Wednesday, June 30, 2010

BCBSND Funding Grants

The Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences Center has announced that the Blue Cross Blue Shield Rural HIT Grant Program has $375,000 available in grant funding with five to seven awards ranging from $40,000 to $65,000.

The BCBSND seeks projects that demonstrate collaborative efforts involving rural healthcare facilities where measurable outcomes will improve access, safety, quality, effectiveness, and provide efficient health services to the rural population in the state. Proposed grants must address the high priority health needs of a rural population through the planning and implementation of an HIT infrastructure.

Special consideration will be given to programs that:

• Work collaboratively with other healthcare facilities
• Demonstrate a solid planning process for implementation and adoption of HIT
• Help patients transition between healthcare settings
• Reduce duplicative and unnecessary testing and services
• Impart evidenced-based best practice guidelines to providers and patients
• Develop and implement a program with an emphasis on e-prescribing

Projects should place emphasis on the development of systems that improve the exchange of health information along the continuum of care. Such HIT systems can involve provider-to-provider and/or provider-to-patient relationships.

Eligibility can include single healthcare entities or a network (public or private, for-profit or non-profit) involving a variety of organizations but not necessarily limited to hospitals, clinics, medical and nursing providers, nursing facilities, public health units, mental health providers, dental clinics, tribal health providers, home health agencies, pharmacies, EMS units, academic centers, other community and health organizations, plus economic development organizations.

The grant process begins with submission of a Letter of Intent which must be received no later than 5 pm CDT on Thursday July 15th. Proposals must be received by 5 pm CDT on Monday August 30th.

For more information on RFP#187-2010, go to or contact Lynette Dickson Program Director, Center for Rural Health by email or call (701) 777-6049

Technology to Help Veterans

With chronic diseases on the rise and the aging of veterans there is going to be an increased demand for limited healthcare resources. The VA is continually addressing these issues and looking at the most advanced medical technologies to help veterans receive the care that is needed.

Several companies working with the veteran population appeared at the recent House Committee on Veterans Affairs, Subcommittee on Health and described how their company’s solution can help VA facilities utilize wireless services to help vets receive care especially in rural communities.

John Mize, Director for LifeWatch Services, Inc., in Rosemont IL, a GSA small business vendor presented his company’s technology as an example of what can be accomplished to treat rural patients. The LifeStar Ambulatory Cardiac Telemetry (ACT) platform is able to automatically and instantly detect and transmit clinically significant changes in heart rate and rhythm.

The transmission is sent via a cellular network such as Verizon to one of the monitoring facilities where certified cardiovascular technicians are available 24/7. The technicians view the transmission, edit the EKG data, create a report, and then send it to the clinician to go in the electronic medical record via a secure password.

For example, the Las Vegas VA Medical Center was flying patients to San Diego to be hooked up to antiquated technology. The VA clinic made the decision to use ACT and now the veterans are able to remain in their homes for diagnostic care.

According to a recent article published in USA Today, “Veterans are four times more likely than other Americans to suffer from sleep apnea. About 5 percent of all Americans suffer from sleep apnea compared to 20 percent of veterans.”

To meet this market need, Mize discussed how LifeWatch recently introduced a home sleep testing service to diagnose Obstructive Sleep Apnea. The service called NiteWatch will potentially reduce costs for the severely overburdened sleep labs within the Department of Veterans Affairs. It also will save the VA millions in lost revenue from fees paid to commercial sleep labs

Dan Frank, Managing Partner for Three Wire Systems LLC in Vienna Virginia explained how their Vet Advisor Support Program provides mental health outreach and health coaching services to OEF/OIF veterans and their families in both urban and rural areas.

VetAdvisor provides complementary, non-clinical support to veterans by using telehealth platforms to enable veterans to stay connected and to focus on health and medical concerns without leaving their home.

As Frank explained in the past, veterans who opted to use their virtual world health coaching program required wired broadband internet connectivity for their desktop or laptop computers to access a 3D environment so that they could work with their health coach. Frank explained that one of the problems facing veterans in rural areas is obtaining wired services. To make it easier for vets, VetAdvisor will launch a virtual world smartphone capability in the fall of 2010. If veterans opt to not use the virtual world, they can simply use their cell phones to obtain health coaching services.

Kent E. Dicks, Chief Executive Officer, and Chairman and Founder of MedApps, Inc., in Scottsdale Arizona, said, “The VA could potentially extend its capacity for remote monitoring on a daily basis from 35,000 patients currently to over 100,000 patients by using innovative mobile enable medical technology.”

He showed how MedApps HealthPal technology can work effectively to enable a patient to stay connected with their EHR and their caregiver. A doctor may ask a veteran with COPD or CHF to take a reading once a day in order to make sure that they are staying within the safe zones. He was able to demonstrate how the Pulse Oximeter reading went automatically over to the HealthPAl without the patient having to press any buttons and does this by using Bluetooth wireless technology.

The HealthPal has mobile phone technology using a technology called “Machine 2 Machine” (M2M). It works by having the 3G mobile broadband chipset the size of a quarter that is embedded in the device connect veterans to their healthcare providers.

Dicks concluded by saying, “Wireless mobile technology is available today but robust mobile networks need to start right away to bring care to where it is so desperately needed. The VA and the country as a whole could save a significant amount of time, money, and natural resources by using mobile wireless enabled medical technology.”

Funding for Medical Technologies

NIH’s National Institute of Biomedical Imaging and Bioengineering (NIBIB) will use supplemental funding to partner with engineers and scientists from India. The goal is to develop low cost diagnostic and therapeutic medical technologies to be used in underserved communities worldwide.

The supplemental funding was announced at the U.S. India Science and Technology Joint Commission meeting in Washington D.C. on June 24, 2010. The initiative between NIBIB and the Department of Biotechnology (DBT) of the Ministry of Science and Technology in India, will made it possible for the two nations to capitalize on the expertise and resources of both nations and develop medical technologies that will significantly impact underserved populations.

Applicants are encouraged to submit proposals for any collaborative technology development or device that would be appropriate in a low resource setting, such as low cost imaging devices or point-of-care screening tests. More information and examples of potential low cost technologies can be found at

Applications are now being accepted. Funding amounts will vary and are limited to 25 percent of the direct costs of an existing NIBIB grant. The funding opportunity closes on September 10, 2011.

NIBIB and DBT have established an online networking group at Scientists, engineers, and clinicians with interest in medical technologies for low resource settings are encouraged to participate in the Indo-U.S. Coalition for Low Cost Medical Technologies LinkedIn group.

DARPA Funds Brain Research

According to the CDC, 1.7 million people experience traumatic brain injuries of varying severity in the U.S each year including many returning war veterans. The Defense Advanced Research Projects Agency (DARPA) is leading research on the brain with current funding initiatives.

Recently, DARPA awarded the SUNY Downstate Medical Center $12.8 million to study the brain’s plasticity or ability to recover from brain injury. The newly funded research will create a realistic computational model and deliver a system that can be used for rehabilitation.

DARPA awarded the contract through their Reorganization and Plasticity to Accelerate Injury Recovery (REPAIR) program. The program seeks new methods to analyze and decode neural signals in order to understand how neural-based sensory stimulation could be applied to accelerate recovery from brain injuries.

The project draws on complex research at SUNY Downstate and research being done at the University of Florida, Johns Hopkins University, the University of California at Berkeley, and from industry partner NIRx Medical Technologies. The team includes neuroscientists, biomedical engineers, roboticists, physicians, and clinical scientists.

In another project, researchers at four institutions led by Stanford University, Brown University, University of California San Francisco, and University College in London are studying how both the brain and its microcircuitry react to sudden physiological changes and what can be done to encourage recovery from brain injuries. DARPA is providing $14.9 million for two years with an option to increase the project’s scope to $28.8 million and four years through their REPAIR program.

The team hopes to develop a new model to show the flow of information around the brain and research how each part generates the signals needed by other parts. This information could help lead to the development of prosthetic computer chips that mimic and replace the computational role of injured regions of the brain. These chips could possibly be miniaturized versions of the implants developed in the REPAIR project that would be capable not only of reading neural-electrical signals but also able to generate optical-neural signals for use by brain cells.

Improving Infusion Pumps

Physicians at Johns Hopkins University and engineers at JHU Applied Physics Laboratory (APL) are studying ways to apply systems engineering principles to improve the safety of infusion pumps. According to FDA, there have been 710 reported deaths linked to infusion pump malfunctions over the last 5 years and 87 recalls likely an underestimate given that most deaths aren’t reported as a device malfunction.

Infusion pumps are used in nearly every healthcare setting to provide critical fluids to patients including insulin to diabetics, liquid food to patients unable to eat, chemotherapy medications to cancer patients, and anesthetics via epidurals to women giving birth. However, the devices which often have a computerized screen and a number of parts are prone to mechanical and electronic malfunctions as well as user errors.

Peter Pronovost, an anesthesiologist and critical care physician at Johns Hopkins Hospital and Director of the Quality and Safety Research Group, Pete Doyle a member of the Hopkins Hospital’s Clinical Engineering Services, and Alan Ravitz an engineer in APL’s Biomedicine Business Area, have initiated a pilot program that pairs a healthcare delivery team with systems engineers to address the problem.

The project is still in its early stages and is now identifying stakeholder communities and subject matter experts, conducting literature searches along working to improve the infusion pump requirements in terms of design, implementation, testing, fielding, and support. The team has already identified several specific areas of systems engineering that if applied could help to improve patient safety.

The goal is to align the design of infusion pumps with clinician workflow which is one of the areas that FDA notes as a failing in today’s infusion pump designs. The engineers are also working to automate the system so that manual data entry is minimized, develop less ambiguous human computer interfaces, and provide for tighter integration with medical information management systems within the clinical setting.

Dr. Pronovost said, “We are asking clinicians to do a Herculean task that requires them to compensate for poor system design. Instead of telling clinicians to be more careful, we should design products that are easier to use.”

Sunday, June 27, 2010

Advancing Wireless

Gail Graham, Deputy Chief Officer, Health Information Management, Office of Health Information at VHA, appeared before the House Committee on Veterans Affairs and the Health Subcommittee to discuss how the future expansion of wireless technologies will help veterans in rural communities. Graham sees the potential use of wireless to target veterans with TBI, PTSD, or visual impairments.

The VA has initiated plans to develop and deploy a nationwide program to use wireless networking that is separate from the VA wireless LANs to use at VA healthcare facilities. Veterans and their families will be able to use this technology for communications, email, and therapeutic activity during patient stays at VA facilities.

VHA recently established a Program Office dedicated to using Real Time Location Systems (RTLS) to locate and track equipment, clinical staff, patients, and patient or staff movements. This information will also help improve the quality and efficiency of healthcare delivery to veterans by improving workflow. RTLS uses wireless LAN, RFID, Infrared, and other technologies. Future plans include developing requirements, standards, and overseeing the broader RTLS deployment.

Joseph M. Smith, M.D., PhD, Chief Medical and Science Officer at the West Wireless Health Institute in La Jolla, suggested that the VA in their Care Coordination/Home Telehealth (CCHT) program needs to take the next step and incorporate innovations beyond traditional telehealth equipment.

Plans should be made to evaluate and implement wireless health solutions to further extend the reach of the CCHT program. The technology should include wireless biometric sensors to monitor highly relevant physiologic parameters to track disease activity on a continuous basis and then be able to transmit the information to the patient’s healthcare provider.

Currently, the West Wireless Health Institute is exploring a VA demonstration research project in San Diego that is working with a small cohort of recently diagnosed PTSD patients. The demonstration project incorporates a mobile device with video conferencing capabilities to enhance crisis management, provides for regular “check-ins”, and biofeedback therapies. The plans are to increase access to real-time support for veterans with PTSD so that hospital admissions and acute events will decrease.

Dr. Smith thinks that the VA with the new $80 million VA Innovation Initiative (VAi2) will certainly improve veterans care but he wants to encourage a program such as VAi2 to accelerate wireless health solutions to enable home and mobile monitoring for symptoms and biometrics to enable remote therapies for a wide range of chronic and acute care needs.

According to Colonel Ronald Poropatich M.D., Deputy Director TATRC, the Army has developed, deployed, and is evaluating a mobile telephone-based secure messaging system called “mCare”. As of June 2, 2010, “mCare” has delivered over 18,500 messages to over 300 warriors assigned to Community-Based Warrior in Transition Units.

As the Colonel explained, there have been a number of challenges to overcome to achieve success with “mCare”. Today, the personal cell phones that patients use come in a wide variety of phone models and wireless carriers and as a result, these needs must be accommodated. Each wireless carrier has separate testing and certification processes that require specific devices that have different installation processes. This has resulted in a complex technological process for clinical teams to navigate.

Developing a streamlined simple process to be used by the care team while negotiating with each wireless carrier to enable accessibility to patients at no cost, is a time consuming process and is still ongoing. Also, full integration with the PHR is not currently part of the “mCare” model however, the feasibility and the cost to incorporate the PHR is being explored.

Colonel Poropatich discussed how the Army is specifically trying to help in the treatment of diabetes. The Army is exploring an important wireless application by examining the impact of a video cell phone reminder system to help in glycemic control in patients with diabetes mellitus. The evidence shows that the positive impact of Self Monitoring of Blood Glucose (SMBG) is important so that more patients can reach appropriate goals for glycemic control. However, SMBG remains suboptimal and one-third of patients with diabetes are not adhering to their medications.

Preliminary results show that AIC improves more in patients who are provided with video reminders as compared to those who did not receive them. Using reminders delivered via the cell phones appears to be an effective way to improve glycemic control and long term outcomes.

Currently, the Army Research and Development Command (RDECOM) is evaluating commercial handheld solutions and how they can work in a tactical setting. RDECOM has developed numerous handheld command and control solutions and is supporting the development and transition of “MilSpac”, to operate in a social networking environment.

As Colonel Poropatich stated, “The challenges that need to be addressed include integrating legacy information systems with mobile applications. As mobile phones evolve from simple communication tools into complex physiological data gathering devices, the line between cell phone and a medical device will blur. From a practical perspective, it is important to avoid overloading already busy clinicians with more information than they are able to use.

Medicaid Patients to Surge

Speaking at the National Press Club on June 21st, Dr. Edward Miller, CEO of Johns Hopkins Medicine, and Dean of the Johns Hopkins University School of Medicine, explained how the Johns Hopkins integrated health system is able to run a very large Medicaid managed care organization called Priority Partners.

Priority Partners responsible for 175,000 lives has enrolled approximately 25 percent of Maryland’s Medicaid beneficiaries. According to Dr. Miller, Hopkins is very familiar with the numbers 32 and16 in the new healthcare reform legislation. Thirty two million is the number of individuals that gained healthcare insurance by 2019, and 16 million is the number of individuals who will gain insurance through Medicaid eligibility.

To help address the challenge, Hopkins developed a population health model to examine coverage by examining cost data in order to identify how to achieve quality health outcomes. Priority Partners population health strategy takes into account factors such as age, gender, frailty, medication patterns, lab results, claims histories, clinical events, secondary medical condition, and hospital dominant conditions.

The first step is to give each person in the program a risk score every month to determine who needs what kind of help. The focus is on self-management, behavior modification, and when necessary, intervention. A team approach is used with caregivers, family members, social workers, nurses, nurse practitioners, and a primary care physician acts as the quarterback.

Hopkins has found that an informed motivated patient with an action plan backed up by a proactive medical team, backstopped by electronic health records and transitional care, is going to have improved, higher quality health outcomes.

The second step is to stratify the population from low scores to high in the form of a pyramid. At the base of the pyramid are low severity patients approximately 70 to 80 percent of the population. In the middle of the pyramid, are the more challenging patients approximately 15 to 20 percent of the population where specific interventions are provided including technology, assisted home monitoring, health coaching, and care coordination.

However, at the top of the pyramid, there are approximately 5 to 7 percent of the patients with very serious multiple chronic conditions which results in the most costly patients. For these patients, the program provides individual case management plans, registered nurses, telemonitoring, and visits by R.N case managers.

As Dr. Miller pointed out, there are two Medicaid programs considered the most difficult and costly areas that have had good results. The first program involves End Stage Renal Disease (ESRD) often caused by diabetes and high blood pressure and all too common in the Medicaid population.

Generally, the Medicaid population has overall poor compliance, lower literacy rates, and many co-morbid conditions. By using data compilation, intervention, and care coordination, costs have been reduced in ESRD patients by 47 percent.

The second program has Hopkins providing prenatal and high risk infant care. It has been found that babies born with low birth weights account for half of the spending on births every year. In Maryland, four out of ten babies are paid for by Medicaid. Since there women are of low social economic status they have a strong potential for very low birth weight outcomes so the result is that a large percentage of Medicaid dollars are spent on the neonatal care units.

To address this issue, Hopkins has started a program called “Partners with Mom” and the first step is to identify expectant mothers within the Priority Partners program. Information is gathered on their risk factors, maternal age, substance abuse, smoking, poor nutrition, low levels of education, and chronic conditions. Follow-up is provided and care management plans with goals are developed and in addition, monitoring the expectant mother is done if needed. Today, Hopkins has a NICU admission rate lower than the state’s Medicaid population as a whole and lower than the national Medicaid population.

As Dr. Harris summarized, the fact remains that Medicaid patients require cost management strategies to be used and quality health outcomes for Medicaid patients will only result in the context of a population health patient-centered care model.

USAID/Russia Collaboration

Russian maternal and child health experts met with USAID to discuss collaborating on key Maternal and Child Health (MCH) issues. Gennadiy Sukhikh, Director of the Kulakov Federal Center for Obstetrics, Gynecology, and Perinatology, met with Scott Radloff, Director of USAID’s Office of Population and Reproductive Health along with other experts from government.

Russian colleagues discussed the innovative uses of technology that USAID and the Kulakov Center are introducing in Russia to improve MCH and how they are using video conferencing to review cases of maternal and infant mortality and “near miss” mortality.

USAID-supported organizations in Russia are also exploring the use of mobile text messaging and other applications of technology to reach pregnant women and new mothers with information about prenatal and neonatal care.

The Russian delegation met with Jonathan Hale, Deputy Assistant Administrator of USAID’s Bureau for Europe and Eurasia, and Dr. Sukhikh and Dr. Radloff jointly met with senior representatives from the White House Office of Science and Technology Policy, HHS, and the private sector to learn more about “text4baby”.

As explained to the delegation, “text4baby” is a free mobile information service to be used to promote maternal and child health. The service is a program of the National Healthy Mothers, Healthy Babies Coalition (HMHB) to provide pregnant women and new moms information that they may need to take care of their health and to give their babies the best possible start in life. Women who sign up for the service are able to text BABY to 511411 to receive free SMS text messages each week timed to their due date of their baby.

An analogous program is being considered in Russia that would be managed by the Healthy Russia Foundation, a Russian non-governmental organization that is also a key implementing partner of USAID projects such as the “Health Russia 2020”.

In addition to the partnership efforts with Russia to specifically improve maternal and child health, USAID also collaborates on projects with the Russian Ministry of Health and Social Development, regional governments, NGOs, and faith-based organizations, along with international agencies such as the World Health Organization and UNAIDS on a number of other health issues.

For more information about USAID’s work in Russia go to

Delaware Issues RFP

The state of Delaware is looking for vendors to implement the “HIV Prevention Data Collection and Reporting System”. The state issued RFP (HSS 10 085) to find vendors capable of replacing the “Prevention Evaluation and Monitoring System” (PEMS) now in use.

CDC-PEMS developed by CDC is maintained on CDC servers and accessed via the internet. The system has been semi-functional from its launch several years ago and is incapable of collecting or reporting the data needed to evaluate program performance relative to CDC’s mandated performance measures.

Delaware, as well as many jurisdictions across the nation have experienced data losses, difficulty in data entry, and lack of a reliable mechanism for extracting meaningful data from the system once it is entered. Use of CDC-PEMS does not permit reasonable program monitoring and requires excessive staff time to maintain.

Additionally, Delaware implemented a customized scanning system for the collection of HIV testing data from the provider’s completed scanned forms. While the software and forms performed as designed, the amount of time needed to correct user errors in completing the forms has become excessive and cost prohibitive.

The purpose of this RFP is to implement a data collection and reporting system that is:

• Compliant with CDC HIV Prevention Program Grant requirements
• Effectively adaptable to frequently changing grant requirements
• Capable of reasonable customization to suit local specifics and variations in program design and implementation
• Capable of producing the reports required by CDC for the interim plus annual progress reports
• Able to manage regular transmission of data to CDC-PEMS
• Able to eliminate the scanning of HIV Testing reporting forms and incorporates all data entry via secure web access

The due date for the RFP is August 9, 2010. Preference will be given to vendors who have already successfully implemented systems in other states and jurisdictions and/or have proposed solutions previously to DHSS. Preference will also be given to vendors that have experience training users and can provide on-going technical support.

For more information, contact Bruce Krug at (302) 255-9290.

Wednesday, June 23, 2010

Hill Panel & Showcase

An enthusiastic crowd gathered on Capitol Hill to attend the HIT Showcase and Demonstration on June 17th. As part of National Health IT Week in Washington D.C., the Congressional Luncheon program coordinated by HIMSS and the Institute for e-Health Policy brought together leading experts for a panel discussion on the possibilities and need for using health technology in rural unserved and underserved communities.

Opening the event, Neal Neuberger, Executive Director for the Institute for e-Health Policy welcomed all the attendees, presenters, and the 178 co-sponsors taking part in the event. Senator Kent Conrad (D-ND) Chairman of the Senate Budget Committee and Founder of the Steering Committee thanked Neal for his excellent leadership in organizing the Capitol Hill briefings since 1993 and for being involved in a cutting-edge field that can make a big difference in the quality of life. In appreciation, the Senator was presented an award for all of his past and ongoing efforts to improve the quality and efficiency of healthcare.

Katie Oppenheim, Legislative Assistant for Senator Mike Crapo from Idaho relayed the message that the Senator realizes the importance of telehealth since it is used successfully in many rural areas of Idaho to provide high quality healthcare services.

Congressman David Wu from Oregon and Chair of the Science Committee’s Subcommittee on Technology and Innovation is a strong force in addressing the anticipated healthcare IT workforce shortage. He stressed the need to increase training for health IT to meet the need for an estimated 40,000 to 50,000 workers in the future.

A focused discussion on the best way to bring the benefits of health IT to rural and underserved populations was moderated by Feygele Jacobs. She is Executive Vice President of the RCHN Community Health Foundation (RCHN CHF) and she understands the critical issues since RCHN CHF is a not-for-profit supporting and devoted exclusively to the work of Community Health Centers.

From the federal government perspective, Garth N. Graham M.D. M.P.H, Deputy Assistant Secretary for Minority Health, told the attendees that it is important for all populations in this country to have the same health expectancy even where there are disparities in the population. He mentioned how important it is to engage folks in the regional extension centers and to develop both public and private partnerships in order to make the necessary inroads needed into minority communities.

Ruth Perot, Executive Director/CEO, Summit Health Institute for Research and Education, Inc. and the National Health IT Collaborative for the Underserved (NHIT), said, “The Collaborative was formed with federal agencies and other key private sector and community-based stakeholders to make certain that no community is left behind as health IT leaves the station.” She continued to say “Health IT must be used as a tool to help close the health gaps particularly as African Americans and Hispanics very often do not receive equal care.”

Looking at the problem from a large organization that is very involved with minorities, J. David Liss, Vice President, New York-Presbyterian Hospital, reported that the hospital serves four campuses but only one campus has a wealthy patient base and the other three campuses treat primarily minorities. Since the minority community has an insufficient number of physicians available to treat patients, emergency rooms have an eight hour wait with a 12 hour wait for admission to the hospital.

The need for technology is great but he noted that the focus for technology should be on designing interfaces for the illiterate population. As Liss pointed out, one of the ways to reach the greatest number in the minority population is to use cell phones to help effectively manage healthcare.

Explaining how a regional and major referral and medical center operates, Chuck McDevitt, Chief Information Officer, at Self Regional Healthcare reported that Self provides advanced healthcare services to more than a quarter of a million people. Self located in Greenwood South Carolina, has 414 beds, employs 2,400 health professionals, and has a medical staff of more than 200 representing almost every major medical specialty.

Self’s focus is to provide healthcare to patients in seven counties most of which are located in rural settings. Self treats an aging diverse underserved black and white population with health issues that include diabetes, hypertension, and obesity. The average income in the area is $33,000 per year with unemployment rate at 12.8 percent plus 14.5 percent of the population is not being able to get care because of the high cost.

To help bring efficiency and better care to the population through the use of EHRs, Self recognized the need to replace its outdated technology and help physicians implement EHRs so they can qualify for the stimulus incentives. Self selected Allscripts and their EHR and Practice Management solution to help the physicians implement EHRs.

Kate Wilson, RN, BSN, Director of HIS, Arlington Free Clinic (AFC), Arlington VA discussed how a small non-profit volunteer organization providing healthcare to low income uninsured adults can adopt technology. AFC ventured into using an EMR back in 2005. The system with a simple patient demographic and appointment system also tracked basic clinic program reporting. However, with slow connectivity and an inflexible design, the system could not be used for clinical charting or care management— so the result was a continued dependence on paper charts.

In 2010, AFC’s new electronic medical record went live for the first time. The clinic was able to implement the new EMR (HealtheStates), that includes new eligibility screening and demographic software plus new pharmacy management software. The Clinic is working with the Virginia Hospital Center to develop an electronic interface to enable both AFC and VHC to exchange patient medical information.

According to Earl Rugg, Chief Executive Officer, Rural Health IT Corporation, in Portsmouth New Hampshire, RHTIC works to improve quality outcomes and lower costs for patients and hospitals using IT. RHTIC’s role is to help rural hospitals obtain federal grants to purchase electronic health systems.

To do this, RHTIC provides grant writing education seminars and consulting services throughout the entire grant process. So far, successful grant awards have gone to the Critical Access Hospital Consortium NH/VT, Critical Access Hospital Consortium including Dartmouth Hitchcock Medical Center, the University of North Dakota to include three Critical Access Hospitals and Tertiary Center, and to the Transylvania Community Hospital in Brevard N.C. that includes seven clinics.

The Technology Showcase featured leading federal agencies, associations, leading research organizations, and companies demonstrating their latest advances. For more information, email Neal Neuberger Executive Director, Institute for e-Health Policy at

Investing in Public Health

HHS announced funding for $250 million to strengthen the primary healthcare workforce and another $250 million to support prevention activities and develop the nation’s public health infrastructure. The new investments are funded through the Affordable Care Act.

The funding to expand the healthcare workforce will support the training and development of more than 16,000 new primary care providers over the next five years. The $250 million to strengthen the workforce will:

• Create additional primary care residency slots with $168 million to use to train more than 500 new primary care physicians by 2015
• Support physician assistant training in primary care with $32 million to provide for more than 600 new physician assistants
• Encourage students to pursue full time nursing careers with $30 million used to encourage over 600 nursing students to go into this career
• Establish new nurse practitioner-led clinics with $15 million to operate 10 nurse-managed health clinics to train nurse practitioners
• Encourage states to address health professional workforce needs with $5 million to help states to plan and implement innovative strategies to expand their primary care workforce by 10 to 25 percent over ten years

The $250 million in funding to be used to address prevention and public health will:

• Support federal, state, and community prevention initiatives with $126 million to be used to integrate primary care services into publicly funded community-based behavioral health settings to address obesity prevention and fitness and tobacco cessation
• Further develop the public health infrastructure with $70 million to support state, local, and tribal public health infrastructure and build state and local capacity to prevent, detect, and respond to infectious disease outbreaks
• Support funds to do research and tracking with $70 million to be used for data collection and analysis
• Support public health training with $23 million to expand CDC’s public health workforce programs and public health training centers

New Test for Heart Attacks

According to the June newsletter “VA Research Currents”, a new diagnostic tool to detect heart attacks using saliva is being tested at the Michael E. DeBakey VA Medical Center in Houston. The research is being done through a partnership with Baylor College of Medicine and Rice University’s BioScience Research Collaborative.

Chest pain brings about five million people to emergency rooms each year, but 80 percent are not suffering heart attacks. Electrocardiograms are often inconclusive and blood tests that look for biomarkers can take several hours.

The device works by analyzing saliva to look for cardiac biomarkers of injury implicated in a heart attack. The device called the Nano-Bio-Chip was developed by Rice bioengineer John McDevitt, PhD plus he is the inventor of a “lab-on-a-chip” system to diagnose oral cancer. McDevitt envisions Houston becoming the hub of a biomarker highway where the biochip will be configured to diagnose a variety of diseases.

With the Nano-Bio-Chip, gums are swabbed and the saliva is transferred to the disposable microchip. The chip is then inserted into an analyzer and within a few minutes, the saliva sample is checked for results. McDevitt finds that the electrocardiograms are able to provide more accurate information when combined with the saliva test.

Over the next two years, some 500 ER patients at the Houston VA are expected to take part in the study. It is anticipated that this test will be an alternative or complementary technique to use to draw blood when making an early heart attack diagnosis and it is hoped that ultimately the testing will be done in the ambulance before the patient arrives in the emergency room.

CMS Launches EHR Website

The official website for the Medicare and Medicaid electronic health record incentive programs just launched houses the most up-to-date information on EHR incentive programs. The HITECH Act established programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified EHR technology. The incentive payments beginning in 2011 will be made to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate “meaningful use” of certified EHR technology.

This is a new program and it is separate from other active CMS incentive programs such as Physicians Quality Reporting Initiative, Reporting Hospital Quality Data for Annual Payment Update, and e-Prescribing.

CMS recently published the proposed rule on the EHR incentive programs and accepted public comments for 60 days ending March 15th. More than 2,000 comments were received and CMS is developing and plans to release the final rule in summer 2010.

In addition, CMS is also working with the Office of the National Coordinator for HIT to develop standards, implementation specifications, and certification criteria for EHR technology. Patient privacy and security is also an important consideration in implementing the EHR incentive programs. Currently, CMS is working with the Office for Civil rights and ONC to address privacy and security protections under the HITECH Act.

For more details, go to to learn about who is eligible for the program, how to register, meaningful use, upcoming EHR training, other events, and much more.

Challenges for Small Business

President Obama’s April 2010 memorandum establishes an Interagency Task Force to examine federal contracting opportunities available for small businesses. The Administrator for the Small Business Administration, the Secretary for the Department of Commerce, and the Director for the Office of Management and Budget, are serving as co-chairs of the Task Force. Other agencies on the Task Force along with invited interested parties both from the public and private sector, are being asked to offer their views on the challenges that small businesses face in pursuing federal contracts.

Some of the recommendations and ideas under discussion include:

• Increasing teaming efforts to increase opportunities for small business contractors
• Encouraging small businesses to make good use of mentorship programs such as the mentor-protégé program
• Examining small businesses set-asides and the changes needed and how to mitigate the effects of contract bundling
• Improving training and outreach on procurement issues so that small businesses can participate more in the federal marketplace
• Using new technologies to help small businesses and the agencies better identify contracting opportunities
• Improve training in the procurement process for federal program managers, acquisition officials, and small businesses
• Expanding outreach strategies to match small firms with other small firms

Within 90 days after the release date of the memorandum, the Assistant to the President and Chief Technology Officer and the Federal Chief Information Officer in coordination with the Task Force are to develop a website to improve transparency and accountability. The web site is to illustrate the importance of participation in the federal marketplace by small businesses, including those owned by women, minorities, socially and economically disadvantaged individuals, and service disabled veterans.

Written comments on the issue should be sent directly to by June 30, 2010. A meeting is going to be held on June 28, 2010 in the Department of Commerce auditorium to hear oral comments and discussion on comments received related to the challenges faced by small firms. To register for the meeting, email The agenda for the meeting will be posted at

Sunday, June 20, 2010

Hearing on Capitol Hill

The Senate Committee on Veterans Affairs on June 16th held a hearing to discuss current Department of Veterans Affairs healthcare services provided in rural areas. Robert Jesse, M.D., PhD, Acting Principal Deputy Under Secretary for Health at the Veterans Health Administration, appeared before the Committee to describe how telehealth is helping veterans in rural areas. According to the VA, between 30 and 50 percent of telehealth activity in the VA supports veterans in rural and highly rural areas with ongoing growth anticipated.

Currently, the VA has introduced quality management programs for Clinical Video Telehealth, Care Coordination Store-and-Forward (CCSF), and Coordinated Care Home Telehealth (CCHT). Dr. Jesse pointed out that in FY 2009 quality management programs related to telehealth were combined for all three areas to create a single assessment process.

He reported that real-time video conferencing was provided to more than 37,000 veterans in rural and highly rural areas in FY 2008. The majority of real-time video conferencing services were for mental health conditions, but the veterans also used video conferencing for rehabilitation, speech pathology, polytrauma, and spinal cord injury care. In FY 2009, 21,603 veterans received telemental health services in rural areas with 1,600 in highly rural areas.

As reported at the hearing, veterans are faced with mental health issues and need treatments requiring coordination and treatment. The VA is optimizing its Polytrauma Telehealth Network to facilitate provider-to-provider and provider-to-family coordination, as well as to enable consultations from Polytrauma Rehabilitation Centers and Network Sites to reach other providers and facilities. Currently about 30 to 40 video conference calls are made monthly across the network sites to VA and DOD facilities.

To further to treat veterans with mental health issues, the VA is establishing a National Tele- Mental Health Center to coordinate telemental health services nationally with the emphasis on making specialist mental health services such as PTSD and bipolar disorders available in rural areas.

CCSF also known as store and forward telehealth involves the acquisition and interpretation of clinical images for screening, assessment, diagnosis, and management. These services in FY 2008 were provided to 61,776 veterans in rural areas and 2,911 in highly rural areas, however, in FY 2009, this workload increased by 86 percent.

CCSF services were predominantly used to screen for diabetic eye disease using teleretinal imaging. In the last fiscal year, the VA offered teleretinal screening at 283 sites, 78 of which were in rural or highly rural areas but today the VA has 310 participating sites with 84 in rural or highly rural areas. The remainder of CCSF activities covers teledermatology. The VA has a teledermatology pilot program scheduled to expand nationally to five VISNs in 35 sites, 20 of which are in rural areas.

As Dr.Jesse pointed out, the VA is working hard to help veterans continue to live in their own homes with the VA’s CCHT program coordinating and providing services. Currently, 41,000 veterans receive CCHT for non-institutional care, chronic care management, acute care management, and for disease prevention.

Thirty eight percent of these patients live in rural areas with two percent in highly rural areas. The funding for FY 2009 helped the VA increase the delivery of care via home telehealth by 19 percent and today the VA is seeking to further increase delivery of these services by 20 percent in FY 2010.

To help in home care, new Polytrauma Telehealth Network Initiatives are in development and one initiative includes using home buddy systems to maintain contact with patients in rural or highly rural areas with mild TBI, veterans with amputations, and veterans in the need for remote speech therapy.

The VA has developed a Telehealth and Home Care Model as described in the President’s FY 2011 budget submission. The VA’s goal is to develop a new generation of communications tools to include social networking, micro-blogging, text messaging, plus self management groups to provide more care in the home.

Looking ahead, the VA is addressing weight issues among the veterans. The plan is to implement a “Managing Overweight and/or Obesity for Veterans Everywhere” (MOVE) program within the CCHT program to expand groundbreaking programs for weight management.

Iowa Submits Plan

The Iowa e-Health Strategic and Operational Plan has been submitted to the HHS Office of the National Coordinator for HIT. The plan developed by the Iowa Department of Public Health (IDPH) in conjunction with the e-Health Executive Committee and Advisory Council is a required component of the ONC State Health Information Exchange Cooperative Agreement program and plans to provide $8,375,000 to Iowa e-Health over the next four years to implement Iowa’s HIE.

According to the plan, starting in July 2010, the schedule is to review the planning and implementation efforts for the statewide HIE including Medicaid HIT activities. At that point, this plan will be submitted to the e-Health Executive Committee.

Plans for activities in the August 1, 2010 to October 31, 2010 time period are to:

• Find a vendor to work with Iowa e-Health to plan and facilitate focus groups
• Develop and maintain a web site to provide up-to-date information on ongoing activities
• Work with Iowa Medicaid and other entities to identify potential participants
• Establish partnerships with Iowa healthcare payers and payer associations and have them distribute Iowa e-Health information to their membership
• Engage labor unions and business associations to assist in the dissemination of information about Iowa ehealth
• Develop a communication and outreach plan
• Conduct strategy meetings with the Iowa Regional Extension Center and Iowa Medicaid to coordinate activities
• Coordinate activities with health IT workforce and educational workgroups to include meaningful use in training programs and health IT curriculum development
• Explore opportunities to align with existing standards and systems
• Identify funding resources to develop the workforce plan
• Explore options for loan and group purchasing programs to lower costs for health IT

In general, from September 2010 to November 13, 2010, the plan is to execute a contract between the state and the selected vendor to implement the proposed HIE solution. Specifically beginning in October, the goal is to work with the HIE vendor and the eHealth executive committee to select pilot organizations.

The timeframe for developing the Iowa Medicaid health IT plan is to start in September when a contract between the state and vendor will be executed and then the Medicaid health IT plan will be submitted to CMS. Starting in October, the vendor is to select pilot organizations, develop an evaluation plan, and facilitate focus groups.

The Strategic and Operational plan is available at For more information, contact Polly Carver-Kimm at (515) 281-6693.

eHI's Capitol Hill Event

The eHealth Initiative’s (eHI) June 14th event on Capitol Hill was held at the start of Health IT week. eHi is actively working to ensure patient engagement and patient access to information as an integral part of the health IT movement. A demonstration at the event showed how technology helps stroke survivors and enables health professionals provide good care at a distance.

Paul Berger, a stroke survivor and ePatient living in Virginia demonstrated how computers can connect stroke survivors so that they can receive treatment from their home. He fully embraces the computer to receive not only his own therapy but also to inspire other stroke survivors. He demonstrated in real-time how effectively using technology can help individual stroke survivors.

Paul’s journey started when he suffered a massive stroke from a ruptured aneurysm when he was only 36, which happened over 20 years ago. His stroke resulted in paralysis of his right side and aphasia but he was determined to live a full life which meant returning to work, taking part in volunteer activities, hobbies, and continue his desire to travel.

Aphasia is a disorder that results from damage to portions of the brain that are responsible for language which for most people are areas on the left side of the brain. Aphasia usually occurs suddenly often as the result of a stroke or head injury, but it can also develop slowly as in the case of a brain tumor, infection, or dementia. Approximately 80,000 individuals acquire aphasia each year from strokes.

To Paul, tele-rehabilitation has made the difference. In Paul’s case, Bill Connors is a certified speech language pathologist specializing in combining technology, neuroscience, and learning theory with current evidence and research was able to help him by using telehealth technologies. Connors is Director of the Pittsburgh Aphasia Treatment Research and Education Center as well as founder of and as a professional in the field, he conducts individual and group sessions to help aphasia patients

The demonstration showed how a session actually works in real-time. To begin with, Bill and Paul located at a distance from each other were able to view each other and talk to each other in real-time using a two-way internet web-camera and computers. After the equipment was set up Paul was able to demonstrate how a session works with drills and practice exercises while Bill gave input and encouragement to Paul.

In addition, Bill also leads group sessions with up to five clients. In that case, the goals are to provide peer collaborative practice and drills, emphasize taking turns and listening skills, provide social support and networking, and practice treatment skills gained in individual sessions.

Paul is the award winning author of “How to Conquer the World with One Hand—And an Attitude” a book about his adventures after suffering his stroke. Also, Paul leads a very full live and works hard to connect with other stroke survivors through his web site, and publishes an e-newsletter, along with new e-books with tips on recovery.

For more information on the eHealth Initiative and their events, go to or call 202-624-3270.

Broadband Actions

The USDA released the report “Connecting Rural America,” outlining the projects that USDA’s Rural Utilities Service (RUS) has funded under the first round of awards made through ARRA’s Broadband Initiatives Program (BIP).

In the first of two scheduled funding rounds, RUS awarded $1,068 billion for 68 broadband projects in 31 states and one territory. Awards for last mile remote projects received $13 million, last mile non-remote projects received $49 million, and middle mile projects received $6 million. A second round of applicants will be announced later in 2010.

These projects will bring broadband service to an estimated 529,249 households, 92,754 businesses, and 3,332 anchor institutions across more than 172,000 square miles. Community anchors, such as schools, libraries, healthcare providers, colleges, critical community facilities, plus 19 Tribal lands will benefit from the funding for broadband.

As for activities in one state, the Texas Pride Network is going to construct a FTTP telecommunications infrastructure to help advance broadband services to over 50,000 residents and 2,000 businesses in rural communities in the Texas South Plains Region.

The Texas Pride Network received $22,720,551 in Federal loans and $21,829,549 in grants to provide cost efficient services to help first responders, 911 services, distance learning, advance telemedicine, and provide broadband internet connectivity to this underserved community.

In addition, the Valley Telephone Cooperative Inc. received $40,093,153 in loans and $38,520,868 in grants and will also develop broadband infrastructure in eleven unserved and underserved rural areas in the South Texas Plains.

Other agencies are also moving forward and cooperating on broadband issues. Following up on the National Broadband Plan’s recommendation to use the power of broadband to improve healthcare, the FCC and FDA are working together and will hold a joint public meeting in July. The plan is for the two agencies to streamline the review process used for life saving wireless medical technologies and then work together to approve new wireless medical devices for the marketplace.

In addition, the FCC and FDA are working together to identify the challenges and risks posed by the use of new sophisticated medical implants and other devices that use radio communications. They are also examining the challenges and risks posed by the development and integration of broadband communications technology with healthcare devices and applications.

In another cooperative action, FCC Chairman Julius Genachowski and Assistant Secretary of Commerce for Communications and Information and NTIA Administrator Lawrence E. Strickling, met recently to discuss their agencies roles with respect to commercial and federal spectrum and how to maximize spectrum use.

The FCC is also launching a Universal Service Working group to be chaired by Sharon Gillett, Chief of the FCC Wireline Competition Bureau, to provide a comprehensive approach to the reform of the universal service program. Other bureaus within FCC will participate along with smaller inter-bureau and inter-office working groups to propose solutions to developing the universal service vision as it is included in the National Broadband Plan.

Wednesday, June 16, 2010

Advancing Medical Innovation

The U.S. is quickly losing ground as the global leader in medical innovation and must address the issue at the highest levels of government according to a new study prepared by Battelle. The study titled “Gone Tomorrow? A Call to Promote Medical Innovation, Create Jobs, and Find Cures in America” was commissioned by the Council for American Innovation (CAMI). The Council with Dick Gephardt as Chairman is a partnership aimed at urging Congress to adopt a national policy agenda on medical innovation.

For more than a year, CAMI met with experts, including entrepreneurs, innovators, clinicians and patient advocates in communities across the U.S. to understand the challenges faced by those working to advance medical innovation. Based on information obtained, CAMI commissioned Battelle to identify and highlight the best public policy ideas, so that CAMI can bring this information to Congress and to the Obama Administration.

According to the experts, the U.S. medical innovation ecosystem needs:

• White House level leadership that will lead to collaborative efforts to address key challenges

• Public-private collaborations to bridge the gap that exists between early-stage research often funded through public sources, and later stage development projects funded by private-sector sources. This gap currently delays the availability of new life-saving medicines, treatments, and technologies

• To strengthen investments in R&D and manufacturing to foster job growth and competitiveness, Congress needs to make the federal R&D tax credit permanent and adopt tax economic incentives to help boost manufacturing

• To enhance regulatory sciences efforts at FDA by calling on federal leaders to strengthen and meaningfully fund a collaborative effort to develop a regulatory sciences roadmap to advance existing efforts to bring the best science forward

• To increase the U.S. biosciences talent pool by providing federal support for the biosciences through K-12 science, and support for technology, engineering, and mathematics educational efforts, plus support to enhance bioscience teacher professional development

Go to to download the full report.

Funding to Create Network

The World Bank approved $63.66 million to create a regional network of 25 public health laboratories across Kenya, Tanzania, Uganda, and Rwanda. The network operating across country borders, will improve access to diagnostic services so that vulnerable populations in cross border areas will be able to make optimal use of internet and mobile communications.

Laboratories are currently the weakest link in the region’s public health defenses, seriously hindering each country’s ability to confirm and respond in a coordinated manner to disease outbreaks. By bolstering diagnostic and surveillance capacities, the new multi-country laboratory network will help to identify potentially devastating disease outbreaks at an early stage and enable countries to act quickly to prevent the rapid spread of diseases across borders.

Communicating outbreak-related information across national borders in real-time is more important than ever before, as the workforce becomes more mobile with the establishment of the East African community common market plus global travel is continuing to grow.

The network will also support the roll-out of new technology for drug resistance monitoring and provide for more efficient tuberculosis diagnosis most notably for people living with HIV/AIDS. All four countries have a high burden of tuberculosis with an increasing threat of drug resistance. Kenya, Tanzania, and Uganda are on the World Health Organization (WHO) list of 22 “High-burden” countries that together account for 80 percent of the world’s tuberculosis cases while Rwanda is on the WHO list of 15 high TB incidence countries.

Information and communication technologies are an essential aspect of the project to ensure advanced connectivity between multiple locations. Innovations that will be built into the project include web-based knowledge sharing, e-learning modules, and health alerts. The project also supports joint training and capacity building across countries, joint operational research, regional coordination, and program management.

Each participating country will become a Center of Excellence for a key aspect of the project. Rwanda will take the lead on ICTs and performance-based financing. Kenya will serve as a center for integrated disease surveillance and response and for operational research. Uganda will take the lead on laboratory networking and accreditation, and Tanzania will develop high quality training programs.

Several partners have contributed to the development of the project including CDC, WHO, USAID, and the International Union against Tuberculosis and Lung Disease. Parallel financing for specialized TB diagnostics will be provided through the International Drug Purchase Facility grant to support the EXPAND-TB Project (a collaborative effort of the WHO/Global Laboratory Initiative), the Foundation for Innovative Diagnostics, and the Global Drug Facility.

For information on the World Bank in Africa, go to

EHR Lessons Learned

Navy Capt. Michael Weiner, DHIMS Program Manager and Chief Medical Officer, reports that for decades the Military Health System (MHS) has relied on its electronic health record to track and share health information data with providers. He recently posted several valuable lessons learned within MHS regarding the purchasing and use of their electronic health record system.

One of the first lessons MHS learned is to ensure that the EHR fits in with the current work flow before the system is purchased and absolutely before it is deployed. Work flows are similar enough across the environments and that should be a top consideration since customizing the look and feel of records for each station is not feasible nor is it possible. The MHS had to develop a system standardized enough to allow a doctor stationed in Texas who transfers to Germany or is deployed to be able to start using the system on the first day at the new station.

Any piece of software selected for the EHR must have hardware that can run it. When choosing hardware, it is important to choose the hardware that best fits the work flow. The lesson is that not only does the software have to meet the needs for the work flow in order to have a smooth and semi-painless adoption, but this is also equally important for the hardware.

Always purchase an intuitive system that is easy for medical providers to understand plus use software that is easy to use. It shouldn’t take a long time to figure out how to use the system especially if it is similar to the system and software that the user already knows.

Training should be conducted with a hybrid mix of training done in the classroom or it can be training one-on-one or both types of training. MHS has found that even training done in short bursts at busy military treatment facilities will provide each user with an adequate amount of knowledge.

The Defense Department has to host information on its own servers to protect national security and also because DOD needs to deal with an enormous volume of information. Since the MHS services 9.6 million beneficiaries, it makes good fiscal sense for MHS to do their own hosting. It has been found that web hosting increases speed and increases reliability. A centralized server eliminates the need for constant upgrades at the local level and enables upgrades to occur faster.

Wireless is here and it should be used to not constrain medical providers with wires. To best support work flow, wireless tablets, and notebooks should be used to make documentation easier and quicker to use and be portable in the battlefield. Portable technology increases the ease of incorporating EHRs into standard practices and increases the chances of buy-in by the users.

MHS and the VA have more data available than any other two healthcare organizations in the world and need to share data on millions of patients. Not all data needs to be computable to be useful, but some information like information on allergies and medications is really important and needs to be included while other data may not be so important to include.

Empower the staff from the very beginning to feel ownership of the EHR. When the users take ownership and buy in they are more willing and even eager for the change. Users need to be included from the first step of purchasing and then be included in all of the following steps in deploying and using the EHR. The users also need to include physicians, clinicians, nurses, clerks, and administrative support.

The next step is to empower patients to take responsibility as a partner in their own healthcare as very often new technologies can empower patients to have access to their own healthcare data. Offering patients a web-based personal health record will enable patients to email their providers, refill medications, and make appointments, which in the long run benefits both patients and clinicians.

The last lesson is to realize that NHIN is the next generation in our EHR evolution. As NHIN develops, all healthcare organizations and their EHRs will connect into this secure network. The NHIN is the dial-tone for the future and the broker of healthcare for the entire country.

Expanding Heathcare Efforts

In April, Maryland’s Governor O’Malley signed legislation to require the Maryland Health Care Commission (MHCC) to establish a Patient Centered Medical Home (PCMH) pilot program. Insurers, HMOs, managed care organizations and nonprofit health service providers are now authorized to pay a PCMH for providing care and for managing chronic conditions.

This PCMH pilot will test whether this new form of primary care centered on the patient and founded on team-oriented care can improve healthcare quality and lower costs. At the same time, the pilot will assess whether the PCMH model can face and improve the current primary care model and challenges.

Primary care practices including physician and nurse practitioner led pediatrics, family practices, internal and geriatric practices will be eligible to participate. The program hopes to cover 200,000 patients which could translate to about 50 practices and 200 providers. Practices must apply for NCQA PPC-PCMH Level 1 recognition within 6 months of acceptance plus Level II within 18 months.

The Maryland PCMH Program is currently evaluating whether to participate in the CMS Multi-Payer Advanced Primary Care Practice Demonstration Grant. The demo is open to states that are developing and or have implemented a PCMH or will be ready to implement a medical home in 2010 or in 2011. The CMS grant requires that the selected state do an evaluation to determine how the PCMH affects access to care, quality of care, and patterns of use.

The MHCC is also intends to select a contractor to complete a Feasibility Assessment of the Maryland Medical Assistance (Medicaid) program to see how the program can align with existing external health IT and HIE efforts. Specifically, the state is going to assess whether to expand EHR adoption among Medicaid providers, how to ensure provider connectivity to the HIE, and how to administer and oversee certified EHR incentive payments to providers.

Wireless Technology Donated

A Consortium of five Baltimore hospitals led by Johns Hopkins Department of Emergency Medicine has donated new wireless technology able to transmit electrocardiograms from the field over the internet to hospital-based medical specialists. The real-time, diagnostic-quality EKG data is streamed to the doctors on a variety of devices including PCs or via blackberries or smart phones.

The Consortium in Baltimore includes Johns Hopkins Hospital, John Hopkins Bayview Medical Center, Saint Agnes Hospital, Sinai Hospital, and Union Memorial Hospital.

The donation to the Baltimore City Fire Department includes 36 broadband units, enough to equip every paramedic unit in the city and have others available during peak service periods. In addition, the five hospitals each have acquired and installed matching software so that emergency physicians and cardiologists can see EKG data as it is transmitted by emergency responders.

When fully operational in the next month or so, emergency physicians at the five hospitals will be able to review EKG data in real-time as it is sent remotely by city medic units. They’ll be able to quickly diagnose whether the patient is experiencing what is known as an ST-elevation myocardial infarction, or STEMI. Hospital emergency teams will also be able to get appropriate intervention equipment and other resources ready before the patient even arrives at the hospital.

Sunday, June 13, 2010

VA Seeks Innovative Ideas

The Department of Veterans Affairs just opened the VAi2 Industry Innovation Competition with $80 million available for private sector innovations. The VA is seeking the best ideas possible from both public and private companies, entrepreneurs, universities, and non-profits.

In general, the innovation competition program is looking for new innovative solutions to help the VA meet the challenges involved in becoming a 21st century organization. The goal is to increase the veterans’ ability to have access to VA services, improve the quality of services delivered, enhance the performance of VA operations, and reduce or control the cost of delivering those services.

The VA is looking for telehealth solutions that are broad and varied and can provide the right treatment at the right place and at the right time. The VA also wants to improve polytrauma care by using home monitoring for diverse and complex symptoms and wants to see new ideas for developing assistive technologies. In addition, the VA has made reducing adverse drug events a priority and is actively seeking tools capable of integrating this information into VA records and systems so as to be able to continuously monitor for at-risk situations.

Other solutions are needed to address innovative housing technology, new models to use for dialysis and renal disease prevention, and ways to help veterans and service disabled veterans start new businesses.

Go to for more information, click on the solicitation details or go directly to The VA Technology Acquisition Center via the BAA announcement requires solutions to be submitted by industry in response to VAi2 topics by September 30, 2010.

An industry day is scheduled via Webinar on June 16, 2010 where information will be provided for each area of interest and questions from industry will be addressed. As additional information becomes available, it will be posted at and

For more information, email Lauren Oliver, Contract Specialist at or Carol Newcomb, Contracting Officer at

In May, the VA announced the 26 winning ideas submitted to the Technology Innovations Competition from VA employees. Some of the winning innovations included ideas on how to reduce healthcare associated infections using informatics, developing wireless voice communications with hands free options, and ways to enhance care management for patients with chronic diseases.

Telemedicine Helping Students

NIH awarded a five year $2.2 million grant to the Arkansas Children’s Hospital Research Institute (ACHRI) to explore whether school-based telemedicine sessions can help students in rural areas control their asthma. As the most common chronic childhood disease, asthma disproportionally affects minority and low income children and is especially difficult to treat children living a distance from specialists.

The “Reducing Asthma Disparities in Arkansas” (RADAR) research team will examine 12 school districts in rural east Arkansas counties, by placing video conferencing systems in six of the school districts to enable the recruited students with asthma to have regular education appointments with specialists in Little Rock. The remaining schools will act as control sites. The RADAR study will include three years of school-based interventions with each site hosting the video conferencing sessions for a year.

Students ages 7 to 14 will learn how to recognize initial symptoms of an asthma attack, the importance of taking medications as prescribed, and ways to reduce their risk for complications. They will take part in the video conferencing education during non-instruction periods such as in study hall or during recess.

During the sessions, the students will be able to speak directly with ACHRI asthma specialists so that their questions can be answered and the physicians will be able to track their progress. Parents will also be heavily involved and attend courses to learn similar concepts as well as effective methods to use to discuss their children’s asthma with doctors.

Investigators will work cooperatively with the students’ primary care providers, with ACHRI asthma specialists, and provide disease management recommendations based on published national asthma guidelines.

Preliminary studies to support the project were funded in part by the Arkansas Biosciences Institute and the UAMS Arkansas Center for Health Disparities. The UAMS Center for Distance Health also provides training support, technological resources, and telemedicine session coordination.

In other news, CompuMed is partnering with the nonprofit California School Health Centers Association (CSHC) to promote electrocardiogram telemedicine technologies for use in the school health centers throughout California. CSHC represents more than 150 school health centers serving more than 800 primary and secondary schools throughout the state.

The new partnership calls for CompuMed to provide ECG equipment and interpretive over-reads for screenings. On their part, CSHC will promote CompuMed’s ECG telemedicine technologies via their website, e-newsletters, and at their statewide and regional conferences, as well as through other initiatives to be developed.

“A student’s athlete’s heart attack is a shocking event and CompuMed is committed to reducing the likelihood of these tragic events. In communities where ECGs with pediatric cardiology over-reads are performed on all students prior to athletic participation, the incidence of sudden cardiac deaths among student athletes has been reduced by more than 90 percent,” said CompuMed’s lead cardiologist David M. Frisch, M.D.

While the recession has caused many school districts to rethink healthcare spending, CompuMed has made the equipment, software, and over-reads affordable for school clinics. The equipment to perform ECGs is provided free of charge even though it typically costs about $3,500. Each CompuMed over-read by a skilled pediatric cardiologist is priced at $15, though typically priced in the marketplace from $20 to $150 or more.

To help children with Obsessive Compulsive Disorders (OCD), the University of Kansas Medical Center and the Kansas City Center for Anxiety Treatment are conducting a study using the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) to compare the effectiveness when help for OCD is administered in person or by using interactive televideo.

Generally clinicians who have obtained specialized training in OCD assessment and treatment generally practice in urban specialty clinics causing shortages particularly in rural areas. This inequity in provider distribution magnifies the problems of misdiagnosis and inadequate therapy for OCD.

This study involves doing three assessments on three separate days for participating adolescents and parents. This includes an initial assessment to confirm a diagnosis of OCD using the Anxiety Disorders Interview Schedule from DSM-IV followed by an evaluation using CY-BOCS both in person and by using interactive televideo.

Global Blood Database Needed

According to the newsletter “The Portal” published by the Office of the Chief Information Officer within the Military Health System (MHS), the Department of Defense is striving to consolidate defense blood systems. Tracking accurate up-to-date blood donation records through a web of legacy systems without access to a consolidated electronic system remains a challenge in the MHS National Capital Region.

Within the National Capital Region, it is possible for a patient treated at Walter Reed Army Medical Center or at the National Naval Medical Center to also receive treatment at the DeWitt Army Community Hospital for both emergency and routine care. Also patients can also donate blood and receive transfusions at either facility. Therefore, it is important to consolidate legacy donor and transfusion information to help reduce the risks of incorrectly identifying donors and blood units.

The Office of the Chief Information Officer’s Defense Health Information Management System (DHIMS) program office wants to overcome this challenge. The DHIMS Enterprise Blood Management System team recently conducted site visits at the Walter Reed Army Medical Center in Washington D.C, and the National Naval Medical Center in Bethesda Maryland to observe current blood donor center business practices.

After the visits, the team conducted a limited scope gap analysis of the current blood donation process flow as it relates to federally regulated and accreditation agency manufacturing of blood products. The gap analysis enabled the team to assess the risks associated with transitioning from the Defense Blood Standard System to the projected Enterprise Blood Management System commercial off-the-shelf product.

“DHMIS Enterprise Blood Management System will consolidate the blood donor information including demographics, testing and transfusion data, and then merge all existing Defense Blood Standard System data into a single global dataset,” said John Welch, Public Health Service Lt. Commander for DHIMS.

More Rural Grants Awarded

Colorado’s Governor Bill Ritter just announced that the Colorado Rural Health Care Grant Council has awarded nearly $1.1 million in their third round of grant funding to help healthcare delivery in rural communities. The Council awarded 28 grants ranging from $5,000 to $50,000 to physical, mental, and oral healthcare providers in 24 counties.

Grantees include Certified Rural Health Clinics, Federally Qualified Health Centers, public health departments, public and private health clinics, oral health clinics, and mental health clinics and support health IT, construction, remodeling projects, equipment, and staff training.

The Colorado Rural Health Care Grant Program was established in August 2007 with funding of $7.5 million from UnitedHealthcare to be distributed over six years. The Colorado Rural Health Center, Colorado’s non-profit State Office of Rural Health administers the grant program.

The Colorado Rural Health Care Grant Council is co-chaired by Colorado’s Chief Medical Officer, Dr. Ned Calonge and UnitedHealthcare’s Dr. Jacqueline Stiff, Vice President of Health Care Strategies. The Council also includes healthcare consumers, rural healthcare providers, and representatives from the Governor’s Office, and from the Division of Insurance at the Department of Regulatory Agencies, from the Department of Health Care Policy and Financing, and from the Department of Local Affairs.

Innovative Ideas on the Agenda

Networks, platforms, and applications to use for technology-enabled participatory medicine will be key discussion points at the 7th Annual Healthcare Unbound Conference & Exhibition. The meeting organized by The Center for Business Innovation will take place at the US Grant Hotel in San Diego on July 19-20, 2010.

“This year’s Healthcare Unbound comes after stimulus funding was provided for health IT and after the passage of national healthcare reform legislation. History will mark 2010 as the tipping point enabling healthcare unbound technologies, clinical systems, and business models to rapidly move forward,” said Vince Kuraitis, JD, MBA, and Principal for Better Health Technologies, LLC, a chairperson, conference advisory board member, and keynote speaker.

The Conference will include over 60 speakers participating in panel discussions, case studies, workshops, and keynote addresses. Sessions will include in-depth coverage of technology-enabled chronic care management and wellness promotion, impact of health reform and the economic stimulus package on the marketplace, legal/regulatory and reimbursement issues, payer perspectives, wireless technologies, the medical home model and the technology implications, social media, ehealth, games and entertainment to engage consumers, and much more.

An Aging Services Educational track co-sponsored by the American Association of Home and Services for the Aging and the Center for Aging Services Technologies will be an important part of the program.

Some of the keynote speakers include:

• Majd Alwan PhD, Director, Center for Aging Services Technologies
• Michael J. Barrett, Managing Partner, Critical Mass Consulting
• Liz Boehm, Principal Analyst, Customer Experience for Healthcare and Life Sciences, Forrester Research
• Cindy, Assistant Director Operational Consulting, Fazzi Associates, Inc.
• Yan chow, MD, MBA, Director of Innovation and Advanced Technology, Kaiser Permanente
• L. Miguel Encarnacao, MS, PhD, Director, Emerging Technology Innovation, Humana Inc.
• Michael Monson, Senior Vice President of Performance and Innovation, Visiting Nurse Service of New York
• Tracey Moorhead, President and CEO, DMAA, The Care Continuum Alliance
• Gordon K. Norman, MD, MBA, EVP, Chief Innovation Officer, Inverness Medical Innovations/Alere
• Charles (Chuck) Parker, Executive Director, Continua Health Alliance
• Ryan Sysko, CEO, Well Doc, Inc.

The target audience needs to attend to not only hear stimulating and innovative ideas but to take advantage of the many networking opportunities that will be available with the “who’s who” in this emerging field.

Health Plans, Providers, Medical Device, Remote Monitoring, Telehealth, eHealth, and Social Media Companies, Pharmaceutical Biotechnology, Diagnostics Companies, Health IT Companies, Consumer Technology Companies, Government Officials, Consultants, Security Analysts, Investment Bankers, Venture Capitalists, and Home Builders all need to take part in this one of a kind Conference and Exhibition.

TCBI organizes conferences and exhibitions for the U.S. and international markets. For more details on the Conference and Exhibition information, go to or phone TCBI at (310) 265-2570, or email

Wednesday, June 9, 2010

Grants/Loans for Healthcare

ARRA funds for $167.8 million will enable the USDA’s Rural Development Community Facilities Program plus matching funds of $60 million and funds from other sources to provide both grants and loans. Some of this funding is going to be used to provide assistance to healthcare facilities and infrastructure in rural communities.

The following states received funding for rural health projects:

• Alaska’s Sunshine Community Health Center received $150,000 in loans, and $350,000 in grants to provide for a healthcare clinic
• Georgia’s Community Health Care system received $727,180 in loans to construct a new healthcare facility
• Maine’s Houlton Regional Hospital receive $55,000 in grants to renovate a radiology department and install updated scanning equipment
• Missouri’s Medical Delta Center, received $1,300,000 in loans and $250,00 in grants to construct a rural health clinic
• Nebraska’s Memorial Community Hospital received $6,700,000 in loans to remodel hospital
• North Carolina’s Good Hope Hospital received $2,500,00 in loans to construct a 16 bed psychiatric facility
• Oklahoma’s Fairfax Medical Facility received $2,893,277 in loans and $300,000 in grants to construct a green medical clinic
• South Dakota’s Mobridge Regional Hospital received $164,500 in loans and $30,000 in grants to purchase a new intensive care unit monitoring system
• Vermont’s Copley Professional Services Group received $1,382,400 in loans to expand federally qualified health centers
• Virginia’s Tangier Island Health Foundation received $49,879 in grants to purchase a digital x-ray machine

Last week, HHS announced the availability of $83.9 million in grants to help networks of health centers adopt electronic health records and other health information technology systems. The funds are part of the $2 billion allotted to HRSA under the Recovery Act to expand healthcare services to low income and uninsured individuals through its health center program.

The Health Center Controlled Networks provide management, financial, technology and clinical support services. The networks comprised of at least three collaborating organizations are community-based groups support health centers and provide primary healthcare to nearly 19 million patients a number expected to double over the next five years.

Forty five grants will support new and enhanced EHR implementation projects as well as HIT innovation projects. Eligible professionals practicing within health centers that can demonstrate meaningful use of certified EHR technology may be eligible for incentive payments provided under Medicaid and Medicare.

Seven grants were awarded to centers for $3 million with OCHIN in Portland one of the groups receiving $3 million. In addition, in March 2010, OCHIN received $13.2 million to establish the Oregon Health Regional Extension Center program. This funding is part of the stimulus funding and will be used to help over 3,000 Oregon primary care providers install and use EHRs.

mHealth Programs Worldwide

The report “mHealth for Development” authored by Vital Wave Consulting through the United Nations Foundation and Vodafone Foundation Technology Partnership, details a number of worldwide mHealth programs. The programs are taking place in 26 developing countries that are currently operating, slated for implementation, or will take place in the future.

The United Nations Foundation and the Vodafone Foundation Technology partnership is a public-private alliance to strengthen worldwide technology efforts. Their goal is to examine the use of mobile phones used in healthcare and discuss how mobile health applications can and will impact healthcare.

The report’s 51 case studies show the potential of how mobile health can be used to provide health services and information. Some of the case studies in the report include:

• Project Masiluleke and Text to Change are using SMS message campaigns to provide HIV/AIDS education in South Africa and Uganda. Project Masiluleke sends one million text messages per day throughout South Africa. Messages are written in local languages and direct recipients to the National AIDS Helpline

• Health workers are using PDAs provided by the Ugandan Health Information Network to collect health data in the field resulting in cost savings of 25 percent in the first six months

• TB patients in Thailand were given mobile phones so that healthcare workers could call them on a daily basis to remind them to take their medications. Medicine compliance rates were able to reach 90 percent

• In the Primary Healthcare Nursing Promotion Program, the National School for Nurses in Guatemala used a combination of mobile phones and landline phones to train nurses in this rainforest community

• Incidents of Japanese Encephalitis were tracked real-time in Andhra Pradesh, India, via a combination of mobile phones and web-based technologies to enable the government to provide vaccinations based on the evidence of clusters of outbreaks

• Researchers from the University of Melbourne are creating diagnostic and analytical tools to provide mobile phones to health workers in Mozambique. These tools include a built-in calculator for determining drug dosage and reference materials stored in the phone’s memory

The report details the strategic approach that is needed to improve health outcomes on a massive scale. The first step is to design the program with operators, NGOs, policymakers, and funders in mind. In addition, mobile operators have to be pro active and initiate public-private partnerships, team up with governments and NGOs to address pressing national health issues, and at the same time, collaborate with software providers to develop healthcare solutions.

Next mobile operators need to combine mHealth with the delivery of other mServices such as mBanking and mCommerce. Economic advantages are realized by packaging services with mHealth solutions. Mobile operators need to develop strong relationships with handset manufacturers and cooperate to bring phones and devices to market to provide mHealth and other services needed in developing countries.

According to the report, the mHealth infrastructure can vary in developing countries and therefore operator services need to enhance their networks to increased mHealth activities but at the same time, it is equally important to use simple available technology.

In order to fund projects, grantees need to help themselves. Non-profit and international development funding sources are placing a growing emphasis on demonstrable impact. As a result, mHealth proposals and programs must be able to specify and measure program successes. This is even more critical given the early stage of the mHealth market and the absence of research available for program managers to use.

Go to to download the report. For general inquiries call (202) 887-9040.

Study Shows Improvement

A new clinical study shows that telehealth patients experienced a significant improvement in care and quality of life over a 12 month evaluation period according to the final results of the Catalan Remote Management Evaluation (CARME). CARME was conducted at the Spanish Hospital Germans Trias I Pujol with support from Philips. The promising results are being presented at the European Society of Cardiology’s Heart Failure Congress in 2010 in Berlin.

The 92 patients in the study were heart failure patients who used the Philips Motiva system an interactive telehealth system with motivational support tools in the home. The patients spent less time in the hospital and felt that their quality of life had significantly improved over the 12 month evaluation period.

This is the first time that a telehealth system combining remote patient monitoring with motivational educational support tools has been researched and studied and the results demonstrate significant additional value and effectiveness for managing the health of chronically ill heart failure patients.

Previous studies have analyzed the advantages of telehealth in terms of patient care, decrease in hospital admissions, and cost savings. This study demonstrates the additional benefit for patients that result when educational and motivational tools are also used to improve their quality of life.

The study monitored patients with severe heart failure at home while being managed by the Hospital Germans Trias I Pujol Heart Failure Clinic. The interactive telehealth system connected the patients to their healthcare providers via their home television and broadband internet connection.

The patients in the CARME study were randomly assigned to two groups. In one group, the patients received care plan-driven educational videos, motivational messages, and questionnaires. The second group received the same information but was also requested to monitor their blood pressure, pulse rate, and weight.

Patients took vital measurements in their home and communicated the information to their physician via the system. Physicians were able to send the patients educational and motivational information to help manage their health.

Results from using the equipment in the home were compared with clinical outcomes 12 months prior and showed:

• A decrease of 68 percent in heart failure related hospitalizations
• The number of days spent in the hospital were reduced by 73 percent
• Patients showed a continuous and significant improvement in their perception of quality of life over the 12 month observation period—an improvement that ranged from 62 to 72 percent
• Satisfaction with the telemonitoring system was high especially in patients who had vital measurements added to their educational and motivational tools. Up to 81 percent of these patients wanted to keep the solution in addition to their regular care
• By disseminating patient and disease specific information via the television helps family members gain a better understanding of how to support their loved ones in coping with their disease

Also, as part of the EU-funded My Heart research project, Philips and partners are developing an advanced heart failure management system that may provide more comprehensive information about a patient’s condition and enable earlier intervention.

This experimental heart failure management system consists of a wearable vest with an embedded innovative sensor designed to assess the accumulation of fluid in the lung. In addition, the research project will explore comprehensive patient-centric solutions based on innovative sensors for chronic disease management at home.

For more information contact Sabinevan Deursen, Philips Healthcare Communications at +31 (0) 40 2785 093 or email

Preventing Blindness

Automated Medical Diagnostics (AMDx) a start-up company based in Memphis Tennessee has developed a new technology using Telemedical Retinal Image Analysis and Diagnosis (TRIAD) to help millions of people at risk for vision loss from diabetic retinopathy. This technology was recently licensed by AMDx from the Department of Energy’s Oak Ridge National Laboratory and the University of Tennessee Health Science Center.

Edward Chaum, an ophthalmologist and Plough Foundation professor of retinal diseases at the UT Health Science Center at the Hamilton Eye Institute in Memphis and Oak Ridge’s Ken Tobin both partners in AMDx, led the team to develop a way to use computers to aid in the diagnosis of diabetic retinopathy and other blinding eye diseases.

Chaum reports “Today, less than half of Americans known to be diabetic receive the recommended yearly exam because they either can’t afford eye exams, lack access to eye care providers, or are unable to comply with physicians recommendations.”

He commented “In the next 15 years, we will need to be able to screen more than one million patients every day worldwide in order to detect and manage vision loss and blindness due to diabetes. By using automated computer-assisted diagnostic methods like TRIAD this is an achievable goal”

By using TRIAD, patients can quickly be screened for the disease in their primary care doctor’s office and at other remote sites, permitting early detection and referral for diabetic retinopathy and other retinal diseases.

The web-based technology uses a digital camera that takes pictures of the retina. At that point, the patient’s medical data and retinal images are sent to a server and processed through the patented system that quickly sorts through large databases and finds visually similar images representing equivalent states of diabetic eye disease.

This allows the patient to be diagnosed in seconds so patients know before they leave the office if they do not have an eye disease or if they need to follow up with a retinal specialist. With the TRIAD network, all of the computed diagnoses are sent to an ophthalmologist for review along with the computer-generated report.

Sunday, June 6, 2010

Capitol Hill Event

The Congressional Luncheon Seminar coordinated by the Institute for e-Health Policy on June 2nd, addressed several high level issues related to data. As Neal Neuberger, Executive Director of the Institute and moderator for the event said, “Data is critical and key to so many processes plus it is at the core of many issues related to healthcare reform.”

Looking at data from the federal viewpoint, J. Michael Fitzmaurice, PhD, Senior Science Advisor for Information Technology at AHRQ, explained how AHRQ’s U.S. Health Information Knowledgebase (USHIK), is populated with data elements and information models from standards development organizations and other healthcare organizations.

The specific goal for USHIK is to coordinate the data elements and the metadata from health data standards that the HHS Secretary endorses. USHIK supports the implementation of data standards for HIPAA, the Consolidated Health Informatics initiative, and for the Health Information Technology Standards Panel (HITSP) and links to all use cases, interoperability specifications, and other documents.

In addition, USHIK contains specifications needed to electronically report patient safety events to patient safety organizations, to the public, and also reports data element specifications from the states and their all-payer data base. To date about 11 states have gone live with all-payer claims databases to helps consumers with specific payment information. USHIK is now developing a two state pilot with information available from their State All-Payer Claims Databases.

AHRQ contracted with DCG Inc. and Abt Associates to produce detailed specifications for meaningful use quality measures, to provide an information model for meaningful use quality measures, and to develop a pilot USHIK portal with the required data elements based on that information model.

The lessons learned from the development of USHIK is that it is important to use an information model, trade off the value of what USHIK supplies against the cost of supplying it, understand that intellectual property has value, and work to anticipate the needs of the users

Kasey Benton Poon, M.D., Internist in Salt Lake City, discussed how to make data actionable for research, decision support, for reimbursement, meaningful use, and information exchange. He stressed that this can be achieved by using structured, encoded, and interoperable data in the electronic health record.

Dr. Poon emphasized that the first step is to adopt standards. The next step is to address the levels of interoperability in terms of basic and functional interoperability along with semantic interoperability to be able to establish explicit meaning and context. This is done by using the same set of codes to encode data throughout a system to use in hospitals, organizations, regions, the country, and the world.

He recommends the use of the 3M Healthcare Data Dictionary (HDD) as it provides a single source for information, is interoperable, complies with standards, and addresses meaningful use. HDD provides a controlled medical vocabulary with a collection of clinical concepts organized to support synonyms and other lexical characteristics, a knowledge base showing the relationships among concepts, and a medical information model. All of this information is used to establish clinical context, provide alerts, and support medical decisions.

Mark Rempe, as Vice President, for Record Center Operations for North America for Iron Mountain, Inc., pointed out that the company has a large healthcare focus and does $260 million in digital archiving and backup business.

According to Rempe, a major problem in dealing with information is that patient information is trapped in silos resulting in higher costs but not better care. The approach needed is to connect disparate patient records by breaking down the information silos and by consolidating patient information currently stored in different systems.

As Rempe views the situation, the cost of patient recordkeeping is enormous and rising with hospitals continuing to struggle as they move to the EHR. However, if workflow and process issues are addressed, then there will be an opportunity to reduce costs, improve service, establish the correct infrastructure, and permit the healthcare system to transition to a fully digital environment.

Bart Harmon, M.D., MPH, Chief Medical Officer at Harris Corporation, described how important the collection of medical data can be and how it affects the individual. For example, his 90 year old mother has a complex medical history, takes a number of medications, plus sees several doctors. Today, like his mother, most patients have to act as their own health record and fill out forms with all the information for each doctor for every visit. This process is always the same with the patient since they are always entering and reentering data.

Both patients and providers are now requesting better ways to process and obtain information. The goal is to have one central record but at the same time, the economic model must be viable and storage must be provided cheaper and faster.

Progress is being made with the development of NHIN, an interoperable health information infrastructure to connect providers, consumers, and others to support health and healthcare. NHIN Connect an open source software solution is in process to exchange health information both locally and at the national level.

Dr. Harmon summed up by saying that while government systems and big organizations can be innovative, small practices and rural communities are getting left behind and not getting the attention needed. As a result, small groups and rural areas find it difficult to be innovative especially since the reimbursement model without incentives makes it very difficult.

Be sure to attend the “Health Information Technology Showcase and Demonstration” as part of National HIT Week in Washington. This event will be held on June 17th, 10:00am to 3:00pm in room SD-G50 Dirksen Senate Office Building.

For more information, email Neal Neuberger, at