Sunday, November 28, 2010

Speakers Discuss HIEs

Health Information Exchanges (HIE) will continue to play a vital role in transforming the national, state, and local healthcare environment according to several panel experts on Capitol Hill to discuss HIE ongoing progress.

The discussion on November 18th took place with Neal Neuberger, Executive Director for the Institute for e-Health Policy and Joel White, Executive Director for the HIT Now Coalition hosting the Congressional Luncheon Seminar on behalf of the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics”.

Harry Greenspun, M.D., first Chief Medical Officer for Dell Health Services and moderator for the seminar, voiced the immediate need to exchange clinical information. The first panelist, Farzad Mostashan M.D., Deputy National Coordinator, Programs and Policy Office of the National Coordinator for HIT, agreed and said, “It’s a great time for health IT since incredible progress has been made in the past 18 months.”

Mostashan did caution that we must ask real questions and find out if people really want to exchange information and if they have a good reason to do so. In addition, we must make it easy to exchange information, lower the complexity of systems, and reduce costs for moving information. So much has been accomplished but there is still so much to do.

Mostashan pointed out that so far, the stimulus funding has enabled states to plan and establish regional extension centers, establish the BEACON community grant program, initiate research programs, help states plan and establish health information exchanges, plus establish health IT training programs at community colleges and universities. As he noted, it is vital to develop and build the business case whether it involves bundled payments, accountable care organizations, or other forms of coordinated care.

“Currently both DOD and the VA are sharing health data in today’s healthcare environment and are working to achieve a seamless transfer of information”, reports Stone Quillian, Deputy Program Executive Officer for Acquisition Programs for the Military Health System. For example, the Bidirectional Health Information Exchange allows for two-way views of health data in real-time and exchanges data between all DOD and VA medical facilities.

In addition, the Federal health Information Exchange provides the monthly transfer of health data on more than 5 million service members such as lab results, pharmacy standard ambulatory data consultation reports, and deployment-related health assessments.

Quillian emphasized that DOD and the VA are working to assist with mental health issues. Today, the VA Polytrauma Centers in Tampa, Richmond, Minneapolis, and Palo Alto exchange radiology images and scanned medical records for severely wounded service members from Walter Reed AMC, Bethesda NNMC, and Brooke AMC. The electronic movement of data transfers data one-way but this only occurs when the decision is made to transfer the patient to the VA. Currently, DOD providers are able to access VA’s data through AHLTA and VA providers can access DOD data through VistA, CPRS, or VistAWeb.

He went on to explain that a pilot demonstration project involving image sharing is underway with radiology images being shared between a limited number of DOD and VA facilities with users located in specified geographic regions. In the future, the DOD’s Health Artifact and Image Management Solution (HAIMS) will provide access to scanned documents, digital radiographs, clinical photographs, videos, and cardiographic EKGs, and echocardiographs. Plans are for HAIMS to be deployed to additional limited user testing sites in FY 2011.

DOD’s goal is to be able to share data with anyone that has a valid purpose for the information and to increase access to DOD’s inpatient documentation for up to 90 percent of the total DOD inpatient beds by September 2011.

DOD and the VA are working to create a Virtual Lifetime Electronic Record (VLER) to enable viewable and seamless access to electronic records for service members and veterans through a single portal. Collaborative efforts on the project are ongoing with DOD, the VA, Office of the National Coordinator, plus private parties.

Chief Technology Officer for Ingenix, Art Glasgow wants to see the health information technology landscape achieve much greater connectivity and to fully develop on a national and or regional scale. The goal is to reduce complexity and create a coherent workable network with a sustainable partnership model.

As Glasgow looks to the future, HIEs need to be ready to exchange information with providers, hospitals, integrated delivery networks, and pharmacies. He envisions that in the future, clinical information delivery will be primarily workflow driven, will reduce gaps in care, be able to treat population health, provide various treatment options, effectively manage care and diseases, provide for drug surveillance, assist with claims submissions and eligibility requirements, and provide data on comparative effective research.

For an idea of how an effective EHR works, Glosgow mentioned the Quality Health Network covering Western Colorado. This system was the first hybrid-federated EHR in the U.S and exchanges clinical data with two hospitals at Mesa County and the Rocky Mountain Health Plan. He reports that the benefits were found to be astounding and the system is heavily used by more than 1.5 million with 800 people per month viewing the EHR page.

Verizon is taking several unique actions to help in the electronic transfer of data. Peter Tippett, M.D. PhD, Vice President for Technology and Innovation, explained how the company is issuing identity credentials to 2.3 million physicians, physician-assistants, and nurse practitioners at no charge so they can comply with the HITECH Act.

The legislation calls for the use of strong identity credentials when accessing and sharing patient information electronically beginning mid 2011. Currently, there is no universal means of issuing multi-factored credentials to healthcare professionals to access any healthcare system, database, or application.

Now healthcare professionals with credentials will be able to receive digital health information via the Verizon Medical Data Exchange complete with access to a secure private inbox available from a new web-based healthcare provider portal.

Secondly, the Verizon Medical Data Exchange has previously enabled limited sharing of dictated notes. The company is now expanding their Medical Data Exchange to enable a wider range of healthcare providers from large health systems, rural hospitals, to small physician practices to receive the notes and share additional digital records.

Maryland’s “Chesapeake Regional Information System for our Patients” (CRISP) the state’s designated statewide HIE and regional extension center went live in September. David Horrocks, President and CEO of CRISP, said “It took one and one-half years and cost the state ten million but the goals were achieved with the Governors support, the hospital leadership in the state, and the support of all the Maryland communities.

Since the system was rolled out, several hospitals have come on line to include Holy Cross Hospital, Suburban Hospital, and Montgomery General Hospital however; a number of hospitals are coming online before the end of the year. These hospitals will include many of the state’s federally qualified health clinics serving Medicaid, uninsured, and other underserved patients.

According to J. David Liss, Vice President Government Relations for The New York Presbyterian (NYP) Hospital which is affiliated with Columbia and Cornell Medical Schools, the NYP Health System is one of the nation’s largest not-for-profit hospital systems. The system oversees 32 acute care and specialty hospitals, 5 long term care centers, and 24 ambulatory clinics, plus the system manages 5.5 million inpatient and ambulatory encounters each year.

He detailed the specific difficulties in operating in the Washington Heights and the Inwood (WH/I) areas of New York. The area has a population of 270,000 with s 30 percent of the residents living below the poverty level as compared to 21 percent city wide. Over 50 percent of the residents are born outside of the U.S, mainly in the Dominican Republic, Ecuador, and Mexico.

The area served has a prevalence of diabetes with 11 percent as compared with 9 percent for New York City. Chronic disease is rampant with pediatric asthma and mental illnesses the leading causes for hospitalizations and the leading cause of death is cardiovascular disease.

Liss explained that several funding initiatives are helping such as the AHRQ PROSPECT grant support to help characterize patients to determine the sickest patients and to predict which patients will become sicker. In addition, the state’s HEAL NY 17 $120 million program will play an important role so that community-based HITs will produce a more streamlined approach for sharing patient information and help patients with both diabetes and depression.

For more information, contact Neal Neuberger, Executive Director of the Institute for e-Health Policy at (703) 508 -8182 or email

FOA Seeks Low-Cost Devices

On November 23, 2010, NIH issued a Funding Opportunity Announcement (FOA) to encourage collaborative research and/or technology development between scientists and engineers in the U.S. and India. Both NIH’s National Institute of Biomedical Imaging and Bioengineering (NIBIB) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) are encouraging applications through the NIH Small Research Grant Program.

The NIBIB supports research to develop new, low-cost, appropriate diagnostic and therapeutic medical technologies for low-resource settings and supports the reengineering of existing medical devices to help the poor. Appropriate medical technologies are usable, cost effective, sustainable, and effective in meeting clinical needs in a low-resource setting, and/or to provide technology transfer that will impact underserved populations within the U.S. and/or India.

Low-cost technologies are needed to treat chronic diseases, cardiovascular diseases, endocrine disorders, maternal/neonatal/infant health, treat trauma and injury and to do cancer screenings.

Some of these specific technologies are needed but other technologies are also desired:

• Glucose monitoring for diabetics
• Low-cost platform technologies for multiple diagnostic tests
• A multiplex lab-on-a-chip technology for STDs and other infections
• Point-of-care diagnostics for screening infant diseases
• A pre-screening test for blood bank safety
• Diagnostic test for the early detection of cardiovascular disease
• Point-of-care tests and reagents for cancer screening
• Networked and mobile technologies for diagnostic devices
• Diagnostic screening devices that can be operated by people with minimal education
• Non-invasive or minimally invasive screening technologies
• Diagnostic assay development for low-cost screening kits
• Technology and assay development related specifically to screening newborns for heritable disorders
• Low-cost diagnostic imaging devices

Funds available provide for direct costs of up to $75,000 and may be requested for a maximum of $150,000 direct costs over a two year project period.

The opening application date is December 28, 2010. There are other due dates through 2011, 2012, and 2013 starting with January 26, 2011.

Go to to download the FOA (PAR-11-044).

KY Improving Systems

Kentucky’s Governor Beshear is taking steps to balance the Commonwealth’s $6 billion Medicaid budget. Currently, there are 815,655 citizens in the state depending on the Medicaid program while the number eligible for services increased by 3,000 per month in the last two years. A gap in the Medicaid budget of $100 million in state funds exists for FY 2011.The Cabinet for Health and Family Services has saved $86.5 million in state funds in the current fiscal year and plans on saving $80.2 million in FY 2012.

Additional cost containment and other actions are planned. One of the actions includes using public-private partnerships to implement innovative cost saving measures and improved health outcomes. In addition, Requests for Information (RFI) and Request for Proposals (RFP) will be issued to look at the strategies that other states are using to contain Medicaid spending. The state will then study action plans and programs to implement savings based on the results of the RFIs.

RFIs submitted can include details on:

• Performance-based managed care programs for all eligible Medicaid citizens in the state
• Pay-for-performance physician and primary care provider incentive plans
• Performance-based managed care dental programs for children
• Performance-based pharmacy capitation programs
• Long term care coordination program for institutional and community-based care

In another move to save money, the Department for Medicaid Services (DMS) is contracting for a third party to work with DMS to more aggressively identify provider fraud and abuse.

In addition, to help Medicaid save on the high cost for radiologic and imaging services, another RFP will select a vendor to manage high cost radiologic and imaging services estimated to save $7 to $10 million annually.

The Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy received a $1 million federal grant to help CHFS, the Kentucky Public Protection Cabinet, and the Department of Insurance plan and develop the state insurance exchange.

The grant will be used to assess the state’s current information technology systems, infrastructure, and determine if new requirements must be developed. The governance and operational structures for the exchange must be analyzed along with a review on any regulatory and statutory changes needed to implement an exchange. In addition, the eligibility and enrollment systems across Medicaid and KCHIP with the exchanges must be coordinated.

The Kentucky Department of Public Health is going to receive $1 million in federal grant funding to collect data to help make decisions, monitor and evaluate quality, and to make improvements throughout the state’s public health system. Efforts will focus on establishing a Center of Performance Management within the Department for Public Health to provide the infrastructure needed to develop and operate a complete performance management system.

The Kentucky Child Support Enforcement Program (CSE) is developing new technology to improve service. One of the major changes will be to establish a customer service web site to allow custodial and noncustodial parents to view details on their case, data on payments, on appointments, their case status, as well as any updated information. The general public will be able to access general child support information, including how to apply for services online and also noncustodial parents will be able to be able to make payments.

Other initiatives will make it possible for child support staff to simultaneously search a variety of systems. The information will provide additional resources needed to locate participants in a child support case. Business intelligence will help CSE staff access data in the current child support system and to electronically complete federally required reporting. The system will enable staff to electronically store, view, receive, and send information concerning applications, court orders, and insurance documentation to courts and other agencies.

Eye Images Added to Database

NIH expanded a genetic and clinical research database to give researchers access to the first digital study images. The National Eye Institute (NEI) in collaboration with the National Center for Biotechnology Information (NCBI) has made available more than 72,000 lens photographs and fundus photographs of the back of the eye. The photographs were collected from the participants of the Age-Related Eye Disease Study (AREDS).

These images are accessible to scientists through NCBI’s online database of Genotypes and Phenotypes known as dbGaP. This database has data available from studies that explore the relationship between genetic variations (genotype) and observable traits (Phenotype). However, for researchers to use the information, they first must apply for controlled access to de-identified information about study subjects, including the new images.

“The availability of AREDS images through dbGaP may transform the way vision research is conducted,” said NEI Director Paul A. Sieving, M.D., Ph.D. “Scientists will be able to increase their understanding of the impact of genetics and gene-environment interactions on blinding eye disease progression, and this knowledge could aid in diagnosis and in developing effective treatments.”

AREDS began in 1992 as a multi-center prospective study designed to evaluate the progression of age-related macular degeneration and age-related cataracts. Participants 55 to 80 when the study started also were enrolled in a clinical trial using high-dose vitamin and mineral supplements.

Study participants were followed for a median of 6.5 years during the trial and five years after the study ended. Beginning in 1998, DNA was also isolated from blood samples obtained from more than 3,700 AREDS participants.

“AREDA has been the main focus of the translational research program at NEI for a number of years,” said NEI Clinical Director Frederick L. Ferris III, M.D. “This new group of lens and fundus images from well described study participants provides a new opportunity for vision research and is a valuable resource for clinical teaching and training as well.”

Open-access to AREDS data and the link to click to apply for controlled access to individual-level data, including the new images, can be found on the NEI-AREDS study page at

IHS and VA Sign MOU

The Indian Health Service (IHS) and the VA have signed a Memorandum of Understanding (MOU) to improve the health of American Indians and Alaska Native Veterans. The MOU outlines a plan for coordination, collaboration, and resource sharing between the two agencies. The goal for the Indian Health Service and the VA in partnership with the American Indian and Alaska Native (AI/AN) people, is to raise their physical, mental, social, and spiritual health to a higher level.

The MOU expands the partnership established through a previous MOU in 2003 that improved communication between the agencies and tribal governments and developed strategies to share information services and information technology.

The MOU will enable the IHS and the VA to:

• Expand the Tribal Veterans Representative program into the IHS system
• Improve the coordination of care, including co-management for AI/AN veterans by developing and testing innovative approaches
• Improve the development of health IT by sharing technology with both agencies
• Use telehealth services such as telephsychiatry and telepharmacy, mobile communication technologies, and enhanced telecommunications infrastructure in remote areas
• Develop payment and reimbursement policies
• Pay attention to cultural issues in caring for AI/AN veterans
• Improve quality through training and workforce development
• Address emergency, disaster, and pandemic preparedness and response to include sharing contingency planning and preparedness efforts

DARPA Funding PoD

The Defense Advanced Research Projects Agency’s Pharmacy on Demand (PoD) program seeks research on devices and techniques needed to manufacture small molecule pharmaceuticals. Devices need to be capable of manufacturing a variety of drugs using shelf-stable precursors and initial prototypes. Ideally, they should be operable from the back of a mobile platform, such as a High Mobility Multipurpose Wheeled Vehicle (HMMWV).

DARPA proposals are to be submitted in three technical areas:

• Technical area 1 needs to demonstrate the capability to manufacture pharmaceutical agents with a variety of battlefield uses.
• Technical area 2 seeks development of lab-on-a-chip and plant-on-a-chip or similar technologies
• Technical area 3 needs to demonstrate how to consistently manufacture pharmaceutical agents in technical area 1 with the same purity and efficacy as comparable to commercial products

Individual multiple awards will be made and may be in the form of procurement contracts, grants, cooperative agreements or some other type of transaction. Funding will be determined by the quality of the proposals received and the availability of funds.

Proposal Abstracts are due December 1, 2010 with full proposals due January 11, 2011. The funding opportunity number is DARPA-BAA-11-05. For more information email Geoffrey Ling at To download the solicitation, go to

Sunday, November 21, 2010

National Coordinator at AMIA

Returning from a recent trip to Europe, David Blumenthal, M.D., National Coordinator for HIT stressed the need for consensus building and for collaborative efforts to bring health IT to where it needs to be in the future. Speaking at AMIA’s Annual Symposium on Biomedical and Health Informatics, on November 15th at the Washington Hilton, he is looking towards AMIA to continue the progress in order to achieve the ultimate healthcare vision.

Dr. Blumenthal’s recent trip enforced the need for change to bring the healthcare world into the 21st century. He was able to visit a number of general practitioners in London and found that although the majority of providers use EHRs, the technology is unsophisticated. However, even the basic EHRs are helping to effectively meet healthcare goals, provide quality, and produce good outcomes.

As Dr. Blumenthal stated, there are still four major barriers in place that affect achieving the long term vision for health technology:

• Financial issues due to the cost to adopt and to use and lack of financial incentives to improve performance in order to use all of the capabilities

• Logistical and psychological problems that hamper the changes that doctors have to make to adjust to using technology especially in solo or small practices

• Lack of infrastructure and the lack of a strong business case to develop the technology needed

• Public trust in the program still needs to be established

Dr. Blumenthal discussed the ongoing work on the “meaningful use” initiative which has produced incentives, goals, and objectives. The “meaningful use” program is going to require still more work especially on stage two and three. The initiative has been instrumental in stimulating companies to enter the health IT marketplace.

Several programs have been established such as the Regional Extension Program (REC) to help doctors and the healthcare professionals become “meaningful users”. The plan is for the RECs to help remove psychological barriers, and provide technical assistance as needed. Training programs are in place to staff the RECs.

The ongoing Certification Program is in place to establish consumer confidence when buying equipment and using electronic records. Currently, there are three certification bodies but some are very busy so Dr. Blumenthal wants to establish more certification bodies to be able to maintain a competitive market. Right now the certification process is temporary but will soon become permanent.

Dr. Blumenthal notes that one of the major issues involves exchanging health information. Many countries around the world manage the adoption process for EHRs especially in primary care, but are not yet exchanging information since standards are lacking. Currently, a great deal of hard work is taking place to adopt NHIN but realistically not all providers will participate. But with NHIN, every adopter will have at least one means of exchange.

Right now, the states are progressing towards the exchange of health information and are in the process of team building and planning at the local level. The progress in the states varies in their success level since not all states are the same and some have enormous differences in their state populations that require different solutions.

Dr. Blumenthal discussed how a grant program resulting from stimulus funding is helping states to proceed. One is the Beacon Community Program, in place to enable communities to build and strengthen their health IT infrastructure to improve healthcare outcomes specific to their goals.

Research is very important and the SHARP program is another grant program in place to fund research to solve problems that impede the adoption of EHRs. For example, Dr. Blumenthal talked about research in place at the Mayo Clinic that is examining at different technology approaches, Harvard, researchers are studying how an iPhone web app could be used to gather data, and at the University of Texas, a usability testing laboratory is using a process to measure how well individuals can use a product. Now vendors are approaching the laboratory to get their products evaluated.

Safety issues are very vital to address when using health technology and this issue is now in the spotlight, AMIA has published a report on the topic and that should help to make a positive contribution to help protect consumers. According to the National Coordinator, the EHR system makes healthcare safe but not perfect.

For more information on the Symposium, go to

CMS Establishes Initiatives

CMS has formally established the new Center for Medicare and Medicaid Innovation created by the Affordable Care Act. The Innovation Center will examine new ideas and ways to more effectively deliver healthcare in the future.

The Innovation Center will:

• Consult with stakeholders across the healthcare sector including hospitals, doctors, consumers, payers, states, employers, advocates, relevant federal agencies, and others to obtain input and to build partnerships

• Test models to establish an open innovation community to serve as an information clearinghouse on best practices in healthcare innovation

• Create learning communities to help other providers rapidly implement new care models

The Innovation Center announced an upcoming opportunity available to States to apply for contracts to develop new models to improve healthcare, quality, care coordination, cost effectiveness, and to help benefit beneficiaries. The Innovation Center expects to award up to $1 million in design contracts to as many as 15 state programs for this work.

CMS has announced several new initiatives to test the “health home” and “medical home” concept. One initiative involves the “Multi-Payer Advanced Primary Care Practice Demonstration” to support better coordinated care, improve health outcomes for patients, and evaluate effectiveness for doctors and health professionals.

Eight states were selected to participate in this demonstration and include Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. The demonstration will include approximately 1,200 medical homes serving up to one million Medicare beneficiaries

The Federally Qualified Health Center (FQHC) “Advanced Primary Care Practice Demonstration” will test the effectiveness of doctors and other health professionals working in teams to treat low-income patients at community health centers. The demonstration will be conducted by the Innovation Center for up to 500 FQHCs and provide patient-centered coordinated care for up to 195,000 Medicare beneficiaries.

A demonstration currently under development and slated to begin January 1, 2012 is referred to as the “Independence at Home Demonstration” was authorized by the Affordable Care Act. The demonstration will test a delivery model that uses physicians and nurse practitioners to direct primary care teams to help certain Medicare beneficiaries in their home.

Participating practices will be responsible for providing comprehensive, coordinated, continuous, and accessible care to high-need populations at home and coordinate their healthcare across all treatment settings. The practices must also report on the quality measures used to monitor and evaluate the demonstration by using electronic health systems. Practices may share in any savings under the demonstration program if they specifically provide quality measures and achieve savings.

A new State plan option to go into effect by January 1, 2011 required by Section 2703 of the Affordable Care Act will take place with patients enrolled in Medicaid with at least two chronic conditions will now be able to designate a provider as a “health home” provider to help coordinate their treatments. States that implement this option will receive enhanced financial resources from the Federal government to support “health homes” in their Medicaid programs.

Today, many state Medicaid programs have developed medical home models and can receive reimbursement. While many of these models are physician-based, there is a growing movement towards interdisciplinary team-based approaches. The Medicaid “health home” program will be funded 90 percent by the federal government for the first 2 years for each state program.

CMS has also announced quality bonus payments to be part of their three year demonstration for Medicare Advantage plans in 2012. All Medicare Advantage plans with a score of three stars or higher will qualify for a bonus payment and they if they earn the highest performance ratings then they are eligible to receive the largest bonuses of 5 percent.

Europe Boosts ICT Research

The European Commission released their “Call for Proposals” for Information and Communications Technology (ICT) research under the EU’s research framework programs. The “Call for Proposals” (FP-7 ICT-2011-7) published September 29, 2010, will allot $780 million to fund research and technological developments in networking, digital media, and service infrastructure.

Specifically, the goal is to advance research on future internet activities, robotics, smart and embedded systems, photonics, and to increase the use of health technology especially to help Europe’s aging society.

The research challenges focus on high-risk ICT collaborative research. In consumer markets, business growth is foreseen in the short to mid-term to provide new web and internet-based services to operate with the new generations of smart phones, networked sensors, and home personalized health systems.

Looking at the future of the internet in the short term, breakthroughs are expected from the integration of IP-based networking and by developing innovative internet-empowered applications. In the longer term, all-optical networks combined with wireless communication, sensor networks, autonomic network/service management capabilities, and security are expected to yield new network architectures and systems.

The European Commission published the ICT Work Program 2011-12 for FP-7 September 2010. The ICT Work Program document defines the priorities in the “Call for Proposals” for projects to be launched in the 2011-2012 period. These projects will start having an impact on markets in 5-10 years on the average.

The ICT Work Program document focuses on a limited set of challenges with mid-to-long term goals requiring trans-national collaboration. Each challenge addresses a limited set of objectives to form the basis for the “Call for Proposals” plus each challenge specifies outcomes targeted by the research to address the impact on industrial competitiveness and socio-economic goals.

The ICT Work Program is divided into eight challenges. Challenge 5 titled “ICT for Health, Aging Well, Inclusion and Governance” addresses advanced ICT research. The European population over 60 is increasing by about 2 million every year. ICTs are needed to create sustainable solutions and to maximize market opportunities to help reduce related social and healthcare costs.

Challenge 5 research objectives cover:

• Personal Health Research will help with disease management and target rehabilitation and treatment outside of hospitals and care centers so that care can be maintained at the point of need with a focus on specific diseases

• Virtual Physiological Human (VPH) research will focus on more elaborate and reusable multi-scale models and a VPH information infrastructure of larger repositories

• Patient Guidance Services will enable patients’ active participation in their care processes. A special emphasis will be given to semantic interoperability to be able to integrate patient information from multiple sources and locations and to enable secure access to personal health records

• ICT research to help the aging but well population and to develop services and social robotics in a highly intelligent environment

• ICT research to improve social computing and find advanced solutions for learning and skills acquisition as well as for Brain-Neural Computer Interfaces

• ICT research to find the solutions needed for governance and then model policies to deal with future scenarios.

Universities, research centers, SMEs, large companies, and other organizations in Europe and beyond are eligible to apply for project funding under ICT FP-7. Proposals are due by January 18, 2011.

The remaining calls for Proposals FP-8 and FP-9 are expected to be published later in 2011 and 2012. For more information, go to For the Work Program document, go to For contact points, go to

Avoiding Physician Payment Cuts

The Senate Finance Committee has jurisdiction over the Medicare program and the physician payment formula. Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA) introduced the “Physician Payment and Therapy Relief Act of 2010, to provide both a short term and a longer term solution to pay for the Medicare Physician Payment Formula.

The Senate passed the legislation to avoid the statutory cut in physician payments that were scheduled to go into effect on December 1, 2010. The Senate passed the bill on November 18th, and now the legislation must be passed by the House and signed into law by the President. This bill as it stands right now provides just a month long extension of the current levels of the Medicare payment formula.

However, the next step is to find a year extension solution before this fix or patch runs out. Both Senators Baucus and Grassley are going to work together to pursue a year-long fix to the formula. The Finance leaders are going to work to secure a mutually agreeable way to pay for the year long cost of the physician formula as well as other extenders, and they both feel confident that they will find the solution.

Iowa Plans for New MMIS

According to the Iowa Medicaid Enterprise (IME) newsletter “Endeavors Update”, the state is planning to procure a new Medicaid Management Information System (MMIS) early next year. Iowa Medicaid is the second largest healthcare payer in Iowa and is expected to serve 21 percent of the population in the state in FY 2012.

The current system is using a 1970s era mainframe, processing over 23 million medical claims for 656,000 Iowans, has a total budget of approximately $4.2 billion, supports services to 38,000 active healthcare providers, supports claims processing, provider network management, managed care operations, plus other functions.

The benefits of a new system would provide for:

• Real-time claim adjudication for providers so that they will be able to get immediate feedback on coverage
• Auditable claims so that every rule applied to the claim can be identified
• Expanded functionality of the providers website portals so that paperwork would be reduced
• Access to wellness information, personalized alerts, and reminders
• Improved security, better data, modeling and program integrity
• Rapid implementation of programs and decisions

The new MMIS will enable the state to be better positioned to meet and implement the state HIE requirements and to meet other federal mandates. As part of the procurement process, the Department of Health Services plans to release a draft version of the RFP for MMIS early next year for vendor review and comment. Also an Industry Day will be held at that time so that MMIS vendors will be able to interact with IME and discuss the intended procurement.

For more information, email

Wednesday, November 17, 2010

White House CTO is Optimistic

The White House Chief Technology Officer Aneesh Chopra Assistant to the President and Associate Director for Technology within the Office of Science & Technology Policy speaking at the mHealth Summit held in Washington D.C., emphasized how discussions with key technology leaders can move innovative ideas and products to the marketplace. Discussions on the power of cloud computing and how to proceed, how to open data to the public, and how to collaborate with the private sector on standards also needs to take place.

A few months ago, Chopra went on a trade mission to India, to discuss dozens of innovative ideas and how best to provide rural health services to villages that need not only better maternal care but also better healthcare, and how mobile technology will play an important role.

Chopra mentioned several innovative programs such as the Blue Button program recently initiated that enables veterans, military, and Medicare recipients with the click of a button to download their personal health and claims data. Today 100,000 downloads have been accomplished through the program.

The White House, HHS along with CTIA,-The Wireless Association, Voxiva, and Johnson & Johnson plus other private partners, played a key role in using innovation to make the “Text4baby” free service available to women who receive SMS text messages each week timed to their due date or their baby’s date of birth.

Aneesh Chopra, Todd Park, the Chief Technology Officer for HHS, and the National Healthy Mothers, Health Babies Coalition were extremely pleased to announce at the mHealth Summit, that a new multi-million dollar multi-year commitment from Johnson & Johnson will help many more new and underserved mothers get access to information on how to take care of their health and make it possible for the mothers to give their babies the best possible start in life. The goal is to serve at least one million mothers by 2012.

$34 Million to Fight HAIs

AHRQ awarded $34 million in contracts and grants to focus on Healthcare-Associated Infections (HAIs). AHRQ is collaborating with CDC, CMS, NIH, and the Office of Healthcare Quality to develop 22 projects to address research gaps and to accelerate the adoption of evidence-based approaches for HAI prevention.

Several of the projects being funded involve data systems. One project at Children’s Hospital of Philadelphia received grant funding for to improve the Pediatric Health Information System (PHI) that links laboratory results and radiology reports from member children’s hospitals along with administrative data.

The funding will use the PHIS+database to conduct four pediatric comparative effectiveness studies. The pediatric comparative effectiveness studies will:

• Compare the effectiveness of aminopenicillins, second-generation cephalosporinas, and macrolides in children hospitalized with community-acquired pheumonia
• Compare the effectiveness of fundoplication versus feeding via gastrojejunal tube for treatment of gastroesophageal reflux disease in neurologically impaired children
• Compare the effectiveness of monotherapy antibiotic regimens versus two or three-drug combinations of antibiotics in the initial post-operative treatment of children with advanced appendicitis
• Compare the effectiveness of antibiotics active against MRSA versus non-MRSA active antibiotics in the initial treatment of acute osteomyelitis.

Another project at Thomson Reuters will further develop the Healthcare Cost and Utilization Project (HCUP) data infrastructure to provide baseline estimate of HAIs in the ambulatory surgery setting. Implementation strategies aimed at decreasing the occurrence of HAIs in ambulatory surgery settings will also be evaluated.

The objective is to:

• Increase the ability to link patients across time and setting within HCUP databases
• Evaluate the feasibility of developing a national readmission data file to produce national estimates of readmissions to U.S. hospitals, including readmissions for HAIs
• Develop a national ambulatory surgery database
• Develop a toolkit for the states to add clinical data to administrative data with an emphasis placed on “present on admission” a critical data element to distinguish HAIs that develop during a hospitalization

Indiana University-Purdue University at Indianapolis will work on a project to build upon an existing health information exchange and to automate the processing of microbiology reports coming into the exchange that will identify patients with infections from multidrug resistant organisms. The project will also implement clinical decision support for HAIs caused by multidrug-resistant organisms.

For more information on the projects, go to or email James Cleeman, M.D., Senior Medical Officer, Center for Quality Improvement and Patient Safety, AHRQ, at

NIH Director Speaks at Summit

NIH’s mobile research program along with other major technology projects is rapidly growing, according to Francis S. Collins, M.D, PhD, Director of NIH, a keynote speaker at the mHealth Summit on November 8th, In FY 2009, $36 million was spent on researching telehealth capabilities and $36 million was allotted to mobile phone research.

He discussed how NIH’s Genes, Environment, and Health Initiative (GEI) at plays an important role in developing new technologies for bridging the knowledge gap between environmental exposures and human diseases.

The GEI Initiative in their Exposure Biology Program enables scientists, bioengineers, and others to work on innovative projects. For example, wearable chemical sensors are being used to determine personal chemical exposure with units designed to have extensive user interfaces and provide immediate feedback. The wearable sensor units are relatively non-obtrusive so that they can be used in vulnerable populations such as with children. Sensors were used in the Gulf Oil spill to map contaminants in the Gulf.

Tools are being developed to measure physical activity type, duration, and intensity using sensor-enabled mobile phones. The phone may provide real-time feedback of patterns of activity for the general population. The system uses video cameras microphones and GPS to capture videos and images.

In another project, GEI is working on a lens free microscope to use for surveillance to diagnose infectious diseases in resource-limited settings. Cell phones can transmit images and then computer software automatically is able to interpret the images from remote sites.

Researchers have developed technology to help HIV patients monitor the medications that need to take to treat HIV. Doctors are now able to monitor the patient’s medications in real-time to determine if their HIV patients are adhering to medications. This is simply done by using a pill holder that sends signals whenever the pill box is opened.

Director Spotlights Programs

As Director for AHRQ, Carolyn M. Clancy, M.D, told the attendees at the mHealth Summit about several programs making inroads to provide more effective healthcare. The agency is invested to making it possible for health and mobile technologies to reach all populations within hospitals, organizations, and universities to provide the right information at the right time.

Workshops have been held to discuss the challenges and what it takes to develop innovative ideas. For example, AHRQ and the National Science Foundation held a workshop to address the healthcare delivery system. Experts were asked to explore the critical areas of research involving not just healthcare issues but also to look at how both industrial systems engineering and healthcare research can play a supportive role in delivering health technology. A report was published and is available at

Dr. Clancy addressed the healthcare needs for ethnic populations and pointed out several successful programs operating in Colorado that are highly effective. She described how the “Salud Mobile Outreach Program” has reduced health disparities among Mexican immigrants, many of whom are poor, uninsured, and monolingual with limited education.

Mexican Americans are two times more likely to have diabetes and 50 percent more likely to die of the disease as compared to non-Hispanic whites. The popular program helps the Mexican immigrant population to cope with health problems.

To combat the health issues in the rural population, the Salud program sends out a mobile medical unit staffed by bilingual and bicultural medical personnel, outreach workers, and volunteers mostly so far in northern Colorado. The unit is equipped with three networked computers complete with wireless internet access plus other medical testing equipment.

Also in Colorado, Denver Health, a large integrated urban academic safety net institution has successfully integrated IT across their system. Approximately 70 percent of their patients are part of the ethnic minority population. The hospital has been specifically testing using text messaging with the elderly Hispanic population for the past two years to try to help the elderly population with chronic illnesses. This elderly population is amazingly enthusiastic about the program and the messaging program has an enormous impact on treating patients.

For the latest information on AHRQ innovations, go to

NIH Issues FOAs

NIH announced two companion Funding Opportunity Announcements (FOA) to encourage grant applicants to use funding to develop and evaluate systems capable of monitoring health, provide ways to enable clinical decisions, and develop ways to deliver therapies in a real-time. The FOAs are not only seeking ideas for technologies in general but also want to receive applications involving novel technologies to help individuals live independently especially Americans with chronic conditions.

Specifically, the FOAs are seeking technologies to enable the monitoring of personal motions, vital signs, and physiological measures so that there is minimal disruption to an individual’s daily routine but at all times to protect their privacy, dignity, and comfort.

These systems need to be able to integrate, process, analyze, communicate, and present data so that individuals are engaged and empowered in their own healthcare with reduced burden to care providers. The technologies will need to be interoperable with other home-based or mobile technologies and be able to communicate with existing health information technology systems.

In developing effective applications for home-based and mobile technologies, applicants need to provide solutions on how to help and increase adherence to rehabilitation and medical regimens, reduce incidence of avoidable post acute complications, and improve self-care management of chronic conditions.

Technologies designed for home and mobile monitoring will be able to capture rare, irregular, or transient events, symptoms that are difficult for a patient to report, and changes in conditions that evolve slowly over time.

Examples of some of the topics for this funding opportunity include but are not limited to:

• Monitoring devices or sensors to detect personal care needs or acute medical events
• Devices to ensure adherence to rehabilitation and medical regimens
• Real-time monitoring and management of chronic conditions
• Monitoring systems to detect progressive decline in physical and cognitive abilities
• Fall detection or prevention systems
• Technologies aimed at helping the caregiver or provider
• Research and development to improve human computer interfaces for home-use technologies

The FOAs (PAR-11-020 and PAR-11-021) were issued by several institutes to include NIBID, NIA, NICHD, NINR and the Office of Research on Women’s Health. Submissions are accepted throughout the year by specific dates. The first submission date is December 19, 2010.

For more information, go to and

Disability Process Speeds Up

The Social Security Administration has made their fast-track disability process operate even faster. SSA announced final rules in the Federal Register that are effective November 12th that will reduce the time it takes to make decisions on applications received for disability benefits from persons with even the most severe disabilities.

With the new fast-track disability process, help for the applicant now takes less than two weeks on the average. SSA Commissioner Michael J. Astrue, reports that this year more than 100,000 people benefited from the fast track disability process and received decisions in a matter of days rather than the months and years it can sometimes take.

The new rules allow disability examiners to make fully favorable determinations for adult cases under SSA’s “Quick Disability Determination” (QDD) and “Compassionate Allowance” (CAL) processes without medical or psychological consultant approval. It will also help SSA to process cases more efficiently as it will give medical and psychological consultants more time to work on complex cases where their expertise is most needed.

The QDD process, a predictive computer model analyzes specific data within the electronic disability file to identify cases where there is a high likelihood that the claimant is disabled and then SSA is able to quickly obtain medical evidence. The CAL process currently identifies 88 specific diseases and conditions that clearly qualify for Social Security and supplemental Security Income disability benefits and enables this information to be fast-tracked.

Sunday, November 14, 2010

Bill Gates Speaks on Global Health

Using mobile technology along with inexpensive diagnostic tools can help maintain good health globally but it is equally important to provide effective vaccines, reports Bill Gates Founder of Microsoft and Co-Chair and Trustee of the Bill & Melinda Gates Foundation. He made his remarks at the 2010 mHealth Summit keynote luncheon held on November 9th in Washington D.C.

He offers the premise that mobile phones and other technologies offer some big advantages in improving healthcare throughout the world. However, computing technology is especially valuable to the research side and contributes to the development of many of the new vaccines now on the market. As a result of the financial crises, some budgets have been cut affecting basic research so some vaccine research programs tend to be underfunded.

Gates wants to see great efforts made to keep the world’s population under control. If we look at countries with good health, they tend to have lower population growth rates resulting in more care given to individual children and therefore serious illnesses happen less frequently with fewer deaths resulting.

He also noted that since 1960, there has been a dramatic reduction in infant and child mortality as it went from 20 million to 8.5 million. Other factors besides population control contribute to the reduction in mortality in the world, such as having better food available, improved living conditions, somewhat better healthcare, but also helping is the fact that many people worldwide receive smallpox, polio, TB, and measles vaccinations.

Gates went on to discuss how improving global health can be as easy as using inexpensive tools such as cell phones to diagnose diseases. Just using a simple program to remind people to take medications on a regular basis is just one step needed to improve global health and vaccination programs. Another step would be to follow up on drugs given to patients to see if they are working effectively.

He also envisions the health community using the latest mobile technologies to obtain important information to make vaccination programs more effective. Mobile devices could be used to register births, obtain fingerprints for identification purposes, and find information on locations where people need vaccines. Healthcare workers would then have valuable information as to know exactly what areas and what groups of people are currently vaccinated or need vaccines for specific diseases.

Gates also believes that robots will take the lead in healthcare and will play a very strong role in the future. For example, robots could be used to move equipment around and help caregivers with such chores as lifting patients. One advantage is that robots will be able to work 24/7 without getting tired and the technological wonders will probably never forget how or when to do their specific chores.

As he explained, robots may even be able to help with maternal mortality especially in rural or slum areas in developing countries. C sections are needed in developing countries but the operations need to be done in a sterile environment with specific knowledge and expertise on hand provided by the health and medical community which is not always available. Gates pointed out that in some ways, it is a routine procedure. So perhaps, in the future, robots could even be used to perform C sections in isolated situations with doctors or healthcare workers overseeing the operation at a distance.

Gates told the attendees that the Foundation is very interested in expanding their philanthropy and he would like see a group of small exploration grants awarded in the range of $10,000 to find new ideas worldwide. On November 9th, the Bill and Melinda Gates Foundation awarded 65 grants through the “Grand Challenges Explorations” initiative with funding going to 16 countries for $100,000. The program is in place to enable investigators to pursue new bold ideas for transforming health.

Ideas currently being funded in the “Grand Challenges” initiative include studies on developing innovative vaccine strategies and doing a better job to deliver TB vaccinations, developing low-cost mobile phone tools to help identify complications for community health workers caring for pregnant women and newborns, and a project to develop solar powered therapeutic blankets of light for newborns suffering from jaundice.

In the previous five rounds of the Grand Challenges initiative, 405 researchers received awards representing 34 countries. Grants have been awarded to develop a synthetic lymph node to deliver vaccines, a low cost needle free treatment has been created for post-partum bleeding, and a mobile phone-based tool has been developed combining diagnostic testing.

For more information on the “Grand Challenges” initiative go to and for more information on the 2010 mHealth Summit, go to

Mobile Tech Saving Lives

Simple mobile technology, like basic cell phones can save the lives of mothers in childbirth and improve the care of newborns and children by reaching underserved populations in remote areas. Global public health sources estimate that between 342,000 to 550,000 women die during pregnancy and childbirth each year, and 3.7 million children die each year before they are 30 days old.

By using advanced mobile technologies, patients can be checked, better records can be maintained, better methods can be used to diagnose and treat mothers, newborns, and children in the field, and community health workers will be able to consult with general practitioners and specialists to obtain information and guidance.

Five years ago, the idea of using cell phones to improve healthcare for mothers, infants, and children wasn’t feasible. This has changed rapidly now since 70 percent of the world’s five billion cell phone subscribers are in the developing world, almost 90 percent of the world’s population has access to a wireless telephone signal, three quarters of mobile phone users have texting capability with features such as GPS, and by 2010, 60 percent of mobile phones are expected to be web-enabled.

“At the most basic level, mobile phones can be used to track people, call for emergency assistance, and provide appointment reminders, says Julian Schweitzer, PhD, former Chair of the Partnership for Maternal, Newborn & Child Care (PMNCH) and the Chair of the Finance Working Group for the UN Secretary-General’s Global Strategy for Women’s and Children’s Health launched in September.

However, infrastructure is still a problem in remote areas where transmission is often poor and is particularly difficult where midwives are needed the most. In addition, the lack of available data in the local language can also be a barrier.

As growth occurs, more than 100 countries are exploring ways to use mobile phones to improve health. A few of the current programs are:

• The Maternal mHealth Initiative, a partnership between PMNCH and the mHealth Alliance is going to conduct trials using an integrated information and communications technology system to underpin the full continuum of recommended care for expectant mothers and newborns

• The Earth Institute’s Millennium Villages Project is working with governments and ministries of health along with telecommunications companies like Ericsson, AirTel Bharti, and MTN in ten countries in Africa to design, test, and implement standardized and interoperable mHealth systems

• The University of Oslo’s Health Information Systems Program (HISP) is using basic cell phones to collect data on maternal and child health in an integrated manner in locations where there are no computers or access to the internet

• A pilot project in Aceh Besar, Indonesia provided a group of midwives mobile phones and documented their use and experiences. The midwives that were given the phones found them to be a basic necessity

PMNCH was formed to ensure that all countries meet the UN’s Millennium Development Goals (MDG) to improve the health of women and reduce the toll of infant and child deaths by 2015. MDGs 4 and 5 are of special concern which calls for reduced child and maternal mortality.

The most recent assessment notes that 49 of the 68 high-burden countries have made little, if any progress toward meeting goals 4 and 5 cautions Joan Dzenowagis, M.D., of the World Health Organization. Also, most pilot projects are designed as a single solution for a specific problem plus in the field different systems are used which results in a lack of coordination and leads to duplication of expense and effort.

State Issues RFP

The New Hampshire Insurance Department (NHID) in association with the New Hampshire Department of Health and Human Services (NHDHHS) received an award from the HHS Office of Consumer Information and Insurance Oversight to evaluate planning options needed to establish the Insurance Exchange in the state.

NHID issued an RFP on November 5th and plans to contract with one or more vendors to assistance in the planning efforts to establish the exchange. All proposals must be submitted by November 29, 2010 with the letter of intent submitted by November 24th 2010.

The Scope of Work for the project is divided into six segments:

• Segment 1—Overall planning and coordination
• Segment2—Research and analysis to identify development requirements
• Segment 3—Econometric and actuarial modeling and current insurance market study
• Segment 4—Stakeholder involvement and communication
• Segment 5—Program integration opportunities and strategies
• Segment 6—Information technology assessment and conceptual design

For Segment 6, the planning will be relative to the commercial insurance technical components of the exchange and the vendor needs to provide a web portal, provide system integration with the state plus other systems, provide for call center technology, provide enterprise content management to include imaging/scanning, a premium payments system, a master client index, and address security, fraud, and abuse.

The vendor or vendors selected may use subcontractors to deliver services. The project’s six segments may be bid on separately or all together.

For more information, go to and click on RFP 2010-HBE-1 or email Leslie Ludtke, Contract Administrator, NH Insurance Department at

Innovation Fund Launched

The California HealthCare Foundation (CHCF) has launched a $10 million investment fund for nonprofit organizations and for-profit companies to provide innovative services, devices, and technologies to significantly reduce costs and improve access to care in California.

Through the angel investment fund set up to ensure quality care for underserved populations, CHCF will be able to support a broad range of entrepreneurs with proven records for developing scalable sustainable businesses in the healthcare market.

The Fund will provide funding at all stages, with a primary focus on early development, including seed rounds as small as $50,000 to total investments of up to $3 million. In addition to providing capital, CHCF can help with regulatory and reimbursement strategies, provide insight into healthcare financing and operations, and connect companies to demonstration sites in the state.

CHCF will consider both non-profit and for profit organizations and companies that meet the criteria for the program. While CHCF funds very few unsolicited grant proposals, organizations that do not meet the criteria for program-related investments but are closely aligned with CHCF’s strategic priorities may be considered for a grant.

Projects must provide:

• Sustainable access to care for at least 100,000 people in the state over 3 to 5 years with the potential to reach one million people in the U.S.
• Savings resulting in annual savings of at least $25,000.000
• A strong case study for policy changes that will enable statewide or national adoption of products or services that can lower cost and or improve access to the medically underserved

For RFP requirements and instructions on how to apply go to

Diversinet Receives Army Contract

The Army has signed a 5 year deal with Toronto based Diversinet to use the company’s “MobiSecure Health” platform to expand the Army’s mCare Program following a successful one-year pilot program. The Army will now be able to track the progress of as many as 10,000 wounded warriors returning home or returning to community-based transition units following initial recuperation from TBI and other wounds in military medical facilities. As of November 5th, mCare has delivered over 43,000 messages to over 460 Warriors-in-Transition across 28 states.

mCare was developed by modifying commercial off-the-shelf technologies under the oversight of the Army’s Medical Research and Material Command’s and their Telemedicine and Advanced Technology Research Center (TATRC). The application was taken from concept to operations in less than 6 months and works on 270 different mobile device brands.

Specifically, Diversinet’s technology will ramp up mobile health communications services using:

• MobiSecure Wallet and Vault—The downloadable mobile application offers secure two-way communications so that critical personal information can be stored and accessed on mobile devices anytime/anywhere
• MobiSecure SMS—The product enables the mCare team to exchange sensitive information by using two-way text-based messaging via mobile devices with wounded warriors

“Helping the Army expand mCare from an extensive pilot to a formal program with a five year contract is very rewarding as it demonstrates our leadership in securing mobile healthcare applications under some of the toughest guidelines in the industry,” said Albert Wahbe, Diversinet’s Chairman and CEO.

For more information, go to

WWHI Releases Prototype

The West Wireless Health Institute (WWHI), a San Diego-based non-profit medical research organization, announced the development of their first engineering prototype called “Sense4Baby” ™. The device is a non invasive wireless device designed to measure fetal heart rates and uterine contractions and could made available to expectant mothers anywhere in the world, wherever cellular or internet service exists.

Such capabilities could significantly increase access to fetal and maternal monitoring via low cost wireless technologies and reduce the burden of care associated with high risk pregnancies. Women with high risk pregnancies require monitoring several times each week during the last months of pregnancy and in many areas of the world this is hard to do as distances may be great.
According to UNICEF, 80 percent of maternal deaths could be prevented if women had access to essential obstetric and basic healthcare services including monitoring technology.

According to WWHI, by using “Sense4Baby”, the prototype is able to integrate the functionality of the traditional cardiotocography which is the standard technology for measuring fetal heart rates and uterine contractions, with the Sense4Baby device so that data can be viewed and stored anywhere, interface with electronic medical records, and lastly, cost less for the end user to use.

According to Dr. Joseph Smith, Chief Medical and Science Officer, for WWHI, “Our engineering team integrated proven and low-cost technologies into a wireless prototype to potentially use in the home, hospital, or in ambulatory settings. Timely transmission and interpretation of fetal and maternal health data could significantly ease many of the burdens faced by high risk patients.”

“Sense4Baby” is an engineered prototype investigational device but is not yet available for commercial distribution or professional use. WWHI is presently exploring feasibility studies and trial opportunities in the U.S. and globally.

For more information, go to

Support for $3 Million Announced

Over 2,500 attendees from the U.S. and 48 other countries participated in the 2010 mHealth Summit presented by the Foundation for NIH in partnership with the mHealth Alliance and NIH on November 8-10 in Washington D.C. So far, the mHealth Alliance is working with diverse partners such as the Rockefeller Foundation, the United Nations Foundation, the Vodafone Foundation, GSM Association, HP, and the President’s Emergency Plan for AIDS Relief.

The Maternal mHealth Initiative a core project of the mHealth Alliance designs, develops, and delivers solutions to reduce maternal and infant mortality around the world through public-private partnerships and cross sector collaborations.

Speaking at the Summit, Dr. Judith Rodin, President of the Rockefeller Foundation, announced that the Foundation is providing a $1 million grant to go to the mHealth Alliance to support the core budget and activities of the mHealth Initiative including the Health UnBound online community and the Alliance-led Maternal mHealth Initiative.

She said “Innovations in mobile communications are unparalleled and may have limitless potential in overcoming persistent global health challenges. These innovations will only succeed if we create the networks and partnerships that allow us to bring them to scale and unlock their full potential.”

The Norwegian Agency for Development Cooperation announced that they are also providing $1 million to support the “Maternal mHealth Initiative”. As Co-Chair of the UN’s Innovation Working Group for the Global Strategy for Maternal Health, Norway was instrumental in identifying mHealth as a critical innovation to achieving UN Millennium Development Goals 4 and 5 concerning child and maternal mortality and health. The grant from Norway will also focus on undertaking a global inventory of current maternal and newborn mHealth projects and hopefully spark consensus discussions concerning model solutions.

In addition to the other organizations, HP announced a two year $1 million donation to help improve healthcare and health systems around the globe using mobile technology. David Aylward, Executive Director of the mHealth Alliance said “The financial, technical expertise, and project support provided by HP will help the mHealth Alliance expand partnerships, find solutions, and provide sustainable deployments of mobile technology globally.”

For more information, go to

Sunday, November 7, 2010

Telehealth Coverage Increased

CMS has finalized all of their proposed code additions pertaining to telehealth coverage for 2011 with changes going into effect January 1, 2011. The final rulemaking released on November 2, 2010 and due to be published in the Federal Register on November 29, 2010, presents the finalized CMS proposals relating to telehealth.

Proposed code additions for Telehealth payments will include:

• Individual and group Kidney Disease Education (KDE) services (HCPCS codes G04 and G0421) respectively
• Individual and group Diabetes Self-Management Training (DSMT) services with a minimum of one hour of in-person instruction to be furnished in the year following the initial DSMT service to ensure effective injection training (HCPCS codes G0108 and G0109) respectively
• Group Medical Nutrition Therapy (MNT) and Health and Behavior Assessment and Intervention (HBAI) services (CPT codes 97804 and 96153 and 96154) respectively
• Subsequent hospital care services with the limitation for the patient’s admitting practitioner of one telehealth visit every 3 days (CPT codes 99307, 99308, 99309, and 99310)
• Subsequent nursing facility care services with the limitation for the patient’s admitting practitioner of one telehealth visit every 30 days (CPT codes 99307, 99308, 99309, and 99310)

Also, CMS is adding individual and group KDE and DSMT, services, group MNT services, group HBAI services, and subsequent hospital care and nursing facility care services to the list of telehealth services for which payment will be made at the applicable PFS payment amount for practitioner services.

In addition, CMS has reordered the listing of services removed with initial and follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals and Skilled Nursing Facilities (SNF) in 410.78(b) because these are described by the more general term “professional consultation” included in the same section. Finally, CMS is continuing to specify that the physician visits required under 483.40(c) may not be furnished as telehealth services.

Originally, the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided from October 1, 2001 through December 31, 2002 was set at $20 for telehealth services but now the fee is set at $24.10.

Go to to see the final rulemaking and go to pages 486-526 to read the major section on telehealth.

Funding for Rural Areas

Funding for $6 million is available from the Golden LEAF Foundation and six other North Carolina partners to support the second year of the Rural Hope initiative. Rural Hope is designed to spur economic activity in the healthcare sector while improving the availability and quality of healthcare services in rural communities.

Under the initiative, grants and loans will assist in the construction and renovation of new or existing healthcare facilities and to purchase new equipment for existing or for new healthcare facilities. These projects include but are not limited to hospitals, urgent care centers, rural health clinics, hospices, elder care facilities, public health departments, free clinics, physicians, dentists, vision care specialists, and mental healthcare providers.

In addition to Golden LEAF, the North Carolina Rural Economic Development Center, USDA Rural Development, and the Appalachian Regional Commission will provide grants and loans for rural healthcare projects. Other key partners include the Kate B. Reynolds Charitable Trust, the North Carolina Office of Rural Health and Community Care, and the North Carolina Health and Wellness Trust Fund.

The partners are looking for projects that will:

• Leverage other funds
• Result in permanent full time jobs
• Serve populations in the tobacco-dependent, economically distressed areas or rural communities
• Serve unmet needs that are clearly identified in the community
• Contribute to the long-term sustainability of the healthcare facility

Eligible applicants must be governmental and 501© (3) nonprofit healthcare entities. Private health providers and for profit facilities wishing to apply must partner with a governmental unit in order to submit a pre-application.

The application process involves two steps. The first step is to submit a pre-application. All pre-applications must be received no later than Monday November 15. The second step will begin when members of the Rural Hope Funding Collaborative meet and review all completed pre-applications. Based on this review, competitive applicants will be invited by November 23, 2010 to submit an application and will need to submit a completed application by December 17, 2010.

The maximum amount likely to be awarded to any project is $500,000. The average grant however, is likely to be much lower and probably average around $170,000.

For more information, contact Terri Bryant Adou-Dy at or call (888) 684-8404.

Data Availability Improving

A new center called the National Resource for Network Biology (NRNB) based at the University of California in the San Diego School of Medicine will help clinicians analyze an ever growing wealth of complex biological data in order to apply that knowledge to real problems and diseases.

In recent years, the study of biological networks has exploded with scientists shifting much of their focus from single cells to complex systems and producing novel maps of interactive networks of genes and proteins that help define and describe functioning humans. But how do scientists deal with the exponential growth in the data that has resulted?

According to Trey Ideker Associate Professor of Bioengineering in the UC Jacobs School of Engineering, and Chief of the Division of Genetics at the School of Medicine and Principal Investigator of the new center, NRNB is part of the answer. The Center was funded by a five year $6.5 million grant from NIH’s National Center for Research Resources (NCRR) and is the only center of this type to be funded this year.

With support from NIH, the new center will enable researchers to use more and better tools to conduct advanced studies of biological systems that will result in sophisticated models of how human systems function or fail. This research will ultimately lead to new and improved treatments and therapies such as identifying disease biomarkers and molecular targets for potential drugs, being able to define genetic risk factors, plus decipher how individual or group social networks can affect the development and transmission of disease.

The program will have a balanced mix of software developers and bench biologists who know how to communicate with each other and with the greater community. Also the Center will join three other NCRR biomedical technology centers based at UC San Diego.

In another NIH effort, more than 2.5 million images and figures from medical and life sciences journals are now available at, a new resource for finding images in biomedical literature. The database was developed and will be maintained by NIH’s National Center for Biotechnology Information, a division of NLM.

The available images are expected to have a wide range of uses for a variety of user groups. These include the clinician looking for the visual representation of a disease or condition, the researcher searching for studies with certain types of analyses, the student seeking diagrams that elucidate complex processes such as DNA replication, the professional or educator looking for an image for a presentation, and the patient wanting to better understand their disease.

Studying Pain Treatments

Pain is the most common symptom leading patients to see a physician in the U.S., yet the most widely prescribed medications such as opioids and non-steroidal anti-inflammatory drugs have major drawbacks including the potential for misuse and adverse effects that limit long-term use.

In response to this public health need, FDA has signed a partnership agreement with the University of Rochester Medical Center with funding of $ 1 million to launch the “Analgesic Clinical Trial Innovations, Opportunities, and Networks” (ACTION) initiative.

In addition to the University of Rochester, researchers from associations, NIH, the U.S. Department of Veterans Affairs, patient advocacy organizations, and pharmaceutical companies are all going to participate in the FDA-University of Rochester Partnership.

The initiative is designed to streamline the discovery and development process for new pain-reducing drug products. This multi-year multi-phased initiative will address major gaps in scientific information that can slow down analgesic clinical trials and analgesic drug development.

“One of the issues with pain is that it cuts across so many specialties such as anesthesiologists, rheumatologists, emergency department physicians, and others that are all interested in pain”, said Denham Ward, M.D., PhD, Chair of the Department of Anesthesiology at the University of Rochester Medical Center.

In the U.S., there is a major lag in new treatments for pain but this is not due to a lack of potential medications. A multitude of studies testing experimental therapies have been conducted or are underway. The problem is that many trials fail because they are unable to show that a new medication provides greater pain relief than a placebo.

Although some drugs under investigation may have little or no effectiveness when it comes to minimizing pain, researchers believe other factors may play a role in the disappointing results of the many recent studies. The fact contributing to the problem is the way that pain clinical trials are designed and carried out may hinder or limit their ability to distinguish truly effective pain treatments from less effective treatments.

“Clinical trials come at a great cost, take substantial amount of time to carry out, and require significant effort from the patients who participate,” said Robert Dworkin, PhD, Professor in the Department of Anesthesiology and the Center for Human Experimental Therapeutics at the Medical Center and Director for the new FDA-university initiative. “We need to understand why so many pain studies have failed to show efficacy so we can make changes that will increase the likelihood that future studies will identify new treatment options for patients who are suffering”.

The partnership will analyze a wide range of clinical trials of treatments for acute and chronic pain and look specifically at the approach and procedures used in each trial. Researchers hope to identify problems or gaps in trial design and implementation and find ways to bridge these gaps to speed the development of new safe and effective medications.

According to Robert Dworkin PhD, Director of the ACTION Initiative, “An effective therapy may fail to show significant pain relief in a study because the optimal patients were not enrolled or the research design and methods had important limitations. There is a whole range of things that can lead to falsely negative study results, and the goal is to determine what they are and what can be done to modify them in future studies.”

ECRI Receives Contract

ECRI Institute, an independent non-profit doing research to find the best approaches to improving patient care has been awarded a multi-year contract from AHRQ to establish the first national Healthcare Horizon Scanning System. ECRI Institute selected three main subcontractors, the Lewin Group, Thompson Reuters Healthcare, and Mathematica as their three main subcontractors for the project.

The horizon scanning system will be in place to provide a comprehensive, systematic, transparent process for identifying, tracking, and monitoring new healthcare technologies, including drugs, medical devices, procedures, services, and care delivery innovations that could signal important changes in patient care, health outcomes, or the healthcare system. The scanning process will enable AHRQ to better allocate resources for patient-centered outcomes research, and be a better resource for the public.

AHRQ has identified fourteen high priority areas for horizon scanning and patient-centered outcomes research, including arthritis, cancer, cardiovascular diseases, dementia, depression, developmental delays, diabetes, functional limitation, infectious disease, obesity, peptic ulcer disease, pregnancy, pulmonary disease, and substance abuse.

“Every day we hear about new technologies that may lead to breakthroughs in medical science and patient care,” reports Karen Schoelles, MD, Project Director of the Healthcare Horizon Scanning system, and Director, for the ECRI Institute’s Evidence-based Practice Center. “Though this exciting new program, we will assist AHRQ in identifying those interventions that hold promise for addressing the agency’s priority health conditions.”

For more information, go to or contact the ECRI Institute by email at communications@erci.orf or call (610) 825-6000.

Monitoring Medications

According to a recent VA study, patients taking warfarin, a widely used blood-thinning pill requiring careful dose monitoring produces similar outcomes whether the individual comes to a clinic or uses a self-testing device at home. The study involving nearly 3,000 veterans was sponsored by the VA’s Office of Research and Development in their Cooperative Studies Program. The findings published in the October 21, 2010 issue of the “New England Journal of Medicine” is good news for heart patients who live a distance from clinics or are homebound.

Traditionally, doctors, pharmacists, and nurses monitor patients who are taking warfarin, sold as Coumadin, over several clinic visits. They test how fast the blood clots and then the dose is adjusted accordingly. If the dose is too low, then the medication will not prevent blood clots and perhaps these clots will block the blood flow to the heart, brain or other areas of the body. Too high a dose can lead to dangerous internal bleeding.

Patients now have the option of tracking their own blood response at home, using blood analyzers known as International Normalized Ratio (INR) monitors. Patients do a finger stick where they apply a small amount of blood to a test strip and then feed the strip into the device. Patients can then call in the results to their provider and get advice on dose adjustments without coming to the clinic. In some cases, they can even set the proper dose of warfarin on their own.

The authors of the study expected home monitoring to work better than clinic monitoring, partly because self-testing can be done at home more frequently on a weekly basis as compared with the typical monthly schedule of the best clinic-based monitoring. As a result, off-target INR values can be adjusted more regularly and more quickly.

However, the VA study found little difference between weekly self-testing and monthly testing by clinic-based care teams in the measured outcomes, which are strokes, major bleeding incidents, and death.

The study did find that the self-testing at home may offer advantages in other ways. The self- testing moderately boosted the patients’ satisfaction with the medication and slightly increased the length of time that they were in the appropriate dose range. The main message of the study is that patients who are systematically monitored by whatever means are likely to have good outcomes.

Wednesday, November 3, 2010

VA Developing New Technology

Veterans Administration, scientists and engineers at the Advanced Platform Technology (APT) Center located at the Louis Stokes VA in Cleveland are developing emerging technologies for use by veterans with disabilities The research efforts include everything from smart electrodes to electronic bandages.

Researchers are testing electrodes implanted in the brain to see if they are able to pick up signals that can be changed into commands for computers or robotic limbs. Electrodes like this already exist, but they have limitations since the electrodes are made of stiff silicon and as a result, they don’t fit well in the watery environment of the brain.

The APT Center created a material that softens once inside the brain rendering it mechanically invisible as reported in the publication “Science” in 2007”. Today, APT Director of Research and Scientific Affairs, Christian Zorman, PhD, and others are working on incorporating the new material into a device that can record neural activity or stimulate nerves.

Zorman reports “If we can perfect the design, we hope to be able to mass produce the implant at a low cost. However, miniaturization is very important so that surgeons can implant many of the implants and not just a few”. A prototype electrode is in preclinical testing.

Another early-stage project involving the brain is a wireless system for recording brain waves. In some people with epilepsy, brain tumors, or brain injuries, neurologists are able to pinpoint the damage by placing a grid of electrodes on the brain and then reading the resulting waves. Researchers want to make it possible to record brainwave information wirelessly without exposing the brain or the need to run wires to provide continuous long term data on what is going on in the brain. It could also improve patient selection for surgery and surgical accuracy.

Electrodes are helpful but cumbersome when used for wound healing. For slow healing wounds, the standard of care involves applying low-intensity current to the area. This is inconvenient, since patients must receive treatment in a hospital and placing the electrodes on fragile skin can be difficult.

APT engineers are working on an electronic bandage. Their goal is to combine the electrical current with a bandage and make disposable. The bandage would apply current through the wound until the battery wore down and then at that time, the bandage would be thrown out and replaced.

The development of this bandage could possibly be tweaked into a wireless patch for pain control. Right now, Transcutaneous Electrical Nerve Stimulation (TENS) is used to treat chronic pain, but portable units have electrodes and wires that keep the system and the patient homebound. If wireless technology is used, a patient could have mobility and the physician would be able to change the type and pattern of electrical stimulation with just a phone call.

Today full leg braces are designed to help paraplegics stand and walk in a straight line over a level surface. The center’s biomedical engineers are working with a robotics laboratory at Case Western Reserve University to develop a more dynamic brace.

The engineers are working on ankle, knee, and hip joints that can be locked and unlocked using a small wearable computer. The engineers are also working on hydraulics that can slowly release the knee joint, lock one hip, unlock the other hip, and flex the knee slowly. This enables stairs to become possible. The brace also uses electrical stimulation to excite paralyzed muscles so that movement is possible.

According to Rudi Kobetic, co-investigator, the brace is still too heavy and needs to be refined. APT researchers hope that the brace will be ready for technology transfer and eventually FDA approval, so that it will become an option for veterans and other individuals who are paralyzed due to spinal cord injury or disease.

Improving State Medicaid Systems

Several states involved in planning for the Replacement of their Medicaid Management Information Systems (R-MMIS) are involved in several tasks. Some states are looking at vendor product demonstrations, requesting information on requirements to appear in future RFPs, and some states have issued the R-MMIS RFP. In developing the R-MMIS, the states are discussing state and system needs in order to prepare an accurate RFP that meets the vision of each individual state involved in R-MMIS.

New Jersey has plans to replace their existing Medicaid Management Information System (MMIS). The State of New Jersey’s Division of Medical Assistance and Health Services (DMAHS) on September 13, 2010 extended an offer to vendors to demonstrate product solutions on October 12-18 before state officials in preparation for the potential release of a future RFP.

The DMAHS held the event to gather product solutions from as many vendors as possible demonstrating a complete MMIS solution or solutions with select capabilities such as Pharmacy Benefit Management, Benefit Plan Management, Third Party Liability, Care Management, or Surveillance and Utilization Review.

The state of Louisiana’s Department of Health and Hospitals on September 22, 2010 issued three Requests for Information (RFI) to help develop requirements for a proposal solicitation to find ways to replace the current MMIS. It is anticipated that in the future there will be one solicitation or RFP issued for an all inclusive Enterprise MMIS. The closing date for the RFIs was October 6, 2010.

The South Carolina Department of Health and Human Services (SCDHHS) issued a notification updating the “Replacement Medicaid Management Information System (MMIS) project. The notification was released to provide preliminary information to vendors but SCDHHS is not seeking proposals at this time.

The state plans to award a single contract to a vendor possibly with subcontractors or partners to replace the current system. Awarding a single contract will shift more work to the vendor and as a result, produce a smaller state team. Also, the state’s goal is to minimize new software development by basing systems on government or commercial off the shelf applications.

The New York Department’s Office of Health Insurance Programs (OHIP) is responsible for administering a wide variety of public health insurance programs including Medicaid and plans to replace their MMIS. An RFP to replace the MMIS was issued in June 2010, and the State received proposals by October 29, 2010. The Department envisions multiple overlapping phases including project planning, implementation, certification, and system and operational enhancements.

According to the Missouri State Medicaid Health Information draft plan released on October 5th, Missouri’s current MMIS system is a legacy mainframe system. Right now, the system is undergoing enhancements and reengineering to improve flexibility, extensibility, and interoperability, as well as support the Missouri Clinical Management Services, Pharmacy (CMSP), and the Prior Authorization System.

CMSP is an extension of the MMIS similar to a data warehouse. It is a web-based HIPAA-compliant data repository supported by tools and applications that enable health care providers to access patient data from MO HealthNet, DSS, DHSS, and DMH. The system enables providers to view a participant’s claim history, prior authorization, some laboratory data, and early and periodic screening, diagnosis, and treatment services.

The Utah Department of Health sent a letter dated September 30, 2010 to the Office of the Legislative Fiscal Analyst in the Capitol referencing the project schedule for their replacement of their Medicaid Management Information System. The individual components going into the MMIS replacement includes a pre-payment editing system, a fraud and abuse detection system, and a point of sale and drug rebate system.

Smart Phones for Mental Health

DOD has made a free smart phone mobile application available to help service members, veterans, and family members track their emotional health. DOD developed the application referred to as “T2 MoodTracker” at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in their National Center for Telehealth and Technology.

The application lets users monitor emotional experiences associated with common deployment related behavioral health issues such as post traumatic stress, brain injury, life stress, depression and anxiety, plus users can add other issues that they would like to monitor.

Each issue has a set of ten descriptions called affective anchors, or feeling anchors, that let users focus in on exactly how their specific issues are making them feel. For example, within the depression description, the rating screen shows a set of ten anchors.

Suppose someone is depressed but yet sometimes happy, others might feel worthless yet sometimes valuable, others tired yet at times energetic, and lonely but yet involved. The user then would move a slider to indicate where on that scale they fit. The application also lets users make notes about special circumstances for any given day or rating.

The application tracks user inputs which makes it possible for users to go to a graph and look up their ratings in a particular area. For instance, if depression is the problem, then the user will see a graph of all their depression ratings for as long as the user has been monitoring depression. Application users can use the results as a self-help tool or share the results with a therapist or healthcare professional to provide a record of their emotional experiences over time.

So far, more than 5,000 people have downloaded the application in just over a month and have recorded more than 8,000 sessions and the application is used on every continent except for Antarctica. The T2MoodTracker application is available for smart phones using Google’s Android operating system and there are plans for the application to be available for iPhone users early in 2011.

Controlling Visual Images

It may be possible someday for the Touchpad to be the Thought-Pad. New research at NIH shows that it is possible to manipulate complex visual images on a computer screen using only the mind. A study published in “Nature” found that when research subjects had their brains connected to a computer displaying two merged images, they could force the computer to display one of the images and discard the other. The signals transmitted from each subject’s brain to the computer were derived from just a handful of brain cells.

“The subjects were able to use their thoughts to override the images they saw on the computer screen”, said the study’s lead author, Itzhak Fried, M.D., PhD, a Professor of Neurosurgery at the University of California, Los Angeles.

The study shows progress in developing Brain-Computer Interfaces (BCI) devices allowing people to control computers or other devices with their thoughts. BCIs hold promise for helping paralyzed individuals to communicate or control prosthetic limbs. In the study, BCI technology was tested mostly as a tool to understand how the brain processes information and especially understand how thoughts and decisions are shaped by the collective activity of single brain cells.

The study involved 12 people with epilepsy who had fine wires implanted in their brains to record seizure activity to locate areas of the brain responsible for seizures. While the recordings from their brains were transmitted to a computer, the research subjects viewed two pictures superimposed on a computer screen, each picture showing a familiar object, place, animal, or person.

They were told to select one image as a target and to focus their thoughts on it until that image was fully visible and the other image faded away. The monitor was updated every one tenth of one second based on the input from the brain recordings. As a group, the subjects attempted this game nearly 900 times in total, and were able to force the monitor to display the target image in 70 percent of these attempts.

The brain recordings and the input to the computer were based on the activity of just four cells in the temporal lobe. Dr. Fried’s team first identified four brain cells with preferences for celebrities or familiar objects, animals, or landmarks, and then targeted the recording electrodes to those cells. The team found that when the subjects played the image switching game, their success appeared to depend on their ability to power up cells that preferred the target image and suppress cells that preferred the non-target image.

“This is a novel use of brain computer interface to explore how the brain directs attention and makes choices. The remarkable aspects of this study are that we can concentrate our attention to make a choice by modulating a few brain cells and control those cells very quickly,” said Debra Babcock, M.D., PhD, a Program Director at the National Institute of Neurological Disorders and Stroke that partly funded the study along with the National Institute of Mental Health.