Wednesday, September 22, 2010

Millions for Public Health

HHS and CDC have awarded $42.5 million for 94 projects to help improve public health services. The funding made possible through the “Prevention and Public Health Fund” created by the Affordable Care Act, will be distributed through cooperative agreements to 49 states, eight federally recognized tribes, Washington D.C., nine large local health departments, five territories, and three Affiliated Pacific Island jurisdictions.

The funding will help health departments build and implement capacity, for training, expand public health staff and community leaders, improve networking, coordination, and cross jurisdictional cooperation, disseminate, implement, and evaluate public health’s best and most promising practices, and build a national network of performance improvement managers.

The highest funding amounts are going to:

• Cherokee Nation ($1,760,128)
• Florida State Department of Health ($2, 060,128)
• Hawaii State Department of Health ($1,100,000)
• Los Angeles County Department of Public Health ($1,859,950)
• Maine State Department of Health and Human Services ($1,758,786)
• Massachusetts State Department of Public Health ($1,960,128)
• Minnesota State Department of Health ($1,960,128)
• Nebraska State Department of Health and Human Services ($1,200,000)
• New Jersey State Department of Health and Senior services ($1,638, 751)
• New York City Department of Health and Mental Hygiene ($2,060,128)
• Oregon State Department of Health Services ($1,860,128)
• Pacific Island Health Officers Association ($1,660,128)
• Philadelphia Department of Public Health ($1,118,493)
• Tennessee State Department of Health ($1,296,995)
• Vermont State Department of Health ($1,100,000)
• West Virginia State Department of Health and Human Resources ($1,200,000)
• Wisconsin State Department of Health Services ($1,960,129)

In response to the CDC’s original funding announcement for “Public Health Systems and Infrastructure” projects in July 2010, CDC received more than 140 applications from health departments seeking funds through the cooperative agreement.

For more information, go to

Georgia Moving on HIT

Governor Sonny Perdue reports that three Georgia broadband projects will receive $14.9 million in federal funds through ARRA to expand high-speed internet and wireless access in underserved areas. With these latest awards support for Georgia broadband projects totals over $162.9 million.

The Georgia Partnership for Telehealth (GPT) received a $2.5 million grant. Coupled with an additional $1.2 million in matching contributions, the funding will help to connect community institutions such as hospitals, schools and public health departments, by expanding an existing telehealth network to 67 additional community anchor sites. GPT also plans to implement a training and awareness program for residents and rural healthcare providers to improve healthcare delivery in areas of the state with high levels of poverty.

The GPT has been named as one of four new Telehealth Resource Centers in the U.S. by HHS along with the University of Arkansas for Medical Sciences, University of Hawaii, and the University of Kansas Medical Center Research Institute. The Southeastern TeleHealth Resource Center (SETRC) will be operated by GPT and provide technical assistance to help healthcare organizations, networks, and providers, implement cost effective telehealth programs serving rural and medically underserved areas and populations.

The Georgia Institute of Technology has been very active in HIT and is part of a new statewide effort to enable the adoption of EHR systems by primary care providers especially those that reach underserved portions of the state’s population.

The work is part of a $19.5 million federally funded project headed by the Morehouse School of Medicine’s National Center for Primary Care and will be coordinated by the Georgia Health Information Technology Regional Extension Center (GA-HITREC). The Georgia Tech Enterprise Innovation Institute will receive $2.8 million for their contribution to the project.

The GA-HITREC project will help as many as 5,200 primary care providers in smaller practices select EHR systems, properly install the software, and implement new workflow processes that achieve meaningful use of the technology. Using its existing statewide network of regional technical assistance offices, Georgia Tech will be among several organizations providing direct support to providers as they adopt the technology.

Georgia Tech is also helping to establish a group purchasing program to help healthcare providers more simply and easily obtain their EHR software. According to Stephen Fleming, Executive Director of the Georgia Tech Enterprise Innovation Institute (EI2), the institute will provide the services and will receive $2.8 million to contribute to the project. In a study released in 2010, EI2 documented that the state’s health information technology industry includes more than 100 companies and employs approximately 10,000 people.

NIH Issues RFP

In August, NIH published a pre-solicitation notice with details on the new “Chief Information Officer Solutions and Partners 3 (CIO-SP3) Government Wide Acquisition Contract” (GWAC). On September 17, 2010, NIH issued the full Request for Proposal with funding totaling $20 billion. The proposal is to be submitted by November 19, 2010.

A GWAC is a procurement vehicle that can be used by any federal, civilian, or DOD agency to purchase information technology products and services. The new NIH CIO-SP3 GWAC contracting vehicle just issued can support the full range of IT needs not only across the federal government, but across the agencies especially involved in healthcare and clinical biological research.

In responding to this solicitation, vendors can bid on up to ten task areas. C.2.1 Task Area 1 is specifically for IT services for Biomedicine Research, Health Sciences, and Healthcare. A sample of work to be performed under this task order includes:

• Telemedicine, e.g. mobile health/mHealth
• Health science informatics and computational services
• Biomedical information services
• Biomedical Modeling visualization and simulation
• Biosurveillance and disease management support
• IT clinical support services
• IT services management
• Standards development for HIT services

Other task areas include Imaging and another task area on Digital Government. The government is also seeking software development and looking for vendors to develop customized software applications, database applications, and other solutions not presently available in off-the-shelf modular software applications.

NIH plans to release the small business version of CIO-SP3 soon. To download the current RFP go to, then go to NIH and to September 17th. To see the original news article released in Federal Telemedicine News, on August 24, 2010 with the headline “NIH Issues Pre-Solicitation Notice”, go to

Studying Electronic Records

Few portable medical record technologies, paper or electronic have been evaluated in a randomized clinical outcome trial to determine the clinical benefits and the costs. Although there are many studies that have evaluated processes of care, only a minority do so within a randomized design.

The “Portable Health Files (PHF) Improve Quality of Care and Health Outcomes: a Randomized Controlled Trial” (PHF-RCT) (NCT01082978) currently recruiting participants will assess outcomes resulting from the usage of electronic records carried by the patient on a USB memory device versus paper portable health files in a population that uses many medical services. In addition, the study will look how PHFs are used in caring for patients to see if they are acceptable and satisfactory to patients and their healthcare providers either short or long term.

The sponsor of the study is St. George Hospital in Australia with collaborators that include the South Eastern Area Health Service, University of South Wales, and the National Health and Medical Research Council in Australia. Estimated time for the entire study is from 2010 to March 2018 with 750 subjects enrolled.

The first 12 months of the trial constitutes Stage 1 with the subsequent 36 months constituting Stage 2 with the e-PHF or paper PHRF to be used for 4 years total. The subjects will also be followed for an additional 3 years beyond the conclusion of the trial to see if there are any long term effects.

The study will look at Primary outcome measures in terms of the total number of important clinical events such as hospitalizations, serious out of hospital events, and deaths. Secondary outcome measures to be studied include, quality of life, health service utilization, costs, medication errors, duplicative investigations, clinical workflow, subject and health care provider acceptability and satisfactions, health literacy, and information technology and computer expertise.

Several arms of the trial will take place:

• Some Patients will be given a USB memory device containing the Portable Health File (PHF) software. The portable health files will contain core medical data which functions as a subset of a comprehensive medical record. The PHF is updated by the provider at each visit and can also be updated by the patient between visits if necessary

• Some patients will be given a paper portable health file with core medical and other important data to function as a comprehensive medical record and will be updated at each visit and updated by the patient between visits

• Other patients will receive their usual standard of care and not be given a PHF

The subjects for the study must be 60 years or older, live independently, must have visited their medical practitioner in the previous 12 months, have at least two chronic diseases that require prescription oral or drug treatments or surgery, and require at least annual specialist consultation. The subject’s GP must have access to a computer during the consultation visit.

For more information contact the Principal Investigator, Marissa Lassere, Professor, at or +61 (2) 9113 2992. The identifier is NCT01082978.


On September 16th, the Ohio Health Information Partnership (OHIP) issued a Request for Proposal (RFP) to eight technology vendors invited to propose technical solutions for supporting a statewide HIE.

The purpose of the RFP is to identify a vendor whose solution aligns best with OHIP’s HIE State Plan strategy and sustainability model. Vendors will be evaluated on their ability to address OHIP’s priorities while demonstrating their strategic and technical capacity to be flexible and adaptable to change.

The invited vendors were selected following a Request for Information (RFI) that concluded in April 2010. Their selection was based on their ability to support a substantially sized market. Since that time, OHIP staff and stakeholders have focused on completing the HIE State Plan that was submitted to the Office of the National Coordinator in July 2010.

In August a stakeholder workgroup met with HIE vendors to begin a dialogue on the pros and cons of technical models currently supported in the marketplace. There are three primary considerations such as the ability to integrate with both regional HIEs and NHIN, support interoperability requirements specified by ONC, and connect to the state’s new Medicaid Management Information system.

OHIP is a non-profit entity funded through a combination of state and federal grants, including ARRA to develop a statewide HIE for Ohio to enable hospitals and physicians to communicate electronically and to assist Ohio physicians and other providers implement and adopt EHRs.

VA & Partners Launch HIE

The Department of Veterans Affairs (VA) launched a new pilot in the Spokane region that will improve the portability of health information to veterans and active duty service members. The Spokane VA Medical Center and the Fairchild Air Force Base in Spokane is partnering with Inland Northwest Health Services (INHS) a highly recognized health information exchange network.

The goal for this new pilot is to securely exchange EHR information using the Nationwide Health Information Network as a next step towards the implementation of the Virtual Lifetime Electronic Record. The Spokane pilot is planned to run through 2012 and will advance EHRs for the VA, DOD, and other community providers.

This new pilot HIE is the fourth that the VA created with private medical providers. The first two located in San Diego and Tidewater areas of Virginia also included a partnership with the DOD. Right now, the previous pilot program for the Tidewater area of Virginia is preparing to go live. Also recently, the VA announced plans for a pilot in the Indianapolis area which has an established HIE.

INHS, a non-profit corporation based in Spokane provides the backbone for current and future innovative technologies in HIE. INHS connects 38 hospitals and healthcare facilities, enabling physicians and providers to securely access patient information using wired and wireless technologies. Today, the INHS network includes more than 4000 physicians, 450 clinics and physician offices, and 3.5 million electronic medical records.

“More than 5,500 active military personnel are stationed at Fairchild Air Force Base, where thousands of vets and their families call the greater Spokane region home,” said Tom Fritz, CEO of INHS.” “We are honored to work with the VA and the Department of Defense to build on a nationally recognized health information network to provide an even more efficient health information delivery system.”

The VA will invite veterans who already receive healthcare form the VA and veterans from selected hospitals and providers in Spokane area to sign up for the pilot with the understanding that their information will not be shared without their authorizations. Veterans who are selected to participate in this pilot program will be helping their public and private sector healthcare providers and doctors share specific health information electronically.

Sunday, September 19, 2010

Millions for Health Workforce

HHS with HRSA overseeing the programs announced $130.8 million in grants to strengthen and expand the health professions workforce. Six areas are targeted and include primary care workforce training, oral health workforce training, equipment to improve training across the health professions, loan repayments for health professionals, health careers opportunity programs for disadvantaged students, and patient navigator outreach and chronic disease prevention in health disparity populations. The grants total $88.7 million in funding from ARRA of 2009.

Secretary Sebelius said “Today’s awards not only will provide more training opportunities for people interested in a health professions career, but will also support equipment purchases and faculty development to expand and enhance the quality of training.”

Funding for $50.5 million from the Recovery Act will provide 208 awards to assist with purchasing equipment for training current and future health professionals across disciplines at the undergraduate, graduate, and post-graduate education levels.

Awardees will include academic health centers, area health education centers, centers of excellence, and other educational institutions that serve underserved and uninsured patient populations, rural communities, and minorities. Equipment purchases will expand current training capabilities by replacing outdated equipment and technology or can be used to purchase equipment.

The equipment to be purchased will include e-learning tools such as video, audio and interactive learning systems, human patient simulators to help students improve clinical judgment and critical thinking, and mobile dental vans to deliver training to diverse segments of the population.

Funding for $3.8 million will provide 10 grants to help develop and operate patient navigator services and to improve healthcare outcomes for individuals with cancer or other chronic diseases emphasizing populations with health disparities... Grant recipients will recruit, train, and employ patient navigators to coordinate care for patients with chronic illnesses. Eligible applicants include federally qualified health centers, health facilities operated through Indian Health Service contracts, hospitals, rural health clinics, and academic health centers.

Funding for $42.1 million with $31.5 million coming from the Recovery Act, will provide training in primary care to support family medicine, general internal medicine, and general pediatrics programs, and also includes curriculum development, provide for faculty development, didactic and community-based education. Training will be provided in underserved areas for primary care residents, pre-doctoral students, interdisciplinary and inter-professional graduate students, and physician assistant students.

Funding for $23.9 million with $6.7 million from the Recovery Act will support oral health workforce development programs to include pre- and post-doctoral training for dental residents, dental faculty, loan repayments for faculty who teach primary care dentistry, and training for practicing dentists and dental hygiene programs. The funding also includes $4.3 million to go to the states to provide 9 new grantees with the opportunity to address their state’s unique oral health workforce needs in underserved urban and rural areas.

The health careers opportunity program with $2.1 million will enable 3 grantees to increase diversity in the health professions by developing an educational pipeline that will enhance the academic performance of economically and educationally disadvantaged students and prepare them for careers in the health professions. Eligible applicants include schools of medicine, public health, dentistry, pharmacy, allied health, and graduate programs in behavioral or mental health.

Funding of $8.3 million will enable 29 grants to be made to states that can provide matching funds to assist health professionals in repaying their educational loans. Health professionals eligible to receive funding include physicians, dentists, nurse practitioners, nurse midwives, physician assistants, psychologists, and social workers.

Go to for more information and to see grant award tables by state. For more information on HRSA’s health professions programs, go to

Establishing Local RECs

The California Health Information Partnership and Service Organization (CaHIPSO) founded in February, is using $32.1 million in funding via ARRA to establish ten Local Extension Centers to deliver services to healthcare providers throughout the state. The goal is to assist 6,187 Priority Primary Care Providers achieve federal meaningful use guidelines by 2012.

Each Local Extension Center will serve either a specific geographic area or a targeted provider segment. For example, the Lumetra Local Extension Center will serve private providers in the greater Bay Area, while the California Health Care Safety Net Institute will serve public hospital systems across the state.

The ten local extension centers will serve the healthcare safety net communities to include primary care providers working in small private physician practices, community health centers and other primary care clinics, ambulatory clinics affiliated with public and rural hospitals, and other practices serving medically underserved patient populations. Although specialists are not eligible to receive subsidized services, they can still join CalHIPSO to access education, receive training, obtain group purchasing discounts for EHR products, and obtain fee-based technical assistance.

CaHIPSO has completed Stage 1 of the two stage process to identify and contract with selected EHR product vendors. As a result of RFPs received, eight vendors have been selected for Stage I in four provider categories. The vendors include AllScripts Professional, eClinicalWorks, GE (Practice and Advanced Systems), Greenway, NextGen, AthenaHealth, McKesson Practice Partner, and E-MDs. The Stage I vendors will participate in the contract negotiation process to be managed by Council Connections who will then act as the groups purchasing partner.

Stage II will provide discounted pricing on products available to CalHIPSO members. The standard contract requirements are being developed in collaboration with other statewide organizations to capture meaningful use requirements. Future capabilities involving health information exchanges will be integrated into the products under contract. It is anticipated that CalHIPSO will release an RFP by late September for Outreach Partners to assist in promoting services to Priority Primary Care Providers.

CalHIPSO will provide services to all of California except for Los Angeles and Orange County. In the case of Los Angeles County, it is is served by L.A. Care Health Plan, and has received a $15.6 million federal grant to establish HITEC-LA, a REC created to help support Los Angeles County healthcare providers purchase and implement Electronic Health Records in a meaningful way.

Recently, L.A. Care awarded $529,000 to help support five community clinics' Health Information Technology projects. This funding is part of L.A. Care’s HIT Initiative to help community clinics purchase and implement EHRs and to help community clinics become meaningful users of EHRs and to help community clinics become meaningful users of EHRs in order to qualify for federal HIT incentives. The HIT projects are expected to take up to 24 months to complete.

To date, L.A. Care Health Plan has funded 27 HIT Initiative projects totaling nearly $3.8 million through the Community Health Investment Fund. For example, L.A. Care will use $210,000 in grants to open a new dental clinic in Lawndale California. With the funding, the South Bay Children’s Health Center’s new clinic will be able to purchase Dentrix, an electronic dental health records system to connect dental offices and to transfer patient information.

CalHIPSO will hold a Town Hall Session on September 21, 2010, for providers and stakeholders. The session will include a team of Meaningful Use experts, including representatives from CMS and Medi-Cal. To participate go to, enter 130264407, then enter 1967603. For questions, call 1-866-551-1530.

CaHIPSO is now actively enrolling providers in the local extension centers and waiving membership fees for Priority Primary Care Providers who enroll before December 31, 2010. For more information, go to

Robotics Helping Sroke Patients

More than half of all stroke patients suffer chronic motor impairment with a large percentage experiencing difficulty in using their hands and arms. The California Institute for Telecommunications and Information Technology (Calit2) researchers will use a five year $1.5 million grant from NIH to determine the efficacy of robot assistance in restoring fine motor skills.

David Reinkensmeyer, mechanical and aerospace engineering professor along with other researchers know that exercise after a stroke helps to restore brain pathways, but what the researchers want to know is whether the exercise is more beneficial if aided by robots. Since current therapies are designed to be administered by physical therapists perhaps the exercise would be even more beneficial if also aided by robots.

The researchers are working with local hospitals, starting with the University of California Irvine Medical Center to study possible benefits using robots in the first days after the stroke has occurred. In Orange County alone, more than 40,000 individuals have experienced a stroke.

The team will start with hand movements and will build a wearable sensor to measure patients’ movements in the days and weeks after a stroke but before the therapy begins. They will also fabricate a compact portable device to assist patients at home as they exercise the affected hand. The “smart” apparatus will build a computer model in real-time to see how much support is needed for each patient to complete the required tasks.

Reinkensmeyer envisions the sensor as a wristwatch type device that can be strapped onto the affected wrist to measure immediately how much movement occurs. In the past, he reports patients have entered studies several months after a stroke, preventing researchers from knowing how much movement the limb has already undergone.

After the patients have completed formal physical therapy, they will be randomly divided into two groups. In one group, the hand robot will assist in the limb exercises with the second group using the robot, but the robot will be programmed to give a higher level of assistance. The device small enough for home use, will provide games to encourage stroke patients to practice moving their fingers in different configurations and use different gripping techniques.

Because the severity of stroke is an important factor in recovery, all patients will undergo pre-study brain scans. These scans will determine the degree of damage to the neurons and study how the insulating material referred to as the “telephone lines” carry instructions from the brain to the muscles. The researchers hope to determine the extent to which brain imaging, sensor data, and robot-assisted exercise can predict how much limb dexterity patients can expect to regain.

According to Reinkensmeyer, the study hopes to answer three questions:

• Does the increased sensory input generated by the robot actually improve the outcome?
• Can too much robotic assistance actually decrease the patient’s effort level and ultimately his recovery?
• Does the specific combination of intact brain matter, post stroke history of hand movement, and robotic exercise predict which patients will ultimately experience the most favorable outcomes?

Maine REC Posts RFQs

HealthInfoNet (HIN), the Maine Regional Extension Center (MEREC), on September 10th posted two Requests for Qualifications (RFQ) seeking qualified vendors of electronic health records systems and software/hardware products to participate in the MEREC program. HIN is using the RFQ process to help participating providers get the best price and quality from these vendors.

The first RFQ (HIN0910-EHR_v0820.1) seeks EHR product vendors with the capability to deploy a large number of EHRs to primary care providers in the state. Based on the response, MEREC will identify “Supported Electronic Health Record Vendors” (SEHRV). The candidates identified will be eligible to sign an “Electronic Health Record Vendor Regional Extension Center Participation Agreement”.

The second RFQ (HIN0910-100_v0819.1) seeks implementation and optimization vendors. Based on the RFQ response, MEREC will identify “Supported Implementation Optimization Organizations” (SIOO). These SIOOs will be able to sign “Supported Implementation Optimization Regional Extension Center Participation Agreement”.

For more information on the RFQs, go to or email Todd Rogow at The due date for the RFQs is October 6, 2010. When the RFQ process is complete, recommended vendors will be posted on the HealthInfoNet site.

Robotic Catheter for Hearts

Atrial fibrillation, a heart disorder affecting more than two million Americans is considered a key contributor to blood clots and stroke. Now researchers from North Carolina State University are developing a new computerized catheter that could make the surgical treatment of atrial fibrillation faster, cheaper, and more effective while significantly decreasing radiation exposure related to the treatment plus provide cost savings for hospitals and health insurance companies.

Atrial fibrillation occurs when there is random electrical activity in the upper chambers of the heart, the atria. This causes the heart to operate less efficiently, and can lead to lightheadedness and fatigue. It can also lead to blood pooling in the heart, which contributes to blood clots and increases the risk of stroke.

Today, doctors use a cardiac ablation technique that mitigates fibrillation by inserting a catheter into the heart, and using extreme heat or cold to create small scars through the walls of the affected atria. These scars block the problematic electrical signals. Throughout the procedure, doctors use x-rays to track the tip of the catheter but at this point, exposing the patient and medical personnel to radiation.

Existing commercial catheters are manually controlled and can only move in two directions. These catheters require doctors to painstakingly manipulate the catheter to control exactly where each individual lesion should be applied.

“We are developing a robotic catheter with significantly improved maneuverability and control,” says Dr. Gregory Buckner, a Professor of Mechanical and Aerospace Engineering at North Carolina State and lead researcher for the team.

The new robotic catheter will utilize smart materials to provide significantly better maneuverability and is expected to reduce operating times. The smart materials act as internal muscles, contracting when an electric current is applied. This allows the catheter to bend left, right, up, down or in any combination of those directions.

Doctors will be able to use a specialized joystick to locate key points on the atrium. A computer program can then trace a curve along those points and essentially connecting the dots. This creates a solid line of scar tissue that will then block the electric signals causing fibrillation.

The research team at NC State received a Phase II SBIR grant from NIH in August to take their robotic catheter prototype from the lab and put it into the hands of doctors. The $1.1 million grant will fund two years of development and surgical testing. Half of the funds will go to North Carolina State while the remainder will go to Southeast TechInventures to help bring the technology to the marketplace.

Other groups have commercialized their own robotic catheter designs, but their work requires multimillion dollar capital investments and customized catheter laboratories. The new technology under development at NC State could be made available at a fraction of the cost and help larger number of patients due to significant reductions in initial overhead and operations costs as well as address logistical concerns.

Reducing Hospital Readmissions

Every day thousands of patients are readmitted to hospitals because they did not get adequate follow-up care following their previous hospitalization. In fact, 18 percent of patients are readmitted to a hospital within 30 days of discharge and as many as 76 percent of these readmissions are preventable. According to recent national figures, healthcare expenditures indicate that unplanned hospital readmissions cost Medicare $17.4 billion in a single year.

In their latest report “Technologies for Improving Post-Acute Care Transitions,” the Center for Technology and Aging examines how the use of a variety of existing technologies could dramatically reduce readmissions.

“Several technologies widely available have the potential to support post-acute care transitions, but they are underutilized,” reports David Lindeman, PhD, Director of the Center for Technology and Aging. “Home-use of technologies helps decrease readmissions by engaging patients and caregivers in ways that promote better communication, medication adherence, and help monitor chronic conditions.”

The report covers four post-acute care transition (PACT) technology focus areas:

• Medication Adherence Technologies are responsible for 33 to 69 percent of medication related hospital readmissions
• Medication Reconciliation Technologies would reduce adverse drug events. Twenty percent of discharged patients experience an adverse event and two-thirds of those events are medication related
• Remote Patient Monitoring Technologies can involve some popular RPM devices such as Health Buddy, Telestation, Genesis DM, Intel’s Health Guide, LifeView, Ideal LIFE Pod, and Healthanywhere
• Health Information and Communication Technologies (ICT) involve PHRs, web-based social networking, and remote training and supervision technologies

The report includes a description of four well known care transition models with varying use of home-based technologies such as Care Transitions Intervention, Guided Care, Transitional Care Model, and Geriatric Resources for Assessment and Care of Elders.

To download the complete report, go to

Wednesday, September 15, 2010

Upgrading Mental Health IT

According to the Draft Version of the “New York Statewide Comprehensive Plan for Mental Health Services 2010-2014” the New York Office of Mental Health (OMH) and OMH facilities depend on IT for patient care, financial and human resources management, and communication.

In New York, more than 2,500 locally operated mental health programs use IT systems for required financial reporting, and increasingly for care coordination and outcomes reporting. Also county and New York City mental health authorities use IT systems for planning and to oversee their local systems.

Overall OMH IT resources are directed toward systems management, data communications, and data processing for the Central Office, field operations, and outpatient and inpatient hospital settings. One of the priority areas for the state is to use EHRs at psychiatric centers to provide for the computerized entry of physician orders and for bar-coded medication administration.

In addition, the New York State Clinical Record Initiative (NYSCRI) is underway and is developing a standardized set of clinical record forms to be used by outpatient both day and residential programs for adults and children.

The pilot phase of the project has been completed in which more than 80 programs in the state took part. All of the 1800 comments received from the staff that used the forms in the pilot were reviewed, characterized, and the recommendations were followed to revise the forms as appropriate.

Because the Clinical Record Initiative will lend itself to an EHR format, data mapping of all completed forms will be done so that EHR vendors can apply to develop an electronic record that will be certified as compliant with NYSCRI requirements. This part of the process is due to be completed in September 2010.

In news last week, eleven healthcare organizations in New York State were awarded $109 million in two year state grants to coordinate healthcare using health IT. The funding was provided by the New York State Department of Health and the Dormitory authority of the State of New York (DASNY) through Phase 17 of HEAL NY and the Federal State Health Reform Partnership. The healthcare organizations will connect to the statewide Health Information Network for NY so that the providers can retrieve, store, and share up-to-date patient information.

Most of the organizations received funds that ranged from $3.8 million to $20 million to support projects to advance the Patient-Centered Medical Home model of care. Most of the funds are going to help the state deal with mental disorders such as affective disorders, major depression, schizophrenia, psychotic disorders but several of the organizations will also address chronic illnesses such as diabetes or other metabolic diseases.

For a list of the organizations that received grants through Phase 17 of HEAL NY, go to Go to to download the 2010 Draft “New York Statewide Comprehensive Plan for Mental Health”.

Telestroke Survey Released

Christina Thielst, Executive Director of the Northwest Regional Telehealth Resource Center stresses that acute stroke care capacity and services are lacking in many hospitals in the Northwest region, particularly in rural areas. Access to acute stroke care personnel is of particular concern especially in rural areas where only 1 in every 8 hospitals has access to a neurologist either in person or by phone.

Because of this situation, only 53 percent of rural hospitals in the Northwest region have administered t-PA for strokes caused by blood clots—even once in the past year. Emergency personnel often cite the lack of available neurology consultations being given, as one of the reasons for not giving t-PA more often.

Telestroke uses real-time telephone and/or video conferencing technologies to link hospitals to regional stroke centers with specially trained neurologists. The Regional Telestroke Initiative (RTI) representing stroke neurologists, physicians, nurses, clinicians, telemedicine experts, EMS, public health, AHA/ASA and NSA in seven states have just released the results of a comprehensive survey to understand the capacity and use of telestroke care in the Northwestern U.S.

The states surveyed AK, ID, MT, OR, UT, WA, and WY show that an overwhelming 88 percent of respondents said their rural communities suffered from a lack of stroke neurologists. Sixty four percent are currently in the process or considering developing a telestroke program to address this lack of local neurology resources.

Hopefully, the results will help improve stroke care in the region by bringing attention to the rural-urban disparities in stroke treatment and the increasing capacity of rural hospitals to treat stroke patients. The survey results emphasize the need for RTI to continue to help providers improve telemedicine capacity and stroke care services and to take advantage of broadband capabilities to expand telehealth networks.

One of the problems is that upfront costs to providers who implement telestroke programs plus professional consultations are not always covered by insurers, even though they may lead to reduced severity of impairment and future medical costs. The leading sources of funding for organizations providing telestroke services are stroke specialty tertiary (hub) hospitals (28 percent) and grant funding (21 percent). When it comes to reimbursement for a neurologist’s on-call telestroke time, 32.6 percent report that the hub hospital covers the cost, but 32.6 percent report that there is no reimbursement for their services.

Go to to see the survey results and also for information on the Regional Telestroke Initiative. For more information on NRTC, go to

Receives Award for Biosensor

Sandia National Laboratories researchers competing in an international pool received four R&D awards this year. The awards focused on practical effects rather than pure research. One of the awards given to Sandia researchers was for the development of a biosensor in collaboration with the University of New Mexico Health Sciences Center.

The project “Acoustic Wave Biosensor for Rapid Point-of-Care Medical Diagnosis” is essentially a handheld, battery-powered portable detection system capable of identifying a wide range of medically relevant pathogens from their biomolecular signatures.

Detection can occur within minutes, not hours, at the point-of-care whether that care is in a physician’s office, a hospital bed, or at the scene of a biodefense or biomedical emergency. According to the researchers, the device provides fast, low-cost diagnostic results with as good or better sensitivity than traditional techniques.

The device’s sensor array works like a miniature analytical balance, weighing the amount of pathogen that binds to its surfaces. The pathogen-bound sensor acts like a spring with a small weight bouncing at one end. As more pathogens stick to the surface, the weight on the spring increases causing the spring’s bouncing speed to decrease by a measurable amount. The sensors detect minute weight differences by this method.

A variety of sticky substances attach to different pathogens. Surface tension draws the sample over the sensor so no pumps or valves are required. This makes the sensors smaller, more reliable and less expensive to manufacture, and the process extends the operating time of the rechargeable batteries. System control, data analysis, and reporting are performed by a personal digital assistant.

Foundation Accepting Proposals

The Gates Foundation is now accepting proposals for the latest round of Grand Challenges Exploration, a $100 million grant initiative to encourage bold and unconventional global health solutions.

The Grand Challenges Exploration enables researchers to possibly win grants of $100,000 to foster innovative projects with the potential to transform health in developing countries. Projects however showing success will have the opportunity to receive additional funding of up to $1 million.

Applicants need to focus their proposals on several technology areas. One goal is to create low cost cell phones to help with priority global health conditions. The UN predicts that cell phone ownership will reach 5 billion in 2010 with most of the growth in the developing world. Cell phones provide previously unavailable capabilities in the developing world, such as computational power, text and images displays, imaging, incentive structures, and standardized interfaces that can be leveraged to create powerful systems.

The need for new technologies to improve the health of mothers and newborns in the poorest countries is needed. The goal for this topic is to solicit novel and innovative technological approaches to reduce maternal, fetal or neonatal mortality and morbidity in communities in primary clinics.

Other areas that the Gates Foundation wants to address in the healthcare field include developing ways to eradicate polioviruses permanently. Although much progress has been made, polio is still evident in the developing world and new ways need to be found to provide total eradication and monitoring.

Health problems in the world are also due to the need for improved sanitation technologies in order to reduce waterborne illnesses and produce next generation sanitation technologies. The goal is to make sanitation services truly safe and sustainable in order to save the lives of millions of children in the poorest countries.

Another topic will be to explore and design new approaches to curing HIV infections for patients currently on antiretroviral therapy. Elimination of all reservoirs of HIV from a patient is a complex challenge that may require a combination of approaches. Consideration will be given to proposals that address any of the several different lines of study that could ultimately contribute to an effective cure.

The Gates Foundation is seeking proposals that are “off the beaten track,” daring in premise, and clearly different from the approaches currently being developed or employed. The proposals must have a testable hypothesis, include an associated plan on how the idea would be tested or validated, and yield interpretable and unambiguous data in Phase I in order to be considered for Phase II funding.

The request for proposal open to anyone from any discipline was posted August 30th and is due by November 2, 2010.

For more information, go to

Report Analyzes Market

Iowa’s Governor Chet Culver and the Iowa Utilities Board (IUB) released a new report “Iowa Broadband: Current Market Analysis & Initial Recommendations for Acceleration of Iowa’s Broadband Market”. The report offers the state’s first look at key broadband market data to be used to form a clear strategic plan for broadband expansion in the state.

The IUB conducted the initial assessment of the state’s broadband landscape based on data collected from the Connect Iowa mapping and planning initiative. Connect Iowa was funded with a $2.2 million award by NTIA to launch the initiative in the state and to carry out their work over a five year period.

The report is being used to support the work of the Iowa Broadband Deployment Governance Board (IBDGB) created in 2009 to develop a comprehensive plan to promote sustainable deployment and adoption of high speed broadband access in the state. The IBDGB expects to complete the plan in 2011.

“Broadband service is now available to about 95 percent of Iowa households, yet only 66 percent of those households are subscribing to the service,” Culver said. While 95 percent of Iowans have access to broadband, the report also highlights that fewer Iowans have access to broadband at the higher speeds that will be necessary in order to compete in tomorrow’s economy.

The IBDGB will use the data to engage stakeholders like elected officials, civic leaders, educators, economic developers, and private entrepreneurs to help understand the state’s broadband challenges.
Go to to download the report. Go to the Connect Iowa website to find broadband providers and check their current internet speeds.

NC Makes EHR Loans Available

The North Carolina Health and Wellness Trust Fund (HWTF) created the North Carolina “Electronic Health Record Loan Fund Pilot Program” to provide seed money for the state’s healthcare providers. The pilot will provide financial assistance to healthcare providers in Tier 1 counties seeking to create or upgrade EHR systems required for CMS reimbursements beginning in 2015.

“Doctors in rural North Carolina need as much help as we can provide,” said Governor Bev Perdue. “These electronic health record systems will enable them to deliver better medical care in the smaller towns and cities across out state.”

A grant of $127.461 was awarded to the North Carolina Medical Society Foundation to provide technical assistance to evaluate the EHR loan fund pilot program over a five year period. The Center for Community Self-Help, a Durham-based non-profit will manage the $750,000 loan fund and underwrite prospective borrowers. The Center will also work in partnership with the North Carolina Medical Society Foundation and the North Carolina Area Health Education Centers to identify eligible providers and help them transition to advanced EHR systems.

The revolving loan fund is designed as a pilot program to expand its initial capital within the first year of operation. Individual loans are expected to range in size from $40,000 to $60,000 and may be used to:

• Purchase a certified EHR technology or upgrade an existing EHR system to meet certification criteria
• Train personnel in the use of the technology
• Improve the secure electronic exchange of health information

Loans will vary in pricing based on the borrower’s credit/collateral profile and will feature flexible repayment terms to better serve the needs of a wide variety of practices.

Sunday, September 12, 2010

Funds to Aid Rural Hospitals

Almost $20 million will provide technical assistance to critical access and rural hospital facilities to help them convert from paper-based medical records to certified EHR technology. Today, there are 1,655 critical access and rural hospitals in 41 states plus the nationwide Indian Country that stand to help the hospitals qualify for substantial EHR incentive payments from Medicare and Medicaid.

This HHS funding provided under HITECH as part of ARRA, is a new category of support aimed at assisting critical access and rural hospitals with their needs and challenges. Incentive payments totaling as much as $27.4 billion over 10 years to be administered by CMS will go to eligible professionals and hospitals to help them adopt and demonstrate the meaningful use of certified EHR technology.

This funding is coming through one of the ONC programs involving Regional Extension Centers (REC) and is part of the Critical Access Hospitals and Rural Hospitals (CAH/Rural Hospital) project. The intent is to provide additional technical support to CAH/Rural hospitals with fewer than 50 beds and help them select and implement EHR systems primarily within the outpatient setting.

According to David Blumenthal, M.D., National Coordinator for HIT, the added level of support will enable the RECs to offer greater field support to these communities as they deal with financial and workforce constraints along with providing access to broadband connectivity to overcome other barriers.

This round of awards builds on the funding that RECs are already receiving under the HITECH Act, bringing the total amount of funding awarded to date to over $663 million. A listing of REC grant recipients may be found at

E-Prescribing Issues

As reported in the Creighton University’s Center for Health Services Research and Patient Safety newsletter, e-prescribing affects pharmacists and the pharmacy setting . The article explains that while financial and organizational incentives have been developed to support physicians’ office settings and hospitals, pharmacies face a financial disincentive.

The authors Kim Galt Pharm.D., PhD, Associate Dean for Research in the School of Pharmacy and Health Professions, and Director of CHRP along with Mark Siracuse Pharm.D , Ph.D, Associate Professor in the School of Pharmacy and Health Professions, wrote the article to specifically explain the problems from the viewpoint of the pharmacist.

To begin with, every e-prescription has a transaction fee incurred to the pharmacist. These fees typically range from $.25 to $.35 and can even go as high as $.75 per prescription depending upon the contract that the pharmacist has with the transaction company.

In addition, pharmacists must also invest in compatible pharmacy system software to receive and accurately display the electronic prescription in the pharmacy. There are no federal or state incentives or private payer incentives to assist pharmacists with the financial burden.

Today, pharmacists report on continuing problems that they have while adapting to e-prescribing. While pharmacists agree that e-prescribing has many benefits such as the reduction of errors, there are still pharmacies that are not yet equipped to receive either email or direct exchange from the prescribers.

The authors reported that their research found that there are still many errors that occur with e-prescribing in the current stage of development. Some of these errors occur at the time of prescribing with the selection of the wrong drug, dose, instruction, or even prescribing the medication for the wrong patient.

These errors were often attributed to the wrong drop down menu selection in the software system. Also there may be incompatibilities between the physician’s software application and the pharmacist’s software application in drug product identification reports concerning errors.

The authors see the adoption of e-prescribing by pharmacies to be a gradual process. However, they conclude that this process is not likely to keep pace with the federal agenda timeline since there is a lack of a viable fiscal policy related to e-prescribing for pharmacists.

According to Dr. Siracuse, there are also other interrelated barriers that need to be dealt with such as the EHR status in the physician’s office and related workflow issues, cost issues, and for physicians and some pharmacies, regulatory and standards issues.

However, other studies have been conducted on e-prescribing concerning issues on the topic. AHRQ has conducted several studies on e-prescribing that looked at the time element when using e-prescribing concerns doctors and pharmacies. An article appearing in AHRQ’s September 2010 issue of “Research Activities”, discusses how a study also partly funded by AHRQ, shows that although it has been shown that e-prescribing improves safety, it also means that there is a small increase in physician prescribing time.

According to the researchers, this means that a provider seeing 20 patients per day spent 6 minutes longer if all prescriptions were e-prescribed than if handwritten, an increase of 20 seconds per patient. The study funded in part by AHRQ was conducted at a multispecialty health system with 16 ambulatory care sites in Washington State.

However, another study funded in part by AHRQ, concentrated medication errors while using e-prescribing. The researchers found that physicians who switched from paper prescribing to e-prescribing reduced their error rate nearly sevenfold, from 42.5 to 6.6 per 100 prescriptions by the end of one year.

This study concluded that the use of e-prescribing eliminated all illegibility errors among adopters, going from 87.6 legibility errors per 100 prescriptions at baseline to none at one year. This study was conducted with 12 adult primary care practices located in a predominantly rural and suburban region of upstate New York. More details on the study are presented in the June 2010 “Journal of General Internal Medicine”.

Assessment Tool Needed

On August 27th, the New York State Department of Health (NYSDOH) issued a Request for Proposals (RFP) (1005130955) for a vendor to deliver an electronic Uniform Assessment Tool (UAT) to address the needs for Medicaid programs in the state. This tool will help the state provide long term care to eligible recipients.

New York’s long term care system has a wide range of inter-connected services and programs and the NYSDOH needs to uniformly assess the level of care needed across settings. The state’s home and community-based programs currently obtain client, quality, and provider performance information from many different screening and assessment instruments.

However, the existing tools lack standardization and a common language which complicates an already fragmented and uncoordinated system of long term care. The Governor and legislature recognized that the state had this problem and appropriated funds in the 2010-2011 state budgets to implement an electronic, uniform assessment system. To achieve these goals, the NYSDOH, Office of Long Term Care must procure services to deliver the electronic solution.

The electronic assessment software will be used to support eight Medicaid programs:

• Assisted Living Program
• Personal Care Services Program and Consumer Directed Personal Assistance Program
• Adult Day Health Care
• Long Term Home Health Care Program
• Nursing Home Transition and Diversion
• Traumatic Brain Injury Waiver
• HCBS Waiver Care at Home
• Managed Long Term Care and PACE

The RFP a competitive procurement will result in a fixed price contract. Written questions are due September 24th, with proposals due November 3, 2010. For more information, email Jonathan Mahar at To download the RFP, go to

Telemedicine Helping OTN

Zargis Medical Corp, a majority owned subsidiary of Speedus Corp. announced that the company has signed an agreement with the Ontario Telemedicine Network (OTN) to provide for the delivery and testing of the Zargis telemedicine remote stethoscope system.

OTN is one of the world’s largest telemedicine networks and operates as an independent, not-for-profit organization funded by the Government of Ontario, Canada. OTN provides access to care for patients in every hospital in Ontario and hundreds of other healthcare locations across the province. In 2010, OTN will conduct more than 100,000 patient visits over more than 2,000 telemedicine systems.

The core component of the telemedicine stethoscope system, TeleSteth™ is the Zargis Cardioscan heart sounds analysis software and the StethAssist ® heart and lung sounds visualization software. TeleSteth was developed to extend the practice of auscultation to situations (listening with a stethoscope) and environments where face-to-face encounters are not always convenient or feasible.

This platform allows healthcare professionals to share heart, lung, and airway sounds with colleagues located across the globe using the internet or a private network. TeleSteth permits patient sounds to be remotely evaluated in real-time (synchronous) or in the store-and-forward (asynchronous) mode.

TeleSteth is designed to be accessed from a user’s PC via a standard internet browser and is available for organizations that require users to access stethoscope sounds from within their private network and can be deployed via a secure enterprise server platform. All components of the telemedicine stethoscope system are HIPAA compliant.

“OTN is one of the world’s most sophisticated telemedicine networks and we are pleased to have been selected as the vendor of teleauscultation solutions for their vast network of healthcare professionals throughout Canada’s most populous province,” said Zargis CEO John Kallassy.

For more details about the company’s teleauscultation tools or to arrange for a demonstration, call (609) 488-4608. For additional information, contact Peter Hodge at (888) 773-3669 (ext. 23) or email or visit and

Certifying Healthcare Homes

Residents in Minnesota with complex and chronic conditions are now able to enroll in healthcare homes also known as medical homes since the first group of clinics have been certified by the Minnesota Department of Health (MDH). The development of healthcare homes is part of Minnesota’s 2008 health reform law and includes payment to primary care providers for partnering with patients and families to coordinate care.

The first eleven certified healthcare homes are in several regions in the state, including both urban and rural clinics ranging from single physician to large system clinics. MDH’s goal is to certify up to 150 organizations by the end of 2011. Currently, nearly 50 additional clinics from around the state representing more than 400 clinicians are in the process of applying for certification.

In addition, 500 people have attended certification training sessions at regional workshops around the state, and more than 30 individual clinics and health systems have received a variety of mini-grants to help them move toward certification.

To be certified as a health care home, providers and clinics must meet a rigorous set of standards that were developed through a public-private stakeholder process, complete an application, and participate in a site visit. A certification assessment tool is available and applicants are encouraged to use this to determine which clinicians are ready to apply for certification as a health care home.

Dr. Jeff Schiff, Medical Director of Minnesota Health Care Programs at the Department of Human Services is partnering with MDH on the healthcare homes initiative. He noted that certified healthcare homes now qualify to receive a monthly per-person care coordination payment for patients with multiple chronic conditions but eligibility for payments may depend on a patient’s health insurance plan.

In preparation for completing applications, MDH and the Minnesota Department of Human Services will put in place a stakeholder advisory task force to advise and recommend options to state staff and the commissioners on key elements concerning the application.

AHRQ within HHS recently awarded a grant for $596,000 to HealthPartners Research Foundation to study the transformation of traditional primary care clinics in Minnesota to health care or medical homes. The Minnesota Departments of Health and Human Services will work with the HealthPartners Research Foundation on the study along with Minnesota Community Measurement and other partners.

They will test whether clinics that have transformed their practice by implementing a healthcare home will see better quality of care for patients with diabetes or heart disease. They will then interview and survey successful clinics to identify key changes important for transformation. The study will also compare more and less transformed clinics in healthcare costs and utilization along with patient and clinician staff satisfaction.

On the federal front, CMS released a solicitation to the states to apply to become a “Medicare Multi-Payer Advanced Primary Care Practice” demonstration site. CMS will pay healthcare homes a care coordination fee consistent with the multi-payer program now being put into place for Medicare fee-for-service enrollees.

Go to for more information.

Studying Substance Abuse

The Department of Veterans Affairs is partnering with NIH and will award $6 million in research grants to examine the link between substance abuse and military deployments and combat-related trauma. NIH’s National Institute on Drug Abuse (NIDA) is collaborating with the National Institute on Alcohol Abuse and Alcoholism, and NCI. NIH is awarding more than $4 million in grant funding with VA awarding around $2 million.

Several projects will look at treatment seeking patterns to study why and when veterans ask for help, and why many won’t seek treatment. Scientists will also explore treatment strategies, including cognitive behavioral therapy and web-based approaches as well as the most effective therapies for soldiers who have other disorders, such as depression and substance abuse. Researchers will also determine if early intervention can improve outcomes along with other projects to help veterans readjust to their work and families after returning from war.

The eleven research institutions in 11 states to receive the grants are Brandeis University, Dartmouth College, the Medical University of South Carolina, the National Development and Research Institutes in New York City, The University of California, San Francisco, the University of Minnesota, Twin Cities, the University of Missouri in Columbia, and the VA medical centers in West Haven, Connecticut, Philadelphia, Little Rock, Arkansas, and Seattle.

Tuesday, September 7, 2010

NSF Funds New Programs

NSF seeks innovative proposals for their new FY 2011“Smart Health and Wellbeing” program. The goal of the program to improve services in patient-centered health and wellness services through innovations and computer and information science and engineering.

Some of the suggested areas for proposals include:

• Protecting patient privacy by providing new security and cryptographic solutions
• Improving personalized medicine with advances in information retrieval, data mining, and decision support software systems
• Providing for continuous monitoring with remote and networked sensors and actuators, mobile platforms, novel interactive displays, and advances in computing and networking infrastructure
• Data collected by sensors at clinic and labs needs to be aggregated for community-wide health awareness
• Study of virtual worlds, robotics, image, and natural language understanding can be used to deliver more efficient healthcare
• Software-controlled and interoperable medical devices are necessary to provide safe critical care
• Healthcare systems and applications have to match the mental model of users so that people make appropriate decisions.

There are three project classes:

• Small projects up to $500,000 total budget with durations up to three years. The full proposal is due from December 1, 2010 to December 17, 2010
• Medium projects from $500,000 to $1,200,000 with durations up to four years. The full proposal is due September 1, 2010 to September 15, 2010
• Large projects from $1,200,000 to $3,000,000 total budget with durations up to five years. The full proposal is due November 1, 2010 to November 28, 2010

The contact for the program is Thomas Henderson, email or call (703) 292-8930. For more details, go to

In other news, NSF awarded a three year $7.5 million grant to a Rutgers-led research team to find a way for the internet to be optimized for mobile networking and communication. The team of nine universities and several industrial partners has dubbed the project “MobilityFirst” reflecting the internet’s drive towards wireless data services on mobile platforms.

The research team will address technical issues, involving reliable data networking in spite of variations in wireless signal quality and strength and the team will also work on how to route traffic across the burgeoning number of nodes in the internet. At the same time, the researchers will address security and privacy needs in both mobile and wired networks and explore how the network can best support features such as location awareness.

HHS Awards Grants for PCOR

HRSA awarded three sets of grants and cooperative agreements totaling nearly $17 million to research comparable treatments and strategies to improve health outcomes for patients. The Patient-Centered Outcomes Research (PCOR) funds made available by ARRA, will establish a network of PCOR centers, enable PCOR in pediatric emergency medicine, and support building capacity for community-based providers to do this type of research.

HRSA Administrator Mary Wakefield said, “These funds enable us to invest in robust systems and infrastructure to bring patient-centered research knowledge into everyday clinical decision-making for the diverse and vulnerable populations that are often under-represented in this kind of research.”

One of the grants awarded separately totaling $3.5 million will be made to the American Academy of Pediatrics at Elk Grove Village, Illinois. The funding will support development of an EHR sub-network within the Pediatric Research Network in the Office Setting.

Five cooperative agreement awards will go to organizations in four states to create the Community Health Applied Research Network (CHARN). The network will be in place to demonstrate how safety net providers and academic institutions can partner together to create an effective infrastructure to support patient-centered outcomes research.

CHARN will consist of a Central Data Management Coordinating Center, based at the Kaiser Foundation Hospitals’ Center for Health Research in Portland, Oregon along with four networks selected as research “nodes” in California, Illinois, Massachusetts, and Oregon. The nodes are geographically dispersed consortia of safety net providers in 17 states.

Three of the four research nodes will focus on patient-centered outcomes research related to the delivery of primary care, while the fourth research node located in Boston will focus more specifically on research relevant to treating individuals with HIV/AIDS.

Another grant totaling $3.5 million will be awarded to Columbia University to support patient-centered outcomes research within the Pediatric Emergency Care Applied Research Network (PECARN). The funds will help boost data capacity, conduct studies and disseminate information on research findings involving pediatric emergency care.

Accessing Info with a Click

According to a policy paper released by the Markle Foundation, the simple but rarely offered ability for people to download their health records should be a priority in the nationwide push to upgrade health information technology.

Representing a wide array of providers, consumers, technology companies, insurers, and privacy advocates, 46 organizations are supporting a specific set of privacy and security practices for the “blue button.” The group envisions the blue button as a common offering among secure websites for patients and beneficiaries by medical practices, hospitals, insurers, pharmacies, laboratories, and information services.

“By clicking the blue button, you could get your own health information electronically—like summaries of doctor visits, medications, and test results. Being able to have your own electronic copies and share them as you need to with your doctors is a first step in truly enabling people to engage in their healthcare”, said Carol Diamond, MD, MPH, Managing Director of the Markle Foundation.

Medicare and the Veterans Administration are planning to implement a blue button this fall that will for the first time, allow beneficiaries to electronically download their claims or medical information in a common form from the “My” and “My HealtheVet” secure websites.

The Markle collaboration’s recommendations are timely because ARRA requires that individuals need to be able to receive electronic copies of their records from their providers’ electronic health record systems. In addition, new federal economic stimulus rules require healthcare providers and hospitals to deliver electronic copies of items such as lists of medications, after-visit summaries, and lab results if they choose to participate in federal subsidies for using HIT.

The Markle policy recommendations details privacy policies and practices when implementing download capabilities with security safeguards included. The proposed privacy policies build on the Markle Common Framework for Networked Personal Health Information, a set of recommended practices for individual access to information and privacy. The framework first released in 2006 is widely supported by a range of technology companies, insurers, provider groups, consumer, and privacy advocates.

Go to to download the brief.

NIH Supports Space Research

NIH awarded the first round of new grants totaling $1,323,000 under the “Biomedical Research on the International Space Station” (BioMed-ISS) initiative, a collaborative effort between NIH and NASA. Using a special microgravity environment that earth-based laboratories cannot replicate, researchers will explore fundamental questions about important health issues, such as how bones and the immune system get weak.

The National Laboratory at the ISS provides a virtually gravity free or referred to as microgravity environment where the cellular and molecular mechanisms that underlie human diseases can be explored.

Scientists will conduct their experiments under a two-stage mechanism. The first is a ground-based preparatory phase to allow investigators to meet select milestones and technical requirements. The second is an ISS experimental phase that will include preparing the experiments for launch, working with astronauts to conduct them on the ISS and performing subsequent data analyses on Earth.

“BioMed-ISS offers a novel opportunity for gaining scientific insights that would not otherwise be possible through ground-based means,” said Stephen I. Katz, M.D., Ph.D., Director of NIH’s National Institute of Arthritis and Musculoskeletal and Skin diseases, and NIH’s liaison to NASA.

The first round of grants has been awarded to:

• Massachusetts General Hospital/Harvard Medical School in Boston, to study osteocytes, the most common type of bone cell believed to have gravity-sensing abilities and to play a key role in bone remodeling

• Northern California Institute for Research and Education in San Francisco plans to apply lessons learned from studies of immune cells in microgravity to a new model for investigating the loss of immune response in older women and men

• University of California San Diego will study how alcohol can compromise the natural barrier function of cells in the gastrointestinal tract. This can increase the movement of toxins from the intestines to other organs in the body. The researchers will use microgravity three dimensional cell culture models to help generate insights into the barrier properties of the intestines and explore how the absence of gravity affects the alcohol’s ability to diminish this barrier.

New Telehealth Contracts Signed

Philips has signed three-year telehealth contracts with FirstHealth of the Carolinas and Mountain States Health Alliance (MSHA). The contacts involve using Philips Telehealth at home devices including the TeleStation, to collect and transmit patient vital sign data and to enable communication between clinicians and patients. Philip’s wireless devices are able to measure vital signs including weight, blood pressure and pulse, blood oxygen, ECG heart rhythm, and blood glucose.

FirstHealth and MSHA signed their multi-year contracts with Philips with costs for the programs offset by more than $700,000 in Telehealth Network Grants awarded through HHS designed to help communities build the human, technical and financial capacity to develop sustainable telehealth programs and networks.

More than $2 million was awarded in Telehealth Network Grants with funding paid out of FY 2010 funds from HRSA’s Office of Rural Health Policy. The eight Telehealth Network Grant awards averaged $255,000 per award.

"Open Mic Forum" Next Week

The Northern Regional Telehealth Resource Center (NRTRC) announced that their “Open Mic Forum” will be held on Monday, September 13th at 3:00pm MDT. With an unprecedented level of telehealth activities and funding opportunities available, a number of persistent barriers are limiting potential growth in the delivery of clinical services.

This forum presents an opportunity to understand the CMS reimbursement process and learn what your network can do to seek reimbursement for clinical services not currently reimbursed. After the forum and further discussion, NRTRC will provide CMS with a list of five procedures to be included in the 2012 payment structure.

Greg Billings, Senior Government Relations Director in DrinkerBiddle’s government and regulatory affairs practice group will moderate the forum. He works primarily in the healthcare arena representing and advising providers, medical simulation training organizations, and nonprofit health systems on telemedicine issues.

NRTRC provides technical assistance, information on telehealth as a healthcare delivery tool, how to improve access to specialty care through regional collaboration, and how to develop information on best practices and telehealth toolkits.

For more information on how to register for the “Open Mic Forum”, go to or email

Wednesday, September 1, 2010

Telemedicine Helps Native Americans

The University of California, Davis School of Medicine is using grant funding to train Native American communities in the state. The training sites include the Round Valley Indian Tribes of Covelo, Mendocino County, and communities served by Northern Valley Indian Health Inc. that includes Glenn County and portions of Butte, Tehama, and Colusa.

The goal is to decrease obesity and type-2 diabetes in the Native American population through a $1 million research grant from NIH’s National Institute of Diabetes and Kidney Diseases. The researchers plan on collaborating with community members to teach them how to perform research on their own communities and to make certain that the research is culturally appropriate.

Specifically, the two year research initiative will train community members on using community-based and community-governed participatory research techniques. The UC Davis researchers will work with two established community health centers such as the Round Valley Indian Health Center and the Northern Valley Indian Health Inc.

Over one third of all American Indian adults nationwide are obese, compared with about 22 percent of non-Hispanic whites. Among the Native American communities participating in the study, nearly 68 percent of adults are obese and 24 percent of children between 2 and 5 years old have body mass indexes in the 95th percentile for their ages. American Indians are 2.6 times as likely to be diagnosed with diabetes as non-Hispanic whites.

Telemedicine will be used through the UC Davis Center for Health and Technology that uses real-time video conferencing to provide education and group interaction as well as specialist and subspecialist consultation for patients and physicians in remote rural areas throughout the state. James Marcin, Professor of Pediatrics, and Director of the UC Davis Pediatric Telemedicine Program will direct the work.

An important aspect of the research according to Dennis Styne, study principal investigator and the Yocha Dehe Endowed Chair in Pediatric Endocrinology is the development of the Nor Cal Tribal Institutional Review Board to review and approve research projects needed by these communities. This work will be supported by the UC Davis Health System Institutional Review Board.

In Oregon, ophthalmologists from the Legacy Good Samaritan Devers Eye Institute in collaboration with researchers at Oregon Health & Science University (OHSU) are using telemedicine to help treat Native Americans hundreds of miles away in Pendleton Oregon and in Wichita Kansas. The medical community hopes to help underserved patients in these areas not lose their eyesight to complications of diabetes.

Less than 50 percent of Native American Diabetic patients receive annual eye exams. Only two of the 43 federally recognized tribes in the Pacific Northwest have affiliated clinicians who can provide yearly eye exams. The long distances between many rural reservations and urban eye care centers complicate providing routine care. Telemedicine has a large potential to help in these remote areas.

OSHU’s Center for Healthy Communities, a Prevention Research Center funded by CDC for the past 6 years has been collaborating with the Legacy Devers Eye Institute and the Northwest Portland Area Indian Health Board. Together, the institutions have initiated vision screening and eye exams in multiple tribal communities and have found a high prevalence of patients with undiagnosed glaucoma as well as diabetic retinopathy.

OSHU and Legacy Devers Eye Institute are using a HIPAA-compliant, secure, store-and-forward web-based telemedicine system that uses non-mydriatic cameras to capture images of the retina and optic disc.

Community-based research assistants in Pendleton and Wichita photograph diabetic patients’ eyes and transmit the images electronically to Legacy Devers for reading and diagnosis. OSHU researchers serve as the administrative hub for the projects, providing data analysis and then evaluate the program to measure its efficiency and long term sustainability.

OSHU’s involvement in the project made it possible for the program to win a $2 million grant from CDC since OHSU is a member of the CDC’s Prevention Research Center Program. This grant funding will be used to determine the effectiveness of telemedicine in detecting the progression of diabetic retinopathy as compared with traditional annual eye exams in a physician’s office.

Other goals include:

• Developing and refining the “Compliance with Annual Diabetic Eye Exams Survey” to determine the factors related to adherence with annual eye exams by using telemedicine and also traditional surveillance methods

• Estimating the cost effectiveness of a telemedicine system from the perspective of both the provider and the individual patient

The data obtained from the project will be presented to legislators to provide the framework for changes in national and statewide guidelines.

Help for SBIR Awardees

NIH’s Commercialization Assistance Program (CAP) is available to NIH SBIR Phase II awardees to help awardees transition their SBIR developed products into the marketplace. The Larta Institute of Los Angeles is working with the CAP program to advise the awardees.

CAP will begin October 2010 and will conclude the end of June 2011. The program has two tracks:

• The Commercialization Training Track (CTT) with 60 slots is appropriate for the majority of SBIR Phase II companies. CTT assists participants on how to evaluate their commercialization options based on their specific technologies. This include the need and prospect for investment, strategic partnerships, or licensing, and helps the companies to develop a solid market-entry plan covering an 18 month period plus assists in the development of market appropriate tools

• The Accelerated Commercialization Tract (ACT) with 20 slots available is for SBIR Phase II companies who have successfully commercialized or sold products and/or services, generated revenue, established partnerships and achieved a level of market development that will be sustainable over a definitive period. However, these companies may be lacking in a specific applicable issue such as a solid regulatory plan, a license-focused IP strategy, or a term sheet for investors which is key to their continued growth

All NIH SBIR awardees that have been active in the past six years are eligible to participant. Participants must meet the SBIR small business eligibility criteria available at

CAP participation is free of charge for selected participating companies however, participants are responsible for travel and lodging expenses associated with attending workshops and for partnering for investment events.

Go to for more information. The deadline for submitting an application is September 17, 2010. For more information email Kay Etzier at or Judy Hsieh, at

ONC Names 2 Review Bodies

The Certification Commission for Health Information Technology (CCHIT), in Chicago, Illinois, and the Drummond Group Inc. in Austin, Texas were named by the National Coordinator for HIT as the first technology review bodies authorized to test and certify EHR systems for compliance with the standards and certification criteria issued by HHS earlier this year. This means that EHR vendors can now begin to have their products certified as meeting the criteria needed to support meaningful use objectives.

CCHIT already has plans to launch the HHS certification program on September 20th with a Town Call web cast describing their application and testing process. CCHIT will take new health IT developer applications at and the first group of HHS certified complete EHRs and EHR modules will be announced within weeks after the launch.

“Multiple steps are underway to carry out the intent of Congress to support the rapid and effective adoption of EHRs throughout the healthcare system,” Dr. Blumenthal National Coordinator said. “The naming of initial ONC Authorized Testing and Certification Bodies (ONC-ATCBs) is a very important step.

CMS is also working to create an online system for providers to use to register for the EHR incentive programs with the first incentive payments to be made May 2011. Meanwhile ONC is carrying out new programs to provide technical assistance and training, especially for smaller hospitals and physicians.

Help for Remote Area

Two hundred sixty volunteers from the University of Virginia Health System filled a tractor trailer and personal vehicles with medical supplies and drove 300 miles to Southwest Virginia to transform the fairgrounds into a scaled-down hospital. Thousands of people were able to receive free medical dental and vision care at the 2010 Wise Remote Area Medical (RAM) clinic.
UVA along with many other organizations provided patients with free access to specialty care and technologies normally only available through hospitals. Patients were able to receive emergency care, mammograms, ECGs, ultrasounds, chest x-rays, neurosurgery consultations, bone density testing, diabetes management, plus access was provide via telemedicine to other specialists at UVA.

Michael Harper, MD Medical Director of the remote clinic said “In the past several years, we’ve been able to bring some technology to this environment. One of our cardiologists was really surprised when he got an echocardiogram done in less than 15 minutes, which is not easy to do in some hospitals.”

The high-tech care is helped in part by donations from the Verizon Foundation, which for the past eight years has provided an estimated $100,000 in grants and broadband connections for the Wise RAM. Verizon installed T1 broadband lines to enable volunteers to access the internet and send mammograms back to the UVA Medical Center.

Three years ago, UVA began using its patient registration system at the Wise RAM to create an electronic medical record for each patient. Verizon awarded $88,537 in grants to support the system including two grants in 2007 and one recent grant for $20,000.

According to Eugene Sullivan, Director of UVA’s Office of Telemedicine, “Any UVA clinician can look up what treatments a patient received at last year’s RAM.” Sullivan added that in 2009, UVA clinicians provided more than 6,500 direct patient encounters in Southwest Virginia in addition to the 5,600 patient encounters at the RAM clinic in Wise.

State Receives AHRQ Grant

The Governor’s Office announced that Massachusetts received a $2.9 million grant from AHRQ to support a three year collaborative effort to study ways to improve patient safety and reduce medical malpractice in primary care settings.

The award is the result of a partnership between the state’s Department of Public Health, Brigham and Women’s Hospital, Health Care for All, the Coalition for the Prevention of Medical Errors, and other leading health organizations.

Working with two leading medical malpractice insurers in Massachusetts, DPH has assembled a consortium that will work with leading quality improvement and safety experts to employ state-of-the-art approaches and tools to address three areas of identified risk in primary care practices. This includes medication management, test ordering and results management, and follow-up and referral management. Best practices developed during the project will be shared with primary care providers statewide at the conclusion of the three year grant cycle.

ATA Mid-Year Meeting Coming

The ATA 2010 Mid-Year Meeting will combine multiple telemedicine events and a telehealth exhibit hall to run concurrently in one convenient location on September 26-28 at the Hilton in Baltimore MD. There will be many opportunities to network with the most influential movers-and-shakers in telemedicine and to discuss the future of healthcare and telemedicine.

Among many topics, the ATA Summit 2010 will discuss government funding for telehealth, private payers of telemedicine, answer questions on federal regulations, and discuss how academic medical centers are influencing telemedicine.

The ATA Meeting will identify the swift changes underway in healthcare delivery and specific opportunities provided by those involved in telemedicine. The exciting line-up of speakers at this meeting will share the challenges and opportunities of health reform and the important role that telemedicine can play.

The agenda includes a line-up of all star speakers to present many perspectives in healthcare. For the first time, senior management from CMS, HRSA, and other major federal programs will actively participate in the telemedicine meeting, signifying a significant shift in federal public policy. Also participating will be senior leaders from regulators and private payers.

Featured speakers include:

• Marilyn Tavenner, Principal Deputy Administrator and Chief Operating Officer for CMS
• Anthony “Tony” Rodgers, Deputy Administrator for Strategic Planning CMS
• Reed V. Tuckson, MD, Executive Vice President, Chief of Medical Affairs, UnitedHealth Group
• Molly J. Coye, MD, MPH, CEO, Health Technology Center
• Mary Wakefield, PhD, RN, Administrator, HRSA
• Phoebe Yang, Senior Advisor to the FCC Chairman, and General Counsel, Omnibus Broadband Initiative, FCC
• Ronald C. Merrell, MD, FACS, Professor of Surgery, Virginia Commonwealth University
• Dale Alverson, MD, Medical Director, Center for Telehealth, University of New Mexico Health Sciences and President of the American Telemedicine Association
• Mark B McClellan, Director, Engelberg Center for Health Care Reform
• Bernard A Harris Jr. MD, President-Elect, ATA, President and CEO Vesalius Ventures
• William D. James, MD, FAAD, President, American Academy of Dermatology
• Jonathan Linkous, Chief Executive Officer, ATA

The 5th Annual Pediatric Telehealth Colloquium will be held at the Mid-Year Meeting to hear discussions on original research related to pediatric telemedicine, innovative pediatric telehealth applications, achieving sustainability, providing quality of care, financial impact on the field, novel technologies, and advancing telecommunications.

The meeting will also feature pre-meeting events and partner meetings to include a Telemedicine Basics Tutorial plus an ATA Leadership Development Seminar.

Don’t miss out on the 2010 Mid-Year Meeting Exhibit Hall. This is where healthcare professionals will be able to find, handle, and test telemedicine products and services. Dedicated exhibit hall hours and the controlled size of the exhibit will enable prospective buyers and sellers to connect in a relaxed environment. There are still exhibit spaces available, but the deadline to be included in the final program is September 1, 2010.

For more information on the meeting, to find out about exhibiting or to register, go to