchers had initially planned for a four year study with 400 patients participating. However, the study’s steering committee halted the trial after an analysis clearly showed that one group was superior to the other based on the preliminary data for 222 patients. In the final analysis, the telemedicine group was found to be far superior for correct decision making. When adjusted for initial stroke severity, there was no difference in the number of cases resulting in brain hemorrhage, death, or long term outcomes between the telemedicine or telephone groups.
The researchers say that the next step is to do a study to evaluate the long term health outcomes of patients. However, this will require a bigger trial to determine if there are any differences in clinical outcomes for these patients.
Using robots may also prove to be beneficial in helping stroke patients. According to a study done by researchers at the Rochester Institute of Technology, Georgia Tech, and Georgetown University, robots may be the solution for people with disabilities to regain the use of their limbs. The study was funded through the National Science foundation Computer, Information Science and Engineering Directorate.
The study showed that bio-signals produced by the human body, can improve the performance of external assistive devices called orthoses. These devices could aid individuals with physical disabilities such as strokes or major spinal cord injuries. By using a robotic orthoses to work with an individual’s residual strength and any remaining physiological information or signals in their limbs produced by their muscles, may be a way to enable stroke patients to regain significant use of their limbs.
The ATA meeting will serve as a forum for sharing scientific research findings, significant advances in related technology and applications, groundbreaking programs, projects, and case studies.
Attendees will learn the newest information on wearable computers, gaming and health, robotics to assist the elderly, smart home technology, personal health records, innovative home telehealth programs, successful state and national programs using remote monitoring, utilizing RPM in creative settings, and using home telehealth for acute and chronic disease.
The Pediatric Telehealth Colloquium already established as a premier event for the pediatric telehealth community, will hear presentations from investigators in clinical science on original research related to pediatric telemedicine.
Several of the key issues to be discussed at the Colloquium include inpatient and outpatient telemedicine, innovative pediatric telehealth applications, sustainability, quality of care, financial impact, novel technologies and telecommunications.
For more information, go to www.americantelemed.org/conf/MidYear2008/index.htm
Wednesday, August 6, 2008
It is possible to reduce these hospital acquired infections according to Dr. Van Enk. For example, hospitals can significantly reduce the risk of Ventilator Associated Pneumonia (VAP). The Keystone initiative, funded by a group of payers and the Michigan Hospital Association developed interventions to reduce the risk of VAP.
Some of the VAP interventions need to provide the appropriate sedation, keep the patient’s bed elevated, provide for a daily spontaneous breathing trial, provide tight glucose control, and track goals and compliance. However, according to Dr. Van Enk, each element requires the healthcare team to do something new and extra and there may be resistance or non-engagement from physicians and nurses.
He continued to say “the good news is that the Bronson Methodist Hospital VAP rate has decreased following implementation of the VAP interventions and went 31 months without a VAP. Although we still have VAP cases, the incidence has decreased and we feel that we are now doing everything possible to reduce the risk of VAP.”
In addition, there are other projects underway. Using fast track funding by AHRQ, five research collaboratives with over 70 academic medical centers, community hospital systems, and other healthcare organizations across the U.S. are investigating various strategies to prevent infections.
The Indiana University School of Medicine, the Regenstrief Institute, Inc., the Roudebush VA Medical Center, and the Indiana University-Purdue University Indianapolis School of Engineering and Technology are working together as a national resource center to prevent hospital acquired infections.
The team is using their expertise in evidence-based medicine, informatics, and systems engineering to help determine best practices and how to implement these practices at hospitals large and small, urban and rural, and public and private.
Over the next 18 months, the team consisting of researchers, systems engineers, informaticists, infectious disease experts, and doctors and nurses will help collect data in forms so that the team can effectively evaluate the different approaches to infection control at the 72 healthcare institutions that are being studied. The ultimate goal is to share lessons learned about successes, barriers, and challenges and then implement and maintain strategies to help decrease hospital acquired infections.
In addition, starting October 1, 2008, Medicare and Medicaid will not pay hospitals for some medical care made necessary by adverse events. For example, after that date, Blue Cross Blue Shield of Michigan and the Blue Care Network policy on reimbursement for serious adverse events will not pay hospitals for objects left in a body after surgery, air embolism as the result of surgery, blood incompatibility, equipment associated infections, advance pressure sores, and hospital acquired injuries such as falls.
NIH and CDC posted their SBIR pre-solicitation (PHS 2009-1) notice on August 4, 2008. The SBIR Phase 1 contract solicitation will be available on or around August 8, 2008 with the closing date for the proposals to be November 3, 2008. The web site http://grants.nih.gov/grants/funding/sbir.htm will give further details on the solicitation when it is available.
Some of the research topics include:
- NCI---Health IT to facilitate patient-centered communication in cancer related care
- NHLBI---Wireless communications systems for magnetic resonance imaging
- NIAID---Clinical sample collection and processing technologies for infectious disease diagnostics
- NIDA---Electronic drug abuse treatment referral systems for physicians, and virtual reality simulations to train caregivers and providers
- CDC—Development of a publication database and information retrieval system, and development of standardized evaluation software for blood disorder public health surveillance systems for the National Center on Birth Defects and Developmental Disabilities
- For more information, email firstname.lastname@example.org or phone 301-435-2688.
The DOD SBIR program on July 28, 2008 issued the SBIR 08.3 prerelease notice with the Air Force, Army, Navy, MDA, DLA, and OSD requests. The solicitation opens and proposals will be accepted starting August 25, 2008 with a closing data of September 24, 2008.
The Office of the Secretary of Defense is interested in researchers developing new technology-based approaches to protect the health of the force. Areas of particular interest include:
- Health surveillance planning and decision support tools---Decision support tools, data and knowledge management, information visualization technologies are needed
- New methods to monitor health status and clinical laboratory data---Information analysis tools are needed to collect and harmonize disparate data and information sources and to provide health status surveillance pre-or post injury
- Medical training and learning tools—Advanced learning, simulation-based training and other computer based training technology is needed
- The Defense Health Program’s biomedical technology area---A specific need for a medical simulation-based training system to use for rapid trauma skills training
In addition, the Army’s Medical Research and Materiel Command is seeking researchers to develop hand held devices to analyze proteins in the blood, and handheld devices to detect and identify viruses in the blood at the point of care.
For more information, go to www.acq.osd.mil/sadbu/sbir/solicitations/index.htm.
Total available grant funding is $3.5 million with readiness assessment and planning awards to be made up to $50,000 and implementation awards up to $750,000. There is a one-to-three matching funds requirement. All applicants must provide one dollar in the form of cash or in-kind services for every three dollars provided by the grant program. In addition, Minnesota has an electronic health record loan program with $3.15 million available for no interest loans.
Eligible applicants include community e-health collaboratives, community clinics, and regional and community-based health information organizations.
The applications are due on September 5, 2008, with awards estimated to be made on October 17, 2008. The grant agreement will start December 1, 2008, and end April 30, 2010.
The 2008 MN e-Health Summit held June 2008, discussed the barriers and opportunities from a state and national perspective to promote the effective use of health IT. The attendees discussed what has been done and needs to be done to reach the goal of an interconnected EHR for every provider by 2015.
For more information on the grants and the proposal process contact Anne Schloegel, Office of Rural health & Primary Care at (651) 201-3850 or email email@example.com. To see information on the 2008-2009 Minnesota e-Health Grant program, go to www.health.state.mn.us/e-health or go to www.health.state.mn.us/divs/orhpc/funding/grants/word/ehealth.doc.
Realities facing combat casualty care today will be highlighted at the Battlefield Healthcare Mid Year Meeting to be held in San Diego, California on August 18-20, 2008. Medical advancements in the battlefield and refinement of the continuum or care have led to the largest number of casualty survivors in modern combat history. This has created entirely new considerations in military medical science and pre-deployment training.
Attend this important meeting to learn how to deliver effective care in remote environments using new tele-medical applications, gain insight into front line procedures, newest treatments for wound care, and learn about infection control advancements.
Military, civilian medics, nurses, MDs, research engineers, scientists, program managers and others will gather to discuss goals and objectives, implementation strategies, enablers and barriers, and existing program initiatives to improve battlefield healthcare.
Keynote speakers and carefully selected panelists will talk on topics such as:
- Front Line Technologies
- Medical Information Systems
- Polytrauma Coordination
- TBI & Combat Stress Injuries
- Pre-Deployment Medical Training
- Orthopedic Rehabilitation
The top speakers confirmed so far are:
- Vice Admiral Adam Robinson, USN, MC, U.S. Navy Surgeon General & Chief, U.S. Navy BUMED
- Colonel Les Folio, USAF, MD, MPH, former Radiology Flight Chief, 332nd Expeditionary Medical Group & Associate Professor, Radiology and Radiological Sciences, Uniformed Services University
- Colonel Lee Payne, USAF, MD, Commander 60th Medical Group, David Grant Medical Center, Travis AFB
- Captain Gerald Demarest, USNR, MD, FACS, Burn and Trauma Surgeon, University of New Mexico
- Kathy Helmick, MS, CNRN, CRNP, Manager, Office of Clinical Standards, Defense and Veterans Brain Injury Center, WRAMC
- Elizabeth Twamley, PhD, Psychologist/Local Recovery Coordinator, VA San Diego Healthcare System, Assistant Professor of Psychiatry, University of California, San Diego
Ronald Ruff, PhD, Clinical Professor of Psychiatry, University of California, San Francisco, Past-President, National Academy of Neuropsychology
- Henry Lew, MD, Director of Polytrauma Research and Staff Physician, PM&R Service, VA Palo Alto Healthcare System
- Alisa Gean, MD, Professor of Radiology, Neurology, and Neurosurgery at the University of California, San Francisco
- William Perry, PhD, Associate Director of Neuropsychiatry and Behavioral Medicine, USCD Medical Center, & Chief Supervising Psychologist, UCSD Medical Center
For more information, to register, or to request a reminder nearer the time to register, go to www.battlefieldhealthcare.com. For further details, email Jamie.Langan@iqpc.com.
Sunday, August 3, 2008
Dr. Ejnes explained that the PCMH is a delivery model that involves a patient relationship with a personal physician who works with a practice team to provide first contact and whole person continuous care. The PCMH model is based on the premise that the best quality of care is provided not in episodic, illness-oriented care, but through patient centered care that emphasizes prevention and care coordination. In addition, the PCMH practice must be able to demonstrate that it has the infrastructure and capability to provide care consistent with the patient’s needs and preferences.
He continued to say that the process by which an independent third party determines whether a physician practice is a PCMH is one reason why the model has gained considerable traction over the past few years. ACP understands that CMS intends to use a recognition process to identify the medical home practices that participate in the Medicare medical home demonstration project authorized by Congress and included in the Medicare legislation that just became law. Dr. Ejnes however pointed out that additional funding will be needed for CMS to expand the Medicare Medical Home Demonstration to more practices and states.
The House Committee on Small Business heard from the small physician community on July 31, 2008 on the challenges of using EHRs in small specialty practices. Edward Gotlieb, MD, FAAP, a practicing pediatrician and representing the American Academy of Pediatrics, told the Committee that if incentives for health IT adoption are structured to only flow through the Medicare program, more than 60,000 practicing pediatricians will be excluded from the opportunity to qualify for those incentives.
Also, providers often find that clinical information systems have diminished usefulness in pediatrics because EHRs are frequently designed for adult care. So it is important for the pediatric health record to have a number of special functions that can be incorporated into the EHR.
In a hearing held by the Senate’s Special Committee on Aging to specifically discuss “Aging in Rural America: Preserving Seniors Access to Health Care”, Tom Morris Acting Administrator, HRSA, Office of Rural Health, explained how HRSA’s Telehealth Network Grant Program (TNGP) is effectively reaching rural communities.
He told the Committee how TNGP provided nearly 140,000 telehealth visits in 46 specialty services from March 2007 through February 2008, to patients in rural communities. The TNGP program is actively involved in examining the impact of remote disease management services on patient outcomes. From September 2006 through February 2008, 33% of diabetic patients enrolled in telehealth diabetes case management programs achieved control over their disease as measured by their hemoglobin A1C levels
The Denver-based Colorado Health Foundation awarded $10 million in grants to 44 organizations to improve healthcare in Colorado. With the latest grants, the Foundation has awarded more than $25 million to 60 organizations in 2008, with more than $3 million awarded to two major projects.
One of the projects, the Colorado Regional Health Information Organization was awarded $1.4 million to go to their Colorado Identity Management and Federated Authentication project. This project promotes the electronic exchange of information among healthcare organizations in the state. These organizations include the state’s safety-net clinics providing care to the under and uninsured.
The second project Colorado Access in collaboration with the Colorado Department of Health Care Policy and Financing will receive $1.8 million for a pilot project to deliver intensive, multidisciplinary case management services to Medicaid patients with multiple chronic conditions. The goal is to improve the health outcomes of 2,500 of the highest-cost Medicaid patients and provide a model for integrated care and chronic care management.
In addition, some of the other grants awarded from April 1 to June 30, 2008:
- The Colorado Foundation for Public Health and Environment received $337,000 for a leadership development fellowship to create a supportive workplace for nurses in order to improve retention
- The Jeffco Action Center received $250,000 for nursing and medication support, pandemic preparation, and crisis mental health counseling
- The North Colorado Health Alliance received $600,000 to increase access to integrated primary care and behavioral health services for underserved patients in Weld County
- The University of Colorado Foundation received $467,000 to support the University of Colorado Aging Center’s evaluation of programs, strengthen partnerships, and create a model program for other communities with limited financial and healthcare resources
The Foundation has assets of more than $1 billion and this includes an investment portfolio as well as ownership interest in Denver’s HealthONE hospital system. The Foundation accepts applications for funding four times a year. The next deadline is October 15, 2008. For more information, go to www.ColoradoHealth.org.
The goal is to identify, and implement best practices to improve patient safety. In addition, there are many innovations developed in various non healthcare fields such as information management and communication that also need to be considered and adapted to ambulatory settings.
The program is seeking to improve the accuracy of patient identification, improve communication among caregivers, reduce the risk of infections, improve the safety of medications, accurately reconcile medications across the continuum of care and physicians, and encourage patient involvement in their own care.
The Foundation seeks proposals from Michigan-based physicians and doctoral-level researchers based at universities, academic medical settings, community health organizations, and health systems. The Foundation funds research conducted by non-profit organizations but does not provide support to for-profit organizations or individuals associated with organizations not located in Michigan.
The Foundation has $500,000 available for this initiative and plans to award one or more multi-year grants. Grant funding under this program will not pay for equipment, hardware, software, or on-going operating expenses.
The proposals are due September 9, 2008. For more information, go to www.bcbsm.com/foundation/grant.shtml or email Nora Maloy at firstname.lastname@example.org.
The Heart Disease and Stroke Prevention (HDSP) program at the Mississippi State Department of Health has funds available for federally qualified community health centers to promote system change around cardiovascular health. Cardiovascular Disease (CVD) principally heart disease and stroke is the leading cause of death in Mississippi, accounting for 10,223 deaths or 36% of all deaths in 2006. CVD mortality rate in the state is the highest in the nation but the death rates are falling but not as much as the national average.
The HDSP program coordinates statewide activities to prevent and control heart disease, stroke, and related complications. This can be accomplished through partnerships, collaborations, public awareness, professional education, community based training, and policy development.
The purpose of this Request for Applications is to assist community health centers to develop, implement, and sustain chronic care model programs to address cardiovascular health. Each applicant must address patient self-management, decision support, delivery system design, linkages with community resources, and clinical information systems.
The HDSP Programs needs to:
- Improve medical care with data available to see whether the program is successful
- Align medical practices with evidence-based clinical guidelines to use in daily practice and develop evidence-based programs and health policies to support chronic care
- Share ideas and knowledge on the program with others
- Develop a registry with clinically useful and timely information
- Build care reminders and feedback for providers and patients into the information system
Up to $30,000 from the HDSP program is available and community health centers can apply for a maximum of $10,000. The application deadline is August 25, 2008 and award notification will be made by September 1, 2008.
For more information, go to www.msdh.state.ms.us/msdhsite/_static/19,0,205.html or contact Augusta Brown (601) 576-7781 or email email@example.com