NIH Funding "GO" Grants

NIH is funding a new program called Research and Research Infrastructure “Grand Opportunities” but referred to as the “GO” grant program. NIH seeks projects that will have a high short-term impact and provide for growth and investment in biomedical research to further develop public health, and healthcare delivery. The $200 million in funding is part of ARRA funds.

So far some of the NIH Institutes suggested “GO” topics include:

• National Heart Lung and Blood Institute (NHLBI)— looking for novel methods to monitor health disparities in people with chronic diseases, monitor economic effects on health, and to evaluate the results of research in terms of the changes needed in healthcare policy
• National Institute of Biomedical Imaging and Bioengineering (NIBIB)—supports research on information technology to use to share radiology images across healthcare institutions and vendor systems. A key design feature is for the patient to control the access and sharing of the images. NIBIB will also accept applications for development of point-of-care diagnostic systems particularly for use in underserved settings
• National Institute of General Medical Sciences (NIGMS)—interested in large scale pilots in health systems to demonstrate the value of automated methods to define health and disease status. The idea is to use information available from biobanks that have been set up for research purposes and then couple this information with EHRs to define the data across diverse cultural, racial/ethnic, gender, age, and socioeconomic backgrounds

The due date for applications is May 27, 2009. For more information on the “GO” program, visit http://grants.nih.gov/grants/guide/rfa-files/RFA-OD-09-004.html or go to www.grants.gov. For more specific information, go through the individual Institutes by visiting http://grants.nih.gov/recovery/ic_go.html.

Voice System Needed

The Army’s Tactical Combat Casualty Care Committee wants to see accurate yet rapid documentation used for pre-hospital treatment and interventions when caring for critically wounded soldiers. This is needed since first responder or medic documentation is often missing, inaccurate, unintelligible, or incomplete.

Current procedures call for first responders to fill out a form on patients they have treated. However, this form is rarely filled out or used further down in the treatment chain. So now, the Army wants to expand existing commercial or government voice and communication technologies to help develop an easy to use device capable of capturing critical clinical information from the first responder.

The currently fielded AHLTA-Mobile or (BMIST) provides limited documentation capability but is most suitable for sick calls or routing care provided at battalion aid stations. A successful documentation technology must be easy to use, non-intrusive, hands-free, fast, and be of help to first responders.

Creating a Medic Voice Documentation System (MVDS) would provide better and more accurate pre-hospital information. The device needs to be be produced at a low cost and low complexity. In addition, when reaching a combat support hospital or emergency room, the device needs to be capable of up linking to a digital voice file to go to a host server using wireless technology and USB interface.

On February 2, 2009, The U.S Army Medical Research Acquisition Activity (USAMRAA) released a Draft RFP due in February but proposals were not accepted—just comments on how to build the MVDS. Go to www.usamraa.army.mil/pages/homepage.cfm to read the Draft RFP then click on solicitations for more details on the Army’s MVDS project.

The U.S. Army Medical Research Acquisition Activity (USAMRAA) is the contracting element of the U.S Army Medical Research and Materiel Command (USAMRMC) and provides support to the Command headquarters, laboratories, and medical logistics organizations. USAMRAA also supports Army-wide projects sponsored by the Army Surgeon General and numerous congressionally mandated programs.

DOE Helping Patients

At the Department of Energy’s Oak Ridge National Laboratory (ORNL), researchers are developing technology to improve life for epileptics. They have devised a computer-based method that will warn an epileptic that a seizure might occur in the next 20 minutes or so, giving the person time to stop hazardous activities or get medical help to prevent or reduce the severity of the seizure.

This alerting system referred to as “SeizAlert” has dime-sized electrodes worn by the individual that looks for pattern changes in the brain waves and then alerts the epileptic that a seizure is imminent. SeizAlert was developed at ORNL and researchers are working with Nicolet Biomedical Inc., in Madison Wisconsin to develop a commercial version of the system.

At another DOE laboratory, scientists at the Department of Energy’s Argonne National Laboratory are trying to understand epileptic seizures and why they occur. Scientists have created a life-like model of small areas in the brain using state-of-the-art high performance computers.

For many years, computer scientists have used complex models known as “neural networks” to model brain activity. Since each neuron can receive information in the form of an electrical pulse from thousands to tens of thousands of other neurons, scientists need an extremely powerful computer to handle all of the model’s interconnections. Neural network models give scientists a way to piece together things to understand how epileptic behavior translates from the action of just a few neurons to a behavior affecting the entire brain.

According to Argonne computer scientist Mark Hereld, models of neural networks provide a glimpse into epilepsy that complements information obtainable through clinical or laboratory studies. He continued to say “there are some questions that simply can’t be answered by examining a live patient or looking at a small piece of brain tissue in the lab.”

HIEs to Improve Care

A study supported by AHRQ at the Department of Community and Family Medicine, within Duke University Medical Center is looking at ways to take better care of patients with complex healthcare needs. The Center is looking at patients who receive care from multiple providers across disparate care locations and wants to coordinate care for these patients with complex healthcare needs to improve the transition of these patients into the ambulatory care setting.

For this study, the patient’s medical information is being made available to patients, primary care practitioners, and care managers following hospitalizations, emergency department encounters, and specialty clinic evaluations. To be able to exchange information, a regional Health Information Exchange (HIE) network was set up to enable providers to connect with 42,000 Medicaid beneficiaries across traditional institutional boundaries in both rural and urban settings in a six county region in the Northern Piedmont of North Carolina.

This network includes 25 ambulatory care practices, 3 federally qualified health centers, 4 rural health clinics, 3 urgent care facilities, 11 government agencies, 5 hospitals, and 2 cross-disciplinary care management teams. The HIE network has identified 4,608 patients with complex healthcare needs and the program is examining how effectively care transitions can be done between sites.

The study is using a randomized controlled trial with 4600 patients, 309 primary care clinicians, and 31 care management workers. The final objective is to develop a decision support system to provide the necessary information needed when discharging patients, or when patients go to the emergency room, or receive specialty care. The proposed system will be based on an emerging standard to use for decision support and will routinely use available claims and scheduling data.

Another study supported by AHRQ is demonstrating how the Southeast Nebraska Behavioral Health Information Exchange needs to be able to operate between rural and urban providers to improve behavioral health outcomes for patients with chronic mental illnesses. Currently, without electronic communication, behavioral health providers are unable to follow the entire treatment path of patients from mental hospitals, protective custody, or crisis mental health. The project will study the barriers to technology acceptance, the adoption of technology, and the impact of HIEs on clinical outcomes.

Both studies were started in 2008 and are scheduled to finish in 2011.

DOD Opening New Center

Dr. James P. Kelly, a neurologist has been appointed Director of the new Department of Defense National Intrepid Center of Excellence (NICoE) scheduled to open in 2010. NICoE a component center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), will conduct research, diagnosis, and treatment planning to help members of the military with psychological health problems and traumatic brain injury.

The Center will introduce therapeutic methods, referral and reintegration support for warriors, test new protocols, provide comprehensive training and education to patients, providers, and families while maintaining ongoing telehealth follow-up care. Top level experts from the VA, HHS, and other federal, state and local agencies as well as academic institutions will combine their expertise to assist in state-of-the-art healing techniques.

NICoE will be a 72,000 square foot, two story facility located on the Navy campus in Bethesda Maryland adjacent to what will be the new Walter Reed National Military Medical Center. It will have close access to the Uniformed Services University, and NIH.

The Center is being built and equipped through the Intrepid Fallen Heroes Fund, Fisher Foundation, and other individuals and groups. When construction is completed, the Intrepid Fallen Heroes Fund will turn NICoE over to the Department of Defense to operate.

“We are bringing Dr. Kelly to NICoE to assemble a world class team and to plan landmark programs and research so that the new center can begin benefiting our warriors as soon as the doors open,” said Brig. General Loree K. Sutton, DCoE Director and the highest ranking psychiatrist in the Army.

NY Helping Doctors

A program to help train and place physicians in medically underserved communities across New York state will provide $11 million to aid physicians with repayment of qualified medical school loans in exchange for a minimum five-year commitment to practice is an underserved area over five years. In addition, $11 million will be awarded over two years to aid physicians in expanding or establishing medical practices or healthcare facilities to recruit new physicians to practice in an underserved area.

The program called “New York State’s New Doctors Across New York” will offer 83 physicians up to $150,000 over five years for loan repayment, and 126 medical practices will receive funding of up to $100,000 over two years for practice and clinic support. In the coming year, the state expects to spend up to $1.5 million on physician loan repayment awards and spend up to $5.5 million in medical practice support awards.

Approximately 25 percent of New Yorkers live in 91 federally designated Health Professional Shortage Areas plus many other areas also have shortages of critical specialists. Seven counties have no practicing obstetricians and the Southern Tier has seen an 18 percent decline in obstetrician-gynecologists since 2001.

According to Assembly Speaker Sheldon Silver “Over a quarter of New Yorkers live in areas underserved by healthcare providers and half of the resident physicians leave the state after completing their training.”

The awards will include loan repayments for 17 physicians in primary care, 15 in family practice, 10 in obstetrics-gynecology, 11 in internal-adult medicine, 6 in emergency medicine, 4 in psychiatry and its sub specialties, 4 for general surgeons, and 4 for general pediatrics.

Healthcare institutions and physicians’ offices will be able to support 33 more family medicine physicians across the state, 27 primary care physicians, 12 internal medicine-adult medicine doctors, 10 general surgeons, and 8 physicians each in the fields of emergency medicine, psychiatry, and general pediatrics.

The awardees represent more than 100 individual facilities or physicians. Applications were reviewed based on the underserved community and its population needs, and the community’s circumstances such as the length of time the position had been vacant, if there are long waiting times for appointments, or if emergency rooms are overcrowded for routine care.

Canadians Collaborating with U.S.

ArticDx Inc. located in Canada just announced that a test designed to determine an individual’s inherited risk for Age-Related Macular Degeneration (AMD) is available. AMD is a progressive disease associated with aging that causes damage to the macula—the light sensitive cells at the center of the retina at the back of the eye. Over 15 million people in North America are currently affected by AMD and experts estimate that as the population ages, the number of individuals afflicted will double by the year 2020.

Seventy five to eighty percent of all AMD has been traced to genes inherited from family members, but until recently, there wasn’t a way to know who was carrying the genes and at risk. The test Macula Risk® developed by ArticDX makes it possible to know which individuals are carriers.

The test was developed by Dr. Brent Zanke, Chairman and Chief Medical Officer for ArticDx, in collaboration with an international group of independent research scientists. Analytical studies have shown that this test is 100% accurate in identifying AMD genes. Macula Risk® is available as a CLIA-certified laboratory saliva test to anyone who is concerned about a family member or themselves. It is recommended that adults be tested once in their lifetime.

ArticDx will introduce the test in Canada through Clarion Medical Technologies of Cambridge, Ontario. In the U.S, the company is working with a team of U.S. retinal medical advisors along with Dr. Chow that includes Dr Carl Awh (Tennessee Retina), Dr. Tarek Hassan (Associated Retinal Consultants, Michigan), Dr. Phillip Ferrone, (Long Island VitreoRetubak Associates), Dr. Pravin Dugel (Retinal Consultants of Arizona), and Dr. Peter Kaiser (Cole Eye Institute) at the Cleveland Clinic.

In Maryland, Stuart Weinstein, Director of Canadian Relations for Maryland’s Department of Business Development and Investment, reports that his state is trying to entice Canadian companies to invest in Maryland and use the state as their U.S. gateway.

According to Weinstein, there are hundreds of companies in Canada involved in healthcare and with the right investments could create thousands of sustainable jobs in Maryland. The goal is to attract Canadian firms to the U.S. rather than lose the Canadian business to overseas ventures.

Weinstein would like to see the Canadian companies send him a business plan to explain their U.S. expansion objectives over the next 12-60 months window. The businesses also need to provide information on incentives (based on employment created and capital expended) and their goals for creating employment on both sides of the border.

For more information, contact Stuart Weinstein at stuart.weinstein@maryland-canada.com.

Flight Paramedic Invents Tool

According to the recent MC4 publication “The Gateway”, SGT Michael Ferguson a flight paramedic with C Company, 1-168th Aviation Regiment, developed a way to capture medevac patient care information while in transit. SGT Ferguson said that his unit doesn’t find the MC4 handheld devices and laptops user friendly for pre-hospital use as they are geared to the clinical environment.

Flight medics find that the outpatient software on the laptop looks for information that is too detailed for the mission. Flight medics are not supposed to make a diagnosis of a patient’s condition, as you only need to document what they see or what they think is wrong with the person.

For example, if a patient experiences chest pains and you try to enter this information into AHLTA-T—the system wants “chest pain with cardiac origin” or any other specific chest problems entered. The job of the flight medic is not to determine the origin of a pain or injury and in this case should only enter “chest pain”.

To create the right form that is needed by flight medics with the right amount of information, SGT Ferguson developed the Patient Care Record (PCR) form. Now the patient’s information and our treatments are entered on the form while enroute to the hospital. When the flight medics and patient arrive at the treatment facility, the facility staff is given a verbal report based on the information that has been entered on the paper forms.

Medevac personnel enter the data from the PCR into MC4 within 24 hours after contact with the patient, and usually entered after the flight medic’s shift. At this point, the patient encounter and data goes into AHLTA-T with the electronic version of the PCR attached to the record.

As SGT Ferguson said “ our documentation might not be available electronically when the doctors and nurses in Afghanistan begin treating the patient, but when the wounded warrior arrives in Germany, the medical staff has the full medical picture and can know exactly what the flight medics did and observed enroute.

National Coordinator Named

HHS on March 20th announced that David Blumenthal, M.D., M.P.P is the Obama Administration’s choice for National Coordinator for Health Information Technology. As the National Coordinator, Dr. Blumenthal will lead the implementation of a nationwide interoperable privacy-protected health information technology infrastructure as called for in the American Recovery and Reinvestment Act.

Dr. Blumenthal most recently served as a physician and Director of the Institute for Health Policy at the Massachusetts General Hospital/Partners HealthCare System in Boston. He was Professor of Medicine and Professor of Health Care Policy at Harvard Medical School. There, he served as Director of the Harvard University Interfaculty Program for Health Systems Improvement.

Prior to that, he was Senior Vice President at Boston’s Brigham and Women’s Hospital and served as Executive Director of the Center for Health Policy and Management and as a lecturer on Public Policy at the John D. Kennedy School of Government.

During the late 1970s, Dr. Blumenthal worked on Senator Edward Kennedy’s Senate Subcommittee on Health and Scientific Research. More recently, Dr. Blumenthal advised the Obama for America campaign.

Dr. Blumenthal has extensively researched the dissemination of health information technology, quality management in healthcare, the determinants of physician behavior, access to health services, and the extent and consequences of academic industrial relationships in the health sciences.

“I am humbled and honored to have the opportunity to serve President Obama and the American people in the effort to harness the power of health information technology to modernize our healthcare system. As a primary care physician who has used an electronic record to care for patients every day for 10 years, I understand the enormous potential of this technology,” said Dr. Blumenthal.

Innovation Topic at Briefing

“American leadership in medical innovation must be part of our economic recovery plan,” said Former House Majority Leader Dick Gephardt a founding member of the new “Council for American Medical Innovation”. The Council was formed as a working partnership to urge Congress to adopt a national policy agenda to make possible medical innovation and discoveries in the life sciences.

To discuss the Council’s aims, several of its leaders met at the National Press Club in Washington D.C. on March 19th for a panel discussion. With Dick Gephardt as the moderator, the other panelists included Dr. Edward Benz, CEO, of the Dana-Farber Cancer Institute, Dr. Francis Collins, Former Director of NIH’s National Human Genome Research Institute, Billy Tauzin, President and CEO PhRMA, and Marc Boutin Executive Vice President and COO, of the National Health Council.

Dick Gephardt said that the need for our country to increase medical innovation is a personal matter for him and that is why he became instrumental in starting the Council. He recounted the story that his son at the age of 18 months developed cancer and was treated with the most current medicines available at the time. Because researchers had the resources and were able to develop medications, since access to this information was available, and insurance was in place to pay for treatments, his son now 39 survived cancer and is married with two children.

Billy Tauzin a cancer survivor said that when he was diagnosed with cancer, he was told that he would die. He was fortunately offered an experimental new medicine and he survived. He stressed that the U.S. is falling behind in research and innovative techniques and to continue U.S. leadership in the world, we need to maintain a lead role in scientific, technological, and medical innovation.

The panelists pointed out that a study released last month by the Information Technology and Innovation Foundation found that while the United States currently ranks sixth among 40 countries and regions in innovation and competitiveness, the U.S. placed last in terms of progress made over the last decade. Singapore, Sweden, Luxembourg, Denmark, and South Korea now outrank the U.S.

“Science and technology has contributed to more than half of the U.S. economic growth since World War II,” said Francis Collins, however, we have allowed that to slip. We need to establish a bold and coordinated plan of action to prepare out children for careers in innovation, provide support for scientific research, and get our economy back on track.”

“We are dependent on a strong environment for medical innovation as we stake out new territory in the fight against cancer and for the health and well-being of all Americans,” said Dr. Edward Benz, “Research means hope for millions of patients and families and medical innovation creates the cures and miracles of science that help keep Americans healthy and thriving.

All of the panelists are very concerned about the state of clinical trials in this country. Since it is hard to find people for clinical trials, more and more companies are conducting clinical trials in Asia Pacific countries. As a result, only 6% of the eligible patients in the U.S. actually participate in clinical trials with only 3% of U.S. adults with cancer participating in trials.

Other problems contributing to the declining lack of medical innovation in the U.S can be contributed to the reverse brain drain that is happening when skilled scientists, engineers, doctors, and researchers are turned away by U.S. immigration policies, Asia’s science and technology is growing and continues to outpace the U.S. and this growth continues to threaten America’s leadership in scientific and technology innovation, increased foreign competitiveness has led to a decrease in the U.S. global share of patents, plus the fact that the rate at which new drugs are being created has now slowed considerably.

The plan for the Council composed of leaders from research, medicine, academia, education, labor and business communities is to advocate for a comprehensive national medical innovation policy that will address how to:

• Attract companies and well-paying jobs to the U.S.
• Promote risk-taking in research and development
• Encourage more students to participate in science, technology, engineering and mathematics (STEM) education
• Attract the best and brightest researchers to the U.S.
• Support basic scientific research and development

For more information, go to www.americanmedicalinnovation.org.

Legislation Introduced

Senator Patty Murray (D-WA) and Representative Patrick Kennedy (D-RI) recently introduced legislation in both the Senate and the House to help scientists advance their understanding of the human brain and develop new treatments and cures for the millions of Americans who suffer from neurological diseases, conditions, and disorders. The bills referred to as the “National Neurotechnology Initiative Act of 2009” (S 586 and H.R 1483) are also being supported in the House by Ileana Ros-Lehtinen (Florida), Bob Filner (California), and David Wu (Oregon).

“Neurological disorders take a terrible toll on victims and their families,” Senator Murray said. “Yet despite the number of people who suffer from neurological conditions, we still have only a limited understanding of how the brain works and how best to treat injuries and illnesses. Thousands of troops returning home from battle are suffering from PTSD and TBI and the time is now to make a federal commitment to coordinate and fund neurological research.”

Representative Kennedy acknowledges that while researchers have made great strides in neuroscience, there is still much that is unknown about how this extremely complex organ works which means that we need to bring greater attention to brain-related illnesses.

The Senate and House bills would increase funding to NIH, help to remove bottlenecks in the system that would speed up research, help to coordinate neurological research across federal agencies by creating a blueprint for neuroscience at NIH, and streamline the FDA approval process for life-changing neurological drugs without sacrificing safety.

According to Senator Murray and Representative Kennedy, the Act would also provide economic benefits and help to create jobs in the emerging field of neurotechnology. In addition, better treatments could be developed that may reduce healthcare costs for everyone.

Physician Touts EMR System

Neil Calman, M.D co-founded and runs a 25 year old community health center network in the Bronx, Manhattan, and the Mid Hudson Valley of New York State. The Institute for Family Health network is comprised of 26 separate practice locations including 16 full-time health centers, three dental practices, two school health programs, and nine sites which serve New York City’s homeless population.

Dr. Calman explained how active the network is in the communities. The health center network is involved in recruiting underrepresented minority students into the health professions by serving as the New York City Regional Office of the Statewide AHEC. All of the sites train dozens of social workers, medical students, family practice residents, the faculty, and administration programs in the area.

The Institute’s research arm is supported by grants from NIH, CDC, and many other public and private entities to study health disparities. Importantly, the researchers are studying how health information technology can help to reduce and even eliminate those disparities in health outcomes.

According to Dr. Calman, seven years ago the Institute implemented the EPIC System, a sophisticated EMR and practice management system used across the network. The system cost $2 million to purchase and to implement. The purchase and implementation of the system has resulted in saving many lives.

Dr. Calman is actively overseeing that the elderly over 65 receive the vaccination against pneumonia. The system enabled the network to run a report on their patients and by doing the search found that they were giving only 19 pneumonia vaccines per month which seemed very low for the size of the population of patients.

So the computer was programmed to put out an alert whenever a patient over 65 or a patient with a high risk chronic disease had not been vaccinated against pneumonia. As a result, in the first month, 396 doses of the vaccine were given to patients.

As Dr. Calman reports, they have searched the system for patients who have creatinine levels in their blood of over 1.8 and have not been to a nephrologist. The computer search yielded 32 patients and as a result, 32 patients and messages were sent through the system to the providers to prompt them to send their patients for a consultation. The last time, the computer yielded a report to see how many patients with creatinine levels over 1.8 had not been sent to the nephrologist was three.

In another example, two years ago, a report came out that showed women taking Ace-inhibitors to treat high blood pressure could have serious heart and lung birth defects in 7% of all women taking the medication in the first trimester of pregnancy.

A search was done and revealed that 232 women of child-bearing age in the practices were on this medication. The next step was to send a list to each of the primary care providers, to tell them that their patients were at risk and to let them know of the new research data. Letters went out to all 232 patients that they should speak to their provider about taking the medication.

Dr Calman further described how a patient with diabetes who was homeless called him needing medical care late at night. Fortunately, she called his cell phone before leaving to go to the emergency room. Dr. Calman thought maybe the problem was due to an imbalance in her metabolism.

Before she left for the emergency room, he used his home computer to access her list of chronic problems, medications, results of her last EKG and other diagnostic tests, and immediately faxed them to the emergency room. At that point, the information was available to the ER doctors before the patient arrived, and they were able to make the correct diagnosis and treat her appropriately without hospitalizing the patient.

Three months ago, a patient portal was opened up to go into the EHR system. This enables patients to have access themselves to their records plus a hospital or specialist can have access to view major parts of medical their records online—24/7. Over 1600 of the patients served via the network have signed on to this service and over 1200 are already active users.

In summary, the EHR system allows the network to truly mange the 72,000 patients cared for in ways that would otherwise be unachievable.

Still Time to Register for ATA

Telemedicine is one of the most exciting developments in healthcare and is an integral part of healthcare reform. The telemedicine and telehealth field are truly booming. From emergency rooms to physician’s offices, from the home to schools, and in the workplace, telemedicine is extending the reach of healthcare services, improving care, and reducing costs throughout the world.

Now is the time to make plans to go the American Telemedicine Association (ATA) premiere forum to be held for the healthcare industry on April 26-28, 2009 in Las Vegas at the Rio All-Suites and Casino. Vital discussions will center on clinical and business issues related to telemedicine plus there will be hundreds of presentations, posters, and workshops.

More than 2400 attendees from all over the world will gather at the Conference to hear James Henry “Red” Duke, M.D. a trauma surgeon from the University of Texas Medical School give the Plenary Presentation. He will give his expert thoughts and opinions on trauma care, stress management, and how to deliver healthcare in remote and underdeveloped areas.

Dr. Duke has served as Special Assistant to the President of UT Health Science Center and holds a distinguished professorship at the UT Medical School as the John B. Holmes Professor of Clinical Sciences. He established Houston’s Hermann Hospital Life Flight operations and remains the medical director of the trauma and emergency services.

Dr. Duke is the former host of the nationally syndicated “Texas Health Reports” and hosted the former PBS series, “Bodywatch”. He has been featured on PM Magazine, NBC Nightly News, Today Show, and the Buck James television series.

Some of the 2009 hot topics include discussions on new the administration, home telehealth, remote monitoring, telepsychiatry, next generation communications, future innovations in telehealth technologies, legal and regulatory issues, workforce issues, telerehabilitation, remote imaging, and managing chronic care effectively.

The ATA 2009 Exhibit showcase is a one-stop shop for telemedicine products and services. This year, the exhibit hall will feature over 160 exhibitors and 100,000 square feet of exhibit space. Vendors covering the telemedicine spectrum, the corporate world, academic medical centers, government organizations, and non–profit services will be on hand to demonstrate the latest telemedicine technologies and telemedicine solutions.

Be sure to take advantage of pre-meeting course and symposiums. Telemedicine 101 is scheduled for April 25th Telemedicine 201 has been added to the educational lineup on April 26th along with several Partner Meetings and a full day International Symposium.

Go to www.americantelemed.org/i4a/pages/index.cfm?pageID=3486 for more information or to register.

Disparities in Healthcare

There are challenges to delivering healthcare to rural and underserved areas according to Neal Neuberger, Executive Director for the Institute for e-Health Policy. He was speaking before a packed room at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics briefing held on March 13th. The problems concern the lack of a business case for connectivity, no aggregate buying power exists, areas are isolated with lower incomes, less private insurance available, areas have many older rural residents, plus there are cultural and language barriers.

“Increasing the use of the internet, ehealth and other information technologies among minority populations is the tool to use to reduce health disparities. These technologies have the potential to facilitate behavior change, improve healthcare, and enhance health outcomes”, said, Garth N. Graham MD, MPH, Deputy Assistant Secretary for Minority Health, Office of the Secretary, HHS.

Dr Graham emphasized we must focus on the underserved population since chronic diseases are increasing, more disabilities occur in underserved areas, more obesity exists along with heart disease, diabetes, and HIV/AIDS, and fewer doctors tend to practice in rural areas.

Dr Graham continued to say if more providers had health IT, there would be more access for the uninsured along with better chronic disease coordination and management. Health IT would help providers locate specialty care, track patients and their eligibility for Medicaid, generate reminders at the point-of-care, use e-prescribing with clinical decision support, have immediate access to the patients records, and be able to generate custom reports.

To help address the need to reduce disparities in healthcare, HHS established the “Work Group on Health IT and Underserved Populations” to look at ongoing activities, challenges, and potential opportunities to help the disparity populations.

In addition to the HHS work group, the National Health Information Technology Collaborative for the Underserved was started in 2008. The purpose of the Collaborative is to improve the health of communities and populations that have historically had the worst health outcomes and the least access to care. The objectives are to help consumers use HIT for health self-management, create a health IT workforce, and facilitate funding for health IT implementation.

Coming from Spokane Washington, Nancy Vorhees, COO, Inland Northwest Health Services (INHS), came to describe the important the services provided by INHS and how these services operate effectively in Washington, Idaho, and California. The INHS system enables 38 hospitals in the region to share a single hospital information system and patient identifier. More than 450 physicians in Washington and Alaska are able to use common EMRs, and now patient safety tools have been developed that are used in hospitals in North Carolina and Florida. To further serve the region, the INHS Telehealth network is connected to 65 hospital clinics and public health agencies.

The INHS provides for a number of community programs that entail screenings, health promotions, health education, childbirth and parenting education. In addition, INHS provides for a diabetes center and helps employees maintain their health by providing worksite wellness programs.

As Vorhees pointed out, INHS was successful because early on, the leaders at INHS developed an IT strategic plan, learned from their experiences, and INHS only used vendors that were successful in the field.

Michael Lardiere, Director of Health IT and Senior Advisor, Behavioral Health for the National Association of Community Health Centers, reported that the stimulus funds will help the centers by providing $1.5 billion for construction, renovations, equipment and to purchase health IT.

He explained that providers in Federally Qualified Health Centers (FQHC) are eligible to receive Medicaid incentives if at least 30% of their patients are defined as “needy individuals”. Patients that are covered by Medicaid include individuals in Medicaid management care, enrolled in CHIP, receiving charity care, or individuals paying for their care on a sliding fee scale basis.

He is concerned that the Medicaid incentive payments may not pay for practice management systems. Health centers need to move quickly in order to receive payments and they need to implement e-prescribing, be able to exchange information, and also be able to report clinical quality measures.

To help the centers get started with technology, Lardiere pointed out that the states will provide grants and loans but they will require matching funds such as $1 for $5 of Federal funding. The first awards must be made by January 2010.

Bill Finerfrock, Executive Director for the National Association of Rural Health Clinics reported that the incentive payments in both Medicare and Medicaid are available for physicians, hospitals, and certain other providers, but only physicians are eligible for the Medicare incentives. Physicians must choose whether to receive a Medicare incentive payment or a Medicaid incentive payment but they are not permitted to choose both.

Physicians in order to be eligible for incentive payments must be a meaningful user of a certified EHR system. Physicians are eligible for the incentive payments starting 2011 and up until 2015. By 2015, if the provider has not begun to use an EHR system then the provider will see a reduction in payment.

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.

Developing Tests for Heart Disease

The Framingham Heart Study (FHS) funded by the National Heart, Lung, and Blood Institute has launched an initiative to find risk factors and markers that could lead to new blood tests to identify high risk individuals for heart disease and stroke. A public-private partnership has been established to enable researchers to apply cutting-edge technology to stored blood samples from thousands of FHS participants. FHS is collaborating on the research with Boston University School of Medicine and School of Public Health.

According to NHLBI Director Elizabeth G. Navel, M.D., “This study will take our research to a whole new level. Imagine having a simple blood test to tell us if a patient is at high risk for a heart attack or stroke. At that point, we could do so much more to prevent or delay these often debilitating and deadly diseases.”

“This partnership will help us bolster new discoveries about heart disease risk factors by applying the latest technology to data collected by Framingham researchers while continuing to respect and safeguard our participants’ privacy,” said Daniel Levy, M.D., Director of FHS and the NHLBI Center for Population Studies. Dr. Levy is also Professor of Medicine at Boston University School of Medicine.

Researchers will study 1,000 blood biomarkers. The study called the “Systems Approach to Biomarker research in Cardiovascular Disease (SABReCVD) will identify and validate new biomarkers—such as proteins or molecules in the blood for heart disease.

The research will be conducted under a five year cooperative research and development agreement with BG Medicine, a Massachusetts-based biotechnology research company that has developed patented technology to detect and validate subtle biological changes at the molecular level.

Other projects that compose the SABReCVD initiative will explore protein biomarkers of cardiovascular disease and gene expression changes associated with the biomarkers. Data from these studies will be accessible to other scientists through the Database for Genotype and Phenotype (dbGAP).

PDA's Helping Patients

Faculty members at the Harvard-MIT Division of Health Sciences and Technology along with Brigham and Women’s Hospital recently launched a project in Lima Peru. The group worked closely with the Peruvian sister organization of Partners in Health, Socios enSalud.

Healthcare workers were equipped with PDAs which made it possible for doctors to receive their patient’s test results in just 8 days and eliminated the few cases where results were missing for several weeks or months. The handheld devices are also more cost effective than the paper based system as reported in the “International Journal of Tuberculosis and Lung Disease.”

For patients who have drug-resistant forms of tuberculosis, it is critical to monitor the disease as closely as possible. This means that monthly testing needs to be done for two years six days a week for the first six months.

Under the old patient tracking system, a team of four healthcare workers would visit more than 100 healthcare centers and labs twice a week to record patient test results on paper sheet. A couple of times a week, they returned to their main office to transcribe those results onto two sets of forms per patent. One form went to the doctor and the other form went to healthcare administrators.

From start to finish, this process took an average of more than three weeks per patient. In some extreme cases, results were temporarily misplaced and could take up to three months to be recorded. There was also greater potential for error because information was copied by hand so many times.

With the new system, healthcare workers enter the lab data into their handheld devices, using medical software designed for this purpose. When the workers return to their offices they sync up the PDAs with their computers.

NIST Posts Grant Opportunity

The National Institute of Standards and Technology (NIST) within the Department of Commerce posted a notice on March 16th for the “NIST Recovery Act Measurement Science and Engineering Research Grants Program”. The grant program will provide funding to develop the technology infrastructure needed to address national priorities. NIST announced that $35 million will be available for the awards to go to approximately 20-60 grantees to support NIST’s measurement science and engineering research.

Proposals need to address areas of national importance to include energy, environment and climate change, information technology, cyber security, biosciences, healthcare, manufacturing, and physical infrastructure.

This grant notice (2009-NIST-ARRA-MSE-Research-01) will close for applications, 30 days after the publication of the notice announcing the grant program as it appears in the Federal Register.

For more information and to receive updates, go to www.grants.gov and sign up with an email address. For more information, contact Christopher Hunton, at 301-975-5718.

VA Budget Discussed

The President’s FY 2010 budget request due at the end of April would increase the VA’s budget to almost $113 billion up more than $15 billion from last year’s budget, according to Eric K. Shinseki, Secretary of Veterans Affairs appearing before both the Senate and House Committees on Veterans Affairs. He provided the Committees with some of the proposed budget request details related to veteran healthcare.

The Secretary notes that there needs to be increased funding for healthcare as the VA needs funds to treat more than 5.5 million veteran patients. The number of patients who served in Operations Enduring Freedom and Iraqi Freedom alone will rise to over 419,000 in 2010.

According to the Secretary, the VA is emphasizing treatment for veterans with vision and spinal cord injuries and at the same time trying to meet the rising demand for prosthetics and sensory aids. The VA is collaborating with DOD to establish a DOD/VA Vision Center of Excellence to find better ways to prevent, diagnosis, treat, research, and to rehabilitate eye injuries especially if the injuries are associated with TBI.

The VA is committed to providing outreach services relating to mental health care and cognitive injuries and will dedicate increased resources to treat Post Traumatic Stress Disorder and Traumatic Brain Injuries.

The VA is especially interested in helping veterans that are living in rural areas to receive mental health treatments. The VA is making it possible for veterans to receive appropriate mental healthcare if they are not located reasonably close to the care. Veterans are now permitted to receive care on a fee basis from a private facility. Other strategies needed to provide veterans with better healthcare in rural areas is to expand the telemental health program, Vet Centers, the use of community-based mental health centers plus expand the use of internet-based mental health services through “MyHealtheVet”.

The Secretary reports that women are becoming increasingly dependent on the VA for their healthcare. More than 450,000 women veterans have enrolled for care and this number is expected to grow by 30 percent in the next five years. The VA expects to soon have 144 full time Women Veterans Program Managers serving at VA medical facilities to act as advisors and advocates.

The FY 2010 proposed budget calls for research efforts to focus in general on TBI and polytrauma, but specifically on research studies involving blast-force related brain injuries, burn injuries, chronic pain, and to come up with new ways to advance telemedicine.

According to the Secretary, the proposed budget supports IT development for the VA’s “HealtheVet” program with both the VA and DOD working together to simplify the transition of military personnel into civilian status.

The Secretary also addressed the need for the VA to use an automated system to process claims. Currently, the VA is teaming with the Space and Naval Warfare Systems Command to develop the system. It is anticipated that the automated claims processing solution will be tested in 2010 and by 2012, a fully implemented electronic benefits system will be available.

HIT Topic at Briefing

The massive investment included in the stimulus funding raises a host of challenges but also many opportunities for stimulating health IT. There is great hope that the funding and reform will be able to deliver better health outcomes, according to Susan Dentzer, Editor-in-Chief, “Health Affairs”. She spoke at a briefing held in Washington D.C. on March 10th to release the publication’s March/April issue that has articles on health IT initiatives, healthcare from the industry perspective, privacy concerns, and public policy issues.

Louise Liang, Senor Consultant with Kaiser Permanente Health Affairs described how 8.7 million members have the benefit of a complete or partial KP HealthConnect record with outpatient EMRs available to all care teams. Today, 23 hospitals are working with the complete KP Health Connect suite, and almost 3 million members are actively using My Health Manager at www.kp.org. .

Kaiser has documented their system’s impact on patient visits and patient-physician e-mail messaging at KP Hawaii. Between 2004 and 2007, total office visits per member decreased by 26.2 percent, from about five visits per year, per member to about 3.7 visits per year per member, secure e-mail messaging increased six fold to 51,000 in 2007, and quality and satisfaction was maintained or slightly improved.

Peter Neupert, Corporate Vice President, Microsoft Health Solutions Group, looking at healthcare technology from the industry perspective, told the attendees that the U.S. has to encourage innovation in health IT by setting out objective goals and criteria. Innovation will not happen by mandating specific technologies or development models.

He further commented, “We need to reward innovative doctors who use the internet to provide for a patient-physician connection. At the same time, we need to remove barriers on data sharing and really provide incentives for data exchange. It is very important for the private sector to operate in the right environment so that an information infrastructure to connect data, systems, and people can be developed.” Neupert noted that although standards are very important to develop health IT, the focus should be on making data interoperable today and not wait for standards to develop tomorrow.

Colin Evans, as Vice President of Dossia Consortium an employer-led non-profit organization dedicated to improving health and healthcare, said “The recent passage of the 2009 Recovery Act is a huge step forward. The law expands the patient’s right to have data sent to a PHR or other entity of your choice.”

Dossia focuses on empowering individuals to have patient control and ownership of their health data to enable competition. Informed consumers can make smarter more cost efficient decisions and easily change their health plan or doctor. Real change will only come when every American healthcare consumer has the power and ability to participate as a true stakeholder in their own health.

Addressing community needs, Farzad Mostashari, M.D., Assistant Commissioner for the New York City Department of Health, stressed that community projects create the demand for improved EHR products. It is important to ensure that the implementation of electronic health records is focused on public benefits that might otherwise get overlooked. There is fear that an opportunity to achieve quality and efficiency gained through health IT expansion will be lost unless federal strategy is grounded in the proven success of the community extension model.

Concerning privacy issues Deven McGraw, Director of the Health Privacy Project at the Center for Democracy and Technology (CDT), reported that several specific recommendations were adopted in ARRA and the privacy language of the Act represents the most significant expansion of privacy protections in a decade. The Act includes better enforcement of HIPAA, expands the HIPAA privacy rule, covers electronic exchanges, tightens rules, limits the use of information for marketing purposes, examines HIPAA standards for de-identification, and ensures electronic access by consumers. However, there is still work to be done. There needs to be a reexamination of health care operations in HIPAA and protections are needed for information in PHRs.

McGraw continued to say that privacy is an important part of health reform. With ARRA enacted, the Administration is turning to privacy and the question of healthcare reform. CDT intends to keep working to make certain that effective privacy solutions are included in health reform.

In March 2008, CDT launched a major initiative to address the complex privacy issues associated with the growing use of IT to collect and exchange sensitive personal health information. As a result, the Health Privacy Project was created and led by McGraw brings together key stakeholders active in the health IT arena with the purpose to break the privacy “logjam” by developing pragmatic, effective solutions. In 2009, CDT has been asked to participate in the National Quality Forum’s efforts to provide for the effective and efficient capture of health data for quality purposes.

For more information, go to sgorden@burnesscommunications.com or www.healthaffairs.org

Broadband Meetings Coming

NTIA and USDA’s Rural Utility Services (RUS) have announced a series of Public Meetings to be held from March 16-24, 2009. In addition to the meetings, the agencies are seeking written comments on NTIA’s Broadband Technology Opportunities Program (BTOP) and the RUS Broadband Program that provides grants and loans.

Both of these Broadband programs were established by the American Recovery and Reinvestment Act of 2009. Most of the meetings will be held at the Department of Commerce in Washington D.C. at 10am. The March 17th meeting will be held in Las Vegas, Nevada with the following day’s meeting scheduled for Flagstaff, Arizona.

Both NTIA and RUS are soliciting comments on a range of topics due on April 13th. Some of the possible topics include the purpose of the BTOP, role of the states, eligible grant recipients, criteria for grant awards, grant mechanics, grants for expanding public computer center capacity, grants for innovative programs, broadband mapping, financial contributions by grant applicants, timely completion of proposals, coordination between the BTOP and the RUS grant program, how terms should be defined, how success in the BTOP should be measured, effective ways for RUS to offer broadband funds, how RUS and NTIA can best align their activities, how to determine whether a particular level of broadband access and service is needed to help economic development, how priorities should be set to select applications, and what benchmarks should be used to determine the success of activities.

NTIA is working with $4.7 billion and plans to release three grant rounds with the first round to take place from April to June 2009. RUS will also be releasing three grant rounds in 60-90 days.

The FCC is not giving out grants in connection with the new broadband initiatives but the Commission is directly involved with broadband through their Rural Health Care Pilot Program. Acting FCC Chairman Michael J. Copps said, “The FCC has been given an important role in the next 12 months to develop a national broadband strategy.

Details from both NTIA and RUS on the scheduled meetings and their request for comments were published in the March 12th Federal Register. Comments to be considered can be filed at www.ntia.doc.gov/broadbandgrants.

Telehealth Grant Info Posted

HRSA’s Office of Health Information Technology (OHIT) posted information on the Telehealth Resource Center Grant Program (HRSA-09-195) on March 13, 2009. The grant program administered by the Office for the Advancement of Telehealth within OHIT supports the development of Telehealth Resource Centers as an independent source of technical assistance to help healthcare organizations, networks, and providers implement cost effective telehealth programs. This is mainly to help serve rural and medically underserved areas and populations.

The program will provide funding for fiscal years 2009-2011. Approximately $1,800,000 is expected to be available annually to fund six grantees. The grant application is due April 22, 2009. Matching funds and cost sharing are not required for these grants. The maximum award for an individual Regional Center will be $325,000 for FY 2009 with the maximum award of $175,000 for the National TRC for 2009.

Eligible applicants can include public and private non-profit organizations and institutions, including state and local governments. The regional centers can be collaborative organizations composed of more than one entity, but only one entity can be the official applicant for the funding—all others can be members of the consortium or network. For profit entities may be part of a consortium but cannot be the grantee.

For more information, go to www.grants.gov or contact Monica M. Cowan, Public Health Analyst, Office for the Advancement of Telehealth at 301-443-0076.

China Investing in High Tech

A new study from the RAND Corporation examines how China’s Tianjin Binhai New Area (TBNA) and the Tianjin Economic Technological Development Area (TEDA) can build regional development and economic growth by focusing on emerging high technology applications.

Despite strong economic growth in the past few decades, China still has a number of pressing challenges. China needs to reduce rural poverty, provide for a large and rapidly aging population, meet the population’s health and sanitation needs, meet growing energy demands, address water shortages, reduce pollution, and sustain high economic growth.

According to Richard Silberglitt, lead author of the study and a senior physical scientist at RAND a nonprofit research organization, said “TBNA and TEDA’s pursuit of the recommended technology applications will provide nations with all levels of science and technology capacity to productively engage China as it moves forward, both as consumers and suppliers of advanced technologies.”

The RAND study took national concerns into account along with the missions of the two regions. The study analyzed the factors that can facilitate or hinder implementation of technologies. The researchers also looked at the capacity available to TBNA and TEDA to evaluate which technology applications would be the most feasible and productive to pursue.

The RAND report recommends that TBNA and TEDA focus on promising technology applications to include, cheap solar energy, advanced mobile communications and radio-frequency identification (RFID), rapid bioassay tests to quickly detect the presence or absence of specific pathogens or toxins in blood food, air, or water, membranes, fabrics, molecular scale drug design and development, electric and hybrid vehicles, and green manufacturing.

NIH Funding New Grants

As part of the Recovery Act, NIH is funding at least $200 million in FY 2009-2010 for a new initiative called “NIH Challenge Grants in Health and Science Research”. This new program to fund 200 or more grants will support research on “Challenge Topics” that address specific scientific and health research challenges in biomedical and behavioral research.

Challenge Topics as defined by NIH will focus on specific knowledge gaps, scientific opportunities, new technologies, data generation, or research methods that could benefit from an influx of funds to quickly advance the research in significant ways. The research should have a high impact in biomedical or behavioral science and/or public health.

Some of the topics within this program include comparative effectiveness research, enabling technologies, enhancing clinical trials, health disparities, information technology for processing healthcare data, science, technology, engineering and mathematics education, smart biomaterials, and translational science.

According to Jo Anne Goodnight, NIH SBIR/STTR Program Coordinator, small businesses are eligible to apply for grants under this program. Although the Act provides that the funds to NIH are not subject to the SBIR/STTR set-aside requirements, small businesses are eligible and may apply for Recovery Act NIH funding opportunities.

Small businesses are encouraged to subscribe to the weekly NIH Guide for Grants and Contracts to keep updated on opportunities that are due to be released in the upcoming weeks.

For more information, Go to http://grants.nih.gov/grants/funding/challenge_award/index.htm or go to http://grants.nih.gov:80/grants/guide/guide/rfa_files/RFA-0D-09-003.html or email Jo Anne Goodnight at JG128w@nih.gov. The due date for the Challenge Grants is April 27, 2009.

Centers Integrating Tech

Ohio State University’s Medical Center and Emory University’s Woodruff Health Sciences Center have formed the “Alliance for Predictive and Personalized Health”. The partnership is aimed at transforming healthcare into a more patient-centered system. The goal is to integrate scientific breakthroughs in genomics and molecular biology along with advances in communications and information technology.

Personalized healthcare is the cornerstone of OSU’s Medical Center’s vision. A few years ago, Ohio State formed the Center for Personalized Health Care. The Center’s purpose is to join programs in biomedical informatics, genomics, and biomarker science, imaging, clinical trials and investigations, employee health managed care, and clinical applications. The university has incorporated personalized healthcare practice into university health plans with the introduction of “Your Plan for Health”

Dr. Daniel Sedmak, Executive Director of the Center for Personalized Health Care said “We have a tremendous opportunity to leverage existing strengths and programs within our institutions, so that we can develop a new model of healthcare that is tailored to the individual patient for prediction, prevention, and treatment.”

Emory University and the Georgia Institute of Technology have established the Emory/Georgia Tech Predictive Health Institute. The Institute’s Center for Health Discovery and Well Being combines a research core to investigate new genetic and protein biomarkers. The Center performs clinical testing and translational research.

The OSU/Emory new Alliance will focus on:

• Genomics/biomarker science—Bio-banking, shared databases and shared core resources focused on cancer genetics, autoimmune imaging, critical care medicine, wound care, and behavioral medicine
• Clinical investigation/clinical trials—Phenotyping and biomarkers, access to information, medical and legal liability issues, education and training to change the culture around personalized healthcare, systems biology, and mathematical bioscience
• Biomedical informatics and information technology—Data integration, hypothesis testing, biomedical informatics, healthcare information systems, high throughput computing, and genomics/proteomics
• Technology transfer and research management—Intellectual property management and technology research and development with a focus on databases, biobanks and biomarkers
• Environment—Integrated approach to environmental risks and health maintenance
• Behavioral science—Behavioral medicine, nutritional science, humanities, and social sciences
• Legal, ethical and health policy

CTEC Issues Brief

The California Telemedicine and eHealth Center (CTEC) recently published a brief outlining ways to expand telehealth/telemedicine. The publication “Optimizing Telehealth in California: An Agenda for Today and Tomorrow” addresses the promise and potential for the use of telemedicine in California’s healthcare system.

The brief is organized around two broad recommendations and 37 action steps needed to reach full optimization of the technology in the state. Specifically, the brief recommends that telemedicine should be developed and implemented in every situation where the technology is used to care for patients with the result that costs are reduced. Also telemedicine should be a covered and reimbursable method for delivering services across the entire spectrum of healthcare.

Government plays an important role and according to the brief, there needs to be a telehealth government task force that will make sure that telehealth efforts are coordinated. Also state agencies need to identify possible applications and develop feasibility studies to expand telehealth to achieve reductions in cost and to provide efficient service.

The brief suggests that to achieve support from large employers, the California tax code needs to allow telemedicine sites to be treated in the same manner as other employer provided medical benefits. It is important to encourage health insurers to provide discounts for some of the employers that support preventive medicine via telehealth services and also if they provide health education and home monitoring.

The brief emphasizes that consumer demand is a critical link in acceptance and expansion of any new product and telemedicine is no exception. Consumers will pick telemedicine options if they are informed of the benefits of the program. Researchers at Purdue University, along with many others consider consumer demand as perhaps the single most critical factor in the expansion and deployment of telehealth.

According to Christine Martin, Executive Director of CTEC, telemedicine is an extraordinary tool that has been shown to improve healthcare access, quality, and efficiency in new and cost effective ways. The brief prepared in collaboration with a variety of stakeholders is set to influence California’s use, funding, and support of telemedicine.

For a copy of the brief, go to www.cteconline.org.

Measuring EMR Impact

Experts at Worcester Polytechnic Institute (WPI) have launched a three year study of health IT systems that are operating in various stages of implementation at four medical organizations. The National Science Foundation is funding the study for $750,000. Over the course of the study, the research team will work closely with the leadership at primary care sites, conduct a series of interviews and observational sessions with physicians, management, and support staff. The researchers will observe the planning for health IT implementations and observe the roll-out of the systems in various locations, and examine how management and staff adapt to the new systems and tools.

“Adapting to computer systems will be a learning process for primary care organizations, for physicians, and even for patients,” said Diane Strong, Ph.D., Professor of Management at WPI. “From what we observe, we will develop new ideas and new concepts for healthcare delivery, such as better ways to organize work flow and make decisions to take advantage of the new opportunities that IT systems provide.”

Two of the organizations to be studied are located in Massachusetts. One is the Fallon Clinic a large group medical practice located in Central Massachusetts. The other Massachusetts organization is UMass Memorial Health Care, an integrated medical system with 700 primary care physicians, several community hospitals, and an academic medical center serving Central New England. The organizations outside of the U.S. involved in the study include the Vancouver Coastal Health District with a primary care office in Canada and two sites in Israel.

Israel is unique and operates their hybrid healthcare delivery model with four health funds that provide medical care to the entire population. The study will examine primary care practices in two of the health funds that provide care in Israel.

Israel, for example has the most extensive experience with health IT since Israel has more than 90% of physicians already using the technology. “Looking at the experience in Israel will give us a reality check,” said Professor Isa Bar-On Ph.D., Professor of Mechanical Engineering and one of the principal investigators leading the study. “We’ll see what works, and what doesn’t work and learn from people who have been using these systems for more than ten years. We will look at organizational changes in response to the implementation of these systems. We want to see how people live with the systems.”

The four sites were chosen because of their diversity of operating models, management structures, financial systems, and cultural differences. The sites are all at different points on the continuum of migrating from paper-based systems to fully digital systems which should provide the researchers with a broad range of perspectives and data for analysis.

Research Key to Success

Funding health IT research is needed to prove that health technologies can be totally productive in the healthcare environment, according to Kentucky’s Lieutenant Governor Daniel Mongiardo M.D. He voiced his ideas at the 2009 Health Information Security and Privacy Collaboration (HISPC) Conference held in Bethesda Maryland on March 5th.

He explained that Eastern Kentucky with 10,000 uninsured patients has used e-health for the past several years. By being able to share medical information, costs in that part of Kentucky have been reduced by 60% for patients in the top ten healthcare categories, by 87% in hospitals, and 92% in ER visits. This has occurred because decision makers can provide the right care by having the right information at their fingertips.

The Lieutenant Governor notes that although healthcare professionals have been slow to implement electronic health technology, this is not necessarily because of the cost involved or the providers’ lack of interest in using technology in their offices. One of the main reasons for slow implementation is that since there hasn’t been any research done on comprehensive IT models, and therefore providers haven’t seen the proof that health IT is effective. They are told continually that health IT is effective but many providers aren’t yet convinced.

The Lieutenant Governor reported that so far, limited funds have been available for investing in health IT research. Funds are needed to prove that HIT is effective, the data needs to be published, and at that point, the technology should be integrated into clinical practices.

The Lieutenant Governor went on to say a National Research Facility is needed that would provide a comprehensive model for next generation healthcare. The research must prove that there is a return on investment in the technology and that the use of health IT has an impact on health outcomes.

The proof obtained from research on the effectiveness of health IT would really help U.S companies such as GE, Microsoft, and Google sell the medical community on technology. Health IT companies need to have the right evidence to be able to penetrate the largest IT markets not only nationally but globally.

Research dollars also need to develop decision support tools, develop programs to help deal with population health and prevention, provide biosurveillance data to increase the ability to pinpoint hot spots for diseases, and provide for a viable program on genomics.

Managing Digital Data

Developing the framework to effectively provide access to digital scientific data is the goal for the National Science and Technology Council’s Committee on Science and their Interagency Working Group on Digital Data. The Group published the report “Harnessing the Power of Digital Data for Science and Society” in January 2009 that examines how digital technologies are reshaping science and the tools that scientists need to deal effectively with the data.

Digital imaging, sensors, analytical instrumentation, and other technologies are becoming important in all areas of science. Digital technologies are changing and revolving due to the expansion of networked cyber infrastructure and all the new technologies that now or will be used to make observations of unprecedented quality, detail, and scope. As a result, the need for access to all this form of information will greatly increase around the world.

Today there are revolutionary sensor systems, massive databases, digital libraries, unique visualization environments, and complex computational models. While digital technologies are the engine of this revolution, the fuel is digital data. Data that is “born digital” which means the data is available only in digital form and preserved only electronically is now becoming the primary output of science. The total volume of digital data and the rates at which the data is being created globally is increasing at a very rapid rate.

There are a number of issues that can affect managing the enormous amount of data now and that will be even more evident in future years. Some of the prime problems that need to be examined concern the loss of digital data, decay of the storage media, dependence on outmoded formats or systems, and errors in reading, writing, and transmission. In addition, data may be put at risk of being discarded because the owner is no longer identifiable or available. Strategies for mitigating these risks include management planning, controlled redundancy, managing migration to new technologies, and developing error checking schemes.

The Interagency Working Group on Digital Data has worked with nearly 30 agencies, offices, and councils to develop strategic requirements. The Group came to the conclusion that digital data challenges can’t be met by the federal government or any one sector acting alone. Government at the federal, state, and local levels, industry, academia, foundations, international organizations, and individuals are all participants and need to address the capabilities needed for digital information preservation and access.

For more information, go to www.ostp.gov/cs/nstc.

Presolicitation Notice Posted

The National Institute on Drug Abuse (NIDA) has issued a Presolicitation Notice. The contract when awarded will provide data management and statistical analysis services to support multi-site clinical trials conducted within the Institute’s Clinical Trials Network. The activities are to support trials carried out under cooperative agreements with regional Research and Training Centers located across the nation.

The trial studies include behavior, pharmacological, and integrated therapies in community-based Treatment Programs. Support services needed are in the following areas to:

• Administer systems to collect manage and store study data
• Design and perform all statistical analyses
• Review and monitor the quality of study data
• Monitor trial progress
• Prepare reports for the Data and Safety Monitoring Board
• Provide support for protocol development in the data management and statistical areas
• Prepare and maintain data files for NIDA Data Share
• Participate in relevant committee and subcommittee meetings and conference calls
• Provide expert consultation and support services as needed

It is anticipated that there will be an award of one cost reimbursement contract for a base period of two and a half years. NIDA anticipates substantial subcontracting opportunities. RFP N01DA-9-2217 will be available electronically on or about March 23, 2009.

Go to www.fbo.gov or through the NIDA website at www.nida.nih.gov/RFPList.html to access the RFP when it is published. For more information contact Pedro M. Godinez, at pg186o@nih.gov or phone 301-443-6677.

Nurses Provide for the Uninsured

President Obama hosted a healthcare summit at the White House on March 5th bringing together 120 Summit attendees. Many issues were discussed but one of the most critical issues facing our country is finding ways to provide healthcare for the uninsured.

According to the American Academy of Nursing, nurses have already been implementing innovative, cost effective, and efficient tactics to mandate coverage for the uninsured. AAN wants nurses to be viewed as a core component in healthcare reform with legislators and healthcare colleagues fully incorporating nurses into the discussion.

For example, the Queen Street Clinic an independently-run facility provides affordable health services for the medically uninsured in Alexandria, Virginia and in the surrounding areas of Northern Virginia. The Clinic was established without government funding, and to keep office costs to a minimum, the clinic does not interact with insurance companies. Instead they charge a nominal fee for primary care and work with patient assistance programs to order medications that otherwise would be cost prohibitive to the patient.

The Clinic has treated more than 20,000 patients since opening in 2001. By allowing access to necessary treatments for the uninsured through fairly simple measures, they have cost- effectively helped to lessen undetected heart disease, pregnancy, and diabetes in the NOVA region

In another effort, a successful partnership program called the Nurse-Family Partnership helps first time uninsured parents give their children a better start through a nurse-home visitation schedule. These visits have helped to lessen the prevalence of high-risk pregnancies in the inner city.

Washington State University Institute for Public Policy in evaluating the program found that the program had the highest return on investment among all home visiting and child welfare programs. Overall, this program provided a net benefit to society of $17,180 in 2003 dollars for each family served, which equates to a $2.88 return per dollar invested in the program initially. For the higher risk families now served by the program, a RAND Corporation analysis found a net benefit to society of $34, 148 per family served, with the bulk of the accruing to government.

Tech Helps Stroke Survivors

Stroke is the leading cause of long term disability in the U.S. On an average, a stroke occurs every 40 seconds in this country with approximately 780,000 people suffering strokes annually. Two-thirds of all stroke patients require intensive rehabilitation. It has been found that stroke patients who were rehabilitated using a robot to navigate virtual reality environments were able to walk faster and walk a greater distance following physical therapy as compared with those patients trained with the robot alone, according to researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ).

The experiment had the patients manipulate the robot by using a handheld gaming joystick with their feet and navigate a plane and a boat in their virtual environments through various targets and changing weather conditions.

As Judith E. Deutsch PT, PhD, Professor and Director of Research at the Virtual Environments and Rehabilitation Sciences (RIVERS) lab at UMDNJ pointed out more and more physical therapists will learn how useful virtual reality systems to drive behavior and train patients can be. In the future, there will be a substantial interfacing of robotics and virtual reality systems that will be used for rehabilitation. Dr. Deutsch, reports that RIVERS Lab’s next endeavor is to figure out who are the right patients for this type of rehabilitation.

In another project at New York-Presbyterian/Weill Cornell, researchers studied how to help stroke survivors suffering from partial paralysis on one side of their body. It has been found that only 5 percent who receive rehabilitation therapy ever regain full control of their arm, however, a new high tech arm brace just developed may better those odds and help millions of patients to regain the ability to perform everyday tasks.

The researchers are using the Myomo e100 NeuroRobotic System ™ that works by sensing electrical impulses in the muscles that are indicating intended movement and provides patients with motorized assistance. A pilot study published by Dr. Joel Stein, Director of the Rehabilitation Medicine Service at the hospital, showed that stroke survivors with severe arm weakness that used the Myomo device showed a 23 percent increase in a measure of arm movement.

This New York hospital is the first and only metro area hospital to offer the Myomo device. The device manufactured by Myomo of Boston is available only for use under the supervision of an occupational or physical therapist.

States Launch Stimulus Sites

Several states have set up stimulus web sites to help residents learn about the federal stimulus law, how stimulus dollars will be spent in individual states, and how the sites will track specific recovery projects. A number of states are planning web sites but some of the state sites are already up and running.

A few of the sites:

• Alabama is expected to receive $3 billion. The site provides information on funds for various programs at www.stimulus.alabama.gov. The site will be updated to reflect new information on the stimulus law as federal agencies issue specific regulations on funding uses and requirements. The site will soon include a feature to allow organizations and individuals to submit proposals for use of the funds. At that point, submitted proposals will be reviewed to identify projects that might qualify for funding. Much of the information regarding individual programs and applications is not yet available
• Massachusetts is expected to receive between $6 and $9 billion over the next two-plus years. The governor has plans to invest in infrastructure, information technology, and broadband access. The website www.mass.gov/recovery will enable residents to track state performance in implementing projects and the success of those projects. Last December, the Patrick Administration began mobilizing for recovery aid and established Task Forces to review and develop clean energy, education, information technology, and other projects that may be eligible for federal funding
• Ohio is working to lower healthcare costs. The website http://recovery.ohio.gov is an interactive portal for entities to submit proposals for stimulus dollars and to view general information. As of 3/1/2009, 13,423 proposals have been submitted
• Maryland’s site www.recovery.maryland.gov will enable residents to track projects using the Geographic-Information System. The state is planning a series of workshops for local government officials to share information about applying for grant money and to examine the impact and flow of the dollars coming to the state. StateStat will maintain the site
• Virginia launched www.stimulus.Virginia.gov with interactive features and capabilities to enable users to view submitted projects by location or category. The evaluation of submitted projects will begin Friday March 6th. The data breaks down projects by county, category, cost, and produces a daily tally of projects submitted. Since February 10th, more than 3,300 project ideas for funding have been submitted
• Wisconsin’s site www.recovery.wisconsin.gov will provide information on where the stimulus funds are going to go within the state along with the activities, projects, and programs that will be eligible for the funds. Information is provided on potential projects and eligibility requirements for funds. In the future, the site will go to specific state agencies and programs that will be administering the contracts and grants
• New York is expected to receive at least $24.6 billion from ARRA of 2009. The site www.economicrecovery.ny.gov will track how funds are spent and where to submit proposals for funding. The Governor created the New York State Economic Recovery and Reinvestment Cabinet to manage the development of state and local infrastructure projects.
  
  
  
  
  
  
  
  
  
  
  
  
  

Military Awards $1.4 Million

The Military Health System awarded $1.4 million to Vangent, Inc. in Arlington Virginia to help collect Traumatic Brain Injury (TBI) and associated Behavioral Health (BH) information for military service members throughout the entire continuum of care. The contract’s subcontractors include Akimeka, LLC, Guident, Inc., Enterprise Information Management, Inc., Forgentum, Inc. and n-tieractive, Inc.

The program is managed by the MHS Defense Health Information Management System (DHIMS) program office and supports the DOD and VA response to the President’s Commission on Care for America’s Returning Wounded Warriors.

The contract calls for Vangent to develop a clinical information technology solution to improve the workflow of patients’ behavioral health information and then integrate this data into the military’s electronic health record. When the system is deployed, the information will be quickly available to use for diagnosis, treatment, and ultimately will help to produce positive clinical outcomes.

Other Vangent major contracts include the Common User Database for the Force Health Protection & Readiness Program, E-Commerce Operational System Support for the TRICARE Management Activity, and the Executive Information and Decision Support for the Military Health System.

Trust Formed to Prevent Infections

A statewide hospital research university partnership has been formed in South Carolina. The partnership called the “South Carolina Healthcare Quality Trust” (SCHQT) will be involved in research, identifying causes, and finding ways to prevent infections. The three partners including Health Sciences South Carolina (HSSC), South Carolina Hospital Association and the Premier healthcare alliance are investing more than $1.7 million over a three year period.

The largest research universities playing an important role in the venture include Clemson University, Medical University of South Carolina, and the University of South Carolina. The largest health systems working through HSSC will be using existing evidence-based best practices as well as researching and developing new methods to eliminate preventable infections.

One of the first tasks for the Trust will be to create a special information sharing portal that will allow all South Carolina Hospitals to research the causes of healthcare associated infections, and to identify and promote existing and new processes for prevention. Hospitals will be able to track their improvement against state and national benchmarks via the Performance Improvement Portal which is Premier’s knowledge exchange community of more than 1,500 healthcare experts nationwide. The idea is to share the results with all 65 of the state’s acute care hospitals.

The return on investment can be significant. Premier reported that data available from 16 south Carolina hospitals representing 42 percent of the state’s annual discharges can save the state’s hospitals as much as $40 million and reduce the length of stay of South Carolina patients by up to 24,000 days.

Advancing Medical Simulation

Tulane University School of Medicine has opened the Tulane Center for Advanced Medical Simulation and Team Training. The Center is a $3 million 14,000 square foot facility to provide comprehensive training for all health professionals in a realistic environment.

The Center replicates a hospital setting and features high fidelity life-sized robotic patients that can mimic the ailments and symptoms that hospital staff sees on a daily basis. The manikins breathe, move their eyes, speak, and have a variable pulse and heart rate. They can even react to doses of medication, receive intravenous therapy, and go into cardiac arrest and expire.

While Tulane’s Center features the latest in industry standard equipment, what sets it apart from other medical simulation centers is its emphasis on inter-professional team training. Instructors will use techniques developed in the military and aviation sectors to teach healthcare trainees and professionals to respond as a team to different scenarios and problems.

On the legislative front, Representatives Randy J. Forbes from Virginia and Patrick Kennedy from Rhode Island recently introduced the bill (H.R. 855) in the House to provide for research, new initiatives, and demonstration projects to improve the deployment of medical simulation technologies. H.R. 855 specifically instructs AHRQ to increase the use of simulation technologies and equipment in medical, nursing, allied health, podiatric, osteopathic, dental education, and training protocols.

The legislation also creates Medical Simulation Centers of Excellence to provide leadership, to do research on expanding the use of medical simulation technologies, and to serve as a resource center for knowledge on medical simulation.

The bill authorizes AHRQ to provide grants to purchase medical simulation technologies for training, to incorporate medical simulation technologies into curricula, and provides for grants to study simulation-based methods in credentialing and accreditation. The bill requests $50,000,000 for grants for FY 2010 and the same for FY 2011 through 2014.

The Act would also establish the Federal Medical Simulation Coordinating Council to coordinate the federal government’s activities in research, development, deployment, and utilization of medical simulation technologies.

H.R. 855 has been referred to the Committee on Energy and Commerce.

States Role in HIT

The new report “Public Governance Models for a Sustainable Health Information Exchange Industry” prepared for the State Alliance for e-Health, assesses the current state of the HIE marketplace and the government’s role. According to John Thomasian, Director of the National Governors Association Center for Best Practices, this report serves as a valuable starting point for states as they consider governance strategies for building, sustaining, and protecting a system to support electronic health records.

The report discusses the significant burden of healthcare costs on state budgets, the imperative to improve the quality of healthcare delivery, and the likelihood of accelerated investments being made in HIT. There is a critical need for state leaders to keep informed of the key issues involved and the strategies needed to effectively leverage investments in technologies for health system improvements.

To compile the report, interviews were conducted with operating health information organizations. The results indicated that key public and private healthcare stakeholders must be engaged and represented by an organized governance structure and there needs to be a technical architecture to facilitate electronic HIEs. Also, data sources, transaction types, and standards need to be identified, along with addressing the financing of HIEs.

The report outlines three conceptual governance models:

• Model 1—Government-Led Electronic HIE
• Model 2—Electronic HIE Public Utility with Strong Government Oversight
• Model 3—Private-Sector-Led Electronic HIE with Government Collaboration

These conceptual models can be used as a starting point for states to use when considering viable oversight strategies. This is based on the level of regulatory control state governments wish to exert over the electronic HIE industry. The body of the report provides more specific rationale and description, details on the legal structure needed, plus financing and accountability considerations are given for each model.

Bill to Expand Technology

On February 24th, Senators John Thune from South Dakota and Amy Klobuchar from Minnesota reintroduced the “Fostering Independence Through Technology Act (FITT)”. The bill would expand the use of telehealth technology under Medicare in rural and other underserved communities.

The FITT Act would create a pilot program to provide incentives for home health agencies across the country to use home monitoring and communications technologies. The home health agencies participating in the pilot program would receive annual incentive payments based on a percentage of the Medicare savings achieved as a result of using telehealth services.

According to Val J. Halamandaris, President of the National Association for Home Care and Hospice, the FITT Act champions the best of modern healthcare. It has the potential to improve the delivery of healthcare to underserved rural areas and urban seniors, employ the expertise of home healthcare providers, and provide Medicare with savings generated from the use of telehealth.

Dave Horzadovsky, President and CEO of the Evangelical Lutheran Good Samaritan Society headquartered in Sioux Falls, commented that “this legislation would help healthcare providers such as his Society develop new innovative ways to reach out and offer supportive services directly in clients homes.”

HRSA Posts Announcement

HRSA’s Maternal and Child Health Bureau (MCHB) posted grant announcement (HRSA-09-180) on February 23, 2009 to help develop a comprehensive child health profile. The goal is to integrate related data systems, develop a health information sharing infrastructure, coordinate public and private programs, and capture health information in a timely manner. The grant proposal is due April 15, 2009.

This program is needed to support decision making at the point of healthcare service delivery and to develop more effective community based public health interventions. MCHB’s Office of Data and Program Development is emphasizing electronic health information exchange to support the President’s major healthcare objectives.

The grant request seeks support for two projects:

• Project 1—To advance health information technology in maternal and child health by developing early a pregnancy intervention program through a health information exchange. The funds will build upon a public-private partnership between a state or RHIO, public health department, and a state Medicaid Office to help target high risk pregnant women and infants. Funding will be provided for FY 2009-2010 with $300,000 expected to be available
• Project 2—To implement a web-based electronic birth records system and assist the states that have not yet implemented the system. Funding for FY 2009-2010 is expected to be $400,000

All public or private entities including an Indian tribe or tribal organization, faith based, and community based organizations are eligible to apply for this Federal funding.

For specific information on the grant announcement, go to www.grants.gov or contact Mary Worrell Grants Management Specialist at mworrel@hrsa.gov or call 301-443-1581. For information on the overall program, contact Mary Kay Kenney, Office of Data and Program Evaluation, at mkenney@hrsa.gov or call 301-443-0755.