Stimulus Role for CHCs

The presenters at the Alliance for Health Reform briefing held on February 23rd on Capitol Hill emphasized how Community Health Centers play a key role in the U.S. healthcare safety net. They provide primary health care and other health services for medically underserved populations including one in eight Medicaid beneficiaries, one in seven uninsured persons, one in three people in poverty, one in ten minorities, and one in nine rural Americans.


Ed Howard Executive Vice President of the Alliance pointed out that healthcare is a major part of the stimulus. The figures show that almost $90 billion to go to Medicaid and CHIP, $19 billion to go to health IT, NIH will receive 10 million, $1.1 billion will to go for comparative effectiveness research, $26 billion to go to COBRA subsidies, plus $2 billion to go to Community Health Centers.

Sara Rosenbaum, Founding Chair of the Department of Health Policy at George Washington University, outlined how the major investments of the American Recovery and Reinvestment Act (ARRA) will specifically be used to help health centers:

• $1.5 billion will be invested in infrastructure, equipment, buildings and HIT adoption
• $500 million will provide for ongoing patient care for operational support and expansions, and provide for additional Medicaid payments and grants to increase the adoption and use of EHRs
• $500 million will go to help stabilize the primary care workforce
• Funding will be used to deal with the potential Medicaid patient growth resulting from the economic crisis by providing for enhanced federal payments and CHIP reauthorization.

Dr. Rosenbaum reports that the increase in infrastructure, operations and other funding will lead to more available sites especially in underserved areas. As a result, more uninsured, underinsured, and Medicaid/CHIP patients will be served, along with an increase in mental health and dental services. Health IT and capital investments funding will lead to improvements in clinical quality measures. In general, the funding should also stimulate the local economies in both the health and non-health sectors.

To present the picture of a community health center in action, Paloma Hernandez, President and CEO of Urban Health Plan (UHP) located in South Bronx, discussed the impact and value that UHP provides to the community. UHP operates with four primary care traditional practices sites in South Bronx and Corona Queens.

UHPs main site is located in a community that lacks primary and preventive healthcare where over 70 percent of the patients are Latino and Spanish speaking. UHP offers a sliding fee scale based on family income and size where no one is denied services regardless of their ability to pay. In addition, the center provides care at schools, homeless shelters, adult day treatment programs, and boys and girls clubs.

UHP’s service area has one of the highest rates of asthma in New York City. UHP has been able to provide more effective care for asthmatic patients than other Affinity Network providers in 2006-2007. In terms of dollars, UHP cost Affinity 22% less for treating the adult asthmatic population and 39% less for treating the pediatric population when compared with the entire Affinity Network for the two years.

The impact of the stimulus package will enable UHP to expand their main site, take care of the growing uninsured population, and be able to recruit workers from a larger pool of candidates, The funding will help support the required ongoing IT infrastructure in place at UHP, but as Hernandez explained, funding is also needed to build a HIE among all community health centers on a national level to improve tracking performance, outcomes, and the collection of comparative data.

Allison Coleman, Founder and CEO of Capital Link, explained that as a nonprofit Capital Link provides health centers and primary care associations with capital-related technical assistance for building and equipment projects. She pointed out that the $1.5 billion to be available from the stimulus funding represents the largest investment in health center infrastructure in the history of the health center program.

Coleman reports that there are many “shovel-ready” projects that can move ahead as soon as HRSA can make the funds available. She continued to say that some of the projects will likely be 100% grant funded, while others will leverage the federal investment with other funds from a variety of sources including new market tax credits, and other state and foundation grants and loans.

The investment of $1.5 billion over 2 years should result in $3 billion in overall economic impact, including direct, indirect and induced stimulus effect, along with more than 20,000 construction-related jobs.

Also based on new capital projects coming on line and growth resulting from $500 million in new funding for health center operations, there will be 48,00 new permanent health center jobs plus 28,000 additional jobs in low income communities based on the health centers’ spending in the community.

Health Spending on the Rise

CMS economists discussed the projections for future health spending at a briefing held at the National Press Club on February 23rd. As reported by the economists in a “Health Affairs” study, U.S healthcare spending reached $2.4 trillion in 2008 and is projected to experience the largest single-year increase as a share of the economy in 2009.

The CMS analysts agreed that by 2018, national health spending is projected to nearly double, reaching $4.4 trillion and consume 20.3 percent of the GDP. Just over 20 cents out of every dollar is expected to be spent on healthcare by 2018.

The ten year healthcare spending projections show how the economic downturn is expected to affect both public and private healthcare spending as more Americans lose their health insurance and as federal and state governments face projected increases in Medicaid enrollment and spending.

“The recession has wide-reaching implications for the healthcare sector and policymakers and the public will be faced with tough decisions regarding the future of the healthcare system,” said CMS economist Andrea Sisko.

Projected slower income growth and an expected decline in private health insurance coverage are expected to dampen growth in private health spending, which is expected to fall to a 15 year low of 3.9 percent in 2009. At the same time, growth in health spending among public payers is predicted to accelerate from 6.4 percent in 2007, or $1.0 trillion in spending to 7.4 percent, or $1.2 trillion in spending by 2009, driven by faster growth in Medicaid enrollment and spending.

Medicare spending reached $466 billion in 2008, an increase of 8.1 percent from 2007. This is driven largely by projected faster growth in spending for prescription drugs, hospital and physician care, and administrative costs. As the baby boomer generation becomes eligible for Medicare, spending is expected to accelerate, growing 8.6 percent by 2018.

Other key report highlights show that between 2014 and 2018, prescription drug spending growth is expected to rebound, as the generic dispensing rate is anticipated to level off and new expensive specialty drugs may be approved. By 2018, prescription spending is projected to reach $453.7 billion.

By 2018, total hospital spending is expected to reach nearly $1.4 trillion up from a projected $746.4 billion in 2008. The growth in hospital spending is expected to slow from 7.2 percent in 2008 to 5.7 percent in 2009, as a result of slower private spending growth for hospital care.

Growth in total physician and clinical services is expected to continue slowing between 2008 and 2009 from 6.2 percent to 6.0 percent. This slowdown is largely due to slower physician price growth and slower projected income growth.

In addition, another study available on the Health Affairs web site provides annual estimates of national personal health spending by medical conditions. The study reports that circulatory system spending was the highest among the diagnostic categories, accounting for 17 percent of personal health spending and reached $253.9 billion in 2005. Nearly half of circulatory system spending is attributable to heart conditions.

The CMS healthcare facts and figures are available in published studies now on the “Health Affairs” web site at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2w346.

FDA Posts RFI

FDA posted a Request for Information (RFI) for the Sentinel Initiative on February 20, 2009 with a response date of March 5, 2009. The agency is seeking information for planning purposes only. The purpose of the RFI is to identify potential sources that have the capability and qualifications to support the planning and development of the Sentinel Initiative. The agency is interested in evaluating and building upon models already developed by other organizations. FDA may consider soliciting services for a base year and four option years using an ID/IQ task order contract vehicle.

The initial stage of the Initiative enabled FDA to further refine requirements and develop the scope of the project and so far FDA has funded eight contracts to support this initial stage. In addition to these contracts, FDA hosted meetings with various stakeholder groups, and in December 2008, a public workshop was held to discuss the goals of the Initiative.

Efforts are being made to study the information that has already been learned from ongoing contractual work. At this time, FDA has plans to undertake new activities to support the initiative including test queries, methodology development, testing, and implementation of support projects, proof of concept development, along with providing for technical assistance.

For more information, contact Tara R. Hobson, at Tara.Hobson@fda.hhs.gov or by telephone 301-827-9691. To view the RFI, go to http://www.fbo.gov/.

NTIA Holding Broadband Meetings

The National Telecommunications and Information Administration (NTIA) within the Department of Commerce will hold meetings with interested parties beginning March 2, 2009 to discuss NTIA broadband grant programs. NTIA will hold individual or group meetings depending on the number of meeting requests received. All of the information will be placed on the public record.

The NTIA broadband grant programs include the grants described in the Broadband Data Services Improvement Act and the American Recovery and Reinvestment Act of 2009 (ARRA). The Broadband Data Services Improvement Act enacted October 2008 directs the Secretary of Commerce to award grants to eligible entities on a competitive basis to assess, identify, and track broadband services in each state.

ARRA establishes the Broadband Technology Opportunities Program (BTOP) to make grants available on a competitive basis to accelerate and expand broadband deployment. $4.7 billion is available to the BTOP program with $250 million to be available for innovative programs to encourage sustainable adoption of broadband services. In addition, $200 million will be used to upgrade technology and capacity at public computing centers including community colleges and public libraries and up to $350 million is designated for the development and maintenance of statewide broadband inventory maps.

To schedule an appointment for a meeting, contact Barbara Brown at 202-482-4374 or email bbrown@ntia.doc.gov.

HIPAA Case Settled

CVS will pay the government $2.5 million and toughen their practices so that the privacy of patients is not violated. The settlement which applies to all CVS retail pharmacies is in response to the HHS Office of Civil Rights (OCR) and their extensive investigation concerning HIPAA violations. In a coordinated action, CVS also signed a consent order with the FTC to settle potential violations of the FTC Act.

OCR opened an investigation in response to media reports that alleged that patient information maintained by the pharmacy chain was being disposed of in industrial trash containers outside selected stores and were not secure and could be accessed by the public. According to the information, CVS also failed to adequately train employees on how to dispose of such information properly. At the same time, FTC also opened an investigation of CVS and this resulted in both agencies working to coordinate the investigation.

Under the HHS resolution agreement, CVS agreed to pay the $2.25 million and implement a robust corrective action plan. CVS will also actively monitor its compliance and the FTC consent order. The monitoring requirement specifies that CVS must engage a qualified independent third party to assess CVS compliance and then submit reports to the federal agencies. The HHS corrective action plan will be in place for three years while the FTC plan will be monitored for 20 years.

North Dakota's HIT Efforts

The report “Connecting North Dakota for a Healthier Future” recently produced by the North Dakota Health Information Technology Steering Committee looked at the obstacles that the state faces particularly in rural areas.

The UND Center for Rural Health currently working with the North Dakota HIT Steering Committee on a survey realizes that there are still problems in the state. These issues include a strong urban and rural divide regarding EMRs in hospitals, a stark contrast between facilities that are part of a healthcare system and independent facilities, the fact that non-aligned physicians are behind system-based physicians in EMR adoption, long term care facilities face significant barriers to adopting HIT, local public health units use multiple electronic data management systems that operate independently of each other, and academic programs lack focus on a HIT curriculum.

The survey also indicated that telemedicine is an underutilized resource in rural hospitals but rural hospitals identified teledermatology and telepharmacy as applications they intend to implement within two years. However, a high percentage of urban and rural hospitals plan to use telemedicine in the future. They expressed interest in exploring telemedicine for telestroke, teledialysis, patient education, and to provide patient-provider and provider -provider consultations. In long term care facilities, there is interest in exploring the use of home health monitors.

According to the report, consideration needs to be given to:

• Creating a formal organization to coordinate HIT efforts and to potentially govern the HIE initiative
• Developing a plan to implant and sustain a statewide HIE
  Creating a state funded grant or loan program to support rural and public health entities in implementing HIT driven quality improvement programs
• Developing HIT training programs to build human resource capability
  Implementing a peer-to-peer HIT support program for rural healthcare provider organizations
• Sponsoring a rotating rural HIT technical support team to assist organizations that do not have the necessary staff to implement HIT projects

Several federally funded projects have been initiated in the state and these projects include grants from HRSA’s Office of Rural Health Policy and FCC’s Rural Health Care Pilot Program. Also, Universal Services will fund 85 percent of the cost to construct a high speed data network to help UND’s Medical School connect their four main campus sites and their medical sites to rural healthcare facilities.

In addition, Blue Cross Blue Shield of North Dakota (BCBSND) has award funding for $375,000 to develop health information technology to help deliver healthcare to rural communities through its Rural Health Grant Program.

The program is administered by the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. “Health information technology is a critical component for providing access to healthcare in rural North Dakota and will improve efficiencies in delivering that care, “said Mike Unhjem, President and CEO, BCBSND.

Lynette Dickson, Program Director, Center for Rural Health, notes that it is very important to transition from paper to technology to provide for the exchange of health information so that patients receive comprehensive and safe care.

A number of the BCBSND grant projects will help improve efficiency by providing for a computed radiography system, support telepharmacy projects, and establish a health information technology network. This grant program has significantly built teleradiology in the state. For example, Altru Health System of Grand Forks will use their funding to establish a secure and reliable medical imaging computer network between regional critical access hospitals and rural hospitals.

The North Dakota facilities that received the BCBSND funding include Kenmare Community Hospital, Altru Health System, Southwest Healthcare Services, Tioga Medical Center, Nelson County Health System, Northwood Deaconess Health Center, Presentation Medical Center, Heart of America Medical Center, Mountrail County Health Center, and St. Andrew’s Health Center.

Telepharmacy has played an important part in providing pharmacy services to rural communities. The North Dakota Telepharmacy Project established in 2002, is still expanding and 23 rural hospitals are working to come up with solutions for pharmacy services. With additional federal funding in 2008 from the Office of Advancement for Telehealth, plans are underway to establish a pharmacist staffed central order entry site in Fargo which will eventually be able to deliver 24 hour pharmacy services using telepharmacy technology to any rural hospital in the state.

The Fargo site will provide supervisory pharmacist oversight to remote rural hospital pharmacies. By having the use of a wireless telepharmacy cart, it will be possible for any rural hospital to have access to a pharmacist and pharmacy services 24/7.

In addition to the North Dakota Board of Pharmacy and the North Dakota Pharmacists Association, the project is partnering with Catholic Health Initiatives to expand hospital telepharmacy capabilities.

Small hospitals in the state are also benefiting from grants provided through the North Dakota Medicare Rural Hospital Flexibility Program known as the Flex program. The North Dakota Flex Program funded through a grant from HRSA’s Office of Rural Health Policy is a state-based partnership that works with and assists rural hospitals to stabilize and sustain their local healthcare infrastructure.

Ten rural communities will benefit from the North Dakota Flex grants to be administered through the Center for Rural Health since the program has distributed approximately $214,000 in funds. Thirteen grants are helping small hospitals across the state to fund studies and evaluate facilities, establish new programs, purchase new equipment, and provide training to staff and volunteers.

The grants were awarded to Southwest Healthcare Services, Cooperstown Medical Center, Garrison Memorial Hospital, St, Aloisius Medical Center, Cavalier County Memorial Hospital, Lisbon Area Health Center, Union Hospital, Oakes Community Hospital, Community Memorial Hospital and Wishek Hospital Clinic Association.

Helping Entrepreneurs

The Memphis Bioworks® Foundation is creating an Entrepreneurship Development Organization called “TECworks” in Memphis Tennessee. Initial funding of $270,000 from the Memphis Bioworks Foundation will be used to launch TECworks. The funding is coming to the Foundation from the Tennessee Technology Development Corporation. The Foundation is a not-for-profit organization that was formed to help lead the collaboration between public, private, academic, and government entities so that the growth of the bioscience industry will accelerate in the region.

TECWorks will be led by Executive Director Jan Bouten. He was formerly a venture partner with Aurora Funds based in the Research Triangle area. Specifically, TECworks will offer education and mentoring to help entrepreneurs develop their products for the commercial sector, educate investors so that individuals and organizations can better evaluate opportunities, and create an Angel Network where qualified individuals can invest in business opportunities.
TECworks will develop a Grants Institute to focus on teaching businesses how to successfully identify, track, apply, and qualify for grants. Each year, the Federal government gives out more than two billion dollars in Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) programs to help technology companies commercialize new intellectual property. This training is needed in Tennessee because the state is the lowest ranked state for successful SBIR/STTR grant applications.

In another venture, Vanderbilt University has gone live with a new e-commerce web site called “VU e-Innovations” to enable users to purchase innovative software, courseware, and other digital products over the internet. The “VU e-Innovations” site features technologies developed exclusively at the university.

“After investigating similar web sites, we have determined that we are one of the first universities to set up an e-commerce site of this type,” said Peter Rousos, Senior Business Development executive in Vanderbilt’s Office of Technology Transfer and Enterprise Development. He continued to say “Since hundreds of patents have been issued to Vanderbilt and the university has entered into numerous licensing agreements, we now realize that a number of them are suitable for online sales.”

For example, OLINDA/EXM listed on the site is a personal computer code that is capable of performing dose calculations and kinetic modeling for radiopharmaceuticals and can calculate radiation doses to go to different organs of the body from systemically administered radiopharmaceuticals.

For more information on VUe-Innovations, go to http://vuinnovations.com and for information on the Memphis Bioworks Foundation, go to www.memphisbioworks.org.

System Launched in California

According to a CalRHIO, a statewide system to provide physicians with secure electronic access to critical patient information will be launched at 23 Orange County emergency departments. The HIE initiative is a collaboration between the California Regional Health Information Organization (CalRHIO) a nonprofit public-private partnership and the Orange County Partnership Regional Health Information Organization (OCPRHIO), a multi-stakeholder collaborative. Molly Coye, MD, CalRHIO Board Chair reports that the HIE initiative is the first step in making comprehensive information available electronically for all Californians.

The new system will augment information already available to Orange County emergency department physicians who care for the county’s indigent population. The information is part of the Medical Services Initiative Program, a county funded safety net program.

Initially the system will provide emergency department physicians with medical record information on 360,000 patients enrolled in CalOptima that provides coverage for people in Medi-Cal, Medicare, and Healthy Kids. The system is to go live by July 2009.

By leveraging the CalRHIO’s technology platform, OCPRHIO does not incur the time and expense of building its own data exchange system. Also physicians in the county will be able to communicate with other doctors and hospitals across the state as well as the national network when it is available.

By early 2010, the CalRHIO system will provide additional data to emergency physicians including medical history, laboratory data, and clinical claims data for patients with commercial insurance. Use of the health information is restricted to patient care and is protected and exchanged under strict medical privacy and confidentiality regulations.

Stimulus Package Passed

The $787 billion economic stimulus package includes $19 billion for HIT. The HHS Office of the National Coordinator (ONC) will receive $2 billion to use to coordinate health IT policy and programs. Programs will be initiated by the Secretary but the National Coordinator will have the responsibility to move and expand the electronic movement of health information.

The ONC will be able to award grants to states or to Indian Tribes to use to establish a certified EHR Technology Loan Fund Program to help providers. Loans may be used by providers to purchase certified EHR technology, improve EHR technology, to train personal to use the new technology, and to improve the secure electronic exchange of health information. These loans won’t be available until 2010.

The National Coordinator has the responsibility for standards and certification. New health IT Policy and HIT standards committees will be formed to serve as federal advisory committees and the committees will then forward their recommendations to the National Coordinator.

With this legislation, all health care providers and insurers plans that are providing services or products for the federal government will now be required to use only standards compliant health IT systems and products.

Incentive payments of $17.2 billion will be made through Medicare to go to health professionals and hospitals for certified EHR technology. Incentive payments will be made to physicians for the first five years from 2011-2015 if the use of EHR technology is demonstrated. The Medicare payment schedule for eligible professionals is $15,000 for the first year. However, if by 2015, a health professional does not demonstrate the use of EHR, then Medicare reimbursement payments will be reduced.

Hospitals will also receive incentive payments for the first five years for making use of EHR technology. If an eligible hospital does not make meaningful use of the EHR technology by 2015, their reimbursement payments will also be reduced.

According to the publication “Health Data Management”, the Congressional Budget Office projects that health IT provisions in the stimulus package will result in 90% of doctors and 70% of hospitals using certified EHR systems by 2019.

The National Coordinator will be responsible for developing a health IT extension program to provide health IT assistance and to help providers adopt health technology. In addition, Regional Centers will be developed to provide technical assistance.

To enhance educational possibilities in the field of health IT, grants may be provided for demonstration projects to help move and integrate certified EHR technology into clinical education. In addition, assistance will be provided in consultation with the National Science Foundation to establish or expand medical health informatics programs in universities and colleges.

The stimulus package will also provide $4.7 billion for NTIA’s Broadband Technology Opportunities Program, $2.5 billion for USDA’s Distance Learning, Telemedicine, and Broadband Program, $1.5 billion for HRSA to use to build or repair health centers and/or to purchase equipment, $1.1 billion to provide for research within AHRQ, NIH, and HHS, $85 million for health IT and telehealth technologies within the Indian Health Service, $500 million for SSA, and $50 million to provide IT within the Veterans Benefits Administration.

Cancer Expert Offers Insight

Dr. John Mendelsohn, President of the University of Texas M.D. Anderson Cancer Center offered his ideas on how to advance the fight against cancer at the National Press Club on February 17th. He offered a ten point plan to shape congressional debate about the future of scientific research, cancer prevention, and healthcare reform.

Dr. Mendelsohn pointed out that new therapies and medical instruments are expensive to develop and are a major contributor to the rising cost of medical care. The current payment system rewards procedures, tests, and treatments rather than outcomes, so that today, cancer prevention measures and services are not widely covered.

His plan calls for a standardized electronic medical record accessible nationwide to ensure quality care for cancer patients with multiple providers at multiple sites. A national electronic medical record would provide opportunities to reduce costs, be able to identify factors that contribute to illnesses, determine optimal treatments, and detect uncommon side effects of treatment.

His plan seeks the formation of new partnerships to encourage drug and device development between research institutions, academia, and industry. According to the doctor, partnerships are needed to bring together sufficient expertise and resources to confront the complex challenges of treating cancer.

Traditionally, academic institutions have worked with biotech and pharmaceutical companies by conducting sponsored research and participating in clinical trials. By forming more collaborative alliances during the preclinical and translational phases prior to entering the clinic, industry and academia need to build on each other’s strengths to safely speed drug development to the bedside.

Today, therapeutic cancer research needs to focus on human genetics and the regulation of gene expression. More knowledge is needed on human genome and mechanisms, how to regulate gene expression, and how to advance technology in the field. Also, collecting data on experiences from clinical trials is needed to produce a greater understanding of the environmental factors that can lead to exciting research approaches.

Dr. Mandelsohn reports that currently the M.D Anderson Cancer Center is making advances in pursuing targeted therapies designed to counteract the growth and survival of cancer cells, identifying the presence of particular abnormal genes and proteins in patient cancer cells or in the blood, developing new diagnostic imaging technologies to detect genetic and molecular abnormalities in cancers in individual patients, researching anti-angiogenesis agents and inhibitors of other normal tissues that surround cancers, discovering ways to boost immune responses in cancer patients, and conducting research that hopefully will lead to the development of cancer vaccines.

The doctor pointed out that with the aging of baby boomers, it is very important to train future researchers and providers of cancer care. Shortages are predicted in the supply of physicians, nurses, and technically trained support staff that are greatly needed to provide expert care for cancer patients.

The pipeline for academic researchers in cancer is also threatened due to the increasing difficulty in obtaining peer-reviewed research funding. After growing by nearly 100% from 1998-2002, NCI’s budget has been in decline for the past four years and has lost 12% of its purchasing power. Lack of funding also discourages finding talented young scientists who can find promising careers elsewhere plus discourages seasoned scientists from undertaking innovative, but risky research projects.

In addition, Dr. Mandelsohn wants to see steps taken to ensure that efficient and cost effective clinical trials are designed to measure, in addition to outcomes, the effectiveness of new agents on the intended molecular targets. As he continued to say “Innovative therapies need to move forward more rapidly from the laboratory into clinical trials.”

Other steps that need to be taken include developing better tests to predict cancer risks, providing more education on preventing cancers, helping cancer patients move forward after surviving cancer, plus the healthcare system needs to make certain than everyone has access to cancer care if needed.

According to Dr. Mendelsohn, along with the improving five year survival rates, the cancer death rate has been falling by 1% to 2% annually since 1990 but we still have a long way to go. While survival rates improve and death rates fall, cancer still accounts for one in every five deaths in the U.S. According to NIH, it costs this nation $89 billion in direct medical costs and another $18.2 billion in lost productivity during the illness according to NIH.

Grants Help Health Services

New York State recently awarded $13.8 million to help community healthcare planning and development projects across the state. The awards are funded through two New York State Department of Health (DOH) programs that include the HEAL NY and the Rural Health Network Development Program.

HEAL NY funding of $7.1 million was awarded to nonprofit and municipal organizations around the state to undertake regional planning activities to improve the efficiency and effectiveness of their community’s healthcare systems. The two year grants will carry out detailed assessments of healthcare resources in their communities and provide forums to discuss local healthcare needs and programs among key stakeholders. Principle issues concern availability, affordability, quality of care, barriers to appropriate care, community health needs, and the strengths and weaknesses in healthcare delivery.

Eighteen awards were made. Awards over $300,000 include the Center for Health Workforce Studies ($362,141), Community Health Care Association of New York State ($398,380), Finger Lakes Health Systems Agency ($988,517), North Shore-LIJ Health System ($550,000), P2 Collaborative of Western New York Inc. ($999,820), The Research Foundation of the State University of New York ($926,530), and the Rockland County Department of Health ($1,000,000).

The Rural Health Network Development Program funding for $6.7 million was awarded to improve access to care, to better coordinate services, to increase the efficiency of service delivery, and to introduce needed community services through the formation and operation of rural health networks.

Thirty five awards were made. Awards over $230,000 include Bassett Healthcare Research Institute ($232,401), Chautauqua County Health Network Inc. ($233, 180), Chenango Health Network ($231,199), Columbia County Community Healthcare Consortium Inc., ($233,961), Hamilton-Bassett-Crouse Health Network ($232,011), Hudson River Healthcare Inc. ($233,961), Institute for Family Health ($233,961), Southern Tier Health Care System Inc., ($233,961), Thompson Health ($233, 961), and Yates County Public Health ($233,961).

In another initiative, the New York State Health Foundation (NYSHealth) will award grants as part of their 2009 Special Projects Fund. The funds are to be used to expand health insurance coverage, improve the management and prevention of diabetes, and to encourage the integration of substance use and mental health services.

Eligible applicants from nonprofits or for-profit organizations with a significant presence in New York State can submit proposals. Organizations can apply for a grant at any time through June 4, 2009. Grant applications are considered on a rolling basis with three deadlines.

NYSHealth particularly wants to see projects that will help low income and elderly consumers navigate the healthcare system, improve access in areas that have acute shortages, improve the quality of care, support and strengthen safety net providers, scale up programs to reach more people, and provide culturally appropriate programs for underserved populations.

In facing the challenging economic environment of 2009, NYSHealth is also interested in proposals on how to help health organizations cope with the economic crisis, and seeks suggestions on how to implement viable options for saving or consolidating organizations threatened by the economic crisis.

For more information on HEAL NY grants, go to the Department of Health’s web site at www.nyhealth.gov. For information on the NYSHealth 2009 Special Projects Fund, go to www.NYSHealth.org or call 1-212-664-7656.

HRSA Posts Grant Announcement

HRSA posted the “Targeted Rural Health Research Grant Program” announcement (HRSA-09-167) on February 13th. HRSA’s Office of Rural Health Policy (ORHP) will award funds to organizations to develop rural health research studies on a selected number of topics that concern issues of national significance in the area of rural health services.

The topics are:

• Rural Health Clinics—Discuss finance in terms of utilization and/or service mix
• Rural Hospital Leadership—Examine leadership in response to changes in the healthcare marketplace and this topic may include hospital administrators, hospital board members, and key hospital staff
• Frontier Health Service Delivery—Address healthcare services from across the spectrum of care including mental health, substance abuse, public health, primary care, etc
• Public Health Workforce—Address issues concerning recruitment, retention, pipeline development, etc

The grant will be for approximately $450,000 is expected to fund up to three new awards for the grant program. The maximum amount per award is $150,000 and will be for an 18 month project and budget period. Eligibility is open to any public, private, and non-profit organization including faith-based and community organizations.

Grant proposals are due on April 13, 2009. The project start is 9/01/09 and is scheduled to be completed 2/28/2011.

Massachusetts Awards Grant

Massachusetts has awarded $32.6 million in FY 09 grants and increased rate payments from the state’s Essential Community Provider Trust Fund to 69 hospitals and community health centers across the Commonwealth. The funding includes $17.4 million in grants and an estimated $15.2 million in increased rate payments.

The goal of the Trust Fund is to help providers serve populations in need of more effective and efficient community-based care, clinical support, disease management, primary care, care coordination, and pharmacy management services. Eighty two providers across the state submitted applications for funding of $110 million.

In reviewing grant applications, the Executive Office of Health and Human Services not only evaluated financial needs and the role that each provider plays in the Commonwealth’s health delivery system, also emphasized the importance of maintaining or expanding behavioral health services, and the development of health centers as “medical homes”.

Some of the grant recipients include Caritas Carney Hospital ($4,000,000), East Boston Neighborhood Health Center ($1,500,000), Tufts Medical Center ($1,000,000), Quincy Medical Center ($2,000,000), Lawrence General Hospital ($1,000,000), Brockton Hospital ($1,200,000), Holyoke Medical Center ($2,100,000), Mercy Medical Center, Sisters of Providence ($7,000,000), and North Adams Regional Hospital ($1,000,000).

Ultra Portable System Deployed

Time and communications are critical in a down range environment where the difference of minutes can save soldiers’ lives. GATR Technologies recently developed and deployed an ultra portable communication system that is completely inflatable. According to Paul Gierow, President GATR, “It provides high bandwidth for secure and non-secure data, voice and video, and can be ready to transport in as little as 15 minutes.

Roy Priest, Program Manager, GATR, said “the system officially called the Deployable Satellite Communication Terminal but generally referred to as GATR, replaces much heavier antennas that currently require as many as 10 cases weighing 100 pounds each.” He explained that both the housing and the collapsible antenna dish inside are made of a flexible fabric that deflates and rolls up into a backpack. The RF feed mechanism, inflation unit, and other accessories to the antenna are easily assembled, disassembled, and stored for transport. The system can be packed into two carrying cases that weigh less than 70 pounds each, so the solider can travel with the system as checked baggage on the airplane.

Gierow said, “The GATR is in limited production but the system is being used in the U.S. Army Special Operations Command. The system first deployed after Hurricanes Katrina and Ike, has been used in Afghanistan for eight months and has been successfully used in both cold and hot climates.”

The U.S. Army Space and Missile Defense Command/Army Forces Strategic Command Technical Center have the contract management responsibilities for this system.

RFQ and Contract News

CMS is looking for an expert consultant to provide oversight and evaluation services that will help monitor home health agencies and hospice providers. The individual needs a combination of experience working with home health and hospice regulations from a CMS survey as well be able to help develop policy and implement plans that will help the agency make needed revisions to the survey.

Specifically, the consultant will need to provide technical consultations, do an analysis of present policy, assist in the development of new policy, and participate in teleconferences with the project officer. The consultant will also review, analyze, and provide written comments on documents related to the home health and hospice survey process, participate in training activities, participate in teleconferences, and attend CMS sponsored meetings.

The request (221-9-306602-RAW) was posted on February 12, 2009, with the response data of February 27, 2009. The primary contact is Renee A Wallace-Abney, 410-786-5128, or renee.wallaceabney@cms.hhs.gov.

John Snow Inc. was awarded a contract from HRSA’s Bureau of Health Professions to revise and consolidate the rules by which federal shortage area designations are evaluated. In the decades since these rules have been created, these designations have determined nearly every component of the federal health care safety net system. The designations are of interest to all stakeholders in the federal safety net system.

This project follows two prior attempts to revise the rules over the past 10 years, both of which resulted in resistance from the stakeholders. JSI staff will work with the Bureau of Health Professions and a panel of national experts in healthcare access to create revisions to the current rules.

For more information, go to www.jsi.com or contact Eric Turer, Project Director, at 603-573-3300.

Innovative Display Developed

Kent State University has developed new innovative data display technology to help doctors improve their ability to evaluate medical images that are commonly used. This patent-pending technology allowing for interactive viewing of large image data sets from virtually any medical imaging device has led to a licensing agreement with Northeast-Ohio based Standing Rock Imaging, LLC.

Dr. Robert Clements, Senior Research Scientist and Dr. James Blank, Professor and Chairperson, Department of Biological Sciences developed the technology. “We believe the system can move rapidly into a clinical setting and significantly improve the ability of physicians to make diagnoses from a variety of imaging techniques”, said Blank.

He continued to say “Our approach enables the physician to rapidly and efficiently study hundreds of images at once by turning the data into a 3-D object that appears to float in midair.
The technology will allow for manipulation of the volume rendered object in real-time, giving physicians the ability to add and remove data, as well as to instantly view internal structures not otherwise visible.”

Gregory Wilson, Associate Vice President for Economic Development and Strategic Partnerships, said “The license agreement is the first novel imaging system to be licensed from the university. Standing Rock Imaging will maintain a presence in Northeast Ohio, and plans to employ residents of the region to further develop and produce the technology.

For more information, contact John O. Krusinski, CEO and President of Standing Rock Imaging at 330-325-0086, or email john@theoringroup.com or James Blank at jblank@kent.edu.

States Pursuing Medical Homes

Minnesota is moving forward on the medical home concept according to “Stateline Midwest” published by the Midwestern Office of the Council of State Governments. Minnesota has passed legislation in the past two years to expand medical home availability and use in the state.

The Minnesota Department of Human Services (DHS) is developing criteria and working with patients and the healthcare community to begin certifying physicians by July 2009. By 2010, the state will begin paying certified medical homes care coordination fees, and while the exact amounts have not been determined, the highest fees will be paid for individuals needing the most care.

In addition, beginning in 2010, all private insurers in Minnesota will be required to pay care coordination fees for their members who receive care from a state certified medical home. Next year, the state will work with the healthcare community to devise a uniform method for calculating payment categories. The formula will group similar kinds of patients together in a hierarchy based on medical complexity so that health plans will all use the same criteria to negotiate care coordination payments.

The Minnesota Department of Health (MDH) and DHS are working on a contract with the Institute for Clinical Systems Improvement (ICSI) to develop recommendations on what the outcomes should be for healthcare homes. ICSI’s final recommendations as well as a report on the “state of the art” of health care homes were both released in January and can be found at www.health.state.mn.us/healthreform/homes/index.html.

Iowa legislation directed the Iowa Department of Human Services to implant a statewide medical home system. “The first priority will be to get children in the Medicaid program into medical homes,” says Beth Jones, Medical Home Coordinator for the Iowa Department of Public Health. The legislation then directs the state to expand the medical home system to adult Medicaid beneficiaries followed by state employees, and finally by privately insured Iowans. An advisory council made up of state officials, consumers, and representatives from medical associations will oversee the new program.

Other states are making plans or developing models for medical homes and include Colorado, Illinois, Louisiana, Maine, Michigan, New Hampshire, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, and Texas.

OSU Launches Heart Initiatives

The Ohio State University Medical Center is testing the safety and effectiveness of an implanted wireless pressure sensor as part of a pivotal clinical study to enable cardiologists to rapidly treat patients. “The device provides real-time access to critical information at any time,” says Dr. William Abraham, Director for the Division of Cardiovascular Medicine at the Medical Center and the trial’s co-principal investigator. “The study will help determine if physicians can use this data to help identify appropriate medical treatment for heart failure patients.”

The device is implanted in the patient’s pulmonary artery using a simple, catheter-based procedure. Pulmonary artery pressure is then measured and transmitted to a secure web site where it is reviewed by the implanting physician. The data is also available to the physician on a handheld computer 24/7. So far, the Medical Center has implanted 10 patients as part of a feasibility study and ongoing CHAMPION trial sponsored by CardioMEMS, Inc., in Atlanta Georgia.

The Medical Center is also working to help patients suffering from the most serious form of heart attack or ST-segment myocardial infarction (STEMI). “We know rapid care for these patients is critical to reducing mortality and improving patient outcomes, so we are continuing to improve treatment times for heart patients throughout the region”, reports Dr. Ernest L. Mazzaferri, Jr., Director of the Regional STEMI Program at Ohio State’s Ross Heart Hospital.

The Ross Heart Hospital’s regional STEMI protocol begins when the catherization lab is alerted either by the physician or EMS when they contact Ohio State’s transfer center using a dedicated hotline number, or by issuing a STEMI Alert. Local providers, MedFlight and OSU’s interventional cardiologist determine optimal immediate patient care and they are often able to mobilize catherization lab teams in 20 minutes. As follow-up, the nurse coordinating the STEMI program then provides feedback to the referring emergency department, EMS, and the primary care physician, or cardiologist.

Through the generosity of an anonymous benefactor, OSU’s regional STEMI team is distributing computer modems to numerous central Ohio EMS agencies. These units transmit electrocardiogram tracings directly from the field to any hospital in the central Ohio region that performs the specialized procedure to open a blocked artery.

Medication Database Progressing

The University of Connecticut, School of Pharmacy received a $781,000 grant to build an electronic medication information exchange for the state. The pilot was funded as part of a $5 million grant that the Connecticut Department of Social Services received from CMS.

The Pharmacy faculty, the Connecticut Pharmacists Association, and a newly created network of Connecticut pharmacists are going to use the funds to develop comprehensive medication profiles for 1,000 Connecticut Medicaid patients. The idea is to develop a pilot program to provide medication therapy management for 200 of the Medicaid patients.

The pilot program will determine how well pharmacist-led medication management and adherence programs can work in the state and how pharmacists can assist the state in developing a comprehensive electronic health and medication information exchange database.

The database will contain all of a patient’s pharmacy insurance claims, medication prescription records, lab test data, notes on potential medication allergies, over-the-counter medications, herbal supplements, and past medication adherence rates. The electronic health information will be available to any licensed healthcare professional seeing the patient at a hospital emergency room, clinic, pharmacy, or other healthcare locations.

Medication therapy management is a relatively new concept that has been proven successful in other areas where it has been implemented. In the late 1990s, two employers in Asheville, North Carolina, the municipal government, and Mission-St. Joseph’s Health System started a pilot program where specially trained pharmacists held face-to-face meetings with employees with diabetes to educate and motivate them to better manage their condition and medications.

As a result, participating employees visited local hospital emergency departments at a rate one-third of the national average. The employers direct medical costs declined in the range of $1,622 to $3,356 per participant, and one employer had an average reduction in program participant sick days of 41 percent.

In a separate project dealing with employees with hypertension and dyslipidemia (disruption in the amount of fat molecules in the blood, including high cholesterol levels), those employees participating in medication therapy management program saw their blood pressure drop. In addition, the percentage of patients meeting their blood pressure goals increased from 40.2 percent to 67.4 percent. Employees also saw reductions in the so-called bad cholesterol with medication use increasing three-fold while related medical costs decreased by 46.5 percent.

“The School of Pharmacy believes that the pharmacist-led medication management and adherence programs would be beneficial not to just the 200 Medicaid patients in the pilot project but eventually to all the residents of Connecticut,” according to Professor Marie Smith, head of the Department of Pharmacy Practice and Principal Investigator for the project. She continued to say “This project will also highlight the value of pharmacists as trained medication experts in the management of patient healthcare.”

Panel Created to Help Consumers

An advisory panel has been created to help the Louisiana Department of Health implement the Louisiana Consumer’s Right to Know Act. The Act will give the state healthcare consumers expanded, web-based access to reliable information on the cost, quality, and performance of their healthcare providers and health plans.

The initiative is being led by Lucas Tramontozzi, a former analyst for Hackensack University Medical Center in New Jersey, who is now a Program Manager in DHH’s Bureau of Policy, Research and Program Development in New Jersey.

The Act authorizes the Department to collect and publish a broad range of healthcare information on the Internet. The advisory panel created with representatives from consumer, technology, academic, and healthcare organizations, will advise on best practices in data collection, risk adjustment of the data to ensure appropriate comparisons, and decide on the best template for the web site.

Under the Act, DHH will create a web site that will publish key performance data on healthcare providers and health plans, including at a minimum death rates, readmission rates, dozens of nationally accepted quality and performance measures for health plans, complication rates for procedures, average costs for procedures, and the number of procedures a given provider has performed.

AHRQ Raises Contract Amount

AHRQ on January 6th issued a solicitation for multiple IDIQ/Task Order contracts to do individual Task Orders. The contracts are going to be awarded to support the AHRQ National Resource Center for Health Information Technology. On February 6th, AHRQ announced that the ceiling amount for all contracts including options will now be to $300 million instead of the previously stated $75 million.

Individual ceiling amounts will be established for each contract award under the following domain areas:

• Support for Health IT Program Management Guidance, Assessment, and Planning—The contractor needs to manage complex projects, demonstrate organizational structure and capabilities to meet project milestones, plus manage resources and cost expenditures
• Health IT Technical Assistance, Content Development, Program Related Projects and Studies—The contractor must be able to manage collaborative efforts among government, academic, and other public and private organizations, develop health IT tools and products, perform health IT research and development, and be able to implement the projects and studies
• Health IT Dissemination, Communication, and Marketing—The contractor must be able to communicate and market AHRQ and other federal health IT research and project results to reach the most appropriate target audiences
• Health IT Portal Infrastructure Management and Website Design and Usability Support—The contractor must be able to manage and operate web sites and collaborative portals, establish knowledge management databases, and perform web site usability studies

In addition, AHRQ has extended the due date for proposals to February 26, 2009. For more information, go to www.fbo.gov to see the original solicitation posted on January 6th. The solicitation Number is AHRQ-2009-10003. The primary point of contact is Sharon L. Williams, Contracting Officer at Sharon.williams@ahrq.hhs.gov or phone 301-427-1781.

Quality & Safety Discussed

We need to view quality and safety research as essential rather than separate from basic and clinical research, according to Peter J. Pronovost, MD, PhD, Professor of the Departments of Anesthesiology and Critical Care, Surgery, and Health Policy and Management at Johns Hopkins University. He is also the Medical Director for the Center for Innovations in Quality Patient Care, and Director for the Quality and Safety Research Group.

Dr. Pronovost appearing before the Senate Committee on Health, Education, Labor, and Pensions recent hearing on “Implementing Best Patient Care Practices” said “We need to eliminate the gap that exists between what we learn in a lab and what actually reaches the patient plus we need to approach patient safety the same way that we approach curing a disease. This means that we need to use rigorous scientific research to produce hard data with clear measurable results.”

He described how researchers at Hopkins worked on the problem of catheter related blood stream infections which kills between 30,000 and 62,000 people a year and causes nearly $3 billion in excess costs.

Hopkins used a plan developed in three phases to prevent this infection:

• Phase 1—Existing data was reviewed and five key procedures were selected that would most likely prevent these infections. These procedures were compiled into an easy to follow checklist. Potential barriers to using the checklist were identified and tactics were developed to overcome those barriers. The intervention was pilot tested at Hopkins and performance was measured with the result that these infections were nearly eliminated
• Phase 2—AHRQ provided a matching grant to help Hopkins pilot test the program in Michigan. Within 3 months after implementing the interventions, the median rate of infection in the 103 participating ICUs plummeted to 0 and has stayed at 0 for 4 years. In just one year, the reduction in infections were estimated to have saved the hospital system millions and thousands of lives
• Phase 3—AHRQ provided funding to enable Hopkins to partner with the American Hospital Association to implement this life saving program in 10 hospital systems in 10 states. In addition, philanthropic support was donated to enable Hopkins to reach another group of states
• Dr. Pronovost pointed out that the fragmented approach that our country uses to reduce infections points to deep problems within our healthcare system. These include vague or non-existent performance standards, poor or absent and often invisible measures of performance, misaligned financial incentives, and fragmented and under resourced labors. These factors all cripple efforts to improve quality, reduce cost, and implement health IT.

His other suggestions for improving quality and patient safety are to:

• Advance and invest in the science of healthcare delivery and with more funding for AHRQ
• Create an Institute for Healthcare Delivery that would be similar to the human genome project to link provider organizations, insurers, payers, and regulators to work together to design, implement, and evaluate interventions
• Establish a “supra agency” to facilitate and monitor the integration of inter-agency activities. This group should report directly to the Secretary of HHS
  Invest in health IT so that efforts to improve health IT would be linked with efforts to improve quality and reduce costs

ACP Discusses Medical Homes

“The state of America’s healthcare is poor,” according to Jeffrey P. Harris, MD., President of the American College of Physicians (ACP) as reported at the ACP State of the Nation’s Health Care briefing held on February 2, 2009 at the National Press Club in Washington D.C. “There are too many uninsured and underinsured people, we have too few primary care physicians, and we under recognize the true value of patient-centered care that can be delivered by primary care physicians.”

Bob Doherty, Senior Vice President, Governmental Affairs and Public Policy for ACP, said “ACP wants help from Congress to expand the Patient-Centered Medical Home model to more states, more practices, and more patients. This innovative model of primary care delivery offers enormous potential to improve quality and lower the costs of care especially for patients with chronic illnesses.”

The ACP on February 2nd released the report “Assuring Universal Access to Health Coverage and Primary Care:” that addresses the state of the nation’s health Care in 2009 and provides recommendations needed for reform. The report addresses the urgent need for primary care physicians and how the need for physicians will only increase with the growing number of patients with chronic illnesses.

The report notes that in order to succeed, it is important to transition to a new payment model for primary care. The suggestion is that practices that are organized to deliver patient-centered care using the Patient Centered Medical Home (PCMH) model should be paid a monthly, risk adjusted care management fees for each eligible patient, plus fee-for-service payment for face-to-face encounters with patients. In addition, there should be performance-based payments for reporting on quality, patient satisfaction, efficiency metrics, plus a shared savings component might also be included.

The total payments for PCMHs should be high enough to fully cover the costs including physician and other clinical staff work and the cost for health information systems needed to provide care management. There needs to be an overall and substantial gain in net revenue to go to primary care physicians in such practices.

ACP wants to see the CMS Medicare Demonstration a three year project providing a variety of practice settings in up to eight states, provide reimbursement in the form of a care management fee to physician practices for the services of a personal physician. ACP would like to see CMS set a timeline for transitioning to a new payment model for all practices nationwide that have voluntarily sought and received recognition as Patient-Centered Medical Homes following completion of the Medicare demonstration.

State Seeks Healthcare Experts

The Minnesota Department of Health (MDH) is looking for up to five consultants with nationally regarded and/or significant healthcare industry expertise to consult on technical data, and/or operational issues related to the Minnesota Sessions Laws 2008 and other health reform efforts. Contacts will be awarded on a competitive basis to highly qualified individuals that are able to provide short-term and high-level analyses.

The 2008 Health Reform Law referred to as “Minnesota Sessions Laws 2008, Chapter 358” requires the Commissioner of Health to implement a number of complex market-based health reforms over the next 24 months. These reforms include creating and implementing a statewide healthcare provider quality measurement and incentive payment system, collecting healthcare encounter data, using risk adjustment methods for quality measurement, payment and other purposes, identifying and defining “baskets” of healthcare services, and forming provider peer groups. The goal is to be able to compare healthcare providers in terms of cost and quality.

While the Department will work with separate vendors on each of these projects, the Commissioner also wants to benefit from the advice from national and/or industry experts who have led similar initiatives. The purpose of this expert advice is to complement work occurring at an individual project level and help MDH connect important operational and policy “dots” across these initiatives. For example, the Department may need advice on how to integrate data elements for analytical purposes.

A Request for Proposals (RFP) is available but a written request is required either by email or direct mail to receive the RFP. Proposals submitted are due on February 20, 2009 with the work proposed to start after March 1, 2009.

For more information, contact Mat Spaan, Health Economics Program, 85 E. 7th Place, Suite 220, Saint Paul, Minnesota 55101, telephone 651-201-5171 or email Mat.Spaan@state.mn.us.

AHRQ Awards Contract

AHRQ awarded $618,000 via their “Accelerating Change and Transformation in Organizations and Networks” (ACTION) initiative to study how to implement a patient safety event reporting system for consumers. Research Triangle Institute (RTI) with Baruch College and Consumers Advancing Patient Safety (CAPS) were selected to do this 20 month study project.

The study will make recommendations on offering a consumer reporting system for patient safety events, how to identify the information that needs to be collected from consumers, and how to determine what mechanisms are needed to capture consumer reporting.

“Consumers are an untapped resource to help us learn about vulnerabilities in the healthcare system and often are the only sources of information on the continuum of care for themselves or a family member,” said CAPS President, Susan E. Sheridan. “Understanding patients and their experience with healthcare can improve the safety of care.”

Currently, consumer input on the safety of care has been done through consumer satisfaction surveys, but they tend to focus on interpersonal aspects of care, communicating needs, and their access to care issues. One of the limitations with satisfaction surveys is that they do not provide consumers with an opportunity to comment on patient safety events or provide narrative information on their experiences. Consumer narratives can be used to highlight system flaws that may be amenable to analysis and change.

“Patients are a critical part of the healthcare team and have an important role to play in ensuring the quality and safety of the care that they receive,” said William B. Munier, M.D., Director of AHRQ’s Center for Quality Improvement and Patient Safety. “We look forward to the results of the initiative and to finding ways to use patient reports that will complement the information that is being collected by patient safety organizations.

Ultrasound Devices on the Rise

A small powerful prototype of a therapeutic ultrasound device developed by Cornell graduate student George K. Lewis is slated to advance the imaging field. The device fits in the palm of a hand, is battery powered, and could possibly stabilize a gunshot wound or deliver drugs to brain cancer patients. The device is wired to a ceramic probe called a transducer, and creates sound waves so strong that they instantly cause water to bubble, spray, and turn into steam.

The device is smaller, more powerful, and many times less expensive than today’s models. The hope is that in the future therapeutic ultrasound machines will be found in every hospital and medical research labs. Lewis said “New research and applications are going to spin out using these new systems since they will be cheap, affordable, and portable.”

This higher energy ultrasound machine will be able to treat prostate tumors or kidney stones by breaking them up. The device should be able to relieve arthritis pressure and help treat brain cancer by pushing drugs quickly through the brain following surgery. Lewis reports that this technology could lead to cell phone-size devices that military medics could carry to cauterize bleeding wounds or dental machines to enable the body to instantly absorb locally injected anesthetic.

The device is being tested in a clinical setting at Weill Cornell Medical College under the direction of Jason Spector, M.D., Director of the Laboratory for Bioregenerative Medicine and Surgery. The laboratory is using the devices in experiments to try to minimize injuries that occur when tissues do not receive adequate blood glow.

Peter Henderson, M.D., Chief Research Fellow of the laboratory said “Researchers are realizing that when harnessed appropriately, ultrasound can be used to treat medical problems as opposed to just diagnosing them. It’s a wide-open field and this new device is going to play a huge role in catalyzing the discovery of new and better therapeutic applications.”

DOD STTR Solicitation Pre-Released

The Army and Navy are inviting small business firms and research institutions to jointly submit proposals under solicitation (DOD 2009.A STTR) for the Small Business Technology Transfer Research (STTR) program. The STTR program makes awards to small business concerns to do cooperative research and development jointly with a research institution. An average award is up to $100,000.

Small businesses can work with research institutions, contractor-operated federally funded research and development centers, and universities. The goal is to work together as a team to move ideas from the research institution to the marketplace to foster high tech economic development and to address the technological needs of the armed forces.

STTR which is modeled substantially on the SBIR program is a separate program and financed separately. The key is that proposals not only need to address innovative concepts that will help solve problems but proposals need to show that the technology has a high potential for commercialization in the private sector.

Some of the Army topics listed on www.dodsbir.net under Quick Scan are:

• (A09A- T004)—The objective is to develop a technology to effectively treat drug resistance and eliminate bacteria, including those embedded in biofilms during natural infections, and also on implanted medical devices
• (A09A- T025)—The research needs to find ways to develop a reliable, non-invasive set of tests that can measure changes in motor and/or sensory cranial nerve function to improve the discrimination between mild TBI and PTSD diagnosis. The assessment items should be contained in a container approximately the size of a laptop computer case since the tests may need to be administered outside of the physicians or office or clinic
• (A09A-T027)—To develop an advanced decision support medical monitor driven by algorithms to provide real-time processing of physiologic signals to detect hemorrhagic shock during transport
• (A09A-T028)--To develop specific telesurgical multisensory/multimodal interfaces to enable the surgeon to interact with tissues when performing robotic surgery. Potentially, a telesurgeon using a modular M/MIR system will be able to interface with different manufacturers and robots to perform procedures on patients located in multiple locations

The solicitation was issued on January 27, 2009 for pre-release. To see the solicitation, go to www.acq.osd.mil/osbp/sbir/solicitations/sttr09A/index.htm. DOD will begin accepting proposals on February 24, 2009 and the deadline is March 25, 2009. Small businesses submitting a proposal must be registered at www.dodsbir.net/submission since all proposals must be submitted through the web site.

Many states have established programs to provide help and services to small firms and individuals participating in the Federal SBIR/STTR program. For more information, go to www.ed.gov/offices/OERI/SBIR/statelink.html.

The help desk is available at www.dodsbir.net/helpdesk or by telephone at 866-724-7457.
All previous awards can be searched at www.dodsbir.net/awards.

Studying Birth Defects

Every day in Utah an average of three babies are born with birth defects and as a result, the state has the highest rate of oral-facial clefts in the nation. Birth defects are the leading cause of infant mortality in the U.S. affecting an estimated 150,000 babies annually and contributing substantially to pediatric morbidity and the cost of healthcare.

With a grant from CDC, $5 million in federal funds is available to help the University of Utah and the Utah Department of Health (UDOH) find out why the state has such a high level of birth defects. CDC first funded birth defects research in Utah in 2002.

Marcia Feldkamp, PhD, Director, UDOH’s Utah Birth Defects Network and Assistant Professor of Pediatrics at the University of Utah, School of Medicine, said “the funds will allow us to continue to increase our study population by at least 400 mothers and children with and without birth defects each year.”

The grant will help researchers expand Utah’s epidemiological and genetic birth defect databases and will help extend current studies on environmental and genetic factors that influence birth defects. The researchers will use the Utah Birth Defect Network the state’s population-based surveillance program to find the babies for the study over a five year period.

All of the cases will undergo review by a clinical geneticist. They will collect DNA from babies and parents to look at genetic susceptibility and environmental exposures. Mothers willing to participate will be interviewed by participating in computer-assisted telephone interviews.

The next step will be to analyze and disseminate surveillance data, identify environmental factors, and then initiate projects to find genetic risk factors. The project will then disseminate data and develop and complete epidemiological and genetic studies on risk factors.

Save the Date for Med-e-Tel

Healthcare providers, industry representatives, researchers, association executives, medical specialists, general practitioners, and government officials from over 50 countries will have an enormous opportunity to do global networking and hear the latest up-to-the-minute news on a variety of topics. The Med-e-Tel 2009 Conference to be held April1-3 in Luxembourg is the leading education, networking, and business forum held for the international eHealth, Telemedicine, and Health ICT community.

Over 150 presentations and workshops will be featured on such subjects as broadband and wireless networks, bioinformatics, business models, cost-benefit studies, developing countries ehealth issues, legal and ethical aspects, reimbursement, standardization and interconnectivity issues. In addition, workshops will be held on, telenursing, telemedicine and chronic disease management, experiences in cybertherapy, telerehabilitation, telepsychology, e-learning, and mobile technologies.

Learn about current applications and best practice examples along with new developments and future trends that will lead to higher quality of care, cost reductions, workflow efficiency, and a wider availability of healthcare services.

The Conference is the place to establish partnerships and contacts, both globally and locally, and to meet and network with healthcare and industry stakeholders to exchange new ideas. Med-e-Tel is collaborating with the International Society for Telemedicine & eHealth, and several other national and international stakeholder organizations so attendees will have the opportunity to go to a number of international and regional association gatherings at the Conference. This will enable attendees to learn about promising ideas and to increase the circle of associates in the industry.

The expo area will be filled with solutions and technology at work. Computer hardware/software, diagnostic/monitoring systems, electronic medical records, home and personal monitoring services, imaging devices, mobile/wireless devices, surgical systems, vital signs monitoring, and assistive technologies will be on display.

The expo will have dedicated meeting rooms for one-on-one meetings with industry leaders, and important demonstrations will be conducted to give attendees a better view on the potential behind Telemedicine and eHealth tools.

For more information, go to www.medetel.lu, email medetel@skynet.be, or telephone +32 2 269 84 56.

Funding for HIT Discussed

Representative Patrick Kennedy (D-RI) and Representative Tim Murphy (R-PA) Co-Chairs of the 21st Century Health Care Caucus joined HIMSS at a press conference on Capitol Hill January 28th to stress how important the stimulus package is for health IT. Representative Kennedy is pleased and appreciative that President Obama has made HIT a priority and is anxious to see the bill signed into law.

Representative Murphy told the press that it is an exciting day with the House passage of the bill but he would like to see the work resulting from the stimulus package stay in the U.S. since it will use taxpayer money.

Sue Schade, CIO, Brigham & Women’s Hospital actively involved in health technology reports that 65 CIOs representing healthcare providers throughout the U.S. have just called on Congress to increase EMR adoption rates across the nation and have signed a “Congressional Call for Action”. The hospitals represented by the 65 CIOs are among the top hospitals in the U.S. in terms of EMR adoption.

To emphasize the need for health technology adoption, Stephen Lieber President & CEO, HIMSS, explained how the White River Rural Health Clinic in Arkansas with 24 medical locations has instituted EHRs in all 24 locations as part of their “Total Care System”. Patients now use a web-based Patient Portal to easily and securely communicate with their clinicians and the system is used to review prescription information, lab results, diagnostic results, and appointment information.

The efficiencies gained have enabled White River to open new facilities including two wellness centers and a dialysis center that are not federally funded. The efficiencies gained from using technology have allowed White River to reduce the workforce of more than 200 employees to 165.

The Steering Committee on Telehealth and Healthcare Informatics held a briefing following the press conference bringing together leaders from many of the organizations that are addressing critical issues concerning healthcare technology. Representatives from AHIMA, ATA, eHealth Initiative, HIMSS, HIT Now Coalition, and the National Council for Community Behavioral Healthcare emphasized that their respective organizations are pleased that so much progress is being made and look forward to seeing changes that will help all Americans benefit from an improved healthcare system.

Meredith Taylor, Director of Congressional Affairs, HIMSS detailed the HIT provisions in the House bill that just passed that supports $20 billion for Health IT. The House bill provides for funding of $2 billion for the Office of the National Coordinator. Some of the provisions include having a Chief Privacy Officer to advice the ONC, establishing two advisory committees—one on policy and the other committee to advise on standards, and the bill provides grant programs, demonstration programs, and education and training. Medicare and Medicaid will provide increased reimbursements to physicians, hospitals, and other healthcare provided that they adopt technology.

Jonathan D. Linkous, CEO, American Telemedicine Association, said “the legislation represents a first step but we will then need to focus on how the legislation will be implemented and what the rules will be put in place.”

Linkous also mentioned that the $2 billion proposed for healthcare through the Office of the National Coordinator specifically mentions telemedicine as a priority for spending. Other areas for telemedicine spending include the USDA Distance Learning and Telemedicine Grant program and the Broadband grant program in the Department of Commerce. In addition, there are other funds for telemedicine that may be contained within expanded funding for federal programs at NIST, IHS, and SSA.

Linkous pointed out that since the stimulus package involves a number of agencies with HIT and telemedicine activities and responsibilities, it is very important to not only coordinate HIT and telemedicine activities within each of the agencies, but also in the Federal government as a whole.

Telehealth Bills Introduced

Representative John T. Salazar from Colorado introduced HR 667 on January 23rd to improve the diagnosis and treatment for traumatic brain injuries. The bill would help expand telehealth and telemental health programs at DOD and the VA. The bill has been referred to the Committee on Veterans Affairs and to the Committee on Armed Services.

A few states have also made a few modifications or a few additions to their proposed bills concerning telemedicine. For example, the state of Washington has just added a new section to Senate Bill 5497 and House Bill 1529. The legislation relates to the delivery of home healthcare services using telemedicine.

The new section says that an in-person contact between a home healthcare provider and a patient is not required under the state’s medical assistance program for home healthcare services. The bill provides that care delivered via telemedicine and eligible for reimbursement needs to include healthcare professional oversight and intervention as appropriate but must still be medically necessary for a telemedicine visit.

Home healthcare services if delivered by telemedicine are covered by and reimbursed under the state’s Medicaid payment program. The department will establish the reimbursement rates, but the rates must be comparable to the rate currently paid for home health visits and reimbursement is not provided for the purchase or lease of telemedicine equipment.

Before treating a patient via telemedicine for the first time, the patient must sign a written statement. The written statement allows the patient to refuse the telemedicine care without it affecting future treatments, plus the patient has full rights to all medical information resulting from the telemedicine visit.

In New Mexico’s 2009 session, House bill 229 and companion Senate bill 199 provides for $2 million to go to the state Department of Information Technology to provide matching funds for a FCC allocation of $11, 300,000 million to the state. These funds are to be administered in collaboration with the University of New Mexico Center for Telehealth to help design, create, and implement a rural health telemedicine network.

Also $150,000 will be available to the Department of Health to use to contract with a nonprofit organization to implement a Health Information Exchange collaborative network to increase the capacity of existing telehealth services.

In New York State, legislation has been introduced to further study telemedicine in order to identify safety concerns, the effectiveness of the telehealth system, and examine patient privacy issues. The study will look at technical, legal and cost issues, barriers to developing telemedicine in the state, conduct surveys, look at other efforts in other states, solicit input from interested parties, advise the Governor and legislature on improving public polices related to telemedicine, make recommendations on integrating new and emerging technologies and applications, and make recommendations on using federal funds to the maximum extent possible.

The Wyoming legislature has recently introduced House bill HB 0281 and a companion bill in the Senate that would make it necessary for the Office of Rural Health to expand and implement telemedicine facilities and also create a statewide Electronic Health Information Exchange.

The Hawaiian legislature is supporting the expansion of telehealth services and technology. The bill SB 1676 supports the need to increase access to healthcare for rural residents living on the neighbor islands and Oahu. The legislation also makes it clear that physicians can use telemedicine as long as a licensed physician is providing services.

Tech Helps Pregnant Women

Several programs are providing better access to care and improving the outcomes for high-risk pregnancies in rural areas. The Antenatal & Neonatal Guidelines, Education, and Learning System (ANGELS), a successful program in Arkansas, links clinicians and patients across the state with the University of Arkansas for Medical Sciences. Telehealth consultations are provided with patients, their local physicians, and UAMS specialists using interactive teleconferencing.

UAMS provides virtually all of the state’s high risk pregnancy services, maternal-fetal medicine specialists, and prenatal genetic counselors. UAMS has the only board-certified maternal fetal medicine unit in the state and employs three maternal-fetal medicine specialists handling 2,300 births each year in their 12 bed labor and delivery unit. In addition, there is a 30 bed neonatal unit with an additional 70 neonatal beds at Arkansas Children’s Hospital.

UAMS telemedicine consultations have increased from less than 50 in 2000 to 1,270 in 2007. The Center receives more than 2,000 calls per month. In addition, ANGELS has fully equipped 20 rural sites with telemedicine technology plus an additional 20 sites with teleconferencing equipment.

So far, ANGELS has increased the proportion of low birth weight infants delivered at UAMS from 37.7 percent to 42.1 percent which means the 60 day infant mortality rate was reduced by 0.5 percent.

Since 2005, 1,244 high-risk women in need of tertiary care have been transferred to UAMS and would not have been if the program weren’t available. The likelihood of a Medicaid beneficiary being able to deliver a premature or low birth weight infant at UAMS has increased by 42 percent since the program began.

In addressing ROI, the consultations and more specialized care has resulted in fewer medical complications leading to savings for the Arkansas Medicaid program. Estimates are that ANGELS has generated a cost savings for the Medicaid program of between $1.30 and $1.50 for every dollar spent on program services.

In another program in Tennessee as reported by (chattanoogan.com), the Community Health Network and Regional Obstetrical Consultants are working together on a video medical network project funded with a $1.8 million grant from BlueCross BlueShield of Tennessee Health Foundation.

The program helps pregnant mothers and their babies in the rural areas of East Tennessee by linking three centers. Small town doctors who are now treating pregnant women will be able to consult electronically with obstetric specialists in Knoxville and Chattanooga when there are serious problems.

The program will be connected to the Community Health Network’s existing network for telemedicine and to other telehealth applications that stretch across the state. Obstetrical patients at any of the CHN Telehealth Network’s 55 existing sites or any of the eleven new perinatal sites will be able to consult in real-time with a remote perinatologist by scheduling a telemedicine visit in their local community. Within the next 12 to 18 months, nine other areas will be added according to Dr. David Adair, CEO, Regional Obstetrical Consultants clinics in Tullahoma and Newport.

NIH Awards New Pilot Projects

NIH awarded three contracts for pilot projects to improve informatics support for researchers doing small to medium-sized clinical studies. The projects will be administered by NIH’s National Center for Research Resources with each of the two year contracts totaling $4 million. The funding will help advance collaborations in clinical and translational research by using interdisciplinary teams of investigators.

The project at Case Western Reserve University includes investigators from the Marshfield Clinic, University of Wisconsin, Madison, and the University of Michigan. The team will develop Physio-MIMNI, an informatics infrastructure for collecting, managing, and analyzing diverse data types across institutions. This research will enable researchers to collaborate in national studies that have complex data sources such as heart and brain monitoring data, along with genomic information. This research will help design informatics tools to improve the efficiency of clinical research.

The University of Washington pilot project will enable researchers at three large, geographically distributed medical centers to easily access large shared data sets to assist in designing research studies and generating hypotheses. The team of investigators from UC Davis, and UC San Francisco will extend Harvard University’s i2b2 software architecture to support cross institution searches. The project will provide model policies and procedures to advance multi-institutional sharing of clinical data to support research.

The third pilot project at Vanderbilt University includes investigators from Oregon Health and Sciences University and Mayo Clinic coming together to collaborate on a project that will extend the capabilities of the Research Electronic Data Capture (REDCap) system. The system is a software toolset that will provide research teams with easy workflow to rapidly develop secure, web-based applications to collect, manage, and share clinical study data. REDCap currently supports 300 studies across an international consortium of 31 institutions.

Software resulting from the three pilot projects will be freely available to biomedical researchers, educators, and institutions in the nonprofit sector. The availability of the software will permit the broad adoption of the tools and allow for the commercialization of customized versions.

Full project descriptions with a list of project partner institutions, is available at www.ncrr.nih.gov/ctsa/informatics.

Correction

The correct URL for information on the Telemedicine in South Carolina Conference to be held February 27, 2009 in Columbia South Carolina is https://www.scahec.net/telemed.html. For more information, go to http://telemedicinenews.blogspot.com/2009/01/telemedicine-for-south-carolina.html.