Sunday, December 20, 2009

Funds for HIT Innovation

In an update from David Blumenthal, MD, National Coordinator for HIT, the Obama Administration has made $60 million available to support “Strategic Health IT Advanced Research Projects” (SHARP). The program will fund research to find the technology solutions needed to deal with the problems impeding the broad adoption of HIT.

The SHARP program will address barriers to adoption in four specific areas:

• Security of HIT Research will address the challenges involved in developing security and risk mitigation policies and the technologies needed to build and preserve the public trust

• Patient-Centered Cognitive Support Research will address the need to harness the power of health IT in a patient-focused manner and align the technology with the day-to-day practice of medicine

• Healthcare Application and Network Platform Architectures Research will focus on the development of new and improved architectures necessary to achieve electronic exchange and the use of health information in a secure, private, and accurate manner

• Secondary Use of Electronic Health record Data Research will identify strategies to enhance the use of health IT to improve the overall quality of health care, population health, and clinical research while protecting patient privacy

“The SHARP program will bring together some of the best and brightest minds in the nation to find breakthrough solutions and innovations that will eliminate barriers to adoption and over time, increase the meaningful use of health IT,” said Dr. Blumenthal.

Another important aspect of the SHARP program is that the research projects will being together key stakeholders, researchers, patient groups, healthcare providers, and others to work with one another to transform health IT research into applications.

According to Dr. Blumenthal, “This collaborative approach will allow us to consider the many voices of health IT stakeholders and work together towards common goals. With our eyes on the vision of patient-centered quality healthcare, we can focus research on innovative, pragmatic, and realistic solutions which can then be implemented across the nation”.

Public or private institutions of higher education and research organizations are eligible to apply for funding. HHS expects to award qualified SHARP applicants cooperative agreements with each agreement lasting four years. Applications are due on January 25th 2010 with awards anticipated in March 2010.

Go to for information on the SHARP program and the cooperative agreement applications. Information on the program is also available at For additional questions, email

Rep. Kennedy Introduces Bill

The passage of ARRA will expedite the adoption of EMRs throughout the healthcare sector. “While the implementation of EMRs is an internal feature of the act, a new and innovative technology such as the Personal Health Record (PHR) will help to further strengthen the healthcare system,” remarked Representative Patrick Kennedy (D-RI) on December 7th as he introduced the “Personal Health Record Act of 2009 (H.R. 4216) in the House.

The Act defines the critical components to be included in PHRs, such as medical and surgical histories including diagnoses and procedures, laboratory results, and information on medications, prescriptions, and allergies.

The Act would require the National Coordinator to develop guidelines regarding the technological standards for interoperability between PHRs and EHRs, and make recommendations for the incorporation of PHRs into community and behavioral health programs.

The Act specifies that Medicare and Medicaid reimbursement available through ARRA would be available to providers that can demonstrate “meaningful use” of electronic medical records by obtaining interoperability for EMRs with PHRs.

Since PHRs will change the landscape of how confidential healthcare information is obtained, the Act also requires the issues of privacy, security, and patient safety to be incorporated into PHR development from the onset. While ARRA addresses many of these issues, the Personal Health Record Act will further evaluate these issues specifically pertaining to PHR privacy, utilization, and patient safety.

VHA Partnering With Industry

The Veterans Health Administration (VHA) is looking to partner with commercial organizations to design and manufacture a respirator through a Cooperative Research and Development Agreement (CRADA). The CRADA aims to develop a new respirator for healthcare workers under a project called “Better Respiratory Equipment using Advanced Technologies”.

The idea for the project grew from the Institute of Medicine’s recommendation in 2007 to take steps towards better respiratory protection for healthcare workers. To respond to this need, the VA and the National Institute for Occupational Safety and Health set up a work group to bring a new respirator to the U.S. Marketplace.

The VA’s medical centers employ 118,000 healthcare workers who wear and discharge 1.6 million respirators per year at 900 plus outpatient clinics, 150 plus hospitals and 136 nursing homes.

Since the VHA has an extensive healthcare system, the agency wants to see the development of one or more new respirators in the U.S. marketplace in partnership with other Federal partners. VA hospitals will provide an excellent test environment to assess and guide prototype design, development, and revision. The candidate organization must have the capability to develop and bring to market a new respirator prototype using advanced technologies within 6 to 12 months.

In considering candidates, special consideration will be given to small business firms and consortia involving small businesses. Letters of interest are due by January 8, 2010. This information should be sent to Kimberly Rumping, The National Center for Occupational Health and Infection Control, Office of Public Health and Environmental Hazards, VHA, 1601 SW Archer Road (151B), Gainesville, Florida 32608 or email

CITRIS Provides Funding

The Center for Information Technology in the Interest of Society (CITRIS) has announced a new round of seed funding for FY 2010. The seed funding supports high risk high impact projects that are novel in their approach and may be able to attract larger scale grants from Federal, state funding agencies, or the private sector. The program is seeking proposals in energy, environment, healthcare, intelligent infrastructures, technology for underserved California regions, and for technology to use in the art world.

Proposals submitted on the delivery of healthcare can include IT for telemedicine and telehealth networks, and new biomedical devices and applications to extend the reach of telehealth networks. Projects are needed to provide for the exchange of medical records, to do the statistical analysis for medical data and imaging, and projects to extend telehealth networks wirelessly.

Other projects are needed to develop intelligent infrastructures enabled by sensor web for public health, safety, and first response. Research is needed to develop novel low power sensors, sensors to use on cell phones, and ways to integrate data from massive networks of sensors.

The previous round of CITRID seed funding led to a partnership with the California Telehealth Network to investigate networking for next generation healthcare IT. The research led to the FCC funding $22.6 million to provide healthcare to three million rural Californians. Research has enabled cell scopes to be used that make it possible for cell phone cameras to do remote diagnosis in resource poor areas. These phones are going to be used during a field trial in Mexico.

The one year seed grants are in the range of $30,000 to $75,000 The RFP is open to all CITRIS investigators in University of California at Berkeley, Davis, Merced, and Santa Cruz. For more information, go to

Awards for Research

The HHS Biomedical Advanced Research and Development Authority (BARDA) has awarded nine contracts to research and develop more effective tests and devices to determine levels of radiation that a person absorbs after a nuclear or radiological incident. The contracts total $35 million for the initial phase and up to $400 million over five years.

In the first year of the contract, the contractors will test the accuracy of the biomarkers as an indicator for the level of absorbed radiation. In addition, they will determine if their proposed devices measure these biomarkers effectively.

After completing the studies, the contractors will develop prototypes of portable devices to be used in the field by responders to test for radiation absorption. Knowing a more precise measure of radiation exposure will help healthcare responders determine the most appropriate treatment for patients exposed to damaging ionizing radiation.

The contractors will use the FDA Investigational Device Exemption process that allows the investigational device to be used in a clinical study to collect safety and effectiveness data that is required to support a pre-market approval application or a pre-market notification submission. If the products are approved by FDA, then the products may become eligible for consideration and procurement by the federal government.

The nine contracts went to Arizona State University in Tempe, Arizona, Chromologic LLC in Pasadena, California, Duke University in Durham North Carolina, Meso Scale Diagnostics LLC in Gaithersburg, Maryland, Northrop Grumman electronic systems in Linthicum, Maryland, SRI International in Menlo Park, California, Stanford University, Stanford, California, the University of Rochester, Rochester New York, and Visca LLC in Troy, Michigan.

Wednesday, December 16, 2009

EMR Outpatient Phase Launched

Vermont’s Fletcher Allen Health Care recently launched the outpatient phase of their electronic health record project just five month after implementing the inpatient phase of the project. Fletcher Allen has joined only 1.5 percent of healthcare facilities nationwide in implementing such a comprehensive computer system for patient care.

The Patient Record and Information Systems Management (PRISM) Fletcher Allen’s EHR is now fully functional at Aesculapius Medical Center in South Burlington Vermont. The Medical Center serves 18,000 people and is one of Fletcher Allen’s ten primary care clinics. By the end of 2010, all of Fletcher Allen’s outpatient clinics both primary care and specialty care will go “live” with PRISM.

In June, the system went “live” in Fletcher Allen’s inpatient areas, pharmacy, emergency department and some hospital outpatient areas on the Medical Center Campus in Burlington as well as the Walk-in-Care Center providing inpatient rehabilitation service at the Fanny Allen Campus in Colchester in June 2009.

“We’re very pleased with the progress we’ve made during the inpatient implementation, which has enabled us to start implementing PRISM in our outpatient clinics. We’re now able to offer patients the same enhancements in safety, efficiency, and coordination of care that we provide to patients admitted to the hospital”, reports Paul Taheri MD., President of Fletcher Allen’s Faculty Practice.

Fletcher Allen Health Care as part of the University of Vermont’s Academic Medical Center, partners with the College of Medicine and the College of Nursing and Health Sciences. Fletcher Allen serves as a regional referral center and community hospital for 150,000 residents in Chittenden and Grand Isle counties, has more than 30 patient care sites, and provides 100 outreach clinics with programs and services. In total, Fletcher Allen is providing advanced care to approximately one million people in Vermont and Northern New York.

AHRQ Issues RFAs

AHRQ posted a Request for Applications (RFA-HS-10-005) using Recovery Act funding to go to five organizations to develop the infrastructure needed to improve data collection in terms of quality, depth, and scale. This is particularly important when obtaining data from electronic clinical databases used to help researchers do comparative effectiveness research. Forty four million is available for this RFA over three years.

The projects will help to systematically collect prospective data on diagnostics, therapeutics, devices, behavioral interventions, and procedures used in clinical care. This will be especially useful when dealing with populations that are under-represented in randomized control clinical trials or have limited access to healthcare or both. This will be especially helpful when dealing with patients with multiple co-morbidities, the elderly, and minorities.

Public or non-profit private institutions are available to apply, along with Native American government and designated organizations.

In addition, AHRQ posted a RFA (RFA-10-006) to fund one organization to form the Electronic Data Methods (EDM) Forum where investigators, practicing clinicians, representatives from relevant organizations and other stakeholders will be able to gather to hear experts talk about clinical registries, research methods, health information technology, and outcomes research.

The EDM Forum will present a series of meetings and workshops to help researchers conducting effectiveness research using electronic data understand the necessary technical, organizational, clinical, legal, and ethical issues related to compliance with HIPAA. A total of $4 million is available for this RFA.

For information on both RFAs due January 20, 2010, go to or to

Robotic Approach to Airway Management

The US Army through the Telemedicine and Advanced Technology Research Center (TATRC) has awarded Energid Technologies a follow-on contract to develop a robotic approach to airway management. After trauma or injury, airway management typically involves clearing a patient’s airway and inserting a tube to maintain oxygen flow in preparation for further treatment.

Energid will develop a handheld lightweight robotic system that can perform endotracheal intubation on the battlefield. Energid’s approach uses a novel flexible tube manipulator that quickly and safely deploys inside a patient’s airway. The mechanism integrates force feedback and video tracking for real time active motion compensation and control. It also provides needed feedback to the operator for correct intubation and active liquid clearance.

“The device that we are developing works through a unique technology that we have developed for actuating flexible mechanisms. With Energid’s technology, the device can be effective and lightweight,” said Dr. Pablo Valdivia y Alvarado, the Principal Investigator for the project.

Energid is applying the commercial Actin ™ robot control and simulation toolkit plus the Selectin ™ machine vision toolkit to support control of the innovative hardware used in the device. Advanced control will protect injured patients from the current risks of airway management.

“This technology will be helpful to newly-trained first responders that are deployed with a unit because they don’t have the help of others or responders with years of experience to fall back on. The nuances of endotracheal intubation can be difficult to perform under pressure, therefore a tool that can assist the provider in re-establishing an airway without injuring the vocal cords would be beneficial,” said Nita Grimsley, the project’s contracting officer’s representative at TATRC.

Gateway Interface for Wireless Carriers

FEMA and FCC have adopted design specifications to develop a gateway interface so that wireless carriers can provide customers with timely and accurate emergency alerts and warnings via cell phones and other mobile devices.

The Commercial Mobile Alert System (CMAS) is one of many projects along with the Integrated Public Alert and Warning System (IPAWS) to enable emergency managers and the President to send alerts and warnings to the public.

This is the beginning of the 28 month period as mandated by the FCC in 2008, to allow commercial mobile service providers develop, test, and deploy the system that will have to deliver mobile alerts to the public by 2012.

Wireless carriers who choose to participate in the CMAS will be able to relay authorized test-based alerts to their subscribers. To ensure that persons with disabilities who subscribe to wireless services receive these emergency alerts, the FCC has adopted rules that require that participating wireless carriers transmit messages with both vibration cadence and audio attention signals.

The adoption of CMAS was a collaborative effort between FEMA, Department of Homeland Security in their Science and Technology Directorate, the Alliance of Telecommunications Industry Solutions, and the Telecommunications Industry Association. The next phase of CMAS collaboration with industry will enable FEMA to build the Federal Alert Aggregator/Gateway.

Register for the mHealth Conference

Mobile phones and new communication patterns are changing our society. Attend mHealth Initiative’s “mHealth Networking and Web Conference” February 3-4, 2010 at the Marriott Washington Wardman Park Hotel in Washington D.C. to understand how this new trend is impacting healthcare. This is a golden opportunity to meet and network with users, developers, and vendors in the field.

Learn about the myriad of mobile devices and apps for clinicians and patients, new disease management, new participatory health approaches, management of mobile phones in provider settings, and much more.

Readers of “Federal Telemedicine News” will receive a special discounted rate. (See below for details).

C. Peter Waegemann, Vice President, mHealth Institute has said the “mHealth is a tsunami-like wave that will hit all healthcare stakeholders. One can delay mHealth, but nobody can halt this spontaneous movement.” His presentation at the “mHealth Revolution” will address:

• Current status of 5,000+smart phone apps and apps developments in the near future
• Exciting developments in new communication patterns and what this means for future provider competitiveness
• The future of communication-based disease management
• Discussion on the impact of this disruptive change. Is it a revolution?

Claudia Tessier, President, mHealth Institute and author of the first comprehensive book on mHealth “Management and Security of Health Information on Mobile Devices” to be published by the American Health Information Management Association (AHIMA) in early 2010, will discuss how:

• mHealth will change the way patients deal with providers and payers
• Clinicians will use mobile communication devices to communicate, access patient information, and use to retrieve guidelines and protocols
• New “digital tools” are helping healthcare professions
• HIM professionals need to prepare for mHealth

Some of the other top speakers in the field include:

• Derrell West, Vice President and Director, Government Studies, Brookings Institute will speak on “mHealth and Public Policy; Strategies for Moving Forward”
• Christopher Wasden, Manager, Strategy and Innovation, PricewaterhouseCoopers LLC, will speak on the “The Future of Home Monitoring”
• Joseph Kvedar, M.D., Director, Center for Connected HealthCare will speaking on “Mobile Phone Technology: Addressing Unmet Needs of Parents of Children with Diabetes”

Plus many other additional speakers will be on hand to provide invaluable information and take part in the networking process at the meeting.

Participation in the mHealth Conference can be through personal attendance or by virtual mode. However, if you attend the conference, you will have the advantage of networking with both colleagues and vendors.

For more information on the Conference, go to To register as a reader of “Federal Telemedicine News” for the special discounted rate of $295 through December 31, 2009 (regular rate is $595), use Promotion Code mhealth2010. The next step is to go to The special rate will not show until you hit the “Submit” button after entering your demographic information and promotion code. Then click on the “Buy Now” button. You will then be directed to PayPal for payment. Questions or problems in registering please contact

Sunday, December 13, 2009

Health Centers Receive Funding

On December 9th, President Obama announced that nearly $600 million funded through ARRA, will go to Community Health Centers to help with renovation projects, assist with HIT, and provide for a medical home demonstration. Of that amount, HRSA will fund $88 million under ARRA to help current Health Center Controlled Networks (HCCN) grantees improve their information technology capacity. HRSA has specified that the funding will go for new activities with HCCNs eligible to apply for this funding as long as they clearly delineate the new activities from existing ones.

In this solicitation, HRSA is limiting funding to only HCCNs because they are capable of providing HIT infrastructure and able to implement EHR and other HIT systems. Today, 400 health centers are current members and obtain services from HCCNs. As of July 2009, HRSA currently supports 38 HCCNs for various HIT activities.

There are several categories under consideration for this grant funding. Category 1 provides $78 million to fund up to 26 HCCNs for EHR implementation at a maximum of $3 million for each project. Applicants to be eligible must be in the final planning stages of adopting a certified EHR and have selected a single vendor and platform. This category is also for applicants that are expanding their EHR capabilities

Category 2 provides $10 million to fund up to 10 HCCNs to implement HIT innovative projects other than EHR at a maximum of $1 million for each project. This category enables the use of telehealth to build or enhance existing HIT systems. The end result is to create interoperable information systems to use for more telehealth services.

For example, school-based programs might consider projects that partner with schools and other providers in the community to expand access to services, such as mental health or dental health services through telehealth technologies.

HRSA expects the HCCNs to focus on creating sustainable business models for deploying and maintaining HIT, as well as the health centers will need to be engaged in strategic partnerships to to leverage other HIT initiatives and resources.

Thirty six awards are expected to be funded. The current closing date for applications is February 5, 2010 and a Pre-Application Conference will be held on December 18, 2009. For more information on the HRSA-10-154 grant announcement, go to For additional questions, call Christie Brown (315) 662-7933 or email

Minorities Face Health Challenges

When it comes to health issues, Utah’s racial and ethnic minorities are not like the general population in the state but they are also not like each other. The Utah Department of Health, Center for Multicultural Health has published a series of Health Disparities Summaries that describe many differences among racial and ethnic minorities when compared to the statewide population.

Utah’s goal is to help community members and health workers raise awareness of health issues, plan health programs specific to racial and ethnic minorities, obtain grant funding to help organizations serve racial and ethnic minorities, and eliminate racial health disparities. In general, despite the health problems that plague many Utah minorities, some groups enjoy better health than the statewide population in some measures.

The study found that the African American/Black population including refugees and immigrants, share many health issues with the larger Utah population, but also have health problems unique to their communities. This population has a higher percentage of people without a place to go for health care and they also lack adequate prenatal care as compared to rest of the population in Utah.

Infant death is also more common among births to African-American/Black women as compared to the rest of the population. Sixty one percent of the deaths were due to the illnesses of the mother that complicated the labor and delivery and deaths were also due from infections. Other deaths resulted from birth defects, sudden infant death syndrome, injuries, and illnesses during the first year of life. Preterm births and low birth weight rates were also found to be high for this population.

However, death due to coronary heart disease and cancer are lower in the Utah African-American/Black population than among the U.S. population as a whole. This group meets both the state and national targets for low rates of coronary heart disease and cancer.

Diabetes affects Utah’s Hispanic/Latino population at higher rates than the rest of the Utah population. Reports show that gestational diabetes is more prevalent in the Hispanic/Latino population than among the general population.

Births to teens are frequent among Hispanics/Latinas in not only Utah but also nationally. Women with unintended pregnancies often lack adequate prenatal care and very often expose their fetuses to risks from smoking and alcohol.

However, this group has lower death rates from heart disease and cancer as compared to others in Utah. This group also meets state targets for low rates of stroke death, unintentional injury death, and arthritis problems.

The American Indian population in Utah does not always receive adequate healthcare. This has resulted in fewer health screenings, delayed health interventions, and difficulty in managing chronic conditions like diabetes. Utah American Indians die from complications of diabetes at nearly double the rate for the rest of the population in the state. Also more than 11 percent of Utah’s American Indian population has diabetes, compared to 6 percent of the Utah population.

Commercial tobacco use is a leading cause of death in Utah and is high among Utah American Indians as compared to the general population in the state. Exposure to cigarette smoke can trigger asthma symptoms and full blown attacks in adults and children. The adult Utah American Indian asthma rate of 11.5 percent exceeds the state rate of 7.9 percent.

The overall health status is poorer among American Indians than the rest of the Utah population including both mental and physical health. American Indians report that they do less physical activity than other groups in the state, plus education, income, and lifestyle also play a large role in American Indian health.

Go to for more details on the summaries.

Robots Screening Molecules

The discovery of a new class of molecules holds promise for blocking the clumps of protein that clog the brain in Alzheimer’s disease. This discovery was made possible by the NIH Roadmap Molecular Libraries Initiative. This initiative uses high tech robots and molecular genetics to speedily screen molecules for their biological effects.

To do that amount of screening by hand would take a person eight hours a day, five days a week for 12 years to do what can now be done in three days, explained Dr. Chris Austin, Director of the NIH Chemical Genomics Center (NCGC).

At the NCGC labs in Rockville Maryland, the robots work day and night performing automated high throughput screening. This technique borrowed from industry can rapidly screen vast libraries of chemicals, genes, or drugs for their effect on cells and proteins. The Center transforms the findings into probes for use by NIH scientists in search of better treatments for disease.

The NCGC in their largest search to date have provided small molecules screening in Alzheimer’s disease. Researchers studying Alzheimer’s disease at the University of Pennsylvania are using Genomic Center probes to pinpoint ATPZs that block the tau protein clumping. The researchers are following up with studies of ATPZs in transgenic mice in hopes of paving the way for a new class of drugs to treat Alzheimer’s.

At Vanderbilt University, Roadmap grantees have used high throughput screening to pinpoint two compounds that selectively tweak a subtype of receptor, call M1 for the brain messenger chemical acetylcholine which is known to be critical for learning and memory. This information will help develop a strategy for treating thinking deficits in schizophrenia and Alzheimer’s disease

At Scripps Research Institute’s Comprehensive Center for Chemical Probe Discover and Optimization, researchers have developed high throughput technology for quickly screening tens of thousands of compounds and the researchers are unraveling the workings of still uncharacterized enzymes which previously was a labor intensive task. This has helped the researchers discover compounds that can block certain cancer related enzymes.

Another Roadmap center grantee along with colleagues at the University of New Mexico’s Center for Molecular Discovery, have developed a high throughput way to simultaneously sort out complex cell mixtures and molecular interactions. By doing this, they discovered a new compound called G-15 that regulates cell responses to estrogen. The research will advance the understanding of estrogen’s role in breast, uterine, endometrial, and ovarian cancers. Their findings may also find applications in other estrogen related disorders such as immune system disorders and multiple sclerosis.

e-NC Releases Five RFPs

North Carolina’s e-NC Authority was awarded a grant from the National Telecommunications and Information Administration (NTIA) under the State Broadband Data and Development Grant Program. The grant program enables states to collect comprehensive and accurate broadband data and develop state level broadband maps.

The data collection and mapping process to be conducted by the e-NC authority requires the collection of data using multiple methods:

• Collect data directly from broadband service providers
• Collect provider data through a national data corporation using web crawling techniques
• Collect broadband consumer data at the local level
• Conduct radio wave propagation prediction modeling (using GIS) to look at wireless coverage
• Conduct surveys of citizens to look at broadband availability
• Conduct a survey to assess broadband use among institutions and households in the state

Most of the mapping and planning work will be conducted in house by the staff of the Authority. However, the e-NC Authority has released Requests for Proposals for contracted services.

The five RFPs released include:

• Collecting broadband data at the consumer level and organizations selected will conduct surveys. This RFP is due December 16, 2009. For information, contact Deborah Watts at (919) 250-4314

• Database development and maintenance will require a vendor to host and store the broadband database and another vendor to perform web site maintenance. This RFP is due December 18, 2009. For information, contact Angie Bailey at (919) 250-4314

• GIS mapping/hosting will require the vendor to upgrade, update, and maintain the current GIS application and Map Viewer. This RFP is due December 23, 2009. For information, contact Joanna Wright (919) 623-1127

• Survey analysis of broadband adoption and strategic gaps will require the vendor to track the impact and barriers to using broadband at both the household and industry levels. This RFP is due January 4, 2010. For information contact Jane Smith Patterson (919) 250 4314

• Web-enable data mining for the collection of broadband data will require the vendor to use web enabled data mining to collect broadband service provider data as one of the multiple data collection methods. This RFP is due January 6, 2010. For more information contact Jane Smith Patterson at (919) 250-4314

For more information go to

Wednesday, December 9, 2009

JTMN Moves Information Faster

The Joint Telemedicine Network (JTMN) used by the military enables volumes of medical imaging data to be transmitted faster to where the information is needed. The need for the JTMN emerged when Lt. Colonel Alfred Hamilton, the operational sponsor for the project went to Iraq and Afghanistan in 2007 to visit military healthcare facilities and providers throughout the theater to learn how information technology support could help provide better medical care.

Hamilton reported that it was taking an average of four and one half hours to transmit a single full body CT study of traumatically wounded service members from one medical facility to another. It was also taking more than an hour to transmit a single digital chest x-ray so that in many instances, patients being evacuated would reach the next echelon of care before their medical data and images arrived.

The JTMN team developed the system using satellite communications along with very small aperture terminals with sufficient bandwidth to transmit critical medical data and images. The team successfully achieved initial operational capability for the system in March 2009 and is still working to expand and improve the system.

Now deployed medical personnel can transmit 250 megabit digital x-ray or CT scans within 5 minutes via JTMN. The radiologists are now able to view the images before the patient arrives at the medical treatment facility and also enables the medical team to provide more effective care during the golden hour.

In addition to allowing speedy transmission of medical image files over a satellite network, JTMN enables video teleconferencing, remote consultations, transmission of medical records, and the ordering of class VII medical supplies.

Innovative Projects Helping Counties

Durham Health Innovations (DHI), a partnership between Duke Medicine and Durham County in North Carolina, has set up ten projects to address specific health issues affecting the culturally diverse residents of Durham County. The grant money released earlier this year came from a major grant from NIH that created the Duke Translational Medicine Institute which in turn, created the Duke Center for Community Research to manage the funding. Each of the projects will receive up to $100,000 to be used by the end of the year.

Robert Califf, M.D., Director of the Duke Translational Medicine Institute and Co-Chair of the Duke Health Innovation oversight committee said, “There are many community organizations that are already hard at work to improve healthcare in Durham, but we know that is not enough. However, the solution is not going to be to only work with more money but the solution needs to come from coordinating healthcare better by using more effective information technology.”

“Plans are to house all of the information in an institutional data warehouse and share the information with the community,” according to Lloyd Michener, M.D., Chair of Duke’s Department of Community and Family Medicine.

The projects in the community cover adolescent health, asthma, chronic obstructive pulmonary disease, cancer, cardiovascular disease, diabetes, HIV and sexually transmitted diseases, maternal health, obesity, pain management, substance abuse, and seniors’ health. These health issues affect many communities, but local health officials are not satisfied with the current methods being used to treat these issues.

Some of the projects will involve the design of a medical home model of care for adolescents to help with physical and mental health services, develop a model to coordinate community healthcare teams, develop a chronic disease registry to help improve care for asthma and COPD, provide for a specific coordinated care model for individuals with cardiovascular and chronic kidney disease, and examine how to provide an innovative coordinated care model for adults aged 60 years and older.

In other counties in North Carolina such in Kabbaoikus and Cabarrus Counties, residents have started enrolling in the MURDOCK study community registry and biorepository. The MURDOCK study funded by a gift from David H. Murdock is using modern genomic technologies to identify molecular predictors of outcomes across major chronic diseases and disorders.

The MURDOCK study is organized into a multi-tiered approach known as “Horizons”. The initial phase in one of the Horizon projects is focusing on osteoarthritis, obesity, liver disease, and cardiovascular disease. The study team has scheduled visits with participants to review their situation, have them sign a consent form, and then discuss their medical histories and medications. At that point, their vital signs are obtained along with their blood and urine.

By partnering with a wide range of healthcare providers, the MURDOCK study is able to reach a diverse population of residents including the uninsured and underserved. This enables the study designers to create a population-based registry and biorepository that accurately represents all the residents of the counties rather than just those who have access to healthcare.

After the visit, the staff processes the samples for long term storage and then the data will be analyzed for novel patterns and signatures that may predict risk or response to therapy and hopefully reveal underlying pathways with therapeutic potential. The investigators will eventually validate their findings in prospective trials using the registry and biorepository. The data will available and mined for decades to come to answer questions related to the epidemiology and genomics of disease.

Advancing Asthma Control

The National Heart, Lung, and Blood Institute (NHLBI) has awarded thirteen contracts to local organizations to develop, implement, and test science-based approaches to improve asthma control by using evidence-based national guidelines to help diagnose and manage asthma. The two year contracts, totaling $1.3 million will be administered by the Academy for Educational development based in Washington D.C., which serves as a contractor for NHLBI’s National Asthma Control Initiative (NACI).

Each of the new projects will receive $100,000 over two years to implement and evaluate strategies to improve asthma control. The projects in general will address diverse communities including rural, urban, or suburban settings. Strategies can target healthcare providers, adult and pediatric patients, or patients’ families, school personnel, and others who play a role in helping patients to manage asthma.

For example, specific demonstration projects may include:

• Developing web-based training programs and in-person educational outreach for healthcare providers, patients, parents, other childcare providers, and educators

• Developing a standardized electronic assessment form to use to improve communication between emergency care providers and primary care physicians to better coordinate patient care and to reduce emergency room visits.

Outcomes from the demonstration projects will be shared through the NACI in order to promote the adoption of asthma guidelines and to improve the quality of asthma care nationwide. The NACI will bring together organizations from local, regional, and national levels to share best practices, leverage resources, identify new directions, and to create learning opportunities.

Cloud Computing on the Horizon

Researchers from the Pervasive Technology Institute at the Digital Science Center at Indiana University are working on developing and using cloud computing techniques to support life science research. NIH awarded the university $1.5 million in grant funding to construct an experimental supercomputing network called “FutureGrid”.

Technological advances have made medical and biological research increasingly data-rich in recent years and scientists believe that this trend will continue to accelerate. In the future, processing extremely large sets of digital data resulting from gene sequencing and other medical research technologies generally cannot be met by a single facility or supercomputer.

Cloud computing provides a way to outsource computing infrastructure and can create virtual supercomputers with greater computational power than can be provided by any one facility. Clouds also support new data parallel technologies that can process massive data sets.

Users of clouds can access nearly unlimited computational power created by pooling distributed computation resources and using simple and straightforward web interfaces. This eliminates the need for users or their institutions to own and maintain large expensive computational equipment, and in addition users don’t need to have detailed technical understanding of the computational resources supporting their research.

“Cloud computing approaches are likely to affect research in the coming years, “said Principal Investigator Geoffrey Fox, Director of the Digital Science Center. “These technologies hold significant promise in the life sciences and medical sciences as they offer the potential for greater computational power and faster speeds at a lower cost.”

The project team is developing a software infrastructure to make use of the substantial hardware and networking investment made by Indiana University and the National Science Foundation (NSF). Both the university and NSF have worked together to develop “FutureGrid” a national experimental testbed, and TeraGrid, a national network of high performance computing resources. In the future, the project will also harness commercial cloud computing infrastructure such as Amazon Web Service, Microsoft Azure, and other open source software.

In addition to developing new cloud computing approaches, the research team will partner with several IU life science research teams to apply and test these techniques in their specific areas of life science research. These areas include projects related to population genomics as well as projects involved in assembling and sequencing gene fragments. Cloud technologies will also be applied to gene family clustering and the visualization of their structure in three dimensions.

Wisconsin Sets up eHealth Board

An Executive Order was issued to create the “Wisconsin Relay of Electronic Data (WIRED) for Health Board”. The WIRED for Health Board will develop a plan for a statewide health information exchange by June 2010 to identify, secure, fund, and provide for the technical infrastructure.

The Board will consist of 15 members representing both public and private stakeholders including a commercial payer, a patient or consumer organization, hospitals, physicians, the business community, pharmacies, laboratories, higher education, quality/health organizations, public health, Medicaid, and the State Chief Information Officers.

The Executive Order provides for legislative action to establish a permanent public private entity to implement the strategic and operational plans for statewide health information exchange when the Legislature reconvenes in 2010.

Milwaukee’s regional exchange has demonstrated how vital information can be provided during public health emergencies. Since the onset of H1N1, Milwaukee’s regional exchange has provided immediate data on the number of flu related emergency room visits grouped by hospital and by age group. This has meant that data on the spread of the virus in Milwaukee was done in real time.

Wisconsin is set to receive $9.44 million under a cooperative agreement in Recovery Act funds to support efforts to create a state exchange. The Recovery Act will also provide an additional $34 billion in incentives for hospitals and doctors to begin using electronic records.

Sunday, December 6, 2009

HHS Funds Community HIT

HHS Secretary Kathleen Sebelius and Dr. David Blumenthal, National Coordinator for Health Information Technology have just announced that $235 million is available to support the “Beacon Community Program” (BCP). The goal for the BCP is to enable communities at the cutting edge of electronic health record adoption to use the funds to move their communities forward to a new level of healthcare quality and efficiency.

The program funded by ARRA, will have $220 million available to support communities that can expect EHR adoption rates to be significantly higher than published national estimates. According to Dr. Blumenthal these communities are best positioned to lead the way in accomplishing meaningful use of EHRs and to help other localities start using health IT. The additional $15 million will provide technical assistance to the communities and evaluate the program.

The chosen communities and their recipients of the funding will be asked to define, track, and report on the progress they are making towards meeting measurable goals related to EHR adoption. The data reported by the communities may include data on reductions in blood pressure, reduced blood sugar levels among diabetics, lower smoking levels, or reductions in healthcare disparities among populations.

Cooperative agreements will be awarded to 15 qualified non-profit organizations or government entities representing diverse geographic areas to include rural and underserved communities. To qualify for the program, applicants are expected to build off of existing health IT infrastructure and demonstrate care and cost savings. They will also need to coordinate activities with the ONC programs that include Regional Extension Centers, State Health Information Exchange Programs and the National Health Information Technology Research Center. Information on the cooperative agreement applications will be available at

HHS is also funding several grant programs to help educate professionals in the HIT field. One program called the “Community College Consortia to Educate Health Information Technology Professionals” is making $70 million available to create health IT education and training programs at community colleges.

Another HHS funding program with $10 million will go to help institutions of higher education support health information technology curriculum development. Up to 5 grant awards will be awarded to support curriculum development primarily at the community college level to use for workforce training.

KDHE's Approach to HIT

The Kansas Department of Health and Environment (KDHE) the state designee for health information technology developed the web site to let the public know about the state’s Health Information Exchange. As the operational and strategic planning for the HIE gets underway in January 2010, we want the public to have easy access to information and developments,” said KDHE Secretary Roderick Bremby.

The Kansas e-Health Advisory Council has been meeting in workgroups to focus on issues such as governance, technology, business operations, finances, and legal matters. In January 2010, the e-Health Advisory Council will start consolidating their workgroups in order to form a strategic plan for Kansas. Throughout 2010, the Council will focus on operational and strategic planning.

The eHealth Advisory Council came together in mid November to discuss the key components needed for the statewide HIE. One of the recommendations discussed by the eHealth Steering Team was whether there is value in creating a fast track to support meaningful use for EMR- ready providers.

An idea was discussed as to whether to launch an operation or a small group to focus on the rapid deployment for Kansas providers that already have EMRs and want an HIE option in 2010. This approach would provide an option for those providers that are “ahead of the curve” to try this out while keeping within the framework of the statewide vision. Eighteen of the meeting attendees voted yes and none voted no.

The state submitted their grant application to the Office of the National Coordinator for Health Information Technology in mid October. Kansas expects to receive $9 million for the four year project with confirmation of that amount in December and hopes to have funds available in January.

In the meantime, there some current state and local ongoing IT initiatives that are helping the state to adopt health IT such as:

• The Clinics Patient Index at the Central Plains Regional Health Care Foundation links patient information to six community clinics via a computerized patient enrollment and tracking system

• The Jayhawk Point of Care project brings together all of the Pratt Regional Medical Center’s key departments in a single database to communicate vital patient information

• CareEntrust has several leading employers and healthcare organizations in the Kansas City metropolitan area subscribing to their employer-based electronic health record

• The Northwest Kansas Health Alliance the largest formal Critical Access Hospital network in the U.S links members via telemedicine services to provide teleradiology usage

• The Sedgwick County Community Health Record helps the Medicaid managed care population in the county

• KAN-ED a statewide initiative brings broadband capabilities to hospitals and other member institutions within the state

• The Kansas Health On-Line Consumer Health Online Tool has a website that includes healthcare costs and quality information

• KC Carelink is a non-profit collaborative using IT to help providers across healthcare safety net organizations

• Kansas City Bi-State Health Information Exchange provides a secure, integrated, interoperable HIE in Kansas City

• The University of Kansas Center for Telehealth and Telemedicine network has grown to more than 100 sites across the state

Help for the Visually Impaired

MIT’s Touch Lab has developed a device called the BlindAid system to enable the visually impaired to feel their way around a virtual model of a room or building. Mandayam Srinivasan, Director of the MIT Touch Lab and affiliated with the Research Laboratory of Electronics and the Department of Mechanical Engineering is working on this project with the Carroll Center for the Blind in Newton Massachusetts.

The BlindAid system builds on a device called the Phantom, developed at MIT in the early 1990’s and commercialized by SensAble Technologies. Phantom consists of a robotic arm that the user can grasp as if holding a stylus. The stylus then creates the sensation of touch by exerting a small, precisely controlled force on the fingers of the user.

Orly Lahav, a former postdoctoral associate in the Touch Lab, and David Schloerb, a research scientist in MIT’s Research Laboratory of Electronics, did most of the work to develop and build the device. Lahav presented their work at the Virtual Rehabilitation 2009 International Conference held in Israel last summer.

The BlindAid stylus functions much like a blind person’s cane, allowing the user to feel virtual floors, walls, doors, and other objects. The stylus is connected to a computer programmed with a three dimensional map of the room. Whenever a virtual obstacle is encountered, the computer directs the stylus to produce a force against the user’s hand, mimicking the reaction force from a real obstacle.

Srinivasan’s team has tested the device with ten visually impaired individuals at the Carroll Center. “To successfully use the system, the visually impaired person must have a well developed sense of space,” says Joseph Kolb, a mobility instructor at the Carroll Center. During the testing, Kolb realized that the device could also be used to help mobility instructors evaluate the exploration strategies the subject is using. The instructor is able to determine if the individual uses an organized approach or tends to get stuck in a certain area.

Once Srinivasan obtains additional funding, he hopes to incorporate the BlindAid system into the Carroll Center’s training program which will yield user feedback to help him refine the system for commercial production. In the long term, he believes the device could be used to help blind people not only preview public spaces but to also use the device to travel by public transportation by using virtual route maps and then be able to interact with the virtual map through touch.

New Telemedicine Centers Underway

To develop innovative healthcare education initiatives, the University of Arizona’s Phoenix Biomedical Campus has just opened the Institute for Advanced Telemedicine and Telehealth or referred to as the T-Health Institute. The Institute is working in partnership with Arizona State University.

The facility has the T-Health Amphitheater, a state-of-the-art videoconferencing facility loaded with highly innovative custom designed social networking platforms. The amphitheater is one of the three urban hubs of the Arizona Telemedicine Program’s vast statewide “virtual campus” that stretches throughout Arizona and links to 71 rural and urban communities.

The new T-Health Institute’s advanced video conferencing techniques were developed by Dr. Ronald Weinstein, Founding Director of the UA Telemedicine Program and Richard A. McNeely, Director of Biomedical Communications at UA’s Arizona Health Sciences Center.

Dr. Weinstein reports that it is now time to begin to redesign our healthcare education system. For the past century, healthcare workers have been educated in profession-specific “silos” which means that students in medical schools, nursing schools, pharmacy schools, and allied health professional schools often find communicating with each other to be limited. As a result, the coordination of training in the various health professions is uncommon at most U.S. universities.”

To help implement health IT, the Arizona Telemedicine Program with funding from HHS will serve as the Southwest Regional Telehealth Resource Center to provide training and technical assistance in telehealth and electronic health record implementation.

In California, the new University of California San Diego Medical Education and Telemedicine Center is scheduled to open in the fall of 2011. The facility will be a hub for learning using state-of-the-art design and technology to prepare medical students to become physicians and innovators of tomorrow. The facility will be used by physicians to learn new skills using the latest advances in medical and surgical technology as well as being able to work with surgical robotics. In addition, the new facility will be a regional and statewide center for new initiatives in tele-education and telemedicine.

The 21st century facility will enable tomorrow’s physicians to learn the art and science of medicine by being involved in small academic communities where advanced clinical and research training will be delivered using high tech biomedical simulation along with telemedicine learning laboratories.

Wednesday, December 2, 2009

Draft Strategic Plan Released

Governor Edward G. Rendell’s Office of Health Care Reform issued a draft strategic plan for the Pennsylvania Health Information Exchange (PHIX) on November 30th. The draft strategic plan details how the state can best transition to an electronic system of health records and is requesting comments until December 20, 2009.

The adoption of health IT is a major component of the Governor’s comprehensive health care reform plan referred to as the “Prescription of Pennsylvania”. Up to $17 million is available in federal stimulus funding to pay for the infrastructure.

Hospitals and primary care providers are increasingly using health information systems across the state. The results of a 2008 survey of Pennsylvania hospitals showed that 84 percent of the state’s acute care hospitals are using some functionalities of an EHR, though only 2.4 percent had a comprehensive system in place to all clinical areas. The high adoption rate in hospitals is in part because 98 of the state’s 165 general acute care hospitals are part of larger health systems. Physician adoption of EMR/EHRs is proceeding more slowly with about 20 percent of physicians surveyed using at least some of the functions of an electronic system.

The Draft Strategic Plan addresses the following:

• Long term governance will be through a Public/Private partnership to be created through legislation

• The anticipated HITECH funding for Pennsylvania of $17.1 million plus the Governor’s current PHIX budget of $1 million will be used to implement PHIX beginning in 2010

• To address long term sustainability an assessment will be made on all medical claims paid by insurers to cover the costs of PHIX implementation and ongoing operations

• Pennsylvania will enter into an intergovernmental agreement with Delaware to leverage the existing Delaware Health Information Network contract for HIE services

• PHIX will work with the Pennsylvania Regional Extension Center to promote HIT adoption

• A detailed communications plan will be used to educate consumers and providers on using electronic records and the HIE

• PHIX infrastructure will meet the required federal and state standards for data security and integrity

• Except for super protected information, consent will be established based on existing laws and polices

The draft plan was developed by the Office of Health Reform in consultation with the PHIX Advisory Council, the PA eHealth Initiative, an outside advisory board comprised of health information experts and other stakeholders. The draft plan outlines how the commonwealth will govern, finance, and implement the initiative.

To read the draft plan, go to and to comment on the draft strategic plan, email

Goals for EHR System

The goals for the electronic health record are simple according to Charles Campbell, Chief Information Officer for the Military Health System in an interview appearing in the Defense Health Information Management System newsletter “The Beat”. He wants to see the EHR system stabilized, made more reliable, become more user-friendly, and operate faster.

In looking at the goals for AHLTA and the Military Health System (MHS), he is focusing on the 48 month “EHR Way Ahead Plan” to help modernize the EHR system. Plans are to move the current enterprise architecture to a more flexible “plug and play” service oriented architecture to allow for the deployment of new capabilities at a much faster rate.

He wants to see modernized architecture enable the military to break capabilities into smaller pieces, thereby enabling more people and smaller companies to get involved in developing capabilities to deliver care more efficiently. He believes that more competition will create more innovation.

As Campbell sees it, in FY10, the military will begin their initial sharing of data through the Nationwide Health Information Network (NHIN) with the VA, MHS, large commercial healthcare organizations, and TRICARE partners in the next couple of years.

Campbell’s vision for the MHS over the next three years is to have one central IT portfolio of all the products being used in the Military Treatment Facilities (MTF). The plan would create one medical network to help eliminate single points of failure and delay. By being “virtual”, the military will be able to focus on using web-based applications.

In the future, a new flexible customizable graphical user interface will be implemented so users will be able to move capabilities around on their screens to fit their individual needs. While at the same time, the underlying data will remain standardized throughout all MTFs.

Campbell realizes that most products purchased are mostly Commercial-Off-The-Shelf (COTS) products and although using COTS products is effective, it often means that business practices have to be modified and the workflow often has to be adapted to the particular design of the COTS products.

He is very proud of the work on one special project called “MiCare”, which is the Personal Health Record (PHR) initiative. A team of experts at Madigan Army Medical Center were able to make the PHR operational and the next step is to connect the PHR to the upcoming beneficiary portal.

Actions in Minnesota

In October, the Minnesota Department of Health’s Office of Health Information Technology submitted an application to participate in the 2013 State HIE Cooperative Agreement Program. With $564 million to be used to support state level planning and implementation projects, the plans are to use $40 million over 4 years. The project called the “Minnesota e-Health Connect” project is going to build on the previous five year efforts of the Minnesota-e-Health Initiative, a public-private collaborative.

The goals of the “Minnesota e-Health Connect” project are to develop plans for HIEs, provide oversight to ensure that the needs of the providers are fulfilled, develop the infrastructure to facilitate meaningful use, and implement initiatives to connect providers to state designated HIEs.

The project will garner stakeholder support through the Minnesota e-Health Initiative and the Minnesota e-health Advisory Committee plus work with stakeholders to identify the governance model for HIE in the state.

With the development of a HIE in the state, more help will be available to help the aging population in the state. In 2011, some of the baby boomers in the state will be 65 years old and are looking to a future where technology will enable them to stay in their homes as they age. Also, people in Minnesota tend to want stay in their state as they age.

Specifically to help the state’s aging population, the Minnesota Department of Human Services awarded $2.4 million in grants to community organizations throughout the state to help the aging population live independently and remain in their own homes as long as possible.

The grants provide seed money to develop services to improve chronic disease management and to link long-term care services to promote independence for seniors. For example, the funding will provide caregiver health education, deliver home services, provide telehealth support and mobile health service programs, assist with home modifications and repair, and provide transportation, care coordination, and homemaker services for seniors.

In another move to help seniors, it was announced recently that the Minnesota Department of Human Services, Aging and Adult Service Division will be seeking proposals for FY 2011 with information to be available on January 19, 2010. The purpose for the funding will be to expand and integrate home and community-based services for older adults that will enable local communities to support people in their homes while expanding caregiver support.

The deadline for the proposals will be March 26, 2010. The announcement on the FY 2011 grantees will be provided on July 2010. For more information on the FY 2011 proposals, email Jacqueline Bruno Peichel at

DOD Focusing on mHealth

The Military Health Service (MHS) is taking a strong look at international medical outreach efforts to see how the military can improve public health in the Third World by using cell phones. There are a handful of DOD funded mobile health or mHealth projects now underway with several more being discussed. Some projects are aimed at promoting health for service members returning home while other projects are focused on building up global medical capacity.

“Over half the world owns a cell phone and only 400 million own a computer, so it is only a matter of time before everyone uses a cell phone for all their computing needs,” said Colonel Ron Poropatich M.D., Deputy Director of TATRC at Fort Detrick Maryland. He continued to point out that the tremendous health needs in developing countries are creating the “perfect storm” for the need to use this inexpensive technology to deliver care.

Colonel Poropatich said “mHealth can be used for clinical consultations, education, research, biosurveillance, and disease management. For example, DOD is doing ongoing research at Walter Reed Army Medical Center’s Diabetes Institute. The researchers are using internet-enabled cell phones to pull up 15 to 30 second video clips to provide diabetics educational content on exercise, blood glucose monitoring, and diet.

All 170 diabetics enrolled in the study received the phones, but only half were sent the daily video clips. The first three months of study showed that the subjects in the intervention group viewed the daily reminders about half of the time, and those diabetics who do view the reminders had reduced hemoglobin A1C blood sugar levels and improved glycemic control.

The plan is to target Community Based Warrior Transition Units (CBWTU) providing outpatient care to the Army National Guard and Reserve members with TBI after they are released from inpatient medical facilities. Soldiers suffering with TBI can suffer from a wide variety of functional limitations and these limitations can interfere with their ability to manage their care.

Through the program, each eligible soldier coming into one of the designated CBWTUs will be given a personal cell phone upgraded with the mCare application. Once upgraded, the phones will receive text messages with information on new treatments, program information, and appointment reminders. Even with the special software, cell users must open the secure application by entering a password before being able to access appointment reminders, as well as to obtain health and medical information that is specifically geared to their treatment plan.

The first phase of the CBWTU project will send out text messages to the member’s cell phones and will include educational announcements, sleep hygiene measures, medication and appointment reminders, and helpful hints tailored to unique problems the service members face with TBI.

International mHealth efforts include a project in Peru being carried out by DOD’s Global Emerging Infections System (GEIS) in conjunction with the Navy Medical Research Center in Lima and also with the Peruvian military. The project is using cell phones for biosurveillance detection to send out alerts about suspected emerging infections.

“There are however challenges using mHealth internationally in the developing world. There are many languages that require translation and also illiteracy issues will have to be overcome. It is also important not to encroach on the State Department and the USAID efforts”, said Poropatich. “We need to work with USAID and the host country’s Ministry of Health to give them the server so that they can coordinate with the phone company.”

Poropatich said that in the future, the use of mobile phones could be expanded to help in maternal and child healthcare, for clinical consultations where pictures could be exchanged between providers and the patient, and for biosurveillance research. It also can be used for medical logistics so that information can be uploaded on the quantity of medication stocks to help supply chain personnel know when to resupply medications.

As new mHealth technologies are developed, a major issue will be cost. “The problem is that it becomes very expensive to use proprietary software,” Poropatich said. “We’re beginning to dialogue with organizations to develop open source software.”