Rural Health Issues Discussed

The rural health community from all over the U.S. gathered in Washington D.C. to attend the NRHA Rural Health Policy Institute Meeting held on January 25-28. The attendees listened to discussions on the latest rural health events now taking place in the new administration, and went to Capitol Hill to carry their message to Congress. Tim Fry, NRHA Government Affairs Manager, said “this is definitely the year for change since healthcare is one of the top priorities for the new administration.”

According to the leaders involved in rural healthcare, areas today are faced with more uninsured patients, less access to capital improvements, and a lack of investment. The rural system needs to invest in health information technology so that rural and underserved areas have access to broadband and wireless services. NHRA feels strongly that any economic package needs to provide help for critical access hospitals, rural health clinics, and community health centers.

Each year, the NRHA comes up with their Legislative and Regulatory Agenda to outline healthcare policy issues to let Congress, federal regulatory agencies, the White House, States, and the healthcare industry understand what is needed in rural and underserved communities.

The 2009 NRHA Legislative and Regulatory agenda states actions that NRHA wants to see happen to move rural healthcare forward:

• Congress needs to require vendors of information systems used in rural communities to incorporate national standards for HIT into their systems. This includes systems used in all care settings so that interoperability is possible with both a larger network and within all rural facilities
• Funding is needed for combination grants, loan guarantees, and/or principal interest forgivable loans, to support the expansion, upgrade, and renovation of rural health facilities including HIT and ambulance services
• Reimbursement for services provided through telehealth need to be made based upon medical effectiveness and utilization and not based upon or limited to particular delivery platforms or location
• In the future, the FCC pilot program should be developed to better utilize Universal Service funds to expand access to HIT and networks. The Universal Service program should expand the types of rural healthcare providers eligible to participate and needs to include rural home health care agencies, skilled nursing facilities, public health agencies, EMS, and other healthcare providers without regard to their tax status
• The NRHA supports a Patient-Centered Health Home as described in the policy position “Patient-Centered Health Home published October 2008
• Increase access points for rural veterans by using telehealth systems for access to sub- specialty care, particularly for mental health services. The NRHA supports the full funding of the Office of Rural Health in the VA
• Federal programs and grantees should work together at the federal, state, and community levels to increase efficiency, minimize duplication of effort and services, and maximize the positive community impact of available resources
• NRHA supports federal and state funding to address strengthening and integrating emergency medical services with rural healthcare services and providers
• Federal funding should support innovative demonstrations, improved training, research, telehealth, preventive health, and personnel recruitment for rural and frontier areas

For more information, go to http://www.ruralhealthweb.org/.

Harvard Reaches Out to Industry

Harvard University has started a “Technology Development Accelerator Fund” managed by the Office of Technology Development, to fund early stage applied and translational research that has commercial potential. Very often, early stage funding from industry sources is not available to advance potential important technologies in life sciences. The goal is to accelerate new discoveries, create more attractive opportunities for licensing, investment, and commercial development, and expand public access to new technologies developed at Harvard.

New inventions made by scientists in an academic environment are often at an early-stage of development, while showing great promise; many of these innovations languish or lie dormant due to the lack of data needed to secure the funding required for continued development and commercialization. As a result, many new technologies with potential to save lives never make it out of the lab.

The Office of Technology Development works with start-up ventures on new ideas and technologies. The Office has to consider several factors when considering how to help new companies develop technology. These include questioning whether the technology can provide a platform for multiple product opportunities, availability of risk capital, and the commitment of the inventor to the commercialization process.

An example of a Harvard start-up company is Claros Diagnostics Inc. The core technology was conceived by the Claros founders in the Harvard laboratory of Professor George Whitesides. The goal was to create products to move in-vitro medical diagnostic tests out of the laboratory and into the hands of physicians and patients.

Claros in working with Harvard was able to develop a handheld immunoassay system to provide high performance quantitative laboratory blood test results in an inexpensive, portable, and easy to use configuration. The system consists of a handheld analyzer along with a disposable cassette capable of testing for multiple diseases simultaneously. The test requires only a finger prick of blood and yields quantitative protein measurements in less than 15 minutes.

For more information, go to www.techtransfer.harvard.edu.

Open Source Tech is Here

“The key to any eHealth reform program is to provide information sharing across multiple agencies and eliminate the information silos that exist today. This will allow the government to reduce costs , have fewer errors, and better serve veterans, senior citizens, and the disabled” according to Bill Vass President and COO of Sun Federal.

Vass reports on his blog, that NHIN is the information highway for health data exchange, and that CONNECT a software solution enables federal agencies to securely link their existing systems to NHIN. More than 20 organizations collaborated to build CONNECT through the Federal Health Architecture (FHA), and as a result, agencies are heading towards interoperability.

It’s important to know that FHA built the CONNECT gateway software from open-source code and used Sun’s entire Open Source middleware stack as the foundation. The solution was jointly developed by federal agencies, yet it will be deployed individually at the agency level.

Vass stresses that the benefits included cost reductions for each agency and taxpayer savings, IT consistency and compatibility across multiple agencies, decreased deployment time, and a secure system.

The history and the speed for the development of the CONNECT initiative went from concept to reality in 2008. In March 2008, FHA awarded a contract to develop the CONNECT solution. By September 2008, three agencies were already demonstrating the ability to share information with the private sector through NHIN. The number of participating agencies grew to six for the December 2008 demonstrations, but with plans to have those six agencies participate in NHIN by the end of 2009.

The CONNECT Gateway system will be available to the public by March 2009. The system includes core services to locate patients at other health organizations within NHIN, request and receive patient documents, and record transactions for patients and others.

There are a number of opportunities for federal agencies to use the Gateway. The 2009 development plans for the system include:

• Collecting patient status as the patient moves to various care settings
• Providing Personal Health Records complete with information from federal and commercial systems
• Helping to combat fraud and waste
• Improving coordination of benefits with other payer organization
• Providing onsite care for patients during disasters and other public health emergencies
• Supporting data collection to use to analyze potential adverse events associated with drugs and medical equipment
• Helping to establish local networks among community health clinics
• Providing anonymous bulk test data for pandemic and bio terrorism analysts

For more information, go to the Bill Vass Blog at http://blogs.sun.com/BVass.

NEI Develops Eye Test

The National Eye Institute and NASA together have developed a simple safe eye device to use to measure a protein related to cataract formation. If subtle protein changes can be detected before a cataract develops, people may be able to reduce their cataract risk by making simple lifestyle changes. NEI and NASA developed the eye device to detect the earliest damage to lens proteins that can be used to find early warning signs for cataract formation and blindness.

The new device is based on a laser light technique called Dynamic Light Scattering (DLS). In a recent NEI-NASA clinical trial reported in the December 2008 “Archives of Ophthalmology”, researchers examined 380 eyes and had the DLS device shine a low power laser light through the lenses. They found that age related pre-cataract changes would have remained undetected by currently available imaging tools.

The device was initially developed to analyze the growth of protein crystals in zero-gravity space environment. NASA’s Rafat R. Ansari, Ph.D., Senior Scientist at the John H. Glenn Research Center brought the possible clinical applications for using the technology to the attention of NEI vision researchers.

“We have shown that this non-invasive technology device can not only find the early signs of protein damage due to oxidative stress in the case of age-related cataracts, but the device might also be used to determine diabetes as well as neurodegenerative diseases. “By understanding the role of protein changes in cataract formation, we can use the lens not just to look at eye disease, but also as a window into the whole body” said Dr. Ansari.

The device will not only help people on earth, but NASA is very interested in the device because on a three year mission to Mars, astronauts will experience increased exposure to space radiation that could cause cataracts and other problems. This new technology will help NASA understand the mechanism for cataract formation so that researchers can work to develop effective countermeasures to mitigate the risk and prevent cataracts in astronauts.

IHS Certified for EHR System

The Indian Health Service’s newest version of their EHR system is now certified by the Certification Commission for Healthcare Information Technology (CCHIT). The IHS Resource and Patient Management System (RPMS) a comprehensive health information system, supports patient care at the IHS for 1.9 million American Indians and Alaska Natives who reside in 35 states, and operates in over 190 facilities nationwide.

CCHIT certification signifies that the new system has been tested and shown to meet a rigorous set of criteria to see what the system does to support healthcare, interoperability, and security. “The Indian Health Service is very proud to earn this certification based on industry standards that will benefit our patients in the Indian Health System,” said IHS Director Robert G. McSwain.

Development of the system to meet the CCHIT certification criteria began one year ago and included new features such as electronic prescribing. CCHIT designates RPMS version 2008 as a pre-market conditionally certified product under the 2007 certification criteria for ambulatory EHRs. Full certification will be awarded when the enhancements are implemented in production.

NIH Releases Report

NIH has just released a report that summarizes NIH technology developments. Today, technology development, basic research, and clinical applications drive biomedical research and enables scientists and clinicians to use sophisticated tools to unravel fundamental biological questions.

The report mentions that technological developments in electrodes computers, and materials were critical in understanding abnormal heart rhythms. These basic technological developments are now used to treat abnormal heart rhythms by using advanced imaging and ablation techniques.

In other developments, advances in fiber-optic and wireless communications devices now enable physicians to engage in telemedicine in Tucson, Arizona. A breast health center provides does same-day mammograms, is able to do biopsies, and diagnosis breast cancer using a pathology tool developed by NIH funded engineers. By combining rapid tissue processing with telepathology and teleoncology, cancer diagnosis times have dropped to a matter of hours rather than a one to two week wait.

The report notes that point-of-care technologies now range from handheld glucose monitoring systems to laptop-sized ultrasound scanners. On the horizon a laboratory analyzer is being developed with NIH support to identify specific bacteria responsible for urinary tract infections in a few minutes.

Other breakthroughs in this field include:

• Using wearable upper extremity robotic devices to mimic normal arm movements for stroke survivors
• The ability to communicate via a brain/computer interface for individuals with amyotrophic lateral sclerosis and other neuromuscular disorders
• Using an integrated imaging system with precision-guided surgery to remove seizure causing regions in the brain
• Developing sensor technologies combining multiple analytical functions into self- contained portable tabletop devices to be used by non-specialists to rapidly detect and diagnose disease
• Developing new diagnostic and imaging methods to detect cancer and other diseases early

The report notes that while some of these technologies have experienced widespread acceptance, several barriers must be overcome to make point-of-care diagnostics the norm such as:

• Combining individual components into fully integrated systems that can handle all aspects of analysis
• Capturing data from these devices and transmitting the data to clinical information systems
• Facilitating assessment of clinical opportunities in point-of-care testing to guide the development of emerging technologies
• Developing infrastructure to create multidisciplinary research collaborations to facilitate clinical testing early in the development process
• Being able to validate results from point-of-care technologies
• Being able to prove that point-of-care testing provides a clinical benefit over analysis at a central laboratory

The complete report is available through the Research Portfolio Online Reporting Tool (RePORT) web site at http://biennialreport.nih.gov.

Using Voice Recognition System

Landstuhl Regional Medical Center in Germany now has a faster, more accurate, and highly maneuverable voice recognition system in use by their busy doctors. With the introduction of Dragon Medical speech recognition software, the process of documenting patient medical records can be accomplished in minutes rather than days.

“Not only is the process faster, but it allows for a more detailed, accurate, and cost effective way of doing business”, said Army Major Hamilton Le, a surgeon who has mastered the program in less than a month.

Before, Le would dictate his inpatient surgery notes into a telephone recording machine and wait two to three days for them to return from a transcribing service that cost about 17 cents per line. Reviewing and signing notes for 10 patients could take as long as one hour to complete and even longer if changes of corrections were needed. For outpatient visits, Le typed the visit details in AHLTA.

Now Le can dictate notes into a microphone attached to a mobile laptop and watch as his words appear on screen almost instantaneously. Changes are made on the spot and the record is signed electronically. Inpatient records are stored electronically locally and then the outpatient records are sent to the AHLTA clinical data repository where they remain on file for other medical facilities to access.

For patients seeking further treatment with a provider who doesn’t have access to the records electronically, such as a patient referred to a specialist in the local area, the records from the system can be hand carried to the appointment.

While speech recognition software has long been used by radiologists, the technology is now being expanded. A pilot program at the Heidelberg Medical Department Activity has used the system in their primary care and orthopedic departments.

Major General David Rubenstein, Army Deputy Surgeon General has recommended expanding the program throughout the Army Medical Command. As a result, 10,000 copies of the speech recognition software has been purchased by the Surgeon General’s office and distributed to 42 facilities worldwide. The system should pay for itself in less than year because of savings in transcription fees.

Also, speech recognition software is now being deployed throughout the European Regional Medical Command and should be fully implemented by summer. In addition to the software deployment, the initiative also includes deploying nine trainers to help field the system according to Dr. Bob Walker, a Heidelberg MEDDAC Physician and the ERMC AHLTA Consultant.

IDPH Rolls Out System

The Iowa Disease Surveillance System (IDSS) capable of providing surveillance for over 50 different notifiable diseases was recently initiated by the Iowa Department of Public Health (IDPH) in their Center for Acute Disease Epidemiology (CADE). Now, local public health agencies, hospital infection control staffs, and CADE will be able to work together to rapidly analyze data and understand the source of infectious disease clusters. This will allow the department to partner more with local public health to prevent and contain disease outbreaks like pertussis.

Although CADE has been using a simple electronic database since 1991, the majority of surveillance information has been in paper form, making it difficult to quickly analyze specific risk factors in time to derail outbreaks. Until recently, collaboration and consultation about specific pockets of infection had to be done by telephone using hand written notes.

The new system will be used by close to 500 enrolled users. In the coming months, hospitals, labs, and local public health agencies will have direct access to information about disease activity in their jurisdictions as well as general information about statewide activity. Several layers of security protect the confidential information and while installation is role specific at each facility, the flow of information is largely automated.

In the coming months, the application will be released to different groups of users across the state with sufficient support from CADE. The tuberculosis program is scheduled to begin using IDSS in 2009. Integrating STD surveillance data is nearing the final stage and will be ready for implementation in 2010.

NIST Seeks White Papers

The National Institute of Standards and Technology’s new Technology Innovation Program (TIP) seeks white papers to help support, promote, and accelerate innovation in the U.S. The white papers will be used to help shape the program’s competitions in the future.

NIST is interested in receiving white papers from academia, federal, state, and local governments, industry, professional organizations, and societies. White papers may discuss any area of critical national need such as personalized medicine and complex networks and systems along with other topics such as civil infrastructure, energy, future water supplies, manufacturing, nanomaterials, nanotechnology, and sustainable chemistry.

NIST wants to see personalized medicine addressed since spending per capital in the U.S is high and rising. Currently, the need is to develop effective advanced tools and techniques for genomics and proteomics research. This will help to provide a greater understanding of complex biological systems, biomarker identification, and targeted drug and vaccine deliver systems. There is also a need for improved and low cost diagnostic and therapeutic systems and for better methods for the integration and analysis of biological data, especially when combined with environmental and patient history data.

NIST notes that complex networks and complex systems are very important particularly for biological systems communications networks, security systems, personalized healthcare and other areas. Today, no single organization has the ability to effectively control multi-scale, distributed, and highly interactive networks. Stability and control of these networks can have far reaching consequences in our society. Complex network theory is important in order to model neural systems and to research the molecular physiological response to disease and environmental systems.

The White Papers along with the ideas from government, technical communities, and other stakeholders will be incorporated into the TIP competition selection. For more information, go to www.nist.gov/tip/frn_seeking_whitepapers.pdf. There are several deadlines for the submission of white papers to TIP. The deadlines are January 15, March 9, May 11, and July 13, 2009.

Helping Rural Communities

Open Range Communications headquartered near Denver has just finalized a $267 million loan agreement with the USDA Rural Development Loan Program to provide broadband service to 518 rural communities in 17 states. In addition to the Rural Development loan, Open Range has secured $100 million in financing from One Equity Partners, the private equity arm of JP Morgan Chase & Co.

Broadband services will be provided to rural communities in Alabama, Arkansas, California, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Nebraska, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, and Wisconsin. Open Range will use Wi-Max technology and also offer satellite services.

Since 2001, the USDA Rural Development Loan Program has invested $111 billion to provide equity and technical assistance to foster growth in homeownership, business development, and critical community and technology infrastructure.

In addition, the Rural Development Economic Development Loan and Grant Program was set up to provide no-interest loans to rural development utility program borrowers who then lend the money to local entities to promote economic development and to create jobs. The program is now accepting applications to award $45.8 million in loans and grants to support rural communities. These applications are due by March 31, 2009 for 3rd quarter funding and June 30, 2009 for 4th quarter funding.

For more information, go to www.rurdev.usda.gov.

Telemedicine for South Carolina

Rural Healthcare Providers, Administrators, Nursing Directors, Managers, State Agencies, Third Party Insurers, Specialists in Cardiology, Psychiatry, Neurology, Rheumatology & Dermatology, IT Personnel, and State Legislators need to mark their calendars. The “Telemedicine in South Carolina” Conference will be held February 27, 2009, in Columbia South Carolina. This is the first state-wide planning event to examine the progress made in the telemedicine field from a national, state-wide, and community perspective.

The goal is to explore how to effectively use IT/ICT to provide telemedicine services to rural clinical offices and hospitals in South Carolina. Some of the specific objectives are to find out how telemedicine can be used to increase access to specialty medical services, find out what specific specialty services are most needed in rural and underserved state communities, examine how telemedicine is used in other states to increase access to healthcare services, and the steps needed to increase the use of telemedicine in the state.

Key speakers include:

• Ron Weinstein, M.D., Director, Arizona Telemedicine Program, will provide the Plenary Address
• Amy Brock Martin, Dr.PH, Deputy Director & Research Assistant Professor, South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina will present the South Carolina Needs Assessment Survey Results
• Herman Spetzler, M.S., Executive Director, Open Door Community Health Network in Eureka California will be the luncheon speaker

Several panel discussions will take place. The first panel moderated by Raymond S. Greenberg, M.D., President, Medical University of South Carolina will discuss the “Challenges for the Statewide Telemedicine Program”.

Panelists will include Emma Forkner, M.P.A., Director of the South Carolina Department of Health and Human Services, Richard Lindrooth, Ph.D., Director, Medical University of South Carolina Center for Health Economics and Policy Studies, Ronald S. Weinstein, M.D., Director, Arizona Telemedicine Program, and Nancy E. Brown-Connolly, R.N., M.S., Ph.D., Clinical Consultant to TATRC.

The second panel discussion moderated by Harris Pastides, Ph.D, President, University of South Carolina will discuss the “Community Health Perspective: Opportunities and Challenges for Telemedicine-Improving Access and Healthcare Quality”.

Panelists will include Ralph Riley, M.D., Rural Family Physician, Past President of the South Carolina Rural Health Association, Lathran Woodard, Chief Executive Officer, South Carolina Primary Healthcare Association, Rick Foster, M.D., Senior Vice President for Quality and Patient Safety, South Carolina Hospital Association, and Herman Spetzler, Executive Director, Open door Community Health Network, Eureka, California

A third panel discussion to be moderated by David Garr, M.D., Executive Director, South Carolina AHEC, will tackle “Telemedicine Development and Collaboration: Opportunities for Creating Partnerships and Funding Telemedicine Programs”.

Panelists will include Stan Fowler, Ph.D., Associate Dean for Clinical Research and Special Projects, University of South Carolina School of Medicine, Robert Adams, M.D., Director Medical University of South Carolina Stroke Center, C. Edgar Spencer, M.Ed., M.S.W., Director of the Duke Endowment Grant, Medical Director’s Office, South Carolina Department of Mental Health, and Frank Clark, Ph.D., Vice President for Information Technology and Chief Information Officer, Medical University of South Carolina.

There is no registration fee, but to register, go to https://www.scahec.net/telemed.html or call 843-792-4439. The South Carolina AHEC, the Medical University of South Carolina and the South Carolina Rural Health Research Center in the Arnold School of Public Health at the University of South Carolina along with the grant funding from the Duke Endowment are presenting the conference.

Investing in Healthcare

Actions on Capitol Hill are supporting healthcare IT investments. The economic stimulus proposal includes $20 billion to support healthcare technology and improve quality. Representative David Obey (D-WI), Chair of the House Appropriations Committee introduced a bill proposing $2 billion be spent for health IT and be administered through the Office of the National Coordinator for Health Information Technology within HHS. According to the American Telemedicine Association, the bill specifically mentions telemedicine as one of the priorities for spending.

On the Senate side in a move to specifically help finance healthcare IT, Senators Debbie Stabenow (D-MI) and Olympia Snowe (R-ME) both Co-Chairs of the Senate Health Care Quality Improvement and Information Technology Caucus, just introduced the Health Information Technology Act of 2009. The proposed bill would provide $4 billion in grants to make critical investments for healthcare IT. The grant program would help cover the costs related to clinical healthcare informatics systems and services to purchase, lease, or install computer software and hardware and would target providers most in need of assistance.

An important Senate hearing “Investing in Health IT: A Stimulus for a Healthier America” was held by the Senate Health, Education, Labor, and Pensions Committee on January 15th. This hearing was the first in a series of hearings that Senator Barbara Mikulski (D-MD) intends to hold on health quality. The witnesses presented ideas on how best to design, implement, and update a nationally interoperable system to protect privacy and improve quality

Mary Grealy, President of the Health Leadership Council (HIC) a witness at the hearing, detailed some of the Council’s ideas. The Council would like to see payment rewards or add-ons for healthcare services using HIT, have a revolving low interest loan fund, tax incentives for physicians and hospitals, reimbursement incentives based on improved patient outcomes, have matching private funds along with public funds via grants from HHS, plus HIC would like to see revisions made to the physician self-referral and anti kickback rules.

Support for the Stimulus Package

The potential impact of the stimulus package on healthcare IT was at the top of the agenda at the Steering Committee on Telehealth and Healthcare Informatics briefing held January 15th on Capitol Hill. In summary, the presenters stressed how additional funding would make it possible to effectively educate and train the health IT workforce, help urban hospitals operate more efficiently, greatly improve health IT across rural communities, and further support advanced networks. In addition, Claudia Williams, Director, Health Policy and Public Affairs, Markle Foundation, enforced the importance and necessity for having a sound policy to use as a framework for health IT.

Representatives Tim Murphy (R-PA) and Allyson Y. Schwartz (D-PA) stopped by the briefing to point out that there are certainly challenges to establishing comprehensive medical records. However, if the job is done right, enormous opportunities will be available to put the healthcare system in this country on the right track.

Representative David Wu (D-OR) emphasized the need to move forward with his legislation “10,000 Trained by 2010 Act” to support the growth of the health IT workforce by investing in more education and research. The bill is currently sitting in the Senate but according to Representative Wu, he is anxious to see the legislation passed as a standalone or included in another piece of legislation.

Don E. Detmer, MD, President & CEO AMIA said AMIA with 4000 members has been working very hard with Congressman Wu’s office on the legislation. Dr. Detmer stressed that we must invest not only in technology but we need to ensure that our workforce is poised to meet the challenges facing our healthcare system.

He told the attendees, “It is vital for all healthcare provider and related organizations to be able to find communications and information technology solutions in the coming years. This makes it essential for the U.S. have a workforce that is well trained and up-to-date on design, development, implementation, and use.”

David Liss, Vice President Government Affairs, New York Presbyterian Hospital, is looking at the stimulus funding from the hospital and the community level viewpoint and sees a number of benefits. NYP is affiliated with Columbia and Cornell and is proud to be held in high regard in the community.

As Liss told the attendees that through the “Heal New York” grant program, sharing is going on among the hospital and a group of more than 180 community physicians in the neighborhoods surrounding the hospital. In one project, seven members of the physicians group, Community Physicians of New York Presbyterian are piloting the electronic network linking NYP and CPNYP.

The stimulus would be a boon not only to the hospital but would also help the hospital hire more people and they in turn, would live and shop in the surrounding community. As a result, the community would have more jobs, more people, and be a more viable community. Immediate results would be shorter waiting times in the hospital emergency department with easier access to specialists.

In discussing Virginia’s health IT program, Michael Matthews, Senior Advisor to the Commonwealth of Virginia, Office of Health IT, pointed out how successful innovation grants in Virginia have been helping a number of regions throughout the state.

For example, CareSpark is addressing rural health disparities, CCNV a fully funded and has implemented EHR is live at 15 sites with pilot connectivity to public health services in Southside, the UVA telemedicine initiative identifies high risk poor pregnant woman to minimize pre-term labor, NOVARHIO provides access to patient medical histories in ERs, MedVirginia provides EMR adoption to free clinics, and Centra is the first outpatient EHR link to ACC’s outpatient cardiac registry.

Gary Bachula, Vice President, External Relations, Internet2, emphasized the importance for the stimulus package to support good investments in advanced networks. Bachula continued to report that Internet2 with 211 university members has to be able and ready at all times to deploy high bandwidth networks, do advanced applications, and collaborate with regional networks. He sees the need to connect not only but with academic medical centers and colleges in terms of research and education, but also with researchers at government agency looking for ways to deal with the huge amounts of data expected to be incorporated into the healthcare system in the coming years.

The Steering Committee briefings are produced by the HIMSS Foundation’s Institute for e-Health Policy. For more information on future briefings, contact Neal Neuberger, Executive Director for the Institute at neal@healthpolicy.org or go to the web site at www.e-healthpolicy.org.

HHS Seeks Information

HHS through the Office of the Assistant Secretary for Planning and Evaluation is soliciting ideas via a Request for Information on how HHS can improve and encourage the development of new medical technologies. Information is needed on maintaining and improving the quality of care, controlling overall healthcare costs, and how to use timely and practical administrative procedures.

The responses need to be submitted on or by April 16, 2009. The notice was published in the January 15th Federal Register or go to http://aspe.hhs.gov/sp/medtechinnovation/rfi for more information. The Medical Technology Innovation Desk is available for calls at (202) 690-7858.

In another Sources Sought Notice (09HP00001) published on January 13th, the Office of Health Policy is trying to locate small businesses to do market research for the Office of Health Policy (HP) within the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE). HP provides cross-cutting analysis on health policy issues for the HHS Secretary, conducts policy, performs research, performs economic and budget analyses, reviews regulations, and assists in the development of budgets and legislation.

The businesses can be (8a), service-disabled veteran owned small businesses, HUBZone small businesses, small disadvantaged businesses, veteran-owned, and women- owned small businesses.

The three broad research areas in the notice include:

• Health Financing Policy—Research and analysis of issues related to primarily
  Medicare, and polices affecting healthcare financing and costs. Current areas of interest include Medicare financial status, prescription drug benefit, Medicare Advantage, comparative effectiveness and cost effectiveness, quality, and potential payment reforms
• Health Care for Low Income Populations—Research related to expanded health coverage to the uninsured with a special focus on safety net providers
• Public Health Services—Research and analysis of issues related to health promotion and disease prevention, healthcare disparities, alcohol drug abuse, mental health services, workforce issues, and healthcare for Native Americans and Alaska Natives

The response date for the notice is January 28, 2009. For more information, go to http://www.fbo.gov/, or email Marie L. Sunday at marie.sunday@psc.hhs.gov or call 301-443-7081.

DOE Seeks Industrial Partners

The Department of Energy’s Brookhaven National Laboratory has a patent for the design of a medical synchrotron capable of delivering precision doses of proton radiation to cancerous tumors while producing minimal damage to surrounding healthy tissues.

BNL physicist Stephen Peggs one of the lead scientists on the project is looking for partners in industry to help build the first of these new machines. The laboratory is prepared to help the industrial partners by building the first specialized high tech items, however, since most of an accelerator is made from conventional technology, BNL is looking for most of the work to be done by industry. BNL is looking for an industrial consortium to see this project move into the commercial sector and then move into hospitals across the country.

In treating cancer, proton therapy is considered surgery without a knife because proton beams can deliver cell killing energy with extreme precision unlike conventional x-ray radiation therapy. BNL came up with a new design that has made improvements in beam focusing technology and is now able to make the smallest possible beam size—that is, the sharpest possible knife. Using smaller beams to deliver radiation with increased precision could have a significant impact by shortening the duration of treatment, increase effectiveness, be less costly, and be more reliable.

Compact beam size has other benefits as well. Smaller components makes everything lighter and less expensive and eliminates the need for water cooling magnets as air cooling will be sufficient.

For more information, contact Lori Anne Neiger, lneiger@bnl.gov or call 631-344-3035.

Funding for Veterans

The VA has provided $21.7 million to help regional healthcare systems improve services in rural areas. The extra funding is part of a two year VA program to improve the access and quality of healthcare for veterans in geographically isolated areas. The VA focus is on access to healthcare, using the latest technology, on recruiting and retaining a highly educated workforce, and to collaborating with other organizations.

Specifically, the new funds will be used to increase the number of mobile clinics, establish new outpatient clinics, expand fee-based care, explore collaborations with federal and community partners, accelerate the use of telemedicine deployment, and fund innovative pilot programs.

Veterans Integrated Service Networks (VISN) with less than 3% of their patients in rural areas will receive $250,000. Those with the population of rural veterans between 3% and 6% will receive $1 million each, and VISNs with more than 6% of rural veterans in the population will receive $1.5 million.

Durham N.C, Nashville TN, Kansas City, MO, Jackson, MS, and Minneapolis, MN received $1.5 million. Boston MA, Albany N.Y, Pittsburgh PA, Bay Pines, FL, Cincinnati OH, Ann Arbor MI, Chicago IL, Dallas TX, Phoenix, AZ, Denver, CO, Portland OR, and San Francisco CA, received one million. New York, N.Y, Baltimore MD, and Long Beach CA, received $250,000.

CMS Selects Sites

CMS has selected the sites for the Acute Care Episode (ACE) demonstration. The new hospital-based demo will test the use of a bundled payment for both hospital and physician services for a select set of inpatient episodes of care. A bundled payment is a single payment for both Part A and Part B Medicare services furnished during an inpatient stay.

Currently, CMS pays the hospital a single prospectively-determined amount under the Inpatient Prospective Payment System for all the care provided to the patient during an inpatient stay. The physicians who care for the patient during the stay are paid separately under the Medicare Physician Fee Schedule for each service they perform.

The thinking is that use of bundled payments will better align the incentives for both hospitals and physicians which should lead to better quality and greater efficiency in delivered care. The demonstration will also test the effect that transparent price and quality information has on beneficiary choices.

The demonstration was open to applicants from Texas, Oklahoma, New Mexico, and Colorado. Each site or “Value –Based Care Center’, will be actively marketed to both beneficiaries and referring physicians. The sites selected are Baptist Health System in San Antonio, Oklahoma Heart Hospital LLC in Oklahoma City, Exempla Saint Joseph Hospital in Denver, Hillcrest Medical Center in Tulsa, and Lovelace Health System in Albuquerque.

There are 28 cardiac and 9 orthopedic inpatient surgical services and procedures included in the demonstration. Lovelace Health System will be a center for orthopedic procedures, Oklahoma Heart Hospital and Exempla Saint Joseph Hospital for cardiac procedures, and Baptist Health System and Hillcrest Medical Center for both orthopedic and cardiac procedures.

OPSC Measures Hospital Safety

Early in 2008, the Oregon Patient Safety Commission (OPSC) a semi-independent state agency challenged the state to develop the safest healthcare system in the nation. The Commission wants to have complete information on how well the state is doing in providing safe care. So far, the indices either look at individual components such as adherence to known best practices or they are bundled into large aggregate quality measures, but there has not been enough focus exclusively on safety.

In November 2008, the Commission published a report that addressed hospital safety in six critical areas. For each area, the Commission established a baseline that explains where the state is now and what is needed to be done by the end of 2010.

The Commission made their initial benchmarks and summary of findings concerning hospital measures in terms of:

• Outcome measures—are the hospitals eliminating preventable harmful events? The Commission looked at the number of retained objects accidentally left after surgery or a procedure. Fifty such events occurred in Oregon hospitals in 2007
• Safe practice measures in terms of using evidence-based best practices and the percentage of hospitals that have implemented three specific best practices to eliminate surgical site infections. Seventy five percent of Oregon patients currently receive optimal care
• Risk assessment measures in terms of the number of hospitals that actively share data with the Commission and the learning that resulted from the experience. Thirty nine out of fifty five participating hospitals with 110 reports received have shared adverse event data since the program began in 2008
• Culture safety measures and the need for a culture that supports learning and improvement. The Commission looked at the number of hospitals that routinely monitor their safety culture in terms of learning from adverse events. Currently 80% of Oregon’s hospitals report using such a survey
• Patient empowerment and the need for patients and consumers to play an active role. This can be measured in terms of the number of hospitals that actively encourage their patients to report patient safety concerns. Eighty seven percent of hospitals reported that they have mechanisms in place
• Connectivity measures and the ability to create a connected system of care with progress going towards implementing electronic medical records. Oregon’s hospitals average score is 2.25 and this means that Oregon ranks 17th in the nation

Overall Oregon hospitals are doing a good job in addressing patient safety issues but as the report shows, more work is needed. In the coming months, the Patient Safety Commission will publish separate benchmark reports for nursing homes and for ambulatory surgery centers.

For more information, go to www.oregon.gov/OPSC.

Success with Smart Garments

Researchers at Concordia University in Montreal are examining VivoMetric’s remote patient monitoring system called LifeShirt®. The researchers are trying to find out the lifestyle factors that may put children at risk for developing cardiovascular diseases as they grow older. The study is an inter university project along with researchers contributing from INRS-Institute Armand Frappier, as well as McGill and Laval universities. Funding for the project is being provided by the Canadian Institutes of Health Research.

Children enrolled in the Healthy Heart Project at the university wear the LifeShirt®, a lightweight, comfortable “smart garment” with embedded sensors. The children wear the garment in their normal home environments, while the system continuously collects accurate vital sign data to help researchers understand how physical activity, sleep patterns, eating habits and stress levels might put kids at later risk for heart disease.

Numerous studies have shown that RPM has the ability to curb costs and improve outcomes of patients with chronic diseases, with an estimated potential savings of $300 billion over the next 25 years in the U.S. alone.

VivoMetrics has joined the Continua Health Alliance. “Through our partnership with Continua, we can help to advance a much needed system of personal telehealth devices that will work together,” said Howard Baker, President and CEO of VivoMetrics. He continued to say that as members, we can share in the development of design guidelines and product certifications that will help deliver on the promise of RPM.

In another university research related project, engineers at the University of Michigan are developing a carbon nanotube coated smart yarn with antibodies able to detect albumin a protein common in blood. The yarn is able to conduct electricity and can be woven into soft fabrics to detect blood and also provide health monitoring. For example, if someone is bleeding, the clothing can sense the blood and can send a signal through the clothing’s carbon nanotube to activate an emergency device.

Currently, smart textiles are made primarily of metallic or optical fibers. They are fragile, not particularly comfortable to wear, can corrode, and may have problems when washed. According to Nicholas Kotov, Professor in the Departments of Chemical Engineering, Materials Science, and Engineering and Biomedical Engineering, a much better way to develop smart yarn is to combine two fibers, one natural and one created by nanotechnology. This new material is more sensitive and selective as well as durable than other electronic textiles”.

Clothing that can detect blood could be used in high risk professions. An unconscious firefighter, ambushed soldier, or police officer in an accident can’t always send a distress signal to a central command post, but the smart clothing would have this capability.

Kotov reports that a communication device such as a mobile phone could conceivably transmit information from the clothing to a central command post. The concept of electrically sensitive clothing made of carbon-nanotube-coated cotton could be adapted for a variety of health monitoring tasks by using biomonitoring and telemedicine sensors.

According to the engineers, in the future, it is conceivable that this material could be designed to harvest energy and store the energy to provide power for small electronic devices. However, these developments pose challenges and may be many years away.

The research findings recently published online in “Nano Letters” and in the American Chemical Society Journal were funded by NSF, the Office of Naval Research, Air Force Office of Scientific Research, and the National Natural Science Foundation of China.

RWJF Awards Grant

The Robert Wood Johnson Foundation awarded Kaiser Permanente $8.6 million to develop one of the world’s largest and most diverse source of information for genetic, environmental, and health data. Scientists will use the repository known as a biobank as part of a comprehensive research initiative to establish the genetic and environmental factors that influence common diseases such as heart disease, cancer, diabetes, high blood pressure, Alzheimer’s, asthma, and others.

“Understanding the critical interaction between genes and the environment on health will have an important impact on the way all of us look at health and disease in the future”, said Cathy Schaefer, PhD, Director of the Kaiser Permanente Research Program on Genes, Environment and Health (RPGEH).

The grant will enable Kaiser Permanente’s Northern California Division of Research to gather, store, and protect the biobanks first 200,000 samples of DNA and build a secure database with relevant health and environmental information. The goal is to expand the biobank to 500,000 samples by 2012, and provide a population based database with enough statistical information to be used to identify even subtle effects of environmental and genetic factors for such conditions as mental health disorders and autoimmune diseases.

Research findings from the database could be used to tailor medication to an individual patient and to prescribe lifestyle changes that could prevent life threatening diseases. The data could help researchers do population-based studies designed to better understand genetic and non-genetic factors that could affect the severity or recurrence of common diseases such as cancer or diabetes. These studies would make use of the database’s longitudinal electronic medical records to help tailor tests and treatments to reduce disease severity and recurrence.

Projects scheduled to start in 2009 include a study to uncover genetic and non-genetic factors that put African American men at higher risk for prostate cancer and do a large study on the bipolar mental disorders that can run in families in order to examine specific genes that can determine susceptibility to the mental disorder.

There are concerns about security if the genetic information becomes public. All biorepository data and DNA samples are de-identified and stored in secure locations with limited authorized access. In the database, each participant will be given a unique code that will replace their medical record number, name, and other identifying information. The code can only be linked back to identifying information by a small number of research staff members who must have a special password and go through a rigorous approval process in order to use the database.

Biorepository data including genetic information will not be entered into electronic medical records for individual patients. The KP Division of Research maintains separate information and databases from the health plan and members medical records.

For more information, go to www.dor.kaiser.org/studies/rpgeh.

CMS Contracts with Optimal

As reported in “HHS Pulse”, Optimal Solutions Group, LLC an 8(a) small business company is working with CMS on several contracts. The company does public policy research and provides technical assistance to government agencies, corporations, non-profits, and foundations and is an example of how a small business can gain traction in the federal contracting arena.

The company has showed a steady growth in recent years growing by 7% between 2004 and 2008. In the beginning, the company began working with federal agencies as a subcontractor on projects with HHS and the Department of Education. By 2005, Optimal attained sufficient technical experience as a subcontractor and now the company was ready for “prime time”. At this point, Optimal won contracts with several federal agencies on major research contracts as a prime contractor.

According to INC. Magazine, the Federal Government is spending more than $500 billion annually on Medicare and Medicaid. There is an ever increasing need for fraud and waste research which is Optimal’s fastest growing division of study.

Optimal is now under contract with CMS to monitor and evaluate Medication Therapy Management Programs (MTMP) offered by Part D sponsors. The idea is to identify and understand how MTMPs may be effective for the Medicare Program beneficiaries and providers. Prescription drug plans and Medicare Advantage plans offer prescription drug coverage and are required to have an MTMP for beneficiaries who meet high risk criteria.

The research will assist CMS in identifying MTMPs that demonstrate the most positive impact on medication that Medicare beneficiaries use and will help to identify standardized outcomes that can be measured by all Part D Sponsors.

For more information, go to www.optimalsolutionsgroup.com.

Telehealth Network Grant Program

HRSA released updated information on the Telehealth Network Grant Program (HRSA-09-194) on January 8th. The primary objective of the TNGP is to show how telehealth programs and networks improve access to quality healthcare services in underserved rural and urban communities.

Funds will be awarded in two ways:

• Telehealth Network Grants will support telehealth networks to provide services in different settings to demonstrate how telehealth networks can be used to expand access, coordinate and improve the quality of healthcare services, and expand the training of healthcare providers
• Telehomecare Networks Grants will be used to demonstrate how telehealth networks can improve healthcare when providing clinical care and remote monitoring of patients in their homes using telehealth technologies. These homecare network awards are to focus on evaluating the cost effectiveness of telehomecare services and may include but are not limited to case management by physicians, hospitals, medical clinics, home health agencies, or other healthcare providers who supervise the care of patients in their home.

A grantee must be a nonprofit or public entity that is able to provide the services needed. Funding for both of the programs will go to fund non-profit or public organizations with a demonstrable successful track record in implementing telehealth technology and with a network of partners in place.

The funding for the program is $3,430,000 with 14 awards expected. The closing date for applications is March 6, 2009.

For more information, go to www.grants.gov, or contact Monica Cowan mcowan@hrsa.gov or call 301-443-0076.

Report on Telehealth Grants

The report “Using Telehealth to Improve Quality and Safety: Findings from the AHRQ Portfolio” was prepared by the National Resource Center for Health IT. The report focuses on grants in the health IT portfolio that use telehealth to provide provider-to-provider communication with the patient both present and absent, plus use technology for telemonitoring and for health education.

According to the study, AHRQ HIT grantees in developing, implementing, or evaluating telehealth interventions reported:

• It is very important to do pilot testing prior to implementing the technology so that telehealth will not introduce new error sources into the clinical processes
• In the area of patient safety and the quality of care, one project demonstrated that remote pharmacy services provided to rural hospitals during irregular hours can more effectively detect and prevent dangerous medication errors than traditional methods. This can be attributed to pharmacists manually reviewing night and weekend orders first thing in the morning before turning to day shift activities.
• Implementing telehealth is not always easy since there can be challenges with telehealth equipment. On one project, vendor supplied home monitoring devices failed to work on a regular basis. As a result, one-third of the patients enrolled in the study became frustrated and stopped using the devices. Two projects reported that the video camera equipment did not provide adequate resolution to yield clear images for small pills and patient wound areas.
• Reimbursement for telehealth has been slow to be accepted, however, AHRQ funded projects are working with regional payers to secure reimbursement. One AHRQ funded project agreed to measure component healthcare costs and to demonstrate to regional payers, that there are cost savings when using telehealth. The project investigated specific areas concerning the impact of the early diagnosis on the initiation of treatment, the ability to manage chronic illness via telehealth as opposed to emergency care, and the positive effects of using telehealth to provide continuity of care
• Smaller organizations in the grant program reported that they need technical support 24/7. Without round-the-clock support, the grantees said that patient safety can be negatively impacted with critical patient services
• Telehealth systems need to be integrated with electronic health record systems to promote continuity of care across clinical settings particularly when facilitating medication reconciliation
• Telehealth systems can support team-based care. In one project, telehealth was used to connect nurses at 10 community hospitals with a remote pharmacist after normal hours and was successful. In another project, telehealth was used to create online communities among clinicians and was able to address community health issues with specialists and community providers
• Security versus speed is a problem. A Virtual Private Network (VPN) can be used to provide a secure way to establish point-to-point connections for telehealth visits. Currently connections using VPNs can be slow, especially when one end of the connection does not have a high speed connection to the internet
• Low resolution videos and images require less bandwidth than high resolution quality videos, but they may provide poorer quality images. However, in some cases, there is enough detail to permit clinical diagnosis
• To successfully implement telehealth systems without disrupting workflow, staff training is critical

Go to http://healthit.ahrq.gov/images/dec08telehealthreport/telehealth_issue_paper.htm to read the full report.

HRSA Publishes Grant Announcements

HRSA published grant announcement (HRSA-09-198) on January 5th to fund the Health Center Controlled Networks (HCCN) to implement fully functioning EHRs. The goal is to improve the quality of healthcare in health centers and to improve individual and population health.

HRSA seeks projects with at least three collaborator organizations to provide evidence that data can improve care and demonstrate the value and effectiveness of health centers in the marketplace. An example of such a program is HRSA’s Health Disparities Collaborative Care Model, a Community Oriented Primary Health Care model for system change around quality improvement.

The funds available for this project will not finance all the costs associated with the implementation of an EHR nor will they cover the costs of ongoing maintenance. Therefore the Networks need to focus on creating sustainable business models for deploying HIT as well engage in strategic partnerships that will leverage other HIT initiatives and resources.

Public and non-profit organizations are eligible to apply. The estimated funding will be $2,200,000 for three awards. The application deadline is March 04, 2009 with an estimated award date to be September 01, 2009.

For more information, go to www.grants.gov, or contact Christopher Lim CLim@hrsa.gov or call 301-443-0428.

HRSA also published another announcement (HRSA-09-196) on January 5th titled “Licensure Portability Grant Program” to support state professional licensing boards so that they will be able to cooperate, develop, and implement state policies to help reduce statutory and regulatory barriers to telemedicine.

The program funding is expected to be $700,000 with two awards expected. The closing date for the application is March, 05, 2009. For more information, go to www.grants.gov.

Telehealth Improves Home Care

Veterans with chronic conditions can manage their health and avoid hospitalization by using special technology provided by the VA in their homes according to a study published in the Journal “Telemedicine and e-Health”.

The study authored by VA national telehealth staff members, looked at health outcomes from 17,025 VA home telehealth patients. The results show that when home telehealth was used, there was a 25% reduction in the average number of days hospitalized and a 19% reduction in the number of hospitalizations for patients. The data also shows that for some patients, the cost of telehealth services in their homes averaged $1,600 a year which is lower than in-home clinician care costs.

Dr. Adam Darkins, Chief Consultant in VA’s care coordination program, who led the study, said “VA’s home telehealth program cares for 35,000 patients and is the largest of its kind in the world. Clinicians and managers in healthcare systems, as well as information technology professionals, have been awaiting the result of the telehealth study. The results are not really about the technology, but about how using it helps coordinate the full scope of care our patients need.”

According to Secretary of Veterans Affairs, Dr. James B. Peake, “a real plus is that this approach to care can be sustained because it is so cost effective and more veteran-centric. Patients in rural areas are increasingly finding that telehealth improves their access to healthcare and promotes their ongoing relationship with our healthcare system.”

National eHealth Collaborative Launched

The National eHealth Collaborative formerly called AHIC Successor, Inc. was recently launched in Washington D.C. The Collaborative is a public private partnership to provide a secure interoperable, nationwide health information network as a non-profit membership organization.

The Collaborative’s membership includes all stakeholders and federal, state agencies, health systems, payers, health professionals, medical centers, community hospitals, patient advocates, major employers, non-profit health organization, commercial technology providers, and others.
The Collaborative will work with the Health Information Technology Standards Panel (HITSP), CCHIT, and NHIN as well as other health IT member organizations.

The group has elected John Tooker, M.D., Executive Vice President and Chief Executive Officer of the American College of Physicians to serve as Chair of the 2009 Board of Directors. Kevin Hutchison, President and CEO of Prematics, Inc. was elected Vice Chair, Thomas Fritz CEO of Inland Northwest health Services as Treasurer, and Laura Miller, will act as Secretary.

The Collaborative will work on:

• Developing consistent standards to guide the development for sharing confidential health information within a secure network
• Educating and guiding the widespread adoption of EHRs by health systems, health professionals, and individuals
• Creating a secure interoperable network to provide protected access to personal health information
• Partnering with the Nationwide health Information Collaborative and others to develop a governance plan for NHIN

For more information, go to www.NationaleHealth.org or call 877-835-6506.

SSA to Use NHIN

In 2009, NHIN will come online and exchange “live” data among organizations that are ready, willing, and able to exchange health information using NHIN specifications and standards. The Social Security Administration is going to be the first government agency to use the Nationwide Health Information Network (NHIN) starting February 2009.

SSA will receive medical records for some disability applicants electronically through the NHIN gateway. Social Security uses individual medical records when making a decision for more than 2.6 million people who apply for disability each year. To make these decisions, SSA relies on doctors, hospitals, and others in the healthcare field to provide the medical records. The NHIN will help to make sure that the records are received in minutes instead of months so that determinations can be made in a more efficient manner resulting in cost savings.

Social Security is working with MedVirginia, a health information exchange organization and a member of the NHIN cooperative to enable the first real-world use of the system to begin electronically processing social security disability determinations.

According to Michael J. Astrue, Commissioner of Social Security, “this safe and secure method for receiving electronic medical records will allow us to improve our service to the public by cutting days, if not weeks off the time it takes to make a disability decision.”

HHS Action Plan for HAIs

HHS has unveiled a plan to reduce and possibly eliminate healthcare associated infections (HAIs). The “Action Plan to Prevent Health Care Associated Infections” lists areas where HAIs can be prevented and also outlines cross agency efforts to initiate HAI prevention efforts.

In addition to the tremendous toll on human life, the financial burden attributed to these infections is staggering. CDC estimates that 1.7 million HAIs occurred in U.S. hospitals in 2002 and were associated with 99,000 deaths. CDC also estimates that HAIs add as much as $20 billion to healthcare costs each year.

The plan includes:

• Developing national benchmarks
• Prioritizing and recommending ways for clinical practices to implement and adhere to practices in hospitals
• Producing a coordinated research agenda to strengthen the science
• Initiating a national messaging plan to build partnerships among stakeholders
• Finding ways to evaluate compliance with infection control practices in hospitals

HHS plans to respond to comments from the public and to any new recommendations for infection prevention. HHS plans to hold meetings in 2009 to discuss many of the ideas. The dates for the meetings will be posted on the web site. The plan and instructions for submitting comments on the plan can be found online at www.hhs.gov/ophs.

NY Unveils Web-Based Tool

The New York State Health Department has unveiled a new web-based tool to help achieve a high performing affordable healthcare system with primary care as the centerpiece. The new Prevention Quality Indicator (PQI) web site is the first free publicly accessible tool that identifies hospitalization rates by zip code for circulatory, diabetes-related, respiratory, and acute conditions. Data is also broken down according to patients’ race and ethnicity.

The State Health Commissioner Richard F. Daines, M.D., points out that despite being among the top three states in total per capital healthcare spending, New York ranks 39th among states for hospital admissions for preventable conditions. This means that too many New Yorkers are not getting effective primary care to prevent, detect, and treat conditions before they become serious and require hospitalization.

For example, the PQI data by race and ethnicity in the Morningside Heights neighborhood of Manhattan in three different zip codes illustrates wide disparities. The data shows that the overall PQI rate for African Americans is double the expected statewide rate and about 1.6 times higher for Hispanics, while whites were hospitalized for these conditions at less than half the overall rate.

In Western New York in the south Buffalo zip codes, the data shows that PQI hospitalization rates are about 50% higher than the expected statewide rate. In these zip codes, the hospital admission rates for diabetes are more than double the statewide rate.

In another example in rural central Delaware County, the overall PQI hospitalization rate is 30% below statewide norms. But just to the north near the Delaware-Schoharie county border, the hospitalization rate for potentially preventable hospitalizations is about 37% higher than the state average.

In one final example, some of the zip codes in Albany show hospitalization rates for people with diabetes and complications to be 57% higher than the statewide rate.

“The PQI data will help in healthcare planning at both the state and local levels,” said James W. Clyne, Deputy Commissioner of the State Health Department’s Office of Health Systems Management. “As the department considers requests from healthcare providers to deploy new equipment or establish new healthcare services, we are going to ask all interested parties to consider the needs in each community as reported by the PQI.

In the future, the Health Department plans to expand the number and kinds of measures in the PQI database, including preventable childhood hospitalization rates for conditions such as asthma. The Governor of New York is also working to expand access to primary care in the state and to create a new “Doctors across New York” program to provide financial incentives to doctors to practice in underserved areas. He also plans to shift some Medicaid funding from hospital inpatient care to outpatient and primary care services.

For more information, go to https://apps.nyhealth.gov/statistics/prevention/quality_indicators.

State OMH Seeks Consultant

The Louisiana Office of Mental Health (OMH) wants to contract with an independent consultant not associated with any particular EHR system to help procure and implement a statewide electronic behavioral health record system.

The system will need to support behavioral health standards of care and provide data for state performance monitoring and federal reporting as well as provide daily clinical decision support for service providers at the point-of-care. The system must also enable continuity of care with five state psychiatric hospitals and in acute inpatient care settings.

At the present, the state Offices of Mental Health and Addictive Disorders each operate custom- built web-based enterprise wide information management systems with some EHR components. These systems are not presently comprehensive nor are they integrated across disability areas. The consultant will need the expertise to help assess the pros and cons of building upon these existing systems.

The consultant will be responsible for doing presentations on successful EHR implementations, participate in the selection of the EHR system, developing a needs assessment on the desirable features of the EHR system, developing easy way to use system selection criteria, and participate in system demonstrations. The consultant must also be able to assist the state in writing the Request for Proposal that will be issued to obtain the EHR system according to state standards, procedures, and format.

Resumes must be submitted by January 23, 2009 and it is anticipated that OMH will contact interested contractors in February 2009. The current state of Louisiana requirements limit consulting contracts to a maximum of $50,000 per year unless acquired via an RFP. For more information, contact Randall Lemoine, PhD, at rlemoine@dhhs.la.gov or call 225-342-8605.

Children's Fund Providing Grants

The Children’s Fund of Connecticut wants to see all children in the state particularly disadvantaged children have access to a comprehensive and effective community-based healthcare system. The Innovation Fund in the state funds grants up to $125,000 to go to local primary and preventive pediatric health and mental initiatives that are sound and evidence-based.

The five priority areas under consideration would:

• Enable the pediatric primary care system to support comprehensive quality care (medical home) for all children
• Establish outreach and care coordination systems to ensure access to all needed health and mental healthcare services
• Strengthen the capacity of pediatric primary care settings to address behavioral health concerns
• Support the integration of health and mental healthcare into settings where children are served
• Identify, implement, and/or evaluate evidence-based and best practices in child mental health

The Children’s Fund does not fund individuals, private foundations, or federal agencies. Applicants must be tax exempt under 501c (3). Letters of intent are due on January 22, 2009 and those selected for a full proposal submission will be notified by February 12, 2009. Full proposals are due on March 26, 2009 with awards to be made in late April 2009 for a July 1, 2009 start date. For more information, contact Cindy Langer at langer@uchc.edu or call 860-679-1538.

2009 Report on Federal Activities Released

Bloch Consulting Group has just published the 2009 edition of its comprehensive report on federal government activities in telemedicine, telehealth, and health IT.

This newly released 200 page report includes information on grants, funding, and contracting opportunities at 24 cabinet-level and independent agencies throughout the government and includes URLs for government web sites to search for even more information on federal activities.

According to Editor Carolyn Bloch, this year’s report is exceptionally timely. “With a new administration set to arrive in Washington in just a few weeks, many agencies will be taking a fresh look at funding new initiatives to reform healthcare systems and technologies.”

“Uncovering new information in the field along with grant and contracting opportunities can be difficult because these activities are spread throughout dozens of agencies and departments throughout the government,” she added. “This in-depth report makes it easier for executives, professionals, consultants—and anyone researching telemedicine and health IT—to quickly zero in on specific areas of interest.”

Also available is the 2007 edition of “How to Sell Healthcare Technologies to HHS,” a 30 page report on techniques needed for developing key HHS contacts and how to secure grants and contracting opportunities within HHS.

More information on both of these reports is available at the Bloch Consulting Group web site at www.federaltelemedicine.com.

NIH Seeks Tech to Reduce Disparities

Several Institutes and Centers within NIH released a Request for Application on December 18, 2008 for small business concerns to develop either new or existing medical technologies to use to reduce health disparities in communities. The technology must be low cost, must be amenable to the population’s cultural beliefs and social customs, and needs to be developed according to the specifications of the end user’s environment.

The agency is looking for:

• Telehealth Technologies for remote diagnosis and monitoring
• Sensors for point-of-care
• Devices for in-home monitoring
• Mobile portable diagnostic and therapeutic systems
• Devices that integrate diagnosis and treatment
• Diagnostics or treatments that do not require special training
• Devices that can operate in low resource environments
• Non invasive technologies for diagnosis and treatment
• Integrated and automated systems to assess or monitor for a specific condition
• The technology may be new and innovative or it can be existing technologies that have been redesigned based on the needs of a specific health disparity population. Both may be accepted.

Some examples are devices needed to improve early detection of diseases, low cost portable imaging for prevention and early detection of conditions, telemedicine technology to improve access to specialty care plus and be able to link up to academic tertiary oriented health centers, and inexpensive devices that diabetics can use to monitor blood sugar.

This funding opportunity uses the Small Business Innovation Research (SBIR R4/R44) grant mechanism and all U.S. small business concerns are eligible. The estimated amount of funds to support this RFA is $3.45 million for FY 2009 with 7-12 projects anticipated. The earliest date that an application or letter of intent for this round of applications can be submitted to grants.gov is January 20, 2009. The nearest application deadline is February 20, 2009.

There are specific directions to answering this announcement:

• To apply, go to www.grants.gov/apply
• All companies applying must be registered at two sites. Go to www.grants.gov/applicants/getregistered.isp and go to http://era.nih.gov/Electronic Receipt/preparing.htm to register
• All companies applying must have a DUNS number. Go to http://eupdate.dnb.com/requestoptions/government/ccrreg
• All companies must be registered with the Central Contractor Registry at www.ccr.gov

For more details on the complete announcement, go to http://grants.nih.gov/grants/guide/rfa-files/RFA-EB-09-001.html. The specific title for this RFA is “Development and Translation of Medical Technologies that Reduce Health Disparities (SBIR R43/R44)”.

DLT Grant Application Available

The Distance Learning and Telemedicine (DLT) grant application for FY 2009 was announced in the Federal Register on December 24th but the grants are subject to the availability of funds. The notice was issued prior to passage of final appropriations to allow potential applicants time to submit proposals and to give the agency time to process applications within the current fiscal year. However on January 5th, more details were published in http://www.grants.gov. The estimated funding will be $25,000,000 for 100 awards with the award ceiling to be $500,000.

DLT grants are used to provide access to education, training and healthcare resources for people in rural areas and are used to encourage and improve telemedicine services and distance learning service through the use of telecommunications, computer networks, and related advanced technologies.

For FY 2008, Congress appropriated $30 million and projects have been awarded in 48 states and four territories totaling $263 million over the years.

All incorporated organizations or partnerships, Indian tribes or tribal organizations, state and local governments, consortiums, private corporations either for-profits or not-for-profits are eligible to apply.

The application deadline is March 24, 2009. For more information, go to the December 24th “Federal Register” or to http://www.grants.gov/. For copies of the application and materials for the grant program, go to www.usda.gov/rus/telecom/dlt.htm , by email dltinfo@usda.gov or call 202-720-0413, or fax 202-720-1051.

Sentinel Initiative Workshop Held

Experts and stakeholders gathered at the December 16th workshop sponsored by FDA and the eHealth Initiative Foundation to discuss the current status of the Sentinel Initiative. Currently the FDA is working with public academic and private entities to find ways to access disparate sources of data and to validate methods to link and analyze safety data from multiple sources. The vision is to develop a nation-wide electronic safety monitoring system to be able to monitor postmarket performance of a product.

According to the goals of the project, it is important to pinpoint the data that is needed, find methods to consistently aggregate the data, along with methods to perform an effective statistical analysis. Standard processes will also be needed that can be applied against multiple and different data environments.

According to Janet Woodcock, M.D., Director, FDA Center for Drug Evaluation and Research, “governance” is a key issue under discussion. Governance means defining responsibilities for implementing policies and procedures for administering certain aspects of the initiative such as scientific operations and infrastructure along with designing the capabilities needed.

Mark McClellan, M.D., PhD, Director Engelberg Center for Health Care Reform at Brookings, stressed that it needs to be determined who will be responsible for the various aspects of Sentinel, who will be able to use the Sentinel infrastructure, under what conditions, and most importantly, how will the program be sustained financially.

There are several initiatives both in the public and private sector that are able to provide information and input to FDA such AHRQ’s Effective Health Care Program, Brookings forums on postmarket evidence, eHIs drug safety collaboration, HMO research network, and pilot efforts conducted by numerous health plans and integrated delivery systems. In addition, work conducted under FDA contracts can provide input.

All agreed that it is important to communicate with consumers and providers on their concerns, find out what they need to know, and how to best educate the public concerning the risks and the benefits of medical products.

Legal and privacy issues are high on the agenda and discussions need to take place on what necessary protections are needed to ensure data privacy and whose responsibility is it to ensure that privacy is protected.

The next step is to study the outcome and discussions from the workshop, and to create draft documents for establishing partnership, governance policies and procedures. These documents will be worked on over the next six months. The goal is to have access to data from 25 million patients by July 1, 2010 and to 100 million by July 1, 2012.

Market Patient Safety Products

AHRQ will be soliciting proposals on or about January 9, 2009, for a contractor to help market patient safety products and tools. AHRQ’s Patient Safety Tools and Resources are listed at www.ahrq.gov/qual/pstools.htm. The contractor must have the capability to do traditional product marketing, do face-to-face and one-on-one site visits to change behavior in clinical practices, and be able to reach out to healthcare providers by personal contacts.

The contractor will need to make contacts with specified target audiences, make follow-up site visits to highlight AHRQ safety products so that the products are adopted and used to improve patient safety. Changes in behavior need to happen among staffs, consumers, and patients.

One contract will be awarded for a period of 18 months and is expected to be awarded no later than May 30, 2009. The presolicitation (09-10012AHRQ) notice was published on December 29, 2008 and the full solicitation is scheduled to be published around January 9, 2009. The information will be available on AHRQ’s website at www.ahrq.gov and at www.fbo.gov with proposals due 45 days after the release of the solicitation.