Wednesday, October 28, 2009

Helping Service Members

The web-based TRICARE Assistance Program (TRIAP) uses web-based technologies to bring short-term professional counseling assistance closer to the people who often need it the most to include service members and veterans recently back from overseas.

From the security of their homes, or anywhere else, a service member with a computer, webcam and associated software can speak face-to-face with a licensed counselor over the internet at any time 24/7. Counselors give the returning service members an opportunity to discuss matters such as relationship issues, sleep disturbances, or readjustment difficulties from the comfort and security of their own homes. The counselor then determines if more specialized care is needed, and if so, the service member will be referred to a more comprehensive level of care. A referral or prior authorization is not needed to use the system.

Also, service members are helped after returning return from Iraq and Afghanistan if they have suffered life threatening injuries causing intense pain requiring the constant use of prescription medications. The University of Illinois at Chicago’s Center for Pharmacoeconomic Research and the Milwaukee’s Columbia College of Nursing are studying a robotic device capable of dispensing the proper dose of oral prescription medications to soldiers suffering from TBI, PTSD, and other stressful conditions.

The study is looking at the use of an electronic medication management assistant or the EMMA delivery unit designed to remotely deliver, manage, and monitor a patient’s drug therapy. This delivery unit can help service members adhere to their medications in the outpatient setting under the guidance of a physician, nurse case manager, and pharmacist. EMMA was directed in development by Dr. Mary Anne Papp of the Medical College of Wisconsin in Milwaukee and the system is manufactured by INRange Systems, Inc.

The study of the robotic device with $1.35 million in funding will be administered by TATRC as part of the Army Medical Research & Material Command located at Fort Detrick. The study will initially take place at the Camp Pendleton Naval Hospital in California and at the James A. Haley Veterans Affairs Hospital and Polytrauma Facility in Tampa Florida. If successful, the program many expand to include additional DOD sites.

Texas Investing in Innovation

The state of Texas is actively funding companies with innovative ideas. The state recently invested $600,000 in Cardiovascular Systems Inc. (CSI) to help the company manufacture their arterial disease treatment system called “Diamondback 360. The funding was made available through the Texas Enterprise Fund (TEF).

CSI has developed a minimally invasive catheter to treat peripheral artery disease. The device treats calcified and fibrotic plaque throughout the leg in small and large vessels and addresses many of the limitations associated with existing surgical, catheter, and pharmacological treatments. Since its launch in 2007, the device has been used to treat more than 15,000 patients at nearly 600 hospitals across the country.

The legislature created TEF in 2003 and re-appropriated funding in 2005, 2007, and 2009 to help ensure the growth of Texas businesses and to create more jobs in the state. To date, the TEF has invested more than $383 million and closed the deal on projects generating an estimated 56,000 new jobs and more than $14 billion in capital investment in the state.

The TEF has also invested more than $1 million in Azaya Therapeutics Inc. of San Antonio to develop their “Azaya Liposome Encapsulated Radiation Therapy” (ALERT) to treat cancerous tumors. ALERT uses liposomes, or tiny bubbles made of cell membrane material to deliver cancer therapy drugs through an injection directly to a tumor.

Current cancer treatments such as chemotherapy and radiation do not focus specifically on cancer cells, and are therefore often detrimental to the overall health of a patient. ALERT solves this problem by focusing drug therapy on a specific cancerous tumor, and thereby improving the outcome and safety of oncology treatments. ALERT will be used as a post surgery treatment for several types of tumors and potentially treat a variety of cancers including prostate, breast, rectal, head, and neck.

In the university sector, the state Emerging Technology Fund (ETF) is investing $5 million to expand and recruit researchers for the Texas A&M Health Science Center’s College of Medicine’s Institute of Regenerative Medicine.

“Commercialization of adult stem cell research will provide solutions for Texans suffering from various tissue and organ disorders while protecting the unborn from exploitation,” Texas Governor Rick Perry said. “This investment will promote innovation and commercialization in the evolving biotechnology sector and attract top researchers and outside investment to the Institute.

Initial research has shown that regenerative medicine has the ability to improve quality of treatment and to decrease healthcare costs by replacing or repairing the malfunctioning tissues rather than treating them with therapies such dialysis, implanting replacement devices, or transplanting organs.

More than 70 researchers have been recruited from Tulane University to come to Texas through the ETF award. In addition, the ETF award will recruit additional members to the research team to commercialize 20 existing patient applications including five issued patents for regenerative technology. These researchers will have the opportunity to continue to work on identifying new commercialization opportunities.

The ETF is also investing $3 million in the Patton Surgical Corporation to commercialize their PassPort double shielded trocar device for use in laparoscopic surgeries. Trocars are used to insert instruments into the abdominal cavity during a laparoscopic surgery, and the PassPort device makes laparoscopic surgery even less invasive. The device also has several structural designs that allow adaption for use by different surgeons.

Patton Surgical is partnering with the University of Texas, Austin Department of Biomedical Engineering and the University of Texas Health Science Center, Houston for further development and commercialization of the device.

Access to Physicians Notes

Patients and consumers across the country are voicing a growing interest in having more control over their own medical care. Geisinger Health System is a participant in a new study to examine the impact of adding a new layer of openness so that patients will have access to the notes from their doctor visits. Patients do have the legal right to obtain their paper records, which usually includes notes, but very often they have to wait to get copies and must pay a fee. Online access would be quick, easy, and free.

The Journal of General Internal Medicine reports that consumers want full access to all of their medical records and they are willing to make some privacy concessions in the interest of making their medical records completely transparent.

The 12-month OpenNotes © Project is being funded by a $1.4 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio. The project will bring together 100 primary care doctors and 25,000 patients to evaluate the impact on both patients and physicians when sharing the comments and observations made by physicians after each patient encounter.

The study is being led by Boston’s Beth Israel Deaconess Medical Center and includes primary care physicians and patients at Geisinger and at the Harborview Medical Center in Seattle. Researchers hope to learn whether the increased transparency will increase patient-physician trust and communications and whether it will help patients to manage their own care better.

By early next year, the Geisinger team hopes to provide several thousand patients who use the “MyGeisinger” web portal with online access to their primary care physician’s notes. Patients will receive reminder e-mails that the notes are accessible. By contrasting the experience of trial participants with non-enrolled physicians and patients, the researchers hope to measure the impact access to the notes has on patients’ engagement in their care.

According to Jonathan Darer, M.D., Geisinger’s lead investigator on the project, patients generally retain only a portion of the information that is exchanged with their doctor. While some doctors have been quick to sign up, others are more pragmatic and worry that the notes could be misinterpreted and create more communication issues than they solve.

Patent Bank Web Portal Launched

A new web portal called the “New Jersey Patent Bank” is designed to spur innovation in the state and to foster technology transfer between the state’s academic and business communities. The Patent Bank is a user-generated central clearinghouse for the state’s patented technologies. Users can post any patent that is licensed or unlicensed in the state to market their intellectual property as well as search for patents that match individual or business needs.

In addition to highlighting the state’s cutting-edge research and technologies and encouraging technology transfer between the academic and business communities, the Patent Bank is designed to help new technologies find their way to commercial markets. As innovations are developed, they can provide societal benefits by making health and life quality improvements available to the public.

“Governor Corzine’s Economic Growth Strategy places a high priority on encouraging innovations,” said Jerry Zaro, Chief of the Governor’s Office of Economic Growth. “In addition to supporting economic growth in the state, the Patent Bank will create a potential source of revenue for the state’s inventors and universities.

The Patent Bank was created by the Governor’s Office of Economic Growth, the State of New Jersey’s Office of Information Technology, the Commission on Higher Education, and the Commission on Science & Technology.

For more information, go to

Sunday, October 25, 2009

Targeting DOD Opportunities

How companies can best approach the military with hot technologies was discussed by Dave D. Hood, President DH3 and Associates at the AdvaMed2009 Conference held in Washington D.C. October 12-14, 2009 at the Walter E. Washington Convention Center. The military at present is targeting specific areas such as infectious diseases, combat casualty care, military operational medicine research, medical chemical and biological defense research, and regenerative medicine to help with vision restoration, pain management, and prosthetics.

According to Hood, one of the first places to start targeting ideas is to go to where it is possible for innovative companies, entrepreneurs, and research organizations to propose potential solutions new products, services, prototypes, and concepts to DOD. DOD is constantly reviewing ideas and if DOD is interested, companies will be invited to submit a white paper.

As Hood pointed out, TATRC at Fort Detrick Maryland and other laboratories are good places for the medical community to look for opportunities. TATRC is developing product lines and core competencies in medical robotics, health IT, imaging, advanced prosthetics, computational biology, simulation, and in other areas.

Another viable program is the Fort Detrick Technology Transfer Initiative (FDTTI). The program provides awards to small businesses to support technology development projects. Emphasis is on developing those technologies that meet the medical needs of the Army as well as the commercialization of technologies developed at research laboratories at Fort Detrick.

FDTTI, companies can apply for and receive awards for up to $50,000 for eligible projects. Since the initiative was launched in 2005, 16 companies have received awards totaling $800,000

Also the Congressionally Directed Medical Research (CDMR) overall program looks for funding opportunities to find solutions to advance the prevention, detection, diagnosis, and treatment of military relevant psychological health issues and TBI. The funding is focused on innovative projects that can make a significant near-term impact on helping soldiers, veterans, families, caregivers, and communities.

Within CDMR, the Advanced Technology Therapeutic Development program is supporting promising new products, pharmacologic agents, behavioral interventions, devices, clinical guidance, emerging technologies, along with the possible integration of informatics and advanced computational research to better understand the intersection of psychological health and TBI.

Small businesses need to target products or services to the right government places and offices. In other words, treat the Government like a customer. For example, it is important to know what the Army Medical Command Health Care Acquisition Activity specifically buys in the area of direct healthcare and ancillary healthcare services.

The U.S. Army Medical Research and Materiel Command (USAMRMC) buys through the Medical Research Acquisition Activity and conducts programs in medical research, materiel development, medical logistics, medical information systems, and other new technologies. The USAMRMC is involved in basic research in the lab, interested in innovative product acquisition, and interested in the life cycle management of medical equipment and providing supplies for deploying units.

Hood recommends small companies to look into the SBIR and the STTR programs. DOD’s SBIR program funds early stage R&D projects at small technical companies where DOD has a need and there is a potential for commercialization. The DOD part of the SBIR program was funded at $1.23 billion in FY 09. The STTR program is a companion program and only differs in that the work must be performed by a small business in collaboration with nonprofit research organizations.

For a successful example, Ascension Technology Corporation through help from the DARPA SBIR program has produced a commercial medical system called 3D Guidance that can simultaneously track up to eight low cost disposable sensors. The technology is able to measure the position and orientation of each sensor in the patient and then is able to generate data for 3D visualization. Medical device manufacturers have an interest in this technology to be used in minimally invasive and image-guided products.

For more information, go to For more information on the conference, go to

NIH Seeks Ideas

NIH’s Clinical Center Pharmacy Department is conducting a market survey to use for planning purposes to look for ideas from small businesses to determine their availability and technical capabilities to provide a dispensing system for outpatient/take-home medications. This “Sources Sought Synopsis” was published October 16th and is not considered a Request for Proposal nor will a purchase order or contract be awarded based on this announcement.

The equipment is needed for the pharmacy that fills approximately 400 prescriptions per day. The dispensing system needs to have an information system that includes workflow management features with a dispensing robot plus devices to support dispensing medications not filled by the robot. The system must be able to be interfaced to Eclipsys’ Sunrise Acute Care 5.0 (SAC) to allow medication orders entered in SAC to transfer to the outpatient system.

The system must be able to handle entry of medications not contained in the usual drug databases. The system also needs to produce container labels, auxiliary labels, and patient information sheets. The system needs to be able to refill medication request via interactive voice response or web-based technology and be able to record dispensing medications when picked up by the patient.

The response date for the information is October 30, 2009. For more information, email Ann G. Argaman, Contract Specialist, at, call (301) 594-5919, or go to

CalRHIO's First Site Goes Live

The first site in CalRHIO’s statewide health information exchange system went live in Orange County at Coastal Communities Hospital. As a result of collaboration between CalRHIO and the local HIE effort; the Orange County Partnership Regional Health Information Organization’s (OCPRHIO) 23 hospital emergency departments will have secure electronic access to critical medical information over the next five months.

Initially data will be provided on 380,000 patients enrolled in CalOptima, covering people in Medi-Cal, Medicare, and Healthy Kids. During 2010, more data sources will be added to include prescription histories, laboratory results, and additional clinical claims information. Additional Orange County providers will have access to the data as well in support of OCPRHIO and State of California strategic plans.

“The launch demonstrates how communities can affordably and efficiently bring the benefits of electronic health information exchange to their residents. While we are starting with emergency departments, CalRHIO will also bring patient data to physician offices and clinics around the state”, said Molly Coye, MD, MPH, CalRHIO’s President and CEO.

“Our physicians and nurses are very excited about having this new source of information”, said Nova Stewart, OCPRHIO Chair and Chief Information Officer for Integrated Healthcare Holdings, Inc. She continues to report that four integrated Healthcare Holdings hospitals will be among the first to use the new HIE system along with Coastal Communities Hospital, Western Medical Center Anaheim, Western Medical Center Santa Ana, and Chapman Medical Center.

$17 Million to Fight HAIs

AHRQ has just awarded $17 million including $8 million to fund a national expansion of the Keystone Project. The Keystone Project has successfully reduced the rate of central-line blood stream infections in more than 100 Michigan intensive care units and also saved 1,500 lives and $200 million within just 18 months.

The project was originally started by Johns Hopkins University in Baltimore and the Michigan Health & Hospital Association to implement a comprehensive unit-based safety program. The program uses a checklist of evidence-based safety practices, staff training, and other tools for preventing infections that can be implemented in hospital units to consistently measure infection rates and provide the tools needed to improve teamwork among doctors, nurses, and hospital leaders.

Last year, AHRQ funded an expansion of this project to include 10 states. With the additional AHRQ funding plus additional funding from a private foundation, the Keystone Project is now operating in all 50 states, Puerto Rico, and the District of Columbia.

The new funding will expand the effort to more hospitals in 50 states, extend it to other settings in addition to ICUs, and broaden the focus to address other types of infections. Specifically, the finding will provide $6 million to the Health Research & Educational Trust for a national effort to expand the Comprehensive Unit-Based Patient Safety Program to Reduce Central Line-Associated Blood Stream Infections. The Trust will also use $1 million to support a demonstration project to help fight catheter-associated urinary tract infections.

In addition, $1 million will go to Yale University to support a comprehensive plan to prevent bloodstream infections in hemodialysis patients. AHRQ in collaboration with CDC has also identified several high priority areas to apply the remaining $9 million toward reducing MRSA and other types of HAIs.

For more information, go to

NIH Funds New Virus Database

NIH has awarded a $15.7 million contract to UT Southwestern Medical Center and Northrop Grumman Corporation to develop an open-access national online database and analysis resource center to help scientists study and combat viruses. These viruses can cause hepatitis, encephalitis, smallpox, acute respiratory distress, and dengue fever, as well as newly emerging pathogenic viruses. NIH’s National Institute of Allergy and Infectious Diseases awarded the contract and designated $2.7 million to UT Southwestern which will act as a subcontractor on the project.

Previous research work at the university led to the development of an open-access database sponsored by NIH that has information on influenza including the pandemic H1N1 virus. The new Virus Pathogen Database and Analysis Resource (ViPR) to be developed will enable researchers to develop an online bioinformatics center to contain data and analysis tools for a wide range of viral pathogens.

“ViPR database will support gene sequence data, information about the immune response to viral infections, and information about the protein structure of viruses,” said Dr. Scheuermann, the principal investigator on the local portion of the new contract”.

In investigating H1N1, researchers plugged the virus genetic sequences into the NIH sponsored Influenza Research Database and found that the genetic coding of the H1N1 virus is nothing like the normal circulating seasonal influenza virus. ViPR which will have the same kind of functionality and the influenza database to be developed will help researchers answer similar questions about other human pathogenic viruses.

The ViPR database is scheduled to be available in December at

Sunday, October 18, 2009

Improving Networks

The Ontario Telemedicine Network (OTN) one of the largest telemedicine networks in the world provides service to hospitals and health clinics throughout Ontario province. OTN was created in 2006 by the merger of CareConnect (Eastern Ontario), NORTH Network (Central & Northern Ontario), and VideoCare (Southwestern Ontario). The merger was supported by the Ontario Ministry of Health and Long-Term Care (MOHLTC) and Canada Health Infoway.

OTN with more than 2,700 healthcare professionals delivers care to over 660 sites across the province. In 2008 and 2009, 53,745 clinical consultations and more than 12,000 education and training events in 2008 were delivered.

OTN connects 300 users with the Polycom visual communication solution, but since OTN grows by 20 to 40 percent a year, there are still 150,000 users that could still be connected. There are plans to add thousands of additional sites next year, and officials anticipate that the expanded network will also expand the applications for telehealth.

The telehealth technologies used provide real-time consultations for specialists at large hospitals with their patients at community health centers, connects stroke neurologists to emergency rooms, provides for mental health evaluations and treatment, and cares for inmates in correctional facilities.

In addition to funding from the Province, Canada Health Infoway is providing OTN with funds to help develop a variety of special projects with the work to be further supported by eHealth Ontario. OTN also partners with the Keewaytinook Okimakanak Telemedicine Program to provide regional broadband network services directed by the Keewaytinook Ohimakanak Telehealth Tribal Council.

In West Virginia, a high tech link between healthcare providers in the greater Huntington region and those in rural McDowell County will soon develop a new project called the “Metro Fiber Build” project. Marshall University and the West Virginia Telehealth Alliance are developing the project to provide an advanced broadband interconnection with Marshall University, Marshall’s Joan C. Edwards School of Medicine, St. Mary’s Medical Center, and Cabell-Huntington Hospital.

This project is the first in a statewide initiative to facilitate a health network infrastructure across the state to improve broadband connectivity and advance telehealth capabilities for nearly 300 eligible rural hospitals and rural clinics.

The project will expand existing telemedicine links with the Tug River Health Association in McDowell Country which will be able to access remotely physicians and specialists from each of the three Huntington facilities. The agency operates health clinics in Gary, Northfork, and Welch. Once the Huntington “Metro Fiber Build” is complete, Tug River will be able to use specialists through a single connection point at their Huntington Hospital, St. Mary’s Medical Center, as well as Marshall University.

Specifically Lincoln Primary Care in Lincoln County and Tug River will be able to access physicians and specialists remotely at each of the facilities. Both Lincoln Primary and Tug Valley Health have plans to expand their existing broadband connectivity as part of a second RFP that currently is being prepared.

This project is being funded with an $8.4 million award from the FCC through its Rural Healthcare Pilot Program with the state matching with $1 million and an additional 15 percent in matching funds from the participants in the project. The network is projected to cost $550,000 with an additional $250,000 for equipment.

Tracking Controlled Substances

The State of California has unveiled a web-based prescription drug database to track all controlled substances (Schedule II, III, and IV) prescribed in the state. The tool gives doctors and law enforcement a way to combat prescription-drug abuse.

The state’s database known as the Controlled Substance Utilization Review and Evaluation System (CURES) contains more than 50 million entries for controlled substances dispensed in California. The password protected online system will help prevent so called “doctor shopping” among drug abusers by allowing providers to verify appropriate prescribing of medications.

Doctors, pharmacists, and investigators have access to the Department of Justice patient records under the state’s drug monitoring program and can access the information by fax and mail. However, the turnaround time for these requests typically takes days or weeks. The new California online system will provide information immediately and be helpful for the emergency department and all other physicians who need to treat patients with pain.

Previously in the last three years, Dr. Scott Fishman, Professor of Anesthesiology and Pain Medicine and Chief of the UC Davis Division of Pain Medicine, along with Barth Wilsey, a UC Davis Clinical Professor of Anesthesiology, worked on the largest study of a prescription monitoring program ever undertaken. The project was funded with a grant from the Robert Wood Johnson Foundation, and identified the need for the new database.

Dr. Fishman led a UC Davis study to demonstrate the benefits of the new database. In doing the study, Fishman collaborated with computer programmers and database experts in the Clinical and Translational Science Center (CTSC) and produced an application that was able to sift through over 50 million prescription records and identify potential problems with abuse.

To develop the database, the CTSC programmers created a complex algorithm so that researchers were able to link patient prescriptions in CURES. They found that the magnitude of patients with multiple provider episodes and visits to different doctors and pharmacies for the same controlled substances was significant and potentially represented serious medical and law enforcement problems.

Minnesota DHS Releases RFP

The Minnesota Department of Human Services (DHS) through their Health Services and Medical Management Division released an RFP on September 28, 2009 seeking pilot primary care clinic models to deliver care focusing on care coordination involving patients and families.

The DHS will award grants to support Pilot Projects for children and adults with complex healthcare needs who are enrolled in the fee-for-service Medical Assistance program and eligible for care coordination services based on the individual’s health status and their need for care coordination. The funding available is approximately $750,000 with the proposals due November 16, 2009.

The State is looking to improve the quality of care, generate knowledge on how to better sustain primary care, transform the current system of healthcare, create a more cost-effective healthcare system, and/or facilitate medical homes. The goal is to identify factors associated with standards as pertains to Health Care Home standards along with costs, utilization, quality, and satisfaction parameters.

Approximately 483,000 Minnesotans receive healthcare coverage through Minnesota’s Medicaid program. The program called Medical Assistance is the largest of the state’s healthcare programs and provides the necessary medical services for low-income families, children, pregnant women, and people 65 or older, and people with disabilities.

Each grantee will need to have the capacity to deliver coordinated primary care and be able to describe how they will provide access and communication to individuals seeking care. The project requires a registry to be used to track participants care, track care coordination, track care planning, and requires reports on performance and quality improvement.

The services contracted as a result of the RFP needs to be done in Minnesota. Priority will be given to projects that focus on high-risk high-opportunity children and/or adults with excessive non-urgent ED visits, avoidable hospitalizations, and readmissions.

Projects may focus on the development of care coordination capacity for a particular clinic or organization or may focus on broader strategies to develop care coordination capacity in healthcare homes at a regional or statewide level.

Qualified responders include collaborative and organizations that support multiple clinics. Also providers and clinics that are interested in practice transformation and certifications as a health care home are invited to apply.

For more information, go to Or email Muree Larson-Bright PhD at or call (651) 431-2635.

VA Secretary Appears on the Hill

“The VA is transforming into a high performing 21st century department that will differ from today’s organization” according to the Eric K. Shinseki, Secretary of the Department of Veterans Affairs testifying before the House Committee on Veterans Affairs on October 14th.
The Secretary told the Committee that the Department’s next major leap in healthcare delivery is to connect flagship medical centers to distant community-based outpatient clinics and their even more distant mobile counterparts. This is being accomplished via an information technology backbone that places specialized healthcare professionals in direct contact with patients using telehealth and telemedicine connections.

In keeping up with technology, the VA is now using social media web sites, including MyHealtheVet and Second Life. This makes it possible to make contacts with veterans including the OEF and OIF veterans who do not respond to traditional outreach such as lectures, pamphlets, and telephone calls.

The Secretary went into detail discussing the disability claims backlog at the VA and the urgent need to reduce the time that it takes for a veteran to have a claim fairly adjudicated. The total number of claims in the VA inventory is around 400,000 and backlogged claims that have been in the system for longer than 125 days total roughly 149,000 cases. In collaboration with the VA’s IT leadership the VA intend to revolutionize the claims process to make it faster and to be able to make higher quality decisions.

In April, President Obama charged Defense Secretary Gates and the VA Secretary with building a fully interoperable electronic records system to provide each member of the armed forces, a Virtual Lifetime Electronic Record that will track them from the day they put on the uniform, through their time as veterans, until the day they are laid to rest.

The Secretary reports that today the VA has received two and one-half million deployment related health assessments from DOD on more than one million individuals. Today, information is shared between the Departments and critical health information is now provided on more than three million patients.

DOH Issues RFP

The Mississippi State Department of Health through their Office of Preventive Health issued an RFP to help integrate the “Chronic Disease Self-Management Program” (CDSMP) and other chronic disease and/or health promotion programs into the state Federally Qualified Community Health Centers (FQCHC).

The CDSMP helps people with chronic conditions, such as arthritis, diabetes, heart disease and asthma. The program presents interactive workshops to help people who have on-going health problems and can be suffering from fatigue, pain, anxiety, depression, and sleeping problems. The program workshops teach participants how to manage their symptoms and enable the participants to network with others that suffer from similar conditions.

The CDSMP was developed and tested at Stanford University. A randomized controlled trial by the Patient Education Research Center at Stanford University School of Medicine led to the approval of this program as an effective evidence-based intervention.

Approximately, $24,500 will be available to fund seven FQCHCs to incorporate CDSMP into their Centers. The funding can be used for programmatic costs to support project activities such as class materials and for meeting room space. The proposal is due by October 30, 2009.

For more information, call AIDP coordinator Sebrenia Robinson at (801) 576-7781 or email

Monday, October 12, 2009

Telemedicine Sites to Help Children

Many people living in rural or remote Texas communities know that one of the biggest challenges is to access pediatric health services. More than half of the counties in Texas do not have a general pediatrician and in many cases, gaining access to pediatric care involves lengthy travel to locations where pediatric healthcare specialists are available.

Recently, the Texas Health and Human Services Commission funded $6.77 million over 26 months to go to the Telemedicine Program located at the Texas Tech University Health Sciences Center’s F. Marie Hall Institute for Rural and Community Health. Plans are to establish 30 telemedicine patient sites to expand and study access to pediatric primary and specialty care for Medicaid enrolled children in rural communities in the 108 most western counties in Texas.

The program called Project CHART has provided the first live pediatric specialty consultation for a child in Stratford Texas, a small rural community more than an hour’s drive from Amarillo. The community’s only healthcare services are provided by the solo nurse practitioner in the community. The technology consists of a television linked to a secure encrypted network where the patient is presented by another physician or nurse from a remote location and then the information is sent to a pediatric specialist located at one of the campuses at TTUHSC.

Billy Philips, PhD., Vice President and Director of the Institute said, “This project will also provide an outstanding platform to conduct complementary population-based research activities to further enhance the quality of life in the region.”

Indiana U Receives Grants

Researchers from Indiana University and the Regenstrief Institute were awarded a five year $4.8 million grant by CDC to create the Indiana Center of Excellence in Public Health Informatics, one of only four such centers in the nation. The other centers are located at the University of Utah, University of Pittsburgh, and Harvard Pilgrim Health Care.

Regenstrief physician-researchers developed the Indiana Network for Patient Care (INPC) with the capability to securely exchange health information. Today, INPC enables medical providers across the state to securely obtain patients’ medical histories.

The new Center of Excellence will bring together the expertise of the Polis Center, a leader in community-based and public health research along with applications using geographic information technologies, the Indiana State Health Department, the Marion County Health Department, the IU School of Medicine’s Department of Public Health, the Department of Geography in the School of Liberal Arts at Indiana University and Purdue University Indianapolis, IUPUI’s Center for Health Geographics, and a unique data visualization group at Indiana University in Bloomington.

Areas of initial work will:

• Identify infants who lack newborn screening and improve the electronic exchange of newborn screening results

• Improve the exchange of immunization data between physicians and public health agencies to prevent both under and over immunizations

• Expand the ability to identify cases and events of potential interest to public health officials and ensure instant delivery of public health alerts to physicians and to other healthcare providers

Much of the work will use DOCS4DOCS ®, a clinical messaging services developed by Regenstrief healthcare IT professors and operated by the Indiana Health Information Exchange. Currently, DOCS4DOCS ® delivers more than 5 million messages along with laboratory reports and other test results.

In another award through ARRA, NIH awarded $538,595 to the Indiana University Center for Applied Cybersecurity Research to support a two-year project titled “Protecting Privacy in Health Research.” The project will assemble a blue-ribbon panel of experts in medical research, privacy, security, law, ethics, and patient advocacy from eleven national and international partner organizations. The experts will work collaboratively to develop new approaches to protecting the privacy and security of personal data used in health research, while striving to reduce the challenges imposed by the current HIPAA’s “Privacy Rule”.

The grant proposal was in response to a February 2009 report by IOM Committee on “Health Research and the Privacy of Health Information” which stated that Congress should authorize HHS to develop a new approach to protecting privacy in health research that would exempt health research from the HIPAA Privacy Rule.

The IOM then crafted a broad outline and made recommendations on how to handle the issue. NIH through this grant funding program will use the input from IOM and from the medical security experts and scholars to complete a more detailed set of recommendations.

Plans for the IU project propose to deliver:

• A more fully developed version of the IOM’s primary recommendations to develop a new approach by moving away from HIPAA’s reliance on narrow bureaucratic measures

• A written legislative history that will summarize the existing research, highlight the key policy choices, and identify the panel that made the specific recommendations

Panelists will meet several times over the next 18 months to work and will submit their recommendations by May 2011.

Patient Care Improving

Saratoga Hospital in N.Y. is working with the Albany Medical Center to speed up the evaluation process when treating stroke patients from the Saratoga region. The two hospitals are linked electronically enabling emergency physicians at Saratoga Hospital and stroke specialists at Albany Medical Center to provide faster access to cutting-edge treatments when appropriate.

The physicians are able to view patient scans simultaneously in real-time and to consult on the best course of treatment. The technology used streamlines the process for identifying those patients who need advanced care, and then sends them to the Albany Medical Center sooner.

An inter-institutional medical team quickly decides what treatments to begin in Saratoga and whether to admit the patient to the Saratoga Hospital or transfer the patient immediately to Albany Medical Center. The Center in Albany is the only Capital Region facility with advanced certification in stroke from the Joint Commission and offers additional stroke and neuroendovascular therapies.

“We have always worked closely with Albany Medical Center to arrange transport for patients who need more advanced intervention,” said Angelo Calbone, Saratoga Hospital President and CEO. “Now, we’re taken another step and we are using technology to share vital patient information so that care begun at Saratoga Hospital can continue uninterrupted at the Medical Center.”

Also, on September 1, 2009, the Albany Medical Center was awarded a $242,000 grant from the New York State Health Foundation to fund the improved “Access to Behavioral Health Care” project. The intent of the project is to increase access to comprehensive diagnostic and treatment services for children in the Capital Region with behavioral and mental health needs.

The New York State Health Foundation grant will provide bridge funding to support the expansion of Albany Medical Center’s current services which includes diagnostic assessments, medication management, psychological testing, treatment, and counseling. Funding will support a team of highly trained, experienced behavioral specialists including a developmental and behavioral pediatrician, a nurse practitioner, a clinical psychologist, and two doctoral level therapists.

In addition, the funding will enable the team to provide education and outreach to primary care providers and community organizations who currently struggle to care for pediatric patients with behavioral health needs due to a lack of resources, time constraints, and a limited knowledge base.

Web Site to Help Newborns

The National Library of Medicine (NLM) has launched the “Newborn Screening Coding and Terminology Guide” at to enable the efficient electronic exchange of standard newborn screening data. The web site was created in collaboration with the Office of the National Coordinator for HIT, HRSA, CDC, as well as with a number of professional organizations.

The goal for the Guide is to provide a standard framework for reporting the results of newborn screening tests and to enable this information to be accurately interpreted by recipient electronic systems for use in care, follow-up, and analysis

Newborn screening is important, but test results can be complicated by wide variations among states as to the way that tests are conducted and the way that results are recorded usually by paper-based communications. The new web site translates the information in order to help deal with the complexity of the newborn screening information.

The site provides common terminology and coding standards, covers more than 100 conditions, and lists the terminologies and codes used for each condition. The site also identifies the tests that may be used in screening for each condition. Information is available on all the conditions and tests along with the preferred standard terminology and codes as indicated.

Users of the web site can view the information interactively or download electronic datasets with standard names and the identifiers for use in their systems. The site can also help researchers untangle the confusion of terms and tests that exist today.

Wednesday, October 7, 2009

Funding to Help Telemedicine

HRSA issued funding opportunity announcement (HRSA-10-159) for Licensure Portability Special ARRA Initiative grants. The grants will support state professional licensing boards to carry out programs so that licensing boards of various states will be able to cooperate, develop, and implement state policies to reduce statutory and regulatory barriers to telemedicine.

Telemedicine providers are greatly concerned about the state licensure restrictions against cross-state practice for physicians, as this requires physicians to have a license in each state where they provide telemedicine services on a regular basis. This is particularly a problem for physicians who provide highly specialized services around the country for rare conditions such as genetic counseling.

Funds for $1.5 million will support the grants. In FY 2010, up to three grants will be awarded for up to $500,000 per grant including direct and indirect costs for a two year budget period and a two year project period. The budget period will be for a 24 month period beginning March 1, 2010.

Projects are overseen by HRSA’s Office for the Advancement of Telehealth (OAT) within the Office of Health Information Technology. Eligible applicants can include state professional licensing boards and national organizations of professional licensing boards that provide services to State licensing boards.

The application is due November 18, 2009. For more information on the October 5th funding announcement, go to Forms may be downloaded from To contact the HRSA Grants Application Center, email or call (877) 477-2123.

Broadband Grants Announced

The Department of Commerce’s National Telecommunications and Information Administration (NTIA) awarded the first four grants funded by the Recovery Act under NTIA’s State Broadband Data and Development Grant Program. Broadband activities are funded in California, Indiana, North Carolina, and Vermont.

The California Public Utilities Commission (CPUC) was awarded $2.3 million to collect information on broadband service availability in the state and to create an interactive web-based map to give residents access to information about the services and providers available at their own address. State and federal policymakers will also be able to use the information to analyze the status of broadband deployment in the state and across the U.S., and to develop broadband policies aimed at making advanced services available everywhere regardless of location or income.

CPUC’s grant includes $500,000 for non-mapping activities related to broadband demand and adoption issues. CPUC is partnering with California State University’s Chico Research Foundation for this portion of the grant through a four year agreement. The Chico Research Foundation will identify subscribership levels within census blocks to develop a plan to identify barriers to broadband adoption. They will also develop marketing and promotional materials to use to promote broadband adoption and usage and work with broadband providers to encourage high speed internet services.

The CPUC oversees the California Advanced Services Fund established by the CPUC. This is a two year $100 million effort to provide 40 percent matching infrastructure grants to broadband providers putting up the matching 60 percent of funds to serve the nearly 2,000 California communities that are currently unserved and underserved by broadband.

The other NTIA grants went to the Indiana Office of Technology for $1.3 million, to the North Carolina Rural Economic Development Center, Inc. (E-NC Authority) for $1.6 million with an additional $435.00 to pay for broadband planning activities over five years bringing the entire grant award to over $2 million, and a grant went to the Vermont Center for Geographic Information for $1.2 million. The broadband activities are to be conducted on a semi-annual basis between 2009 and 2011 with initial data to become available in November 2009.

Telesurgery Successful in Iraq

According to a story appearing in MC4’s September newsletter issue of “The Gateway”, LTC T. Sloane Guy IV, M.D., a cardiothoracic surgeon, found that he was not always doing run-of-the-mill procedures in his specialty. However, as Chief of Clinical Services with the 249th General Hospital in Afghanistan until 2006, he successfully completed all of his procedures but he would have been happy with another specialist or two by his side. He could see the need especially in his case to contact with operating rooms in the U.S. to talk to other specialists and to help him assist with his procedures from afar.

LTC Guy thought about the need and came up with an original concept that included a camera system configured in the OR with one camera worn on the head of the surgeon and another camera mounted in the overhead light fixture. This configuration would offer different views of the operative field all connected in real-time over the internet.

In 2007, LTC Guy met with Colonel Ronald Poropatich, Medical Informatics Consultant to the Army Surgeon General and the leadership at TATRC to ask for assistance. In 2008, the project received funds and the next step was to develop the software. The project leaned on SRI International to provide the solution based on their expertise in telesurgical projects.

SRI was able to provide the ability to perform telestration on images. Doctors in the U.S. can now freeze-frame live footage and write instructions or details on an image and then send it to the deployed OR.

At this point, the Medical Communications for Combat Casualty Care (MC4) provided the configuration and technical support for LTC Guy. After resolving firewall issues and inserting the technology into the OR in theater, MC4 provided the hardware to Brooke Army Medical Center and was then able to link LTC Guy with providers stateside.

LTC Guy’s telesurgery mentor system vision took years to germinate from an idea formed in a treatment facility in Afghanistan to a working prototype tested on the Battle field in Iraq. In August 2009, LTC Guy, now Chief of Surgery with the 47th Combat Support Hospital has successfully tested the new telesurgery initiative to connect stateside specialists with the Combat Support Hospital in Iraq.

The surgeon was able to perform a complex and rare surgical procedure. At the same time, LTC P. William “Chance” Conner, a specialist at Brooke Army Medical Center in Fort Sam Houston, Texas peered over his shoulder to view live video footage of the procedure and was able to offer real-time guidance when requested. MC4 enabled the live consult to take place through rugged laptops armed with new technology.

Colonel Poropatich believes the system can be used in any deployed setting whether in Iraq, Afghanistan, Kosovo, or Honduras. It is possible for calls for assistance to go into a central consult routing system and then go to the Tripler Army Medical Center in Hawaii, Landstuhl Regional Medical Center in Germany, or to the 121st Combat Support Hospital in Korea.

“The system can also be used to help during hurricanes in the U.S. and can be of value to help smaller civilian hospitals lacking surgical expertise to handle some of the difficult cases that might come in. In addition, the system could also better prepare new surgeons for the realities of theater trauma care. Surgeons graduating from military programs and preparing to deploy for the first time would be able to watch live procedures from the battlefield. Stateside medical personnel just do not see the same type of cases that are handled in theater”, reports Colonel Poropatich.

NIH's New Grant Program

NIH released a new Funding Opportunity Announcement (FOA) called the “Community Infrastructure Grants Program” with up to $30 million in fiscal years 2009-2010 to fund 30 or more grants. This grant program funding supported by the Recovery Act will be used to develop, expand, or reconfigure the infrastructure needed to enable academic health centers and community-based organizations to collaborate on health science research.

Communities are key consumers of NIH-supported health science research and it is important for this research information to be filtered and presented to the American public. However, NIH recognizes that in order for health science research to reach the public, communities must have the opportunity to be actively engaged in the research, and also be active in formulating research questions.

NIH will establish the role of the Community Research Associate who will be a community representative and service as a primary liaison facilitating communication and collaboration between the academic health center and the local community.

One example for a community-linked infrastructure project could be collaborations that develop or expand telehealth networks linking academic health centers and health care providers in rural and other medically underserved areas. This could be accomplished by leveraging existing telehealth and related programs (e.g. HRSA, IHS, USDA, and other agency resources) to increase community capacity for clinical and translational research.

Another example would be to develop collaborations that establish or expand community-based infrastructure in medically underserved areas, including health promotion, disease prevention research, and dissemination of the information.

The FOA is particularly directed towards Academic Health Centers, but all public and private institutions of higher education, non-profits, small businesses, for profits other than small businesses, state governments, county governments, regional organizations, and others are invited to apply.

The notice was published September 18, 2009. The earliest date that an application may be submitted is November 11, 2009 with Letters of Intent to be received by November 12, 2009. The application due date is December 11, 2009 with the earliest anticipated start date to be July 2010. For more information, go to

Sunday, October 4, 2009

Progress on "Meaningful Use"

Dr. David Blumenthal, National Coordinator for HIT reports on the up-to-date progress that has been made to define “meaningful use” as it applies to the HITECH Act. The Act will provide incentive payments to doctors and hospitals that adopt and meaningfully use health IT.

Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified electronic health records. Hospitals that become meaningful EHR users could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.

The Office of the National Coordinator (ONC) is charged with coordinating nationwide efforts to implement and use the most advanced health information technology along with the electronic exchange of health information.

ONC is working with CMS to officially designate what constitutes “meaningful use”. As a result of the HIT Policy Committee meetings and recommendations, and feedback from more than 200 constituent groups, CMS is going to publish a formal definition of the term “meaningful use” for the purpose of receiving Medicare and Medicaid incentive payments. The definition is expected to be published by December 31, 2009 and in 2010, the public will be able to comment on the definitions.

ONC is also going to present programs to help smooth the transition process for the adoption of EHRs. As Dr. Blumenthal points out, there are some providers particularly providers with small or already stretched physician practices or in the case of small rural hospitals that may find the path toward meaningful use arduous. To others, who would just prefer to stick with the status quo, it may seem like an unwanted intrusion. We believe that the time has come for coordinated action to reduce adverse events, prevent the loss of patients’ lives, delay improper treatments, reduce unnecessary procedures, and in the end, lower costs in healthcare.

NY Funding Health IT

New York Governor David A. Paterson recently announced that $436 million has been awarded under the Health Care Efficiency and Affordability Law of New York State (HEAL NY) to further improve healthcare in the state. Nearly $60 million of the funding through HEAL NY Phase 10 will go to community-based health IT projects to build a more streamlined approach to sharing patient information.

The $60 million in HIT funding will help to develop the Patient Centered Medical Home (PCMH) model to establish a partnership among doctors, nurses, patients, and their families to ensure that patients have the support needed to participate in their own care.

The HIT funding will help the following medical home-based initiatives:

• The Hudson Headwaters Health Network’s “Adirondack Health Institute Care Improvement Initiative” was awarded $ 7,000,000 to work with the Adirondack patient-centered medical home pilot to improve regional healthcare services. Providers will apply population-based evidence-based and patient-centered approaches to treat diabetes using electronic health records and care management tools. Providers will connect to the State Health Information Network for NY

• Maimonides Medical Center’s “Southwest Brooklyn Patient-Centered Medical and Mental Health Home Project” was awarded $6,744,945 to use electronic health records with select outpatient primary care and mental health clinics and to provide access to the State Health Information Network

• The New York City Department of Health and Mental Hygiene’s “Primary Care Information Project’s Patient-Centered Medical Home” was awarded $6,996,837 to coordinate care for the patient population served by more than 2,000 providers and to use electronic health records to improve diabetes care

• The Island Peer Review Organization’s “Improving Care Coordination and Management Project” was awarded $5,297,418 to establish health information technology infrastructure to improve coordination and management through the patient-centered medical home model for adult patients with diabetes

• The North Shore University Hospital’s “Model for High Risk Obstetrics Using Electronic Medical Records” was awarded $6,997,800 to deal with the complexity of high risk pregnancies that require the coordination of care through a single provider. The project will use a patient-centered medical home model to improve the coordination and management of these patients through HIT

• The Hudson River Healthcare Inc. was awarded $5,902,937 and the Fort Drum Regional Health Planning Organization was awarded $6,676,804 to establish “North County Health Information Partnerships” (N-CHIP). These initiatives will establish the patient-centered medical home model to implement electronic health records and to be part of the health information exchange to coordinate care for adult patients with CPOD in areas with unusually high rates of hospitalizations

For HEAL NY awards, go to

VA's Project HERO Discussed

Joseph A. Williams, Jr. Acting Deputy Under Secretary for Operations and Management,VHA, appeared before the Senate Committee on Veterans Affairs on September 30th. He appeared before the Committee to discuss the Department of Veterans Affairs oversight of healthcare organizations contracting with the VA and in particular discussed how Project HERO operates.

There are two principal avenues that the VA uses to contract for healthcare services and this includes contracting with conventional commercial providers and contracting through academic affiliates. All VA healthcare resource contracts are reviewed through the Office of General Counsel, VHA’s Patient Care Services, VHA’s Office of Academic Affiliations, and VHA’s Procurement and Logistics Office. A formal Medical Sharing Review Committee is in place to provide management oversight on healthcare contracting requirements and the acquisition process.

Acting Deputy Under Secretary Williams explained that medical center directors determine when additional healthcare resources are required. When the VA is unable to provide care within the system, for example of a qualified clinician cannot be recruited, the medical director then must consider sending patients to another VA medical center. Contracting for necessary services will only be considered if these options are not appropriate or viable. If contracting for services is required, a competitive bid is the first option considered.

He further explained that since the VHA is not always able to provide veterans care within VA facilities, the VA has a continued need for non-VA services. An initiative established to closely manage the services the VA purchases is called the “Project on Healthcare Effectiveness through Resource Optimization or Project HERO. Project HERO is predominantly an outpatient program providing specialty services such as dental, ophthalmology, physical therapy, and other services not always available in the VA. Project HERO is in year two of a proposed five year contracting pilot to increase the quality and to decrease the cost for purchased (fee) care.

Project HERO contracts for medical prices with Humana Veterans Health Care Services (HVHS) at or below Medicare rates, and the VA’s contract rates with Delta Dental are less than 80 percent of National Dentistry Advisory Service Comprehensive Fee Report for dental services.

The HERO pilot program is currently available at VA Sunshine Healthcare Network (VISN 8), South Central VA Health Care Network (VISN 16), Northwest Network (VISN 20), and the VA Midwest Health Care Network (VISN 23). These VISNs have historically had high expenditures for non-VA purchased care.

According to Tim S McClain President and CEO, of HVHS in his testimony before the September 20th Senate Committee, that there are several myths out there circulating on the effectiveness of Project HERO. Myth number 1 is that Project HERO seeks to undermine the care currently provided inside VA Facilities. He reports that this is false because traditional VA fee-basis care provided through Project HERO are only authorized and provided when the requisite capacity inside the VA cannot support timely access to care or provide care through a specialty available in the VA.

Myth number 2 is that Project HERO reduces the need for the VA’s current fee-basis offices and staff due to services being outsourced. McClain reports that this is not true and explained that all referrals provided to Humana Veterans are generated out of the fee-basis offices at local VA facilities. Once a VA physician sends a referral to the fee office, it has already been determined that the VA does not have the capacity to provide for the care of the veteran, and at that point, the VA needs to decide what avenues are available to the veteran for care rendered outside the system..

However, there has been criticism of the Project HERO program. Mary A. Curtis, Psychiatric Clinical Nurse Specialist and Clinical Application Coordinator at the Boise VA Medical Center appeared at the September 30th hearing on behalf of the American Federation of Government Employees, AFL-CIO. She presented her objections to the Project HERO program.

She described how the Boise VA has a strong Community Care Home Telehealth program that treats veterans with congestive heart failure, diabetes, and other chronic conditions using remote equipment for blood pressure readings, other tests, and the program uses telehealth in their implantable defibrillator clinic. In addition, their mental health team travels to the CBOCs and to other outpatient settings to provide care and the Vet Center now has a new mobile clinic that is able to reach veterans in rural areas.

Curtis continued to explain that one of the specific complaints about the Project HERO is that the implementation and ongoing operations of Project HERO have been conducted largely behind closed doors. Based on the limited objective data available and observations by members in facilities participating in HERO, it appears that HERO has little or no “value added” and HERO contractors are simply not doing a better job at managing contract care than the VA.

In an action on July 29, 2009, the Office of Management and Budget directed federal agencies to end their overreliance on contractors, conduct an inventory of their in-house and contract workforce, and bring appropriate work back into the government.

HIT Success in Rural Areas

HHS releases “New Success Story Report: Health Information Technology Strengthens Care in Rural Communities” a new report emphasizing how health information technology can improve healthcare in rural areas. Approximately 65 million Americans live in communities with shortages of primary care providers and nearly 50 million of those Americans live in rural areas.

The report examines how the Columbia Basin Health Association (CBHA) in Othello Washington operates. CBHA provides 25,000 patients in Central Washington with access to a variety of medical, dental, prescription, and other services. CBHA was one of the first health centers in the U.S. to fully transition from paper-based charts to an electronic health record system.

Diabetes is more common among rural residents than urban residents and also the percentage of diabetes patients who received all three recommended exams for diabetes is lower for patients in rural areas than in metropolitan areas.

CBHA reports that in January 2008, only 31 percent of patients had received a foot exam and only 37 percent had received an eye exam during the previous year. By June 2008, 86 percent of patients had received a foot exam and 63 percent had received an eye exam over the previous year.

CBHA used their EHR system to track 1, 302 diabetic patients and then monitored whether these patients received recommended exams. Feedback was provided back to the healthcare providers on their performance.

By using practice management software, CBHA has decreased no-shows for dental patient appointments by about 50 percent and has filled 200 percent of available appointment slots. This allows clinicians to see more patients and to provide timely care. CBHA now ranks above the 95th percentile nationally in total medical and dental team productivity as reported in the Bureau of Primary Health Care Uniform Data System. In addition, CBHA has partnered with the nearby Othello Community Hospital so that both organizations now have HIPAA compliant access to each other’s EHR systems.

The report addresses health insurance reform and the need for HIT to help especially in rural areas. For example, a recent study found that physicians spends an average of three hours a week dealing with health insurance bureaucracy and this is impacted even more in rural areas by the shortage of doctors. Health insurance reform plus the use of electronic health records would improve efficiency, quality, and access in underserved areas.

According to the report, health insurance reform would make significant investments in developing and reporting on quality issues, but to be effective, HIT is needed to collect, analyze, and report information on the quality of care measures across the healthcare delivery system. In addition, health insurance reform needs to invest in telehealth technologies as part of a continuum of health information technology to enable residents to have better access to the range of services that are accessible to them.

The report along with other reports is available at