Sunday, February 28, 2010

Cancer Specific EHRs Needed

Electronic health records have the potential to transform clinical practices and research. Yet, even with financial incentives, the adoption of EHRs by clinicians depends on how well the solution integrates with how patient care is managed, how the work flows, and having the right sources for data. Currently, general EHR solutions fail to support the unique treatments provided by practicing oncologists.

To support oncologists EHR needs, NCI’s Center for Biomedical Informatics and Information Technology (CBIIT) created the “Clinical Oncology Requirements for the EHR (CORE) project. CORE has brought CBIIT, the American Society of Clinical Oncology, and NCI’s Community Cancer Center (NCCCP) program together to study the problem.

So far, progress has been made to collect and refine functional specifications based on the needs of the community. Requests for Proposals were issued to help the EHR vendor community develop a functional EHR. It is anticipated that the pilot implementations of this new EHR will be in place at selected NCCCP institutions before the end of 2010.

CBIIT plans to work with the NCCCP and other stakeholders to develop and deploy standards-based, oncology specific information to hospitals, physician practices, and consumer EHRs. As it is right now, an open source and open standards-based oncology EHR referred to as caEHR that is targeted directly to the ambulatory oncology community module does not yet exist.

CBIIT’s goal is to help develop the caEHR project by developing a set of standards, or perhaps use other standards, and then vet the standards to a number of participating NCI Community Cancer Center sites.

CBIIT wants to receive ideas and comments on the overall approach to EHR architecture. The information is needed on the standards, recommended technical and deployment approaches for an EHR, information on critical issues, and how the impact of the adoption of the technology.

On February 17th, RFI (S10-126) was published by According to the RFI, SAIC-Frederick, Inc. is seeking market information on sources to help CBIIT implement the CORE program.

The SAIC-F Point of Contact is Gary Krauss, Subcontract Specialist at

Partnerships Impacting Healthcare

Geisinger Health System and the Translational Genomics Research Institute (TGen), have signed a strategic research agreement to look at the gaps in clinical medicine where biomedical research can make a difference. Geisinger is a non-profit medical and insurance provider based in Danville Pennsylvania and TGen is a non-profit biomedical research institute based in Phoenix.

One of the first projects will focus on the causes of obesity, diabetes, and other metabolic conditions. Researchers plan to look at the possible genetic reasons why so many Americans are overweight, and why diet, exercising, and even bariatric surgery many fail to significantly reduce excess weight in some patients.

Geisinger’s value to the partnership is based on its integrated healthcare delivery model, non-transitory population, and advanced electronic health record with nearly two decades of data. In addition to providing the clinical underpinnings for the study of obesity, the data within the EHR will provide researchers with the evidence they need to do research on projects centered on cancer and other serious diseases.

“Given our unique research structure and patient population that overwhelmingly supports cutting-edge research, I am confident that this partnership will allow us to test and apply new clinical translation theories to patient care,” said Glenn D. Steele Jr. M.D. Ph.D., Geisinger’s President and CEO.

Johanna DiStefano, PhD, Director of TGen’s Diabetes, Cardiovascular & Metabolic Diseases Division, will lead TGen’s efforts to understand the genetic basis of obesity and liver disease. She said research strategies would use the strengths of the large multidisciplinary research program in obesity at Geisinger.

“Merging Geisinger’s wealth of clinical information with our genomic and proteomic expertise should provide researchers a richer framework for exploring the genetic origins of disease, and hopefully lead to improved treatments and outcomes, said Dr. Jeffrey Trent, PhD., TGen’s President and Research Director.

In other TGen partnership news, the Institute is presently collaborating through the “Partnership for Personalized Medicine (PPM)” with Arizona State University’s Biodesign Institute and the Fred Hutchinson Cancer Research Center. The PPM’s mission is to improve medical outcomes and reduce costs by more effectively diagnosing disease risks and matching patients to therapies.

TGen has also formed a research alliance with the Van Andel Research Institute (VARI). The agreement enables TGen and VARI to tackle many of today’s leading diseases. The Alliance has already yielded significant benefits for Arizona by helping TGen secure a number of grants from NIH under ARRA.

TGen’s ARRA grants total $18.9 million and this means that TGen’s use of the funding could result in as much as $41.9 million in new business activity. Projects will be undertaken with partners at Arizona State University, University of Arizona, and Northern Arizona University as well as with research institutes and universities across the U.S. and VARI.

NIH & FDA Collaborating

FDA and NIH are working together on an initiative that involves two interrelated scientific disciplines. These disciplines include translational science to shape basic scientific discoveries into treatments and regulatory science to develop new tools, standards, products, and evaluate product safety, efficacy, and quality.

“FDA plays an essential and unique role in how therapies are evaluated. We are the bridge between biomedical research discoveries and new medical products,” said Margaret A. Hamburg, M.D., Commissioner of Food and Drugs.

As part of the effort, the agencies will establish a Joint NIH-FDA Leadership Council to spearhead collaborative work on important public health issues. The Council will work together to ensure that regulatory considerations are an integral part of biomedical research planning and that the latest activities in science are integrated into the regulatory review process.

In addition, NIH and FDA will jointly issue a Request for Applications to provide $6.75 million over three years for work in regulatory science. The research supported through this initiative should add to the scientific knowledge base by providing new methods, models, or technologies so that the scientific and regulatory community can find better approaches to evaluating safety and efficacy in medical product development.

Funding Health Disparities Research

The University of Minnesota Medical School has issued a Request for Proposals for the 2010 Pilot Grants in Health Disparities Research. The grants are designed to encourage community-initiated research and to foster sustainable long-term collaboration between community-based organizations and academic researchers on research projects that focus on reducing and eliminating health disparities.

Priority will be given to projects that have a high likelihood of leading to future funding by NIH or other federal, state, or private funding agencies. Proposed research must address a current health disparity and proposers must submit a detailed plan for future and long term support for the research.

Funding support for the 2010 pilot grants will be provided by the University of Minnesota Clinical and Translational Science Institute and the Masonic Cancer Center. It is expected that four to five awards ranging from a minimum of $10,000 to a maximum of $25,000 will be made available.

All community-based organizations are eligible to apply but applications must address:

• A health disparity topic of importance to the community
• How collaborations across multiple community-based organizations and/or populations will be achieved
• How the research results will be used to help with health disparities in the community
• The likelihood of sustainability and/or leading to long-term support from other funding sources
• How to develop a progress report detailing achievements from previous funding through a previous grant mechanism in the past.

There are multiple steps involved in applying and the first step is to submit a letter of intent. After the letter of intent has been received, community-based organizations will be matched with researchers with similar interests at the university. Applications will then be reviewed by a committee consisting of individuals from the local community and the University of Minnesota. Full research proposals due May 6, 2010.

For more details email Michael Golden at or call (612) 626-9192.

Online Genomics Center Launched

The National Human Genome Research Institute (NHGRI) has just launched an online tool to help teach nurses and physician assistants about genetics and genomics. The tool is part of NHGRI’s effort is to provide healthcare professionals the knowledge needed in this field. The Genetics/Genomics Competency Center (G2C2) was created with the guidance of an advisory group with representatives from a wide range of research and professional organizations.

G2C2 developed at the University of Virginia through a contract with NHGRI, is a free, web-based collection of materials on genetics and genomics. Nursing and physician assistant educators can use the G2C2 to find and download materials for use in their classrooms.

Users can also share their favorite genomic and genetic teaching resources and materials with other educators by uploading material, which is regularly reviewed by the center’s editorial board to ensure quality control.

To encourage sharing and also to reduce duplication across healthcare disciplines, G2C2 helps to match existing educational resources with educational competencies. The online center accomplishes this by using sophisticated, cross-mapping of learning activities and assessment, and provides outcome indicators.

“We’re very excited that physician assistants were included in this pioneering effort. Our profession has been at the vanguard of realizing the importance of genetics and genomics in the future of medicine, and encourages efforts to incorporate more of the key concepts into education and training,” said Physician Assistant Michael Rackover, M.S., an advisory group member who directs the physician assistant program at Philadelphia University.

NHGRI’s Genomic Healthcare Branch will host a webinar this spring to provide educators with a tutorial on using the tool and will be available to answer questions about the resource.

To access G2C2, go to and for information on NHGRI, go to

Wednesday, February 24, 2010

Army Advancing Network Capabilities

The Army Research Laboratory (ARL) will invest up to $166 million over the next five years to bring government, industry, and academic institutions together to advance the Army’s network capabilities. The ultimate goal is to develop a scientific foundation for modeling, designing, analyzing, and examining how very large networks of humans behave as they interact with each other.

According to Dr. Alexander Kott, ARL’s Network Science Division Chief, “The Army is moving rapidly and deeper into a network-centric world. So much today depends on how warfighters with sensors and weapons are able to communicate information through mobile, self forming, and rapidly changing networks.

Rensselaer Polytechnic Institute received $16.75 million in funding from the Army to launch a new interdisciplinary research center devoted to the study of social and cognitive networks. The Center for Social and Cognitive Networks is now part of the Army’s newly created Collaborative Technology Alliance within ARL that includes four nationwide centers focused on the emerging field of network science.

Rensselaer will receive $8.6 million of the $16.75 million to lead the new center for the first five years. ARL anticipates funding an additional $18.75 million for the second phase which brings the total funding to $35.5 million for the next ten years and will involve additional universities and corporations.

Rensselaer will be joined by corporate and a number of academic partners to include IBM Corp., Northeastern University, and the City University of New York, University of Illinois, and collaborators from Harvard University, MIT, New York University, Northwestern University, University of Notre Dame, The University of Maryland, and Indiana University.

As technological advances provide tools to better monitor social interactions and influence social networks, researchers want to understand both the human interactions and the underlying technological infrastructure used.

The Center will link social scientists, neuroscientists, and cognitive scientists with physicists, computer scientists, mathematicians, and engineers to work to uncover, model, understand, and study the complex social interactions that take place in today’s society.

The Center will study the fundamentals of the networks and their role in today’s society and in organizations including the Army. The goal is to gain a deeper understanding of the networks and build a firm scientific basis in the field of network science.

The work will include research on large social networks with a focus on networks with mobile agents. An example of a mobile agent is someone who is interacting with others while moving around the environment. The Army and the societies where it operates are examples of such networks.

Five topics will be the focus for the Center’s research. The first step will be for the researchers to understand human interactions and the underlying technological infrastructure that they use. A second area for study will look at organizational networks and how knowledge, particularly in the Army is spread from peer to peer in the modern military. Researchers will look for digital traces of collaboration and communication within an organization at all levels to understand how information flows.

The third area will be to study adversary networks. This research has important implications for the Army to deal with terrorists and other hidden groups within society. The researchers will study ways to monitor the activities of the networks, map the composition and hierarchy of the network, and try to understand how their dynamics and evolve over time. This work will bring expertise together ranging from computer science to game theory.

The fourth area of focus will examine trust in social networks by measuring the level of trust within a network and how the level of trust moves information through a network. For example, researchers will use mathematical and computational modeling to understand how different types of social interactions impact an individual’s thoughts and behaviors. Finally, the Center will look at the impacts of human error in social networks and use computational systems to predict how human error or bias influences judgment.

The University of Illinois, Department of Computer Science through their Network Academic Research Center will use $8.1 million of the Army funding to work together with industry and university partners to specifically address how to handle massive amounts of data, how to do large scale information mining, and how to process information rapidly.

State Funds to Improve Healthcare

Governor Pat Quinn announced that the state of Illinois will receive $18.8 million in federal funds to develop a statewide Health Information Exchange (HIE). The Governor signed an Executive Order to create the Illinois Office of Health Information Technology to be housed in the Governor’s Office. The Office of Health Information Technology will collaborate with the two ARRA funded Regional Extension Centers in Illinois which are led by Northern Illinois University and Northwestern University.

In another move, the Illinois Department of Healthcare and Family Service (HFS) are moving ahead to reform the delivery of care to the most vulnerable populations covered by the Medicaid Program. The goal is to set up an integrated care delivery system to bring physicians, hospitals, nursing homes, and other service providers into a network connected with electronic medical records.

The Department of HFS seeks two HMOs to provide services to disabled adults and older adults eligible for Medicaid but not eligible for Medicare. The contractors to provide the integrated care services are now being procured through an RFP issued on February 5th and due on April 15th, 2010.

The first phase of the program will focus on traditional medical services with later phases implemented to coordinate long term care. The pilot program will affect almost 40,000 individuals in suburban Cook, DuPage, Kane, Kankakee, Lake, and Will counties.

Another phase of the program to be phased in next year will be to provide individuals with disabilities the support they need to live more independently in the community. The goal is to give individuals with disabilities a greater voice in designing the care plan they need.

Department of HFS will tie some of the compensation that would go to the HMOs to their performance on nationally recognized pay-for-performance measures. In turn, the HMOs will be expected to reward hospitals, physician practices and other providers with incentives based on performance and positive health outcomes. Once the Department of HFS evaluates the effectiveness of the new approach, the department will determine whether it should be employed in other parts of the state.

Michael Gelder, Senior Healthcare Policy Advisor to the Governor described how the statistics from the current Medicaid program demonstrates the potential for the integrated care pilot program to greatly improve the health of the enrollees.

For example it has been found that patients who have coordinated follow-up care, such as a visit with their doctor within two weeks of a hospital discharge have significantly lower readmission rates. Current data shows that only 21 percent of patients in the target group saw their doctor within two weeks of discharge. Follow-up is needed with patients and their medications since only 36 percent of patients with congestive heart failure are on an appropriate medication regimen and 25 percent of diabetics do not have their blood sugar tested even once a year.

The pilot project is expected to save taxpayers close to $200 million in its initial five-year period. If successful, the Department of HFS will identify other areas within the state where this model can work and produce good results.

For more information, email Michelle Maher, Department of HFS Division of Medical Programs at or call (217) 524-7478 or call the Procurement Office Call Center at 1-866-ILL-Buys.

Virginia Expanding HIT Efforts

Nearly $24 million in federal funding will be used by the Commonwealth of Virginia to advance health IT. The state will work with $11.6 million over a four year period of time to develop a health information exchange and the Governor’s HIT Advisory Committee leading the planning for the initiative will establish the Office of Health Information Technology. The state is scheduled to conclude the planning phase for the HIE in the fall and at that time; the implementation phase is scheduled to begin.

HHS and the Office of the National Coordinator have made $12.4 million available to support a statewide HIT Regional Extension Center to help physicians adopt electronic health records. The Virginia Health Quality Center in partnership with the Center for Innovative Technology, Community Care Network, and the Medical Society of Virginia, will lead the effort to provide low cost access and technical support to 2,300 primary care physicians in the state.

The University of Virginia through their Office of Telemedicine is actively helping in areas where disparities exist by linking remotely located patients with health professionals. Since January 13, 2010, almost 17,000 patient encounters have taken place and clinical consultations and medical education is provided through the University’s Telemedicine Network and other telecommunications networks.

Last year, the University of Virginia expanded telemedicine capabilities in Southwest Virginia and opened five new telemedicine sites. Funding for the sites came from USDA, HRSA, the Verizon Foundation, and the Tobacco Indemnification and Community Revitalization Commission.

Funding was also made available to Healthy Appalachia Works and the Southwest Virginia Telemedicine Cancer Outreach Program. Both of these programs provide access to cancer screening, education, prevention, and clinical trials throughout the region. The University of Virginia Health System also provides a teleradiology link to the Buchanan General Hospital in Southwest Virginia to provide radiological reviews after hours and provides consultations on complex cases.

To put the needed infrastructure in place, NTIA within the Department of Commerce recently made funding available for two grants totaling more than $21.5 million to expand broadband in Virginia. The two grants will add 575 miles of new high speed internet for the residents in rural Southern Virginia.

The Southside and Southwest Virginia areas have been especially hard hit by the recession. One of the most immediate needs is to expand broadband internet infrastructure in the entire state but it is particularly important to provide broadband capacity to these particularly distressed areas.

To help the educational system, the Virginia Tech Foundation received a $5.5 million grant with an additional $1.4 million in applicant provided matching funds to add 110 miles of open access, fiber-optic network between Blacksburg and Bedford City. The resulting network will cross six counties in Virginia’s Appalachian region, and provide direct, high speed connections from Virginia Tech’s main campus in Blacksburg to the Virginia Tech Carillion School of Medicine in Roanoke to enable collaboration on cutting edge medical and scientific research.

The Virginia Telehealth Network is very actively working to support the initial design, development, testing, and evaluation of a model stroke network across the Central Shenandoah Region. The Virginia Acute Stroke Telehealth Network is sponsored by the Virginia Department of Health Office of Minority Health and Public Health Policy with funding by the National Office of Rural Health Policy specifically to address the prevention and treatment of stroke and related co-morbidities.

At the federal level, this grant program is known as the “Critical Access Hospital-Health Information Technology Grant” (CAH-HIT) program. At the state level, this project is considered Phase 1 of a larger statewide stroke initiative called the “Virginia Acute Stroke Telehealth Network or VAST.

As part of the VAST initiative, Bath Community Hospital is working with the University of Virginia, Rockingham Memorial, and the Augusta Medical Center to identify, understand, and analyze stroke systems of care from a regional viewpoint.

To further serve the area and to pull many of the ideas and thoughts together on how to close the healthcare gap in rural and underserved areas, the 2010 Rural Health Summit is being held March 16-18 2010 in Danville Virginia.

To zero in specifically on telehealth, the Virginia Telehealth Network and the Virginia Department of Health Office of Minority Health and Public Health Policy are jointly sponsoring a Telehealth Summit to be held on March 18th which will be Day 3 of the Health Summit. Presenters will represent both national health information technology programs and specific telehealth activities throughout the Commonwealth of Virginia.

Vital presentations and discussions will be held on operating telehealth nationwide, operating telehealth in Virginia, implementing the national broadband plan, managing Virginia’s academic and major regional health systems with telehealth, and present day telehealth activities in Critical Access Hospitals and at FQHCs. Topics to be discussed include sessions on reimbursement, coding, specific, legal, and regulatory issues, and the role of telehealth in treating chronic diseases.

Some of the presenters are Kathy Wibberly, PhD, Director, Division of Primary Care and Rural Health, VDH Office of Minority Health and Public Health Policy; Karen Rheuban, MD, Medical Director, Office of Telemedicine, UVA Office of Telemedicine; Neal Neuberger, Executive Director, Institute for e-Health Policy, and President Health Tech Strategies; Dena S. Puskin, Sc.D, Senior Advisor, Health Information Technology and Telehealth Policy at HRSA; Karen R. Jackson, MBA, Deputy Secretary of Technology, Commonwealth of Virginia; Jean-Pierre Auffret, PhD, Director, Center for Advanced Technology Strategy, and a Professor at George Mason University; and Mohit Kaushai, MD, Digital Healthcare Director, Omnibus Broadband Initiative, Office of Strategic Planning and Policy.

For more information and a full list of topics and presenters, go to

New Surveillance System Funded

Medical researchers are developing a new surveillance system to determine the number of patients diagnosed with inherited blood disorders known as hemoglobinopathies. NIH’s National Heart, Lung, and Blood Institute (NHLBI) is funding the four year pilot project along with CDC and six state health departments to learn more about the extent of hemoglobinopathies in the U.S.

Hemoglobinopathies can cause problems with hemoglobin which if abnormal can cause sickle cell diseases and hemoglobin E, or too little hemoglobin can cause organ damage and shorten the lifespan. While all states now test newborns for some of these diseases, there is no system presently to track the diseases nationally. In addition, patients born before the screening program began or immigrated to the U.S are not tracked.

Through the initial phase of the program, researchers hope to determine the prevalence of the hemoglobinopathies among screened newborns and patients not identified through newborn screening. The data should help determine the prevalence of various conditions and help to describe the demographic characteristics of individuals with these conditions as well as their geographic distribution.

Data collected from the $27 million “Registry and Surveillance System in Hemoglobinopathies” project will help researchers determine the most effective way to develop future homoglobinopathy registries. Research findings based on the data from disease registries may provide new ideas for drug therapies and possibly spur the development of tests to determine the severity of diseases over the lifespan.

To work with the states, NHLBI has signed an interagency agreement with CDC’s National Center on Birth Defects and Developmental Disabilities. As part of the project, CDC set up cooperative agreements to create surveillance programs with state health departments in California, Florida, Georgia, Michigan, North Carolina, and Pennsylvania.

Grants to Fund Health IT

HHS just announced that $100 million in federal grants will go to ten states to improve healthcare quality and delivery systems for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

The grants to be awarded over a five year period were funded by the Children’s Health Insurance Program Reauthorization Act of 2009. The funding will help states implement and evaluate provider performance measures and use health information technologies such as pediatric electronic health records and other quality improvement initiatives.

Eight of the ten grantees will test a new set of child health quality measures and seven of the ten states will use the funds to implement HIT strategies with two states specifically planning to develop a new pediatric electronic health record format.

Awardees represent both single state projects and multistate collaborations. Grantees working in multistate partnerships will share award funds with their partners. The states include Maine partnering with Vermont, Oregon partnering with Alaska, and West Virginia, Florida partnering with Illinois, Colorado partnering with New Mexico, Utah partnering with Idaho, and Maryland partnering with Georgia, and Wyoming. Single state projects were awarded to Pennsylvania, North Carolina, Massachusetts, and South Carolina.

Sunday, February 21, 2010

Plans for Global E-Health

E-Health presents tremendous opportunities and promises to transform health and healthcare in remote areas in many developing countries according to Susan Dentzer, Editor- in-Chief, “Health Affairs” and on-air analyst with “The NewsHour with Jim Lehrer”. The February 2010 Health Affairs thematic issue is devoted primarily to finding workable solutions to make it possible for e-Health to reach its full potential in developing countries.

Dentzer moderated the Health Affairs briefing supported by the Rockefeller Foundation at the National Press Club in Washington D.C. on February 16th. Key leaders in the field presented their ideas on the future for e-Health, methods to implement new technologies, the need to collaborate on mHealth, achieving interoperability, and ways to increase the health informatics workforce worldwide.

The current Health Affairs issues includes a paper in the current issue written by Ariel Pablos-Mandez, Managing Director for the Rockefeller Foundation, Tica Gerber MHS/HP, Senior Program Officer, Health Metrics Network at the World Health Organization, and other colleagues.

The paper summarizes the results and thoughts on the Rockefeller Foundation’s 2008 Conference “Making the eHealth Connection: Global Partners, Local Solutions”. The paper discusses the conference recommendations that stress the need to develop global partnerships, find health technology solutions based on local needs, provide for cross-border interoperability, and find ways to leverage current open source networks and shared informatics systems.

Hamish Fraser, PhD, Assistant Professor of Medicine at Brigham and Women’s Hospital, and as Director of Informatics and Telemedicine at Partners in Health (PIH) for ten years has played an important role. He led the development of web-based medical record systems, data analysis tools, and pharmacy systems to treat drug resistant tuberculosis and HIV in Peru, Haiti, Rwanda, Lesotho, Malawi, and the Philippines.

At the briefing, Dr. Fraser stressed that since high quality clinical data requires a large investment in IT systems and training this means that data management has to be an ongoing process. However, he reports that there are insufficient studies to show whether information technology systems are making a positive clinical impact question. The question is whether all systems are delivering high quality timely data for clinical care and reporting, and at the same time, able to provide up-to-date research information?

Dr. Fraser mentioned PIH has been very responsive to the Haiti earthquake and that PIH sites are equipped with satellite internet along with backup generators and/or solar power. PIH sent over 90 flights, hundreds of staff, and over 100 tons of critical supplies in the first 3 weeks. Tracking was accomplished by using a web-based medical information system to track supplies, track surgical cases, monitor the caseload, and resolve infrastructure issues.

Today, partnerships among healthcare and information technology researchers and designers worldwide are creating mobile health tools tailored to local community needs and resources. Walter H. Curioso, M.D., Research Professor at the Universidad Peruana Cayetano Heredia in Lima, Peru, and an Affiliate Assistant Professor, at the University of Washington, reports that much of the hardware and infrastructure is coming from the developed countries of the global north. However many mHealth innovations are also coming from Asia, sub Saharan Africa, and Latin America known collectively as the global south.

He wants to enhance mobile health with south- to-south collaborations but today, most of the mobile health collaborative efforts are still in pilots or demonstration phases. These projects include activities in education and awareness, remote data collection, remote monitoring, communication and training for healthcare workers, disease and epidemic outbreak tracking, and diagnostic and treatment support. Dr. Curioso emphasized that groups must now pull together, and set up more collaborative efforts and develop curriculum to move mobile health forward.

Why is it so hard to achieve interoperability worldwide? Charles Jaffe M.D, PhD, CEO of Health Level 7, the global authority on HIT standards for interoperability, focused on some of the reasons. Major problems can result since many languages are very complex, using medical language can be complex, policies written in different languages can be difficult to understand, and systems can differ and as a result make data hard to transfer.

Dr. Jaffe stressed that HL7 is successfully providing for e-learning related to standards and were the first to develop an educational program in Argentina translated into Spanish. Today teachers teach in real-time in three languages in every time zone. This educational experience provides third world countries with essential information free of charge.

According to Dr. Jaffe, there are several lessons that the developing world has taught the international health technology community. The fact is that it is easier to do it right the first time, the most expensive solution many not be the best solution, stand-alone solutions almost always stand alone, and education trumps almost everything else.

One of the greatest needs to increase the use of health technology is to build up the global health informatics workforce in developing countries. William Hersh, MD, Professor and Chair, Biomedical Informatics, Oregon Health & Science University in Portland, knows that the problem while not limited to developing countries is a serious issue.

To build health informatics capacity in developing countries, it is important to be cognizant of workflow, organizational and cultural factors, local needs and capabilities, and be open to partnering with existing programs and institutions.

Dr. Hersh described a few of the projects that are helping to build capacity in health informatics. For example, the American Medical Informatics Association (AMIA) with others developed the “10x10” program to train healthcare professionals in applied health and medical informatics. The Rockefeller Foundation just awarded a $630,100 project grant to help AMIA implement a global e-Health training program in sub-Saharan Africa, and the Foundation actively supports the “Health Informatics Building Blocks” program developed by AMIA.

In the public sector, NIH’s Fogarty Center is heavily involved in a global e-health. Their grant program “Informatics Training for Global Health” supports informatics research and training in low and middle income country institutions.

For more information on Health Affairs and the current publication, go to The contact at Health Affairs is Sue Ducat at or call (301) 841-9962. Email Caroline Broder at for more information on the briefing or call (301) 652-1558.

Telemedicine Care for Prisoners

The California Prison Health Care Services Office of Telemedicine Services reports that 16,000 telemedicine visits with prisoners are done each year. Another plus is that telemedicine services are about to hit the 100,000 mark in the number of inmate patient appointments conducted since the program started in 1997 and last year has saved California $13 million.

A report published January 2010 by the California Prison Health Care Services (CPHCS) titled “Receiver’s Turn-Around Plan of Action” presents a plan of action for the state prison system and contains updates on the goals and objectives needed to improve care. One of the important goals is to expand and improve telemedicine capabilities.

According to the report the telemedicine staffing and governance continues to improve. The CPHCS has hired two new staff members to conduct the scheduling of specialty services and are presently recruiting for a Health Program Manager. In addition, CPHCS held their initial meeting of the Telemedicine Services Core Leadership Team.

Telemedicine encounters are continuing to grow at a steady pace and today six California institutions are expanding telemedicine. These sites include the North Kern State Prison, Kern Valley State Prison, Richard J. Donovan Correctional Facility, Centinela State Prison, California State Prison at Corcoran, and the Substance Abuse Treatment Facility.

The six institutions are expanding telemedicine by addressing obstacles to care, expanding the provider network, increasing the number of telemedicine specialties, identifying and resolving shortfalls in telemedicine staffing, equipment, and space, and collecting statistics to measure the progress in increasing telemedicine encounters while reducing off-site specialty services encounters.

Linda McKenny, RN, a senior health care services manages oversees the Office of Telemedicine Services (OTS). A cross functional team has been formed at each institution with medical and nursing management, clinical nursing staff members, custody personnel, IT representatives, and other key stakeholders.

Unrika Simon-McCaulley with OTS is leading the effort to expand the telemedicine provider network. In the future, CPHSC expects to complete the six institution initiative, further expand provider networks, and launch initiatives to increase telemedicine at other institutions.

CPHS is actively expanding patient access to telemedicine specialty providers. The addition of new providers has increased the number of specialty services offered from sixteen to twenty with additional plastic/reconstructive, nephrology, oncology, and urology services now available. At this time, the University of California, San Francisco is continuing to transition from on-site services to telemedicine.

The CPHCS team is working with IT experts to identify the most cost-effective approach to use to develop and expand the technology infrastructure needed to support telemedicine services. Recently, CPHCS met with several vendors to review current technologies and equipment including store and forward technology.

CPHCS has implemented various processes and staffing improvements to include reassigning the RN staff from scheduling and administrative functions to clinically focused tasks in the telemedicine program plus the telemedicine scheduling process is being automated.

To support the expansion of the program, contract language has been updated to include telemedicine provisions in all medical general services agreements. The telemedicine program is also working to establish credentialing protocol for telemedicine providers.

The Clinical Data Repository (CDR) project is an effort to establish the framework for electronic medical records within the state prison system. The goal is to establish the CDR to store key patient health information in a standardized manner and to ensure that the information is available to providers at the point-of-care. The current phase of the CDR provides information on current medications, allergies, and lab results.

As of December 2009, the CDR has been rolled out to the Valley State Prison for Women, California Correctional Facility for Woman, and to Los Angeles County institutions. The pilot phase of the project will be evaluated for stability and performance with rollout to additional institutions to begin this month. Once the system is established, the CDR will combine medical, mental health, and dental patient records into a unified accessible format.

To establish a healthcare scheduling and patient inmate tracking system, the “Strategic Offender Management System (SOM) is scheduled to be implemented. SOM will assist the prison healthcare system by providing a unique lifetime ID number, demographic information, continuous real-time location information, along with a comprehensive master schedule and scheduling prioritization protocol information.

Another goal is to evaluate performance and identify the opportunities to improve the quality and delivery system. According to the Rand study that proposed 79 indicators to measure access to care and clinical performance, these measures are now being incorporated into processes and systems. A newly formed interdisciplinary Quality Management Committee is charged with enterprise coordination and evaluation.

For more information, go to the California Prison Health Care Services at then click on Receiver’s Thirteenth Tri-Annual Report January 15, 2010 to download the report.

State Bills Address HIT

Recently, several bills were introduced in state legislatures to improve health information technology efficiency, to provide system interoperability, to help implement state plans, and provide assistance to healthcare facilities and providers to buy only certified products.

Mississippi has several bills under consideration. State Representative Daniel Stephen Holland introduced (MS HB 1423) to establish the Health Information Technology Act. This legislation would make it necessary for all agencies in the state involved in delivering or providing health information technology services to coordinate their efforts with several other state agencies, nonprofit corporations, and with federally funded agencies to avoid wasteful spending of state funds.

State agencies would be required to do a survey geographically in order to analyze state needs and resources available before releasing requests for proposals. Electronic health records, telemedicine, electronic prescribing, and other forms of HIT are to be included. State Senator Hob Bryan introduced companion bill (MS SB 2842). The bills have been referred to the Public Health and Human Services Committee.

Mississippi State Senator W. Briggs Hopson III and Representative Holland have introduced two bills (MS SB 2842) and (MS HB 1423) to establish the Mississippi Health Information Network (M-hin) that will give power to the Board of Directors to govern and also establish rights for individuals when sending data through the system.

In New Jersey, State Assemblyman Herbert C. Conway Jr. M.D introduced (NJ AB 1986) to establish the Electronic Health Information Technology Fund (e-HIT). The fund would be established in the Department of Banking and Insurance to provide for guaranteed funding to support the implementation of the state IT plan.

The plan would be administered by the Office for e-HIT with revenues collected through a reinvestment fee. The Office for e-HIT would be responsible to look for grants or funding available from the federal government, corporations, foundations, or other private sources.

Assemblyman Conway also introduced (NJ AB 1924) to insure that healthcare facilities and providers can acquire products that have been certified by the Certification Commission for Healthcare Information Technology (CCHIT) or any other entity that is approved by the federal government.

Grants for Public Health Tracking

CDC issued a grant notice to develop the first Midwest Health Informatics Database to examine the relationship between the environment and diseases. CDC plans to award FY 2010 funds for $450,000 to the University of Nebraska Medical Center in Omaha to develop the database. The project will focus on collecting health information and samples from approximately 50,000 Midwest residents from ages 35-64.

A survey tool will be developed to collect personal health information from willing participants that might include blood, tissue, and DNA samples. A database would then be created for epidemiologists to track the relationship between environment and disease.

For the past several years, CDC has funded Environmental Public Health Tracking (EPHT) network projects with several universities. The purpose for the CDC funding is to develop and apply methods that can be used to analyze and interpret data to support state and local agency EPHT network programs.

So far, the Universities working on the EPHT network include Tulane, University of California at Berkeley, University of Medicine and Dentistry of New Jersey, and the University of Pittsburgh.

The funding opportunity notice for the “Environmental Health Informatics Project-University of Nebraska-Medical Center, Omaha (CDC-RFA-EH10-002E) is published on

Free Mobile Health Service Launched

The U.S. Chief Technology Officer Aneesh Chopra announced that pregnant women and new mothers will be able to get health information delivered regularly to their mobile phones by text messages. There is no charge for the new program called “text4baby” being provided by a coalition of mobile phone service providers, health professionals, and federal, state, and local agencies.

The new program provides timely health information to women from early pregnancy through the first year of the baby. The service sends important health tips timed to the mother’s stage of pregnancy or the baby’s age.

Currently, in the U.S., more than 5000,000 babies which means one in every eight are born prematurely and an estimated 28,000 children die before their first birthday which is among the highest rate in the industrialized world.“Test4baby is the first fee mobile health service to be taken to scale in the U.S. We know that mobile phones hold tremendous potential to inform and empower individuals”, said Chopra.

Chopra introduced the new service in a keynote address at a joint session of the Health IT Summit for Government Leaders, the National Health Information Exchange Summit, and the 18th National HIPAA Summit.

Women who sign up for the service by texting BABY to 511411 (or BEBE for Spanish) receive three free SMS text messages each week timed to their due date or baby’s date of birth. The messages focus on topics critical to the health of moms and babies, including nutrition, seasonal flu prevention and treatment, mental health issues, risks of tobacco use, oral health, immunization schedules, and safe sleep. Text4Baby messages connect women to public clinics and support services for prenatal and infant care.

Several government agencies are involved in the design, outreach, and evaluation of text4baby that includes HHS, Department of Defense Military Health System, and the Office of Science and Technology Policy.

For information, go to

Monday, February 15, 2010

Grants to Advance IT & Training

HHS Secretary Kathleen Sebelius and Labor Secretary Hilda Solis announced nearly $1 billion in Recovery Act awards are available to help healthcare providers adopt health IT and to help the Department of Labor train healthcare workers for future jobs. The awards will make health IT available to over 100,000 hospitals and primary care physicians by 2014.

Dr. David Blumenthal National Coordinator for HIT reports of the $750 million available in HHS grants, $386 million will go to 40 states and qualified State-Designated Entities. The goal is to rapidly build the capacity needed to exchange health information through the State Health Information Exchange Cooperative Agreement Program.

The funds will be used to help the states implement plans for statewide HIEs by providing for governance, policies, and the technical services needed to support HIEs. The awards will be used to encourage the states to participate in the Nationwide Health Information Network.

In addition, $375 million will create 32 Regional Extension Centers (REC) to support health professionals become meaningful users of EHRs. The RECs will deliver outreach, education, and technical assistance services to healthcare providers in their regions. Each REC will focus on physicians, physician assistants, and nurse practitioners who work as part of individual and small group primary care practices as well as help those that provide healthcare to the underserved. The RECs are expected to hire over 3,000 technology workers nationwide in the month ahead.

Secretary of Labor Hilda Solis announced that $227 million will be used to train 15,000 people in the job skills needed in the healthcare, IT, and other high growth fields. Through existing partnerships with local employers, the recipients of these grants have already identified roughly 10,000 job openings for skilled workers likely to become available in the next two years.

The grants will fund 55 initiatives in 30 states for health IT training programs. These programs will be sponsored by community colleges, local education providers, and universities. The Department of Labor expects freshly trained workers to find jobs, but in addition, the Department will provide employment services via their local One Stop Career Centers.

The HHS and DOL awards are part of an overall $100 billion investment in science, innovation, and technology that the Administration is making through the Recovery Act to create jobs in growing industries.

Go to for a complete list of the awardees.

Communicating During Emergencies

Responding to a natural disaster is complicated by trying to deliver medical care in a chaotic environment where the communications infrastructure on the ground is seriously damaged or completely destroyed. Responding to emergency care has always been very difficult especially during Hurricane Katrina, the Southeast Asian Tsunami, and now with the earthquake in Haiti.

USAID is leading the U.S. government’s efforts in Haiti and working with the FCC to assess present communications needs, the Haitian government’s communications priorities, to assess the damage to key communications facilities. The FCC will evaluate any communication options that can be used to help restore services immediately resulting from the earthquake devastation.

FCC International Bureau Chief Mindel DelaTorre along with the Public Safety and Homeland Security Bureau Chief Engineer, William Lane, went to Haiti to review the destruction of the communication facilities. They met with 25 representatives of the telecommunications industry in Haiti, and conducted extensive talks with company managers, the wireless company TELCO, wireless carriers, and internet service providers.

In addition, to Chief DelaTorre and the PSHSB Chief Engineer, the team also included three staff members who were deployed to Haiti to support the FEMA Mobile Emergency Response Team, plus two FCC engineers, and two industry experts.

FCC Chairman Julius Genachowski said, “The FCC team will continue to work with Conatel the communications agency in Haiti and local Haitian telecommunications providers to come up with practical and sound options for restoring communications services. FCC updates on the communication progress in Haiti is being provided at

The University of California San Diego researchers are also working diligently to find new ways to improve communications during times of disasters. The university has launched a project to find better ways for emergency officials and first responders to talk to each other and share data on the ground at a disaster site.

One of the problems is that disaster sites often have a noisy and chaotic electromagnetic environment that make wireless networks unreliable so researchers are looking for a way for first responders to continue their work even if their connection to a central server is down.

The second problem occurs when first responders arrive at disaster sites at staggered intervals and depending on the size of the disaster, emergency personnel can sometimes reach into the thousands. So the UCSD researchers are looking into a system that is interoperable and self-scaling and has the ability to increase capabilities as responders arrive at the scene.
The third problem is that the capabilities of computer systems in disaster environments can change from moment to moment based on connectivity and infrastructure so applications need to be designed to use information in a seamless way to enhance the work flow for emergency medical personnel.

Recently, $1.5 million was made available from stimulus funding to go to the National Library of Medicine (NLM) to underwrite their WIISARD SAGE project. The new project will pick up where the original Wireless Internet Information System for Medical Response in Disasters (WIISARD) left off and will look at collaborative computing in mobile environments as well as examine self-scaling systems for disaster management.

The WIISARD SAGE project will bring together an interdisciplinary team of faculty from computer science, cognitive science, electrical engineering, and emergency medicine in the UCSD Division of the California Institute for Telecommunications and Information Technology (Calit2) to find better computing for emergency personnel to use at disaster sites.

The UCSD researchers are going to test their solutions with emergency response agencies during large scale disaster drills to be held in San Diego County in mid May 2010. The drills will be federally funded under the San Diego Regional Metropolitan Medical Strike Team (MMST) and will be composed of fire departments, hazmat personnel, bomb squads, and S.W.A.T. teams. In addition to MMST, the UCSD team will also participate in drills organized by California’s Disaster Medical Assistance Team (DMAT).

To get ready for the May disaster drill, UCSD recently pre tested some of their new ideas that includes mobile phones equipped with custom software, Bluetooth barcode scanners to allow responders to scan a patient’s paper triage tag to bring up their on-site medical record, RFID technology to help track where responders are located, and development of new network protocols such as “Grapevine”, a gossip based protocol that allows communication even if not all network connections are functioning.

In addition, WIISARD SAGE will also add GPS units to the nodes of the ad hoc CalMesh network developed at Calit2 to estimate the positions of responders or disaster victims by triangulating signal strengths.

Governors Discuss Cost Savings

New Hampshire Governor John Lynch in his State of State Address on January 21st, mentioned several initiatives his state is taking to lower healthcare costs and to provide better healthcare quality. The state is working online to provide better and more transparent information with cost data and information on outcome comparisons available between hospitals. Also, the state has made it possible for nearly all of the healthcare providers in the state to now prescribe medications electronically.

The Governor stressed that all patients should have a medical home where a primary care doctor coordinates the care so lower costs and improved healthcare will result. According to the Governor, nine medical home pilot projects across the state have been launched with doctors reimbursed for coordinating the care of their patients and the medical home pilot is proceeding with cooperation from major insurance companies with plans to expand the medical home model across the state.

The Citizens Health Initiative in New Hampshire is developing a pilot project to encourage hospitals in the state and provider groups to transform into “accountable care” organizations. The “accountable care” organizations would take what is learned through the medical home concept and expand the idea across health networks. Under this model, a healthcare system is given a budget for serving its entire community with the care then coordinated across its entire system, focusing on prevention and improving outcomes.

Governor Donald L. Carcieri of Rhode Island in his state budget address on February 4th highlighted a number of cost saving proposals that are specific to health and human service agencies in his state. He continued to say that the lion share of the savings involves the major components of the Medicaid waiver, smart purchasing, rebalancing the system, and providing savings through better care management and coordination.

He reported on five possible cost saving initiatives:

• Procure State’s Managed Care Contracts over again to highlight greater care coordination

• Provide for developmental disabilities reform to develop one or more networks of providers to foster a more responsive, accountable, and sustainable system of care for individuals with disabilities. Finance system improvements by increasing efficiency and by providing for more seamless and timely consumer access to services

• Provide for behavioral health reform and care coordination by developing a new coordinated payment system using a set of performance and financial incentives

• Redesign the Department of Children Youth and Families (DCYD) to better coordinate providers and care services. DCYF would be able to contract with one or more operational and fiscal partners that would be responsible for building a comprehensive network of formal and informal services to include residential and home-based services. This would further strengthen and support the home setting

• Provide for care management for long term care and rebalance long term care utilizing a contracted entity to manage primary, acute, and long term services for Medicaid only clients and also provide managed long term care benefits for clients with Medicare

FCC FY 2011 Budget Request

The proposed FCC budget for FY 2011 includes $352.5 million to help fund several initiatives. The monies would go to implement the National Broadband Plan, continue to manage the nation’s spectrum use, overhaul the FCC’s data systems and processes, continue to improve the FCC’s operations using improved technology, support the FCC’s public safety and cyber security role, strengthen consumer information programs, and increase FCC’s role as a advocate for international interests.

The specific initiatives in the budget proposal include:

• Continue the work of the National Broadband Plan and broadband mapping
• Implement a spectrum inventory initiative and emergency response interoperability center
• Provide state-of-the-art consumer information programs provided by the new media and advanced information technology
• Invest in overhauling the agency’s antiquated systems for data collection, processing, analysis, and dissemination of data
• Prove that the new tools and expertise required for the FCC can be a model of excellence, openness, and provide transparency domestically and internationally

The request would also provide funds to cover mandatory increases in salaries and benefits and the inflationary increases for contractual services

For a complete copy of the budget, go to

Simulation Site Selected

Lake Nona’s Medical City has been selected as the national site for the Department of Veterans Affairs Medical Simulation Center for Excellence. The Center to be located at the new Orlando VA Medical Center will be the nationwide training and planning home for the VA’s new medical simulation system. A satellite facility will be located at the Palo Alto VA Medical Center in California.

The VA has developed the Simulated Learning Enhancement and Advanced Research Network (SimLEARN) a system wide strategic education and planning initiative used for clinical simulation training, education, and research efforts. The initiative will establish the SimLEARN National Center as the focal point for strategic planning and curriculum design and for train-the-trainer activities.

The SimLEARN approach is consistent with newer education models currently used in medical and nursing schools across the country and complementary to approaches used by the Department of Defense in training their clinical workforce.

The new Center in Florida is expected to be completed December 2011, however temporary space at the Orlando VA Medical Center will be used in the interim. At the Palo Alto satellite location, the SimLEARN staff will use existing space at the medical center to support their activities.

Wednesday, February 10, 2010

Virtual Reality Advancing

Engineers at Iowa State have developed 3-D software to give doctors and students a view inside the body. The technology converts flat images of medical scans into 3-D images accessible via a personal computer. The 3-D images are easy for doctors to see, manipulate, shift, adjust, turn, zoom, and replay at will.

The 3-D software uses real patient data from CT and MRI scans so that doctors can plan surgeries or a round of radiation therapy, and also be used for educational purposes. The software developed at Iowa State University is now being sold by a startup company.

Two dimensional imaging technologies have been used for a long time, but those images aren’t necessarily easy to read and understood by anybody but specialists. So university engineers Eliot Winer, Associate Director of Iowa State’s Virtual Reality Applications Center and James Oliver, Director of the university’s Cyberinnovation Institute, set out to develop the new technology. At that point, the team worked with Thorn Lobe, a pediatric surgeon based at Blank Children’s Hospital in Des Moines to design a tool that doctors could use.

In 2007, a grant for $109,533 from the Grow Iowa Values Fund, a state economic development program, helped the three develop the technology into a commercial software product. The result is, a startup company founded by the three and based at the Cyberinnovation Institute. The company now has 13 employees, has been busy earning the required approvals from FDA, developing a web site, and beginning to make sales, said Curt Carson, the company’s President and CEO.

For more information, contact Curt Carlson (515) 897-9490, or email or contact Eliot Winer at or James Oliver at

In another venture, the Virtual Reality Medical Center (VEMS) located in several cities, is applying virtual reality technology in combination with physiological monitoring and feedback, to provide therapy and help train military personnel and civilian first responders. The company also supports the military by using the virtual technology to help soldiers with PTSD and TBI, and also to train combat medics.

The Medical Virtual Reality Center (MVRC) at the University of Pittsburgh uses virtual reality to help persons with postural control problems and for persons with or without balance dysfunction. The centerpiece of the MVRC is a virtual reality display room large enough for a person to stand in and to be able to interact with different virtual environments. This room called the Balance NAVE Automatic Virtual Environment was developed in close collaboration with the Virtual Environments Group at UNC (Charlotte) and with

Finding Innovative Solutions

In September 2009, the President released his “Strategy for American Innovation” to find ways to foster innovation in science and technology to help the U.S. obtain sustainable growth by creating high quality jobs. The President wants to see the country address the “grand challenges” we face by creating multidisciplinary teams of researchers and multi-sector collaborators to bring new expertise to bear on important problems and strengthen the social contract between science and society.

In the field of medicine alone, there are specific grand challenges that need to be addressed:

• Complete DNA sequencing for every case of cancer
• Develop smart anti-cancer therapeutics to kill cancer cells and leave their normal neighbors untouched
• Detect diseases earlier from a saliva sample and enable researchers in the field of nanotechnology find ways to deliver drugs precisely to the desired tissue
• Develop personalized medicine to enable prescriptions to be given individually in the right dosage to each person
• Develop a universal vaccine for influenza to protect against all future strains
• Fund regenerative medicine so that the wait for an organ transplant will end

To move the innovation concept forward, the Office of Science and Technology Policy within the Executive Office of the President and the National Economic Council on February 3, 2010 issued a Request for Information to determine exactly what the needs are to further develop innovative solutions to problems.

Go to for the topics that responders to the RFI l need to address. Responses to this RFI must be submitted by April 15, 2020. Email for further information.

In another initiative seeking new solutions, the Bill and Melinda Gates Foundation’s “Grand Challenges in Global Health Initiative” focuses on finding new ways to handle major global health challenges. As part of the Initiative, the Foundation is accepting Letters of Inquiry for “Grand Challenges Point-of-Care Diagnostics Grants” that will fund innovative ideas for diagnostics in the developing world.

The goal for this new initiative is to develop common features and standards that will result in diagnostic devices that cost less, are easier to use, will be more thoroughly disseminated, and be more appropriate for healthcare applications in resource poor settings.

The program has a total of $30 million in funding available to create technologies and components to use to assess patients at the point-of-care in a variety of settings. This competition is expected to fund between ten and fourteen grants and both the public and private sector are eligible to apply. Letters of inquiry must be received by February 16, 2010, then invitations to submit proposals will be made by April 2010, and full proposal applications are due June 2010.

For more information, email

Funds Help in Pennsylvania

The Technology Collaborative, a statewide economic development organization supporting the growth of Pennsylvania’s robotics and digital technologies industries plans to award $1.5 million on or before March 31, 2010 for technology commercialization. The funding will go to universities, start-up companies, and established companies based in the state.

Through a competitive selection process, the Technology Collaborative intends to award funding for projects ranging up to $150,000 each to address engineering design challenges that show a high degree of innovation and show a clear path to commercialization. The objective is to significantly impact the digital and/or robotics related companies in the state. Final proposal submission deadline is February 12, 2010. For more information, go to

The University of Pennsylvania has received $10 million in stimulus money to embark on a new research project. The goal is to integrate behavioral health research with genetic information. The project uses an existing database of genetic information compiled at the Children’s Hospital of Philadelphia. Penn scientists are going to contact 10,000 children who gave blood for genetic research and test them for cognitive functioning and behavior.

The plan is to find genetic markers for different mental disorders and find ways to detect problems early on. Raquel Gur, Director of the Neuropsychiatry program at the university said, “We’ll be able to see if participants with a specific pattern of cognitive difficulty also have a genetic signature to it and use the information to screen children. Cross referencing cognition and behavior with genetic information may lead to new discoveries.” The project is funded for two years and will create 56 full time positions at the hospital and at the university.

The state has recently received $2.25 million in Federal funds to help expand high-speed internet in the state. The funds will be used by the Department of Community and Economic Development and the Governor’s Office for Information Technology to collect broadband coverage data, develop a map of the state’s broadband infrastructure, and plan strategies to address gaps. The funds will generally be used to identify any barriers that exist that prevent the adoption and implementation of the commonwealth’s statewide broadband plan. The grant was awarded to the commonwealth by the Department of Commerce’s NTIA with the state pledging to match 20 percent of the $2.25 million.

NHLBI Funds Tests for Devices

The National Heart, Lung, and Blood Institute (NHLBI) has awarded four contracts totaling $23.6 million to begin preclinical testing of devices to help children born with congenital heart defects or that may develop heart failure. The program is called Pumps for Kids, Infants, and Neonates (PumpKIN).

The program’s goal is to complete the needed animal studies and other tests in artificial environments so that the most promising devices will be able to gain approval from the FDA to begin clinical testing. NHLBI’s funding will support the next phase of the PumpKIN program by enabling further testing and further development of these devices.

The contractors that received the awards are Harvey S. Borovetz, Phd., University of Pittsburgh, Mark Gartner, PhD., Ension, Inc., Pittsburgh, PA, Bartley P. Griffith, M.D., University of Maryland, Baltimore, and Robert Jarvik, M.D., Jarvik Heart Inc., New York, N.Y.

To initially address the problem, NHLBI launched the Pediatric Circulatory Support Program in 2004 by funding the development of five novel circulatory support devices for infants and young children with congenital and acquired cardiovascular disease.

The devices supported in that program provide suitable circulatory support for newborns, older infants, and children who weighed less than 55 pounds and experienced heart failure due to congenital and acquired cardiovascular disease. The devices that were developed were designed to supply adequate blood flow to prevent organ damage while minimizing the risk of blood vessel damage, infection, breakdown of red blood cells, excessive bleeding, brain damage, and dangerous blood clots. The devices are intended to support circulation in pediatric patients for one to six months, be sufficiently small and reasonably portable, and be able to be routinely positioned and functioning in less than one hour.

For more information, go to

SSA Announces Contracts

SSA awarded 15 healthcare providers and networks $17.4 million in contracts funded through ARRA to provide electronic medical records to the agency to be sent via NHIN. “Using health IT will improve our disability programs. We’ve seen a significant increase in disability applications and today the agency sends more than 15 million requests annually for medical records to healthcare providers.” according to Michael J. Astrue, Commissioner of Social Security. In FY 2010, the agency expects to receive more than 3.3 million applications, which is a 27 percent increase over FY 2008.

The awards went to:

• Cal RHIO, San Francisco, CA-$1,625,000
• CareSpark, Kingsport, TN-$1,363,000
• Center for Health Communities, Wright State University, Healthlink, Dayton OH-$999,000
• Central Virginia Health Network/MedVirginia, Richmond, VA-$1,139,000
• Community Health Information Collaborative, Duluth, MN-$977,000
• Douglas County Individual Practice Association, Roseburg, OR-$502,000
• EHR Doctors Inc., Pompano Beach, FL-$1,000,000
• HealthBridge, Cincinnati, OH-$1,400,000
• Lovelace Clinic Foundation, Albuquerque, NM-$1,083,000
• Marshfield Clinic Research Foundation, Marshfield, WI-$998,000
• Memorial Hospital Foundation & Memorial Hospital of Gulfport Foundation, Gulfport, MS-$1,100,000
• Oregon Community Health Information Network, Portland, OR-$284,000
• Regenstrief Institute, Inc., Indianapolis, IN-$350,000
• Science Applications International Corporation, Reston, VA-$1,587,000
• Southeastern Michigan Health Association, Detroit, MI-$2,988,000

Monday, February 8, 2010

$125 Billion Budget Request

Eric K. Shinseki, Secretary of the Department of Veterans Affairs appeared before the House Committee on Veterans Affairs on February 4th to discuss the President’s VA budget request for FY 2011. The President’s budget provides $125 billion in 2011 which is almost $60.3 billion in discretionary resources and nearly $64.7 billion in mandatory funding.

The Secretary reported that in December 2009, the VA successfully exchanged electronic health record information in a pilot program between the VA Medical Center in San Diego and a local Kaiser Permanente hospital using the Nationwide Health Information Network. During the second quarter of 2010, DOD plans to join the pilot and there are plans to add additional Virtual Lifetime Electronic Record health community sites. The VA has $52 million available in IT funds in 2011 to continue the development and implementation of this priority.

The budget provides $51.5 million to use for medical care in 2011, which is an increase of $4 billion or 8.5 percent over the 2010 level. In 2011, the budget provides $2.6 billion to help meet the needs of veterans who have served in Iraq and Afghanistan.

The FY 2011 budget also includes funding to treat new patients resulting from the recent decision to add Parkinson’s disease, ischemic heart disease, and B-cell leukemia to the list of presumptive conditions for veterans with service in Vietnam.

The VA’s 2011 budget includes $250 million to strengthen access to healthcare for 3.2 million enrolled veterans living in rural and highly rural areas. Plans are to provide new rural health outreach and delivery initiatives and to expand the use of home-based primary care and mental health services.

The VA intends to expand the use of cutting edge telehealth technologies and would like to invest in $163 million in 2011 for home telehealth to take advantage of the latest technological advancement in healthcare delivery. The VA’s home telehealth program cares for 35,000 patients and a recent study found that patients enrolled in home telehealth programs experienced a 25 percent reduction in the average number of days hospitalized and a 19 percent reduction in hospitalizations.

According to the Secretary, the Department’s IT operations and maintenance program supports 334,000 users situated in 1,400 healthcare facilities, 57 regional offices, 158 national cemeteries around the country, plus the IT program maintains 8.5 million vital health and benefit records for veterans. The FY 2011 budget provides $3.3 billion for IT, which is the same level of funding provided in 2010.

The IT resources requested would fund IT to process education claims, to help the Financial and Logistics Integrated Technology Enterprise project replace outdated technology, further develop the paperless claims processing system, and continue to develop the VA’s EHR system for $342.2 million.

Status of Mobile Health

Over 300 people attending the first mHealth Networking Conference on February 3-4, 2010 in Washington D.C. were eager to hear the latest on the mHealth revolution. The top thought leaders in the field Claudia Tessier President mHealth Initiative and Vice President C. Peter Waegemann presented their vision for mHealth. Both keynote speakers see mobile health as a huge wave hitting the healthcare field with the result that many new mobile communication systems are here today with many others coming on board in the near future.

Waegemann explained how ehealth differs from mhealth in that the focus for ehealth is on using electronic medical records and other technologies while mhealth health focuses on behavioral and structural changes.

Mobile devices are performing many functions in the virtual world that include accessing patient information at the point-of-care, developing medical networks, and providing remote virtual care. Physicians are now able to use the increasing number of Apps available not only for patient care but also to search and find the most current scientific and medical research information available worldwide.

Developing mobile health technology will save billions by using new technologies that will result in fewer office visits and better quality of care. Physicians will be able to research all of the newer options for treatments, be able to readily and easily communicate with wellness and care providers, patients will be able to contact disease specific groups, communication with payers will be easier, and clinicians will have access to all the necessary information needed to treat patients.

However, experts in the field are realistic and see the hurdles that must be overcome. The issues that need to be addressed involve standard development, legal requirements, certification, payment systems, confidentiality issues, and behavioral changes.

As Waegemann sees the future, the doctor’s role will change from lone doctor to a role similar to being the conductor of an orchestra. Healthcare will no longer be physician driven but will be largely participatory health to include all stakeholders, insurance companies, long term caregivers dentists, public health officials, hospitals, primary care providers, consumers, financial institutions, alternate health systems, and consumer/patient health systems involved in wellness.

Keynoter Claudia Tessier, President, and Co-Founder of the mHealth Initiative presented the 12 clusters for mHealth applications.

1. To help patients prepare for their doctor’s visit, select caregivers, or schedule appointments
2. To provide access to worldwide web-based resources
3. To provide point-of-care information on the patient to doctors and clinicians so that the patient’s history is available in real time and use mobile devices to communicate with electronic medical records
4. Apps are available to helps patients manage chronic diseases like diabetes, asthma, hypertension, and others
5. Help to educate not only patients but also provide new apps in nursing and in other areas
6. To communicate with laboratories, pharmacies, and other colleagues
7. To help the staff make the office work efficiently and to help the staff to communicate better with third parties, payers, laboratories, plus help the staff track supplies and equipment
8. To provide for financial apps to be able to help patients understand their eligibility for services and their billing
9. Help to provide emergency care before the patient arrives at the emergency department and start triage before the patient arrives
10. To provide invaluable information to help public health officials track epidemics, outbreaks, and help to instruct consumers and patients on staying safe
11. To use for pharma/clinical trials and be able to rely on information from mobile devices other than the patient for routine data collection
12. Body area networks will operate where people will wear sensors to collect biometric data with the data sent to mobile phones

Since mobile health or mHealth is developing at such a rapid rate, the mHealth Initiative has just announced that their next mHealth Networking Conference will be held September 8-9, 2010 in San Diego California.

For more information on the mHealth networking conferences go to

Hospital Using Mobile Tech

As Program Director for the Stroke and Neuroscience Program at Holy Cross Hospital in Silver Spring Maryland, Andrew Barbash MD, is actively working to convince others on how to effectively use mobile chat and texting via smart phones to practice medicine in today’s world.

As a keynote speaker at the mHealth Networking Conference on February 3, 2010, he discussed how texting and using mobile chat via his smart phone enables him to treat stroke patients at Holy Cross hospital more efficiently especially during emergency situations. He uses text chat and secure document and message services to share important information with colleagues, staff, patients, and family caregivers.

In today’s medical world, communicating via virtual consultation rooms provides an efficient means to meet “face-to-face” online. As long as the physician, nurse, care manager, or the patient’s family is in a location with a computer, a web cam, and a connection to the internet, a virtual consultation can take place. Using this technology facilitates not only timely consultations, but at the same time, the doctor is able to review the patient’s history and immediately insert the new data into the patient’s electronic medical record.

As Dr. Barbash pointed out, the reward for using the right technology is to advance healthcare communication, workflow, and efficiency. This can all be easily accomplished by having the right clinical expertise available online by voice, text, or video or whatever it takes to have information at the doctor’s fingertips anytime or anywhere 24/7.

As Dr. Barbash emphasized, the result in using effective technology enables busy clinical practitioners to take complete control over what information and tasks they need to capture, how they want to view and organize the data, and how they want to share the information.

To promote the use of technology, Dr. Barbash is one of the founders of the NowDox community which can be found at NowDox is a free professionally supported community to simplify health collaborations. For more information, go to Dr. Barbash on Google Talk at

FCC Addressing mHealth

Dr. Mohit Kaushal, Digital Healthcare Director of the Omnibus Broadband Initiative at the FCC, speaking at the mHealth Networking Conference on February 3-4 in Washington D.C., sees the enormous potential for mobile health. He was very impressed with how mHealth helped a man survive in Haiti because he was able to use the apps on his iPhone to treat his fractured leg and other wounds. This story just points out what telecommunication devices and the right software can do in an emergency situation.

Kaushal reports that the FCC realizes the importance of mobile health and is actively promoting mobile health apps in the FCC National Broadband Plan. However, there are still several barriers to address concerning reimbursement issues, the infrastructure needed, and the concerns that involve regulatory and wireless spectrum issues. As reported, much of the country is not yet covered by wireless networks.

As directed by the Recovery Act, the FCC has the responsibility to develop the national broadband plan needed to provide better healthcare in this country via mobile devices and smart phones. The Act requires the FCC to guide and consult with NITA in the implementation of their Broadband Technology Opportunities Program at the Department of Commerce and submit the FCC’s National Broadband Plan to Congress. The FCC is planning to submit the plan in March.

At another meeting held in Washington D.C, FCC Commissioner Robert M. McDowell spoke at the National Press Club before the Free State Foundation on January 29th and stressed how the mobile app revolution is really helping to save lives. McDowell said the app revolution allows consumers to choose from over 630 mobile devices produced by 32 manufacturers, At the same time, literally hundreds of thousands of mobile apps created by thousand of entrepreneurs have come on the scene with more pouring over the horizon and are now available to app-thirsty consumers through an increasing number of outlets.

Thursday, February 4, 2010

HHS FY 2011 Budget Request

HHS Secretary Kathleen Sebelius at the media budget briefing held February 1 remarked that whether fighting a pandemic, protecting food safety, or transforming the healthcare system with electronic medical records, the agency is guided by some of the finest scientific and medical experts in the world. The President’s HHS FY 2011 budget request totals $911 billion in outlays, an increase of $51 billion over FY 2010.

The budget request for the Office of the National Coordinator for Health Information Technology is $78 million, which is $17 million above FY 2010. The budget request in conjunction with the $2 billion appropriated to ONC under the Recovery Act, will enable HHS to continue implementing the HITECH Act, accelerate the adoption of health IT, and help physicians achieve meaningful use of EHRs.

ONC’s plans for the $2 billion Recovery Act investment in health IT includes $693 million to establish the Health IT Extension Program, $564 million for a Health Information Exchange State Grant Program, $118 million to develop the health IT workforce, $235 million to go to the Beacon Communities Program, $24 million to carry out responsibilities under HITECH Act, $20 million for NIST to develop health IT standards testing, and $345 million to advance the care of all Americans with EHRs by 2014.

The FY 2011 Budget request for HHS divisions includes other funds and programs to advance the health IT agenda and related items.

Highlights include:

• NIH—the budget request is $32.2 billion with an increase of $1.0 billion or 3.2 percent over the FY 2010. In FY 2011, NIH will use the funding to support innovative research, to support genomics and other high throughput technologies that will provide for innovative efforts against cancer and autism, translate basic science into new and better treatments, reinvigorate the biomedical research community, use science to enable healthcare reform, and to focus on global health. The research portfolio for nanotechnology research would increase by $30 million for a total of $359 million. Opportunities to advance science would be accomplished through research and development contracts for comparative effectiveness studies or to support research centers for genomic and other high throughput technologies

• AHRQ—the budget request includes $611 million with an increase of $214 million above FY 2010. The budget includes $32 million which is $4 million above the FY 2010 level for health IT research. This research entails developing and disseminating evidence and evidence-based tools to inform stakeholders how health IT can improve the quality, safety, and efficiency of healthcare. The health IT program will also continue to fund research in strategic focus areas concerning “meaningful use” in collaboration with the ONC for HIT. The budget request for health IT would fund 44 research and training grants to improve the quality and safety of care by looking at the effective use of Health IT, by providing contracts to support the National Resource Center for Health IT, as well as projects to develop and disseminate evidence and evidence-based tools on the use of health IT. The budget request includes $65 million for the AHRQ patient safety program. AHRQ wants to improve primary care and clinical outcomes by supporting healthcare redesign, provide for clinical community linkages, care coordination, and the integration of health IT. AHRQ wants to increase funding for HCUP by nearly $2 million

• CMS—the budget request for CMS is $784.3 billion a net increase of $48.3 billion over FY 2010. This budget request makes fighting healthcare fraud a priority by investing an additional $250 million in new resources and be used to support legislative and administrative changes. This funding would expand data sharing and coordination between HHS and DOJ to help stop fraudulent schemes and practices, and to help expose systemic vulnerabilities that have been exploited by fraudulent healthcare providers. This funding would also provide for the investment in cutting edge and data mining technologies. The budget request includes $3.6 billion, an increase of $186 million to strengthen and revamp IT systems so that CMS can meet the future challenges of both the Medicare and Medicaid programs. The agency wants to increase investments in program management and would invest $110 million for the Health Care Data Improvement Initiative to replace aging information systems, and to transform the healthcare data environment. CMS wants to go from a system primarily focused on claims processing and to focus on state-of- the-art data analysis and information sharing

• CDC—the budget request is $10.6 billion with an increase of $101 million above FY 2010. The budget request calls for $307 million to go for Health Statistics, Health Marketing, and Public Health Informatics. The budget for Health Statistics includes $162 million, $23 million above FY 2010 to obtain and use statistics to understand health problems and recognize emerging trends. The budget includes $78 million a decrease of $2 million to go for health marketing. The Public Health Informatics budget of $67 million would fund information systems and IT to prevent diseases, disability, and other public health diseases. The budget request includes $352 million which is $16 million above FY 2010 for global health programs and also includes $20 million to reduce the rates of morbidity and disability due to chronic disease in up to ten of the largest U.S. cities

• HRSA—the budget request is $7.6 billion with an increase of $29 billion above FY 2010. The budget would provide an increase of $412 million to improve access to healthcare in underserved areas and includes $142 million to improve access to quality rural healthcare. Within this total, $62 million would be used to help Critical Access Hospitals conduct research on rural health issues and support community access to emergency devices. $290 million would be used to expand services at health centers. HRSA will work to develop stronger links between telehealth activities and other investments in rural health. The requested funds for telehealth would total $12 million. The budget request includes $995 million which is an increase of $33 million to support healthcare workforce programs to increase the number of providers in underserved areas. In addition, the budget includes $113 million to maintain training for underrepresented minorities and for financially disadvantaged students in health professions

• FDA—the budget request for $4 billion with an increase of $748 million over FY 2010 would go to support medical product safety, and allow FDA to invest in tools to assure the safety of increasingly complex drugs, medical devices, and biological products. The budget request would provide $1.4 billion for medical product safety which is an increase of $101 million above FY 2010. With the budget request, FDA would provide $4 million to establish a medical device registry. The budget calls for a $25 million increase for advancing regulatory science at FDA. The budget includes $15 million for nanotechnology related research and the increased resources would allow FDA to update review standards and provide regulatory pathways for new technologies such as biosimilars

• SAMHSA—the budget requests $3.7 billion a net increase of $110 million over FY 2010. The budget includes $136 million an increase of $34 million to administer and support national data collection efforts on drug related emergency room visits and deaths. The agency would also fund a new initiative to design and test community level early warning systems to detect the emergence of new drug threats and assist in identifying the public health and safety consequences of drug abuse

• Indian Health Service—the IHS budget requests $5.4 billion an increase of $354 million over FY 2010 and includes an increase of $4 million to support secure data exchange. The budget includes $864 million with an increase of $84 million to purchase medical care including essential services such as inpatient and outpatient care, routing and emergency care, and medical support services such as diagnostic imaging, physical therapy, and laboratory services

Go to or to for more information.

Setting the Standard for eHealth

Ronald Paulus, MD, MBA, and Executive Vice President for Clinical Operations and Chief Innovation Officer for the Geisinger Health System, discussed how effectively their health information system works.

Speaking at the eHealth Initiative’s Annual Conference held January 25-26 in Washington D.C., he explained how the system serves more than 2.3 million residents throughout 42 counties in central and northeastern Pennsylvania. This is accomplished through three main hubs, retail clinics, 60 plus a medical health sites, 48 distribute practices, and helps 1000 practices to have immediate access to information on their patients.

Paulus said that the Electronic Health System is fully integrated across all ambulatory and inpatient sites of care and has 3.5 million patient records on hand, 138,000 active users of “My Geisinger PHR”, and today 2,000 non Geisinger physicians are also using the system,

Geisinger has developed and implemented an advanced medical home. The medical home concept features a team to provide patient centered primary care, and high quality specialists are available for referrals. According to an article in the publication, “Health Affairs”, patient centered medical homes can improve care coordination and quality while reducing costs. The article points out that according to first year results, hospital admissions fell by 20 percent and total medical costs were down by 7 percent.

Geisinger has signed an agreement with Philips VISICU to launch the eICU Program® within six months that will ensure continuous remote monitoring of intensive care patients at the Geisinger Medical Center in Danville and the Geisinger Wyoming Valley Medical Center near Wilkes-Barre. Geisinger will also consider making eICU services available to other hospitals in the region.

The eICU technology will analyze patient data from monitors, life support systems, electronic health records, medical orders, and other sources of information. The system will alert staff when a patient is trending toward a serious health event. eICU programs in general show a 29 to 64 percent decrease in mortality and a 50 percent decrease in patient length of stay.

Geisinger also has plans to implement the mobile version of the program eCareMobil to expand critical care support to post anesthesia and emergency departments temporarily transforming any patient bed with network connectivity into a critical care location.

Using the latest in telemedicine technology Geisinger recently partnered with Evangelical Community Hospital in Lewisburg and Lewistown Hospital to expand stroke services in the Central Susquehanna Valley and Lewistown area. With this partnership, Geisinger’s stroke specialist is available to hospital patients 24/7.

Researchers at the Geisinger Medical Center recently received funding totaling more than $44,000 from the NYU Langone Medical Center (NYULMC) to develop a collaborative project to focus on personalized health care. By partnering with NYULMC, data will be collected from two very divergent populations allowing for collaborative research. Both institutions will integrate the data into their electronic health record systems.

This grant funding will enable Geisinger to administer electronic questionnaires to patients with osteoarthritis via new touch-screen monitors in its orthopedic clinics. Results from the questionnaires will enable physicians to track patient-reported outcomes.

For more information on the eHealth Initiative Annual Conference, go to For details on Geiginger’s eHealth activities go to

Mobile MedlinePlus Launched

The National Library of Medicine’s new Mobile MedlinePlus builds on NLM’s MedlinePlus internet service that provides consumer health information to over 10 million visitors per month. The site can be found at (

The mobile internet audience is large and growing fast and almost doubled from February 2007 to 2009. The mobile internet audience is now able to access the site through desktop computers, laptops, and mobile devices. Some experts predict that within the next five years, more people will connect to the internet via mobile devices than by desktop or laptop computers.

Mobile MedlinePlus information is available in English and Spanish and includes summaries for over 800 diseases, wellness topics, the latest health news, an illustrated medical encyclopedia, and information on prescription and over-the-counter medications.

For example, the “Talking with Your Doctor” page provides information on how to get the most out of your doctor’s visit, the site helps individuals choose specific over the counter medications and learn about side effects, look up information if suddenly your child’s school calls you to tell you your child doesn’t feel well, and the site can be used to learn about safe drinking water when traveling abroad.