Sunday, December 19, 2010

Chronic Care Issues on the Rise

More than a quarter of Americans and two out of three older Americans have multiple chronic conditions with treatments accounting for 66 percents of the country’s healthcare budget. These numbers are expected to rise as the number older citizens rise in future years. As a result of these statistics, HHS has just issued their new “Strategic Framework on Multiple Chronic Conditions” a private-public sector collaborative venture.

Many initiatives, grants, and other actions are being taken at HHS to help improve health outcomes for patients with multiple chronic conditions. For example, AHRQ recently awarded more than $18 million in two grant categories. One grant program focuses on the research infrastructure needed to address the problem. The second grant program will compare how different strategies could be used to prevent and manage chronic illnesses with specific co-occurring conditions.

The HHS Administration on Aging and CMS jointly awarded $67 million in grants to support outreach activities to provide education, counseling, and assistance programs, plus funding was awarded to develop care transition programs to help improve health outcomes.

The HHS Assistant Secretary for Planning and Evaluation (ASPE) with funding obtained from an existing $40 million ASPE contract, awarded the National Quality Forum funds to develop and endorse a performance measurement framework for patients with multiple chronic conditions.

Both the FDA and ASPE are studying the extent to which individuals with multiple chronic conditions are being included or excluded from clinical trials for new therapeutic products and particularly from trials that are used as the regulatory basis for ensuring the delivery of safe and effective drugs for this specific population.

NIH is adding an older adult population to its original “Systolic Blood Pressure Intervention Trial” to determine whether obtaining a lower blood pressure range in the older population will reduce cardiovascular and kidney diseases, age-related cognitive decline, and dementia. For this project, NIH has committed $42.8 million to study these health issues.

The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $34 million in new funding to support the “Primary and Behavioral Healthcare Integration Program” (PBHCI) to promote the integration of care with people with co-occurring chronic conditions.

The funding is going to build partnerships and the infrastructure necessary for grantees to develop or expand their primary healthcare services with an emphasis on people with behavioral health problems. The “Center for Integrated Health Solution” funded by both SAMHSA and HRSA will provide training and technical assistance on the bidirectional integration of primary and behavioral healthcare.

American Indians and Alaska Natives are disproportionately affected by multiple chronic conditions and so the Indian Health Service has recently expanded their “Improving Patient Care Program” (IPC) to 100 sites across the IHS tribal and urban Indian Health system. The IPC program implements the patient-centered medical home model by developing training care teams, redesigning the health system, promoting self-care management, integrating behavioral healthcare into primary care, and improving the use of health technology.

CDC is supporting a new project “Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life”. This project with CDC funding will enable the Institute of Medicine to form a committee to examine the ongoing burden of multiple chronic conditions and what this means for possible population-based public health actions.

CDC has also funded a project to examine the impact of cognitive impairment on co-occurring chronic conditions. The project awarded to the University of Washington will be done with CDC’s “Health Aging Research Network”, to gather information to assist public health practitioners at local, state, and national levels in understanding the effects of cognitive impairment on chronic conditions. This will help researchers learn how to better design and how to better deliver evidence-based programs in spite of the increasing rates of cognitive impairment.

State Health Plan Released

“Healthiest Wisconsin 2020: Everyone Living Better, Longer” is a bold vision reflecting the plan’s goals—to improve health across the life span and eliminate health disparities. The state Department of Health Services is required by legislation to produce a public health agenda for the state at least every ten years.

The document is not only a state health plan but also an ongoing process using science, quality improvement, partnerships, and large-scale community engagement. More than 1,500 people advised, created, and helped to develop the plan.

The plan identifies 23 focus areas to be addressed by public health systems and state communities in the next decade. There are 9 infrastructure focus areas and 12 health focus areas. The infrastructure focus area “Systems to Manage and Share Health Information and Knowledge” discusses present HIT activities and future objectives.

This focus area reports that the state has many health information technologies in place or coming online shortly. The plan emphasizes the need to improve systems that support health, such as research, health literacy, sustainable funding, partnerships and information systems.

However, while progress has been made, there still remains a great deal to be accomplished before Wisconsin has an integrated electronic public health infrastructure capable of delivering statewide and community level data.

According to the plan, Wisconsin has made headway in implementing health information technology and so far has:

• Implemented data systems to support immunizations, vital records, communicable disease surveillance, electronic laboratory reporting, business intelligence, maternal and child health, environmental tracking, and the Women, Infants and Children Program

• Provides hospital admission, discharge, and transfer data for monitoring emerging health threats in southeast Wisconsin and then sent to state and local health departments through the Wisconsin Health Information Exchange

• Made available statewide healthcare claims with data spanning multiple systems and settings available to state and local health departments through the Wisconsin Health Information Organization

However, according to the report, in spite of the progress, funding to support the major public health data systems, is uncertain from year to year and often has to meet specific program objectives set by federal government agencies. So therefore, public health departments often have little discretion on which information technology initiatives to pursue.

Also specific programs often have access to good quality data about their activities but this is not universally true. Complicated data-use agreements often pose barriers to data access and integration and sometimes, the data many not be complete.

In other cases, the data in a given system can be of high quality and value to many program areas, but unavailable because of technical and/or programmatic limitations. As a result programs have difficulty developing a comprehensive picture of a given client or population group.

The state is striving by 2020 to have:

• Efficient, appropriate, and secure flow of electronic information among health information systems
• Access to a nationally certified electronic health record systems and health IT exchange available to all health consumers, providers, and public health officials
• Electronic health information systems to collect comparable data to allow for the measurement of the magnitude and trends of disparities in health outcomes

To view the report, go to or for questions, email Margaret Schmelzer, State Health Plan Director at

VISN 6 Advancing Telehealth

The Veterans Health Administration’s VISN 6 has initiated a telehealth program called “Tele-Move” to provide support in weight loss and help to maintain healthy living for veterans. While the program is available for both men and women, “Tele-Move” targets women that are pre-diabetic and have started to have health problems.

According to Mary Foster, the VISN Telehealth Director and Dr. Katherine Gianola, Health Informatics and Telehealth Chief at Richmond, the program is designed to work with veterans with a body mass index greater than 30 who want help managing their weight.

The program provides ongoing communication and support to provide guidance for healthy lifestyle changes regarding physical activity, healthy eating, and necessary behavioral changes. The program helps to identify issues that might affect weight management. It also provides encouragement through ongoing contacts to help work towards increased veteran satisfaction. Studies show the weekly average weight loss for the veterans is one-half to two pounds.

Also, the VISN is using telehealth to treat a variety of other health issues ranging from high blood pressure, polytrauma, severe cases of spinal cord injuries, tobacco cessation, substance abuse, schizophrenia, bipolar disorders, PTSD, and traumatic brain injuries.

Telehealth is also assisting with chronic disease management as in the case of congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other health issues requiring a high need for monitoring. In addition, teleretinal imaging, the most robust telehealth program in VISN 6 is expanding to all the VISN’s CBOCs in 2011.

One of the newest uses for telehealth is the development of the tele-audiology program recently initiated in the VISN. The program is now being piloted between the Durham VAMC and the Greenville CBOC. The goal is to provide audiometric assessment and hearing aid fitting and adjustment for patients at the Greenville Clinic through a computer connection to a specialist at Durham.

Foster is excited about the increased funding the telehealth program is due to receive as it will make it possible for more veterans especially in rural and remote areas to receive convenient care. Additionally, the VISN will now be able to increase the staffing of telehealth coordinators at seven medical centers in 2011 and enable 1,050 new patients to be treated. There are even more plans for telehealth capability to increase as the program completes the installation of a system with capacity to handle cell phone transmission securely.

State Medicaid Releases RFP

Alabama operates a statewide “Primary Care Case Management” (PCCM) managed care program to help Medicaid recipients. PCCM’s Patient 1st Program provides a medical home. This means that patients are assigned to a Primary Medical Provider (PMP) who is responsible for providing directly or by referral necessary medical care.

Through Patient 1st, providers have access to two patient management tools that includes in-home monitoring and an electronic health record called the “QTool”, which was developed via a Medicaid transformation grant. The monitoring program enables a patient to record certain vital signs and/or test results at home and then transmit this data to a central repository to enable the PMP to monitor the patient’s condition.

Beginning May 2011, Alabama will implement an enhanced PCCM program building on the existing infrastructure. This will be accomplished by establishing regional networks within local systems of care. The plan is to achieve long-term quality, reduce costs, and improve access for Medicaid recipients.

The state will continue to operate the original PCCM program, but primary care providers in select areas of the state will now have an opportunity to become members of a regional network referred to as the “Patient Care Networks of Alabama” (PCNA). Initially, the regional networks will be in pilot counties covering 60,000 patients.

At this time, the Alabama Medicaid Agency has issued a Request for Proposal seeking respondents to establish the pilot regional networks in Area 1 (Tuscaloosa, Fayette, Pickens, Greene, Hale, Bibb), Area 2 (Lee, Chambers, Tallapoosa, Macon), and Area 3 (Limestone, Madison).

The intent of the RFP is for the contractor to provide case management services to the new networks in addition to providing existing care management. Traditional case management for the PCCM program is currently provided through a contract with the Alabama Department of Public Health (ADPH), so the contractor will also be required to provide case management services to the services provided by ADPH.

The contractor must operate as a 501(c) (3) non-profit entity with an office located in each pilot area. It is also a requirement to establish and maintain a board that represents the spectrum of network participants.

The PCNA Program will address:

• The use of information technology resources by participants and providers
• Treatment regimens for chronic illnesses to better conform to evidence-based guidelines
• Behavioral changes and self-care strategies developed in a more holistic way to plan for care
• Consumers care and see if any changes are needed for treatments
• Quality of care and how to improve health outcomes
• Reducing inappropriate use and costs associated with emergency departments and hospital inpatient services
• Population health management and how to perform systematic data analysis

The RFP (2010-PCNA-01) was issued December 1, 2010. A mandatory vendor conference will be held January 10, 2011, with the proposals due at several times. Proposals for Area 1 are due January 31, 2011, Areas 2 and 3 due by February 25, 2011.

For more information, go to, go to Patient Care Networks of Alabama, then go to Request for Proposal for Patient Care Network of Alabama, or for other details, contact Kathy Hall, Project Director, at (334) 242-5007 or by email at

Reducing Infection Rates

All three medical centers in the University of Washington Medicine Health System have reported significant improvement in addressing healthcare-associated infections in their medical centers. They have implemented a “secret observation” program to observe hand hygiene practices and then a report is provided to each patient care unit and department about how they fared.

The Harborview Medical Center achieved a 50 percent decrease in the number of patients with hospital-acquired MRSA and ventilator-associated pneumonia between 2007 and 2009. That drop occurred despite having a patient population that is uniquely prone to such infections.

Northwest Hospital and Medical Center has had three central line-associated infections in the intensive care unit over the last four and one-half years, a figure that ranks well when compared with the average benchmark for similar units.

A year ago, the UW Medical Center set a goal to reduce healthcare-associated infections by 50 percent. The medical center recently reported a 46 percent reduction in central line infections which is a few percentage points short of reaching its goal. Hand hygiene efforts, audited by observations are near perfect at UW Medical Center. The compliance rate for 1,009 observations of nurses, medical and health assistants in June 2010 was 100 percent. Overall compliance for 1,866 observations was 99 percent.

One coordinated step UW Medicine has taken to wipe out central line infections is to implement a standardized education and training program for placing central line catheters. If their training is not complete, physicians are not allowed to perform the procedure.

Examining HIT's Role

Dr. David Blumenthal, the National Coordinator for Health IT will keynote eHealth Initiative’s Annual Conference on January 19-20, 2011 in Washington D.C at the Omni Shoreham Hotel. Other keynoters ABC Congressional Correspondent Cokie Roberts and eHealth Initiative CEO Jennifer Covich Bordenick will join Dr. Blumenthal.

The conference “eHealth: Turning Policy into Action” will bring together influential policymakers, medical experts, and information technology providers to help attendees understand how HIT is improving the quality, safety and efficiency of healthcare.

Key topics to be covered include health information technology’s role in healthcare reform, meaningful use, accountable care organizations and care coordination, and the use of data to support quality improvement in healthcare.

A special session on “Health IT Coordination: Progress and Barriers at the State Level” supported by Medicity will highlight the coordination challenges facing states.

Guest speakers will include:

• Doug Dietzman, Executive Director, Michigan Health Connect
• Gina Bianco Perez, Executive Director, Delaware Health Information Network
• Liza Fox-Wylie, Policy Director, Colorado Regional Health Information Organization
• Tom Liddell, Executive Director, Michiana Health Information Network
• John K. Evans, President, S2A Consulting
• Vikas Khosla, President and CEO, BluePrint Healthcare IT, NJ HIN Privacy and Security Committee.

Another vital panel featuring “Care Coordination in the Age of Health Reform” supported by PriceWaterhouseCoopers, will highlight how cutting-edge organizations in the midst of creating accountable care organizations are dealing with the transition of care.

Guest speakers will include:

• Robert Fortini, MD, Chief Clinical Officer, Bon Secours Medical Group
• Bruce Hamory MD, Executive Vice President, Chief Research Officer, Geisinger Health System
• Charles Kennedy, MD, Vice President for Health Information Technology, WellPoint

For more information, go to

Wednesday, December 15, 2010

ONC Requests Comments

The Office of the National Coordinator for HIT is requesting feedback on the President’s Council of Advisors on Science and Technology (PCAST) new report “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward.”

PCAST is an advisory group administered by OSTP with leading scientists and engineers directly advising the President and the Executive Office of the President. The Office of the National Coordinator is looking for specific public comments on the report’s vision and recommendations.

ONC seeks comments on these questions, but all comments on the PCAST report are welcome:

• What standards, implementation specifications, certification criteria, and certification process for EHR technology and other HIT is required? On this topic, should ONC establish minimal standards for the metadata associated with tagged data elements? Should ONC facilitate the rapid mapping of existing semantic taxonomies into tagged data elements? Should certification of EHR technology and other HIT focus on interoperability?

• What processes and approaches would facilitate rapid development for certification criteria and processes?

• Given current IT architectures and enterprises, what challenges will the industry face with respect to transitioning to the approach discussed in the PCAST report? Given current provider workflows, what are some challenges to populating the metadata that may be necessary to implement the approach discussed in the report? Alternatively, what are proposed solutions, or best practices from other industries that could be leveraged to expedite these transitions?

• What technological developments and policy actions are required to assure the privacy and security of health data in a national infrastructure for HIT that embodies the PCAST vision?

• How might a system of Data Element Access Services (DEAS) be established and what role should the federal government assume in the oversight and/or governance of such a system

• How might ONC best integrate the changes envisioned by the report into its work in preparation for Stage 2 of “Meaningful use”?

• What are the implications of the report on HIT program and activities specifically on HIEs and on Federal agency actions?

• Are there lessons to be learned regarding metadata tagging in other industries?

• Are there lessons learned from any initiatives to be able to establish information sharing languages?

The comments must be received by 5 pm on January 17, 2011 and send to For more details, go to the December 10th Federal Register at

Border Communities Use Telehealth

The communities along the U.S. Mexico border are referred to as the Texas “colonias” which means communities in Spanish. Colonias are not only in Texas but also in New Mexico, Arizona, and California but Texas has the largest number of colonias.

These communities are unincorporated isolated subdivisions along the border and are characterized by substandard housing, inadequate plumbing and sewage disposal systems, and inadequate access to clean water. These conditions provide immediate health threats.

The Texas Department of Health’s data shows that hepatitis A, cholera, tuberculosis and other diseases occur at much higher rates in colonias than in Texas as a whole. For example, tuberculosis occurs almost twice as frequently along the border than in the rest of the state.

The lack of medical services compound health problems and with a shortage of primary care providers, residents have to travel long distances to healthcare facilities. If they go to distance facilities, they fear losing wages for time spent away from work, find healthcare facility hours inconvenient, find a lack of healthcare programs, and many residents do not have health insurance. As a result, many healthcare problems go unreported and untreated.

Since many border area colonias and communities do not have sufficient population to support a physician, these areas can easily be networked using health technologies. Texas Tech is successfully using telemedicine to link clinics in several rural communities and colonias to the Texas Tech University Health Science Center at the El Paso campus. Also, the university is able to provide diabetes education by electronically communicating to the high-risk areas.

In addition, the Colonias telehealth program is helping to improve access to health and dental services by providing health and dental education via mobile medical units. The University of Texas Health Science Center at Houston (UTHSC-H) has been operating a mobile medical clinic for the last 16 years in Hidalgo County. Physicians from the Department of Pediatrics and the Department of Internal Medicine provide colonias patient teleconsultations.

Today, the Texas Department of Health staffed with personnel from UTHSC-H, UTHSC-San Antonio, and the Texas A&M Health Science Center use mobile medical vans to conduct telehealth operations in the valley. The vans are equipped with an exam room, laboratory, blood collection station, health education room, and patient intake area.

Each mobile medical van provides these services:

• Primary healthcare
• Diabetic screening
• Immunizations
• Dental exams and panarex x-rays
• General health screening
• Eye exams
• Health and dental education

The Texas State Energy Conservation Office (SECO) provides funds to operate the vehicles and also to provide a telecommunications link via a satellite connection for telehealth and distance learning. The satellite communications increases the area in which the van is able to communicate and conduct telemedicine activities.

Also, the Rio Grande Valley’s first school-based telemedicine clinic was established at the colonia school, Cantu Elementary with funding from the Cullen Foundation. In addition through more foundation funding, more telemedicine equipment was installed in three additional colonia schools in Hidalgo and Cameron counties. Using telemedicine, healthcare personnel and patients are able to communicate directly to UTHSC-H.

In addition the University of Texas has developed low literacy health promotion brochures in Spanish and English on the topics of anemia and menopause. These brochures are being distributed to the clinics and hospitals throughout the Texas Mexico Border region to provide patient education in areas that previously had a major chasm in health promotional materials in Spanish.

Army Improving Systems

Army researchers are integrating command, control, communications, computers, intelligence, surveillance and reconnaissance capabilities into the early stages of research and development. The research is ongoing at the U.S. Army Research, Development and Engineering Command’s Communications-Electronics Center (CERDEC) at Fort Monmouth N.J.

The CERDEC is working with new capabilities such as sensors, digital technology, applications and data systems. According to David Jimenez, Associate Director of Systems Engineering at CERDEC, the Army network of the future will be a system of systems so it is vital that capabilities and devices be integrated and assessed early in their development to see how they will perform together, rather than waiting until they are fielded.

Jason Sypniewski, Chief for CERDEC’s Command, Control, Communications, Computers, Intelligence, Surveillance and Reconnaissance (C4ISR) and Network Modernization Integrated Event Design and Analysis Branch, views CERDEC’s research as an early test bed for new communications and information systems before they reach the battlefield.

Also, researchers are examining ways for soldiers to scan or move data with their fingers and to present data without a heavy reliance on keyboard actuated response. The Army is also looking into advances that have occurred in the commercial marketplace, such as voice recognition, smart phones, smart apps, and location aware applications. The plan is to work with the technology to find applications specifically of value to the Army.

Efforts to Improve Healthcare

North Carolina received $11.8 million to launch an innovative public-private partnership to help the state healthcare system work more efficiently. The goal is to provide improved health outcomes, lower costs, and provide for more communication between insurers and payers.

“This is a major step forward in the improvement of quality medical care delivered to patients in rural communities across the state,” said DHHS Secretary Lanier Cansler. “The strength of this initiative is that it can be easily replicated in rural areas across the nation, since many states share our state’s characteristics and are struggling to find a model that works for them.”

The North Carolina Department of Health and Human Services with funding from CMS, is partnering with Community Care of North Carolina (CCNC), Blue Cross Blue Shield of North Carolina and the State Health Plan for Teachers and State Employees in a three year Multi-payer Advanced Primary Care Practice Demonstration.

This initiative extends the benefits of Community Care networks, which currently serve nearly one million North Carolina Medicaid recipients to go to rural residents whose health coverage is through Medicare, BCBSNC, or the State Health Plan, can enroll in Community Care Networks.

Community Care’s networks of medical practices provide a “Medical Home” that manages and coordinates an individual’s healthcare emphasizing patient education, management of chronic conditions, and uses information technology to track treatments and outcomes.

In the seven counties where the demonstration project will take place, Community Care medical homes currently serve 112,774 state Medicaid recipients. Over the three year life of the project, CCNC benefits will extend to 128,186 Medicare and 121,011 privately insured BCBSNC or State Health Plan recipients.

North Carolina is also working with AHRQ to help develop a model EHR format for children and package it in a way that the data can be incorporated into other EHR systems. Existing EHR systems generally do not optimally support the healthcare given to children. North Carolina will use its Community Care infrastructure and work closely with the AHRQ contractor WESTAT to develop the Pediatric EHR format.

By December 31, 2010, North Carolina must submit an updated work plan on how to recruit and identify CCNC practices and then identify the vendors now used by primary care practices. At that point, conversations with the vendors will take place regarding interest in implementing the Pediatric EHR Format.

The timeline is for the format to be developed by June 2011 and at that time, AHRQ will begin to assess existing vendor products. Conformance testing should be done by November 2011 with the prototype to be ready by March 2012

In another state project, in August 2010, the private non-profit arm of CCNC called the “North Carolina Community Care Networks, Inc”, released the “Community Care Provider Portal”. This secure web portal helps providers access a Medicaid patient’s health record for medical information, care team contacts, pharmacy claims history and clinical care alerts.

Other entities involved in the coordination of care for Medicaid recipients such as mental health local management entities, public health departments, and state mental health facilities may also access the Community Care Provider Portal. Importantly, the use of Medicaid claims data can provide key information typically unavailable within the provider chart of the EHR.

The Community Care Provider Portal also contains key resources for assisting providers in managing low literacy or for treating Medicaid patients with low English skills. Through a seamless link into a licensed service maintained by an outside partner, providers can retrieve medical information for patients in multiple languages in video or print formats.

CIMIT Requests RFAs

In the mid nineties, a few highly motivated Boston-area physicians and researchers met to identify gaps in healthcare where known and discuss how emerging technologies could help solve clinical problems.

The founding institutions for the Center for Integration of Medicine and Innovative Technology (CIMIT), a non-profit consortium of Boston teaching hospitals and engineering schools includes Massachusetts General Hospital, Brigham and Women’s Hospital, MIT, Charles Stark Draper Laboratory, Beth Israel Deaconess Medical Center, Boston Medical Center, Boston University, Children’s Hospital Boston, Harvard Medical School, Newton-Wellesley Hospital, Northeastern University, Partners Healthcare, and the VA Boston Healthcare System.

CIMIT has recently released their FY 12 Innovation Grants Request for Applications (RFA). The Innovation grants are seed grants to support early stage collaborative research projects for improving patient care with emphasis on devices, procedures, diagnosis, and the delivery of healthcare. CIMIT awards the grants to principal investigators on the faculty at an academic medical center or university in the greater Boston area.

The RFA seeks applications in all of the CIMIT program areas but this RFA is particularly interested in applications in two areas:

• NeuroHealth, including neurotechnology, traumatic brain and spinal cord injuries, PTSD, and pain
• Integrated Clinical Environments to include projects that will create innovations in the delivery of healthcare within or across care environments through the integration of medical devices, decision-support algorithms, electronic medical records, or with patients and care providers.

Applications will be evaluated in two phases. Two page pre-proposals are due January 14, 2011. A second phase will accept full proposals based upon the most promising pre-proposals. Full proposals will be due by March 28, 2011. Final decisions on the proposals will be made by June 6, 2011.

Awards will be for $70,000 direct cost and up to $100,000 total costs. The earliest anticipated start date for the full proposals selected for funding is October 1, 2011. However, this is based on the funds that CIMIT receives from the Federal government.

For more information, go to

Sunday, December 12, 2010

HIT Report Released

The President’s Council of Advisors on Science and Technology (PCAST), a group of experts appointed by the President released the report “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward” on December 8th.

The report calls for the widespread adoption of a universal exchange language that would be able to transfer of relevant pieces of health data while maximizing privacy. The report finds that the technology for creating the necessary infrastructure and exchange language is already proven and available. But since developing these systems is not likely to be profitable in itself, the Federal government should develop the systems with the private sector.

Implementing PCAST’s recommendation to designate a universal exchange language for health information has an advantage. It would not require physicians to replace their existing electronic health records systems since virtually all of these systems could be made compatible through “apps” and other “middleware”.

The report recommends breaking the data down into the smallest individual pieces that make sense to exchange as the way to manage and store data. These individual pieces are called “tagged data elements” because each unit of data is accompanied by a mandatory “metadata tag” that describes the attributes, and requires security and privacy protections for the data.

A key advantage of the “tagged data element” approach is that it allows a more sophisticated privacy model—one in which privacy rules, policies, and applicable patient preferences are innately bound to each separate tagged data element and are enforced both technology and by law.

For example, a patient with diabetes may decide that her blood sugar information should be available to her doctors and to emergency physicians requesting that information if she should have a problem while traveling in another state—but that details about her past treatment for cancer should remain private and not be shared.

Also addressing a widespread privacy concern, such a system would not require the creation or assignment of universal patient identifiers nor would it require the creation of any centralized Federal database of containing patients’ health information.

The report calls upon ONC and CMS to move rapidly to implement the report’s recommendations by creating appropriate definitions in its “meaningful use” standards for health information technology which must be achieved in stages by 2010 and 2015. It also calls upon CMS to accelerate the modernization and restructuring of their IT platforms and staff expertise.

For more information on PCAST and to view the report, go to

FCC Actions Proposed

The FCC seeks to develop innovative spectrum efficient technologies to meet the growing demand for wireless broadband services. FCC’s first action was to publish a Notice of Proposed Rulemaking that would expand the existing Experimental Radio Service rules needed to promote cutting-edge research and foster new wireless technologies, devices, and applications.

This action would entail a new type of experimental license to be approved called a “Program License” to give qualified entities broad authority to conduct research without the need to seek new approvals for each individual experiment.

The FCC proposes three types of program licenses:

• Research licenses—to allow universities, laboratories and other qualified research institution to conduct experiments over a wide variety of frequencies and other operating parameters
• Innovative Zone Licenses—to identify discrete geographic areas especially remote locations where researchers could conduct a wide range of experiments and speed development of new health-related devices that use spectrum
• Medical Licenses—to allow medical institutions to innovate and develop new devices to save lives, reduce medical costs, and provide new treatment options for wounded service men and women

As FCC Chairman Julius Genachowski stated “Experimental licensing can lead to important life-saving medical devices. The goal is to accelerate innovation and reduce the time it takes for an idea to get from the lab to the market. A more extensive experimental licensing program would help the FCC make smarter, faster decisions, by giving the Commission the on-ground intelligence on interference issues and insight into the development of new cutting edge technologies.”

According to reports, the research and medical license experimental programs have enabled research institution to not only develop ultra fast 1 Gigabit per second research and education broadband networks but the universities have also advocated that the FCC help connect these networks to anchor institutions in low-income communities.

For example, the National Broadband Plan describes how Case Western University in connecting its ultra fast, 1 Gigabit per second network to homes, schools, libraries, and museums to a low income community in Cleveland Ohio has led to innovations. This project so far has lead to software and service developments producing environmental efficiency, better healthcare, along with other new applications.

Chairman Genachowski said the FCC is seeking new ideas on how to accelerate new spectrum-efficient policies and technologies. Specifically, the Commission is interested in ideas on how to jumpstart the secondary market for dynamic spectrum access, encourage better information on spectrum use, and how to build an innovative spectrum dashboard.

Cal eConnect Requests Responses

Cal eConnect a non-profit public benefit corporation designated by the State of California is leading a collaborative process to develop HIE polices and services in the state and has announced several new initiatives geared to stakeholders and vendors.

Applying for additional funding through the HHS Challenge program now available can help Cal eConnect. The funding is available through the Office of the Coordinator (ONC) and ONC will accept one application from the State of California in collaboration with Cal eConnect and community partners.

At this time, Cal eConnect is seeking brief proposals from stakeholders interested in partnering with Cal OHII and Cal eConnect.

The following areas can be included in the application:

• Achieving health goals through health information exchange
• Improving long-term and post-acute care transitions
• Consumer-mediated information exchange
• Enabling enhanced query for patient care
• Fostering distributed population-level analytics

Cal eConnect is only able to receive funding in two areas, but is eligible to apply for all 5 areas. Applications are due to ONC on January 5, 2010. A letter of intent has already been submitted to ONC.

Total funding for this initiative is $16,296,562. Awards will range between $1 million and $2 million each and will be in the form of supplemental funding. Only direct award recipients of the State health Information Exchange Cooperative Agreement Program may apply.

The applications from stakeholders need to be submitted to Sheri DeWeerd, Cal eConnect Senior Project Manager at no later than midnight on Monday December 13, 2010.

On December 10, 2010, Cal eConnect posted a Request for Quotation (RFQ-2010-003) seeking assistance from a consultant to provide information technology support services for their computer-based technologies system. Support is needed for hardware and software to ensure the proper implementation of new technologies, to address general management and operation issues, and to maintain the system.

Responses to the RFQ are due to Cal eConnect by 5pm on December 27, 2010 and the vendor will be selected by December 31, 2010. To view the RFQ go to then go to Plans and Projects and click on RFI/RFP/RFQ.

On December 8, 2010, Cal eConnect released a Request for Offers entitled “Medical Laboratory Assessment, Medi-Cal, and Field Licensing Survey and Planning Services Project” (RFO-2010-002). The RFO seeks an experienced professional either an individual or a firm to work with Cal eConnect and collaborate with the State of California’s Department of Health Care Services (managing the Medi-Cal program), State of California, local Public Health Departments, and the Lab Field Services Licensing program. The plan is to identify what is needed by the state to establish ELINCS as California’s standard specification for the electronic exchange of medical laboratory test results.

The contractor will develop a project plan, perform an environmental scan, provide recommendations validated with stakeholder input, and produce a roadmap to successfully encourage ELINCS as the state’s gold standard specification for electronic delivery of laboratory test results.

The RFO is due on January 10, 2011. To view the RFO, go to For questions, email Susan Huffman at and include “RFO Lab Assessment and Planning Services” in the subject area.

AHRQ Seeks to Reduce HAIs

AHRQ recently issued two Special Emphasis Notices announcing AHRQ’s interest in funding grants on preventing and reducing healthcare-associated infections (HAIs). The Department has published the “National Action Plan to Prevent Healthcare-Associated Infections, which is now being updated and will be available in early 2011.

In FY 2011, AHRQ intends to build on the HAI projects funded in 2009 and 2010 by supporting research and demonstration projects related to ways to prevent and more effectively manage HAIs and promote the wide scale adoption of evidence-based approaches in all settings.

Grants in FY 2011 will be funded to:

• To determine the clinical efficacy, effectiveness, and cost-effectiveness of interventions to prevent HAIs
• Develop, demonstrate, and implement strategies to prevent and manage HAIs
• Characterize and assess relevant epidemiological aspects of HAIs, such as patient risk factors, clinical presentation, and sources of antibiotic-resistant organisms involved in developing HAIs

A research focus to receive additional emphasis in FY 2011 is HAIs in ambulatory care. Additionally, AHRQ is interested in developing, evaluating and demonstrating linkages between the various setting of care as in hospitals, ambulatory settings, and long-term care facilities to improve the prevention, management and tracking of HAIs.

Go to, for more information on notice (NOT-HS-11-002) issued by AHRQ and released in November. For more information, contact James Cleeman M.D., Center for Quality Improvement and Patient Safety at

Study on Home Health Care

Using home healthcare technologies may provide a solution on how to sustain global healthcare systems threatened by rising costs and personnel shortages. However, changes will be required to treat patients and will probably face multiple obstacles to adoption, according to a new RAND Corporation study “Health and Well-Being in the Home: A Global Analysis of Needs, Expectations, and Priorities for Home health Care Technology.”

The study finds that a wide array of healthcare stakeholders agree that expanding home-based health tools could give patients a greater ability to self-manage their conditions in partnership with their medical providers and help to improve their health and overall well-being.

However, moving care to patients’ homes would be a major shift in the structure of healthcare and can only be accomplished if consensus is reached between patients, healthcare providers, insurance companies, and policy makers, according to the report.

The study’s findings are from a global study of the needs, expectations, and priorities regarding home healthcare among key stakeholders in China, France, Germany, Singapore, the United Kingdom, and the U.S. Researchers conducted interviews with government officials, regulators, providers, insurers, manufacturers, distributors, and patient organizations, as well as reviewing existing research on home healthcare.

In the U.S., people age 64 and older account for 12 percent of the population, yet incur 34 percent of the nation’s total healthcare spending. While this trend started in the developed world, it is increasingly affecting developing and transitional nations. For example, Singapore has become the world’s most rapidly aging country and already 80 percent of all deaths in China are caused by chronic diseases.

“The aging of the world’s population and the fact than more diseases are treatable will create serious financial and personnel challenges for the world’s healthcare systems, said Dr. Soeren Mattke, the study’s lead author and a senior natural scientist at RAND, a non-profit research organization.

Home healthcare technology spans a broad spectrum from basic diagnostic tools, such as glucose meters, to advanced telemedicine solutions. These advances have pushed the frontier of care management further into the home setting.

While there are signs that home healthcare is increasingly on the radar of policy makers in many countries, researchers say that both the policy environment and the products themselves must be redesigned to realize the potential benefits.

Manufacturers will need to develop affordable products with intuitive designs to meet patient needs, provide ongoing support for patients and their families, and help integrate the services and data provided by other professional care providers.

However, these technologies face a number of barriers to adoption. For example, restrictive insurance coverage and existing incentives for in-person home care creates obstacles, and limited patient readiness because of insufficient health literacy according to the study. Additionally, concerns about audience appropriate product design and support plus limited information on whether the technology is effective and efficient also poses barriers to adoption.

Companies must also provide evidence for the clinical and cost effectiveness of home care products, while healthcare providers will need to embrace a new role as partners to their patients in the care process, rather than acting as paternalistic caregivers according to researchers.

Policymakers will have to develop a vision for the appropriate role of home healthcare and drive the agency to implement that vision. In order to proceed, the healthcare system needs to align the payment system and incentives with policy goals, clarify the regulatory framework for home healthcare technology, and promote receptiveness for the new models of care delivery.

The study was supported by Royal Philips Electronics and is available at

Wednesday, December 8, 2010

Health Technology for Miners

The MINER Act of 2006 established the Office of Mine Safety and Health Research within the National Institute for Occupational Safety and Health (NIOSH). The Office develops new technologies, applications, and awards competitive contracts and grants to institutions and private industry to manufacture mine safety equipment. The Office also has the authority to award contracts to private laboratories to test the performance of products as they relate to new mine technology or equipment.

The Broad Agency Announcement (BAA) “Development and Demonstration of Mine Safety and Health Technology” (Solicitation- 2011-N-13046) was released on December 3rd by the Office of Mine Safety and Health Research with $4 to $6 million expected to be funded for the duration of this BAA. NIOSH estimates that the typical project under this solicitation will require between $200,000 and $300,000 although proposals for other amounts up to $500,000 will be considered. It is estimated that approximately 10 to 15 awards will be made.

The agency is looking to develop a next generation of “Self-Contained Self-Rescuer” (SCSR) to enable voice communication equipment to be worn in the mine in emergencies. The new design is needed to enable miners to have the ability to communicate among themselves or between other miners and personnel on the surface using an enhanced mine communication system. There is also interest in developing a next generation SCSR to improve durability and wearability.

All potential applicants are eligible. In answer to this combined synopsis/solicitation, concept papers and full proposals need to be submitted between December 3, 2010 and March 31, 2011. However, it is advised that concept papers are encouraged prior to submitting a full proposal.

For more information, go to or contact Cynthia Y Mitchell, Contracting Officer at (412) 386-6434, email

State Planning Ahead

Although state health insurance exchanges are not required to be operational until 2014, work is already underway in a number of states to conduct the necessary market research and planning needed for state projects. New Mexico is actively planning for their state insurance exchange through the Human Services Department (HSD).

On November 19th, a Request for Applications was issued with a deadline of November 29th. The state’s plan is to obtain professional services to design data gathering methods and to collect, analyze, and report on New Mexico’s individual and small group health insurance market. This information needs to include a study of plan design and benefit packages, payment models, and purchase plans to help in the development of the exchange.

Applicants for the funding must have experience working with the states’ individual and small group insurance market and must be able to:

• Develop a work plan and timeline for completing all of the tasks
• Design a data collection methodology and tools
• Collect data via surveys, database mining, focus groups, and through interviews
• Provide monthly reports and met with the Office of Health Care Reform staff and project manager to review progress
• Work with other contractors in gathering data and share best practices and resource material
• Design and develop materials appropriate for the healthcare provider stakeholder population to educate them on the exchange
• Provide a final report

Also on November 19th, the New Mexico Human Services Department (HSD) released an RFA soliciting applications to provide similar professional planning services geared to individuals with mental illnesses or substance use disorders.

Potential contractors are to consult with healthcare providers including but not limited to those with experience in prevention, primary care, specialty care, acute care, dental, long-term care, behavioral health, women’s health, traditional Native American healing practices, and alternative medicine.

The state is also developing their Draft Strategic Plan “Positioning Behavioral Health for Health Care Reform: A Framework for Action FY11-FY14” produced by the New Mexico Behavioral Health Collaborative.

The goal is to use and expand behavioral telehealth services starting with psychiatric services in FY11, other clinical services in FY12, and non-clinical services in FY13. The plan also supports telehealth infrastructure in school-based health centers, addresses workforce issues, and seeks to improve recruitment and retention efforts in rural, frontier, and tribal communities by using telehealth.

For more information on the RFAs, email Emily Kaltenbach at Go to to download the Draft Strategic Plan or email Letty Rutledge at

AF Developing Monitoring Device

The Air Force Research Laboratory, 711 Human Performance Wing, Human Effectiveness Directorate at Wright-Patterson Air Force Base in Ohio, is developing the Battlefield Automatic Life Status Monitor (BALSM). The Air Force device being developed in coordination with QinetiQ, will provide remote physiologic life status monitoring for triage, rescue, or recovery, and will be able to provide a health status history over time for each person.

Pararescue jumpers and other medical personnel will be able to remotely determine a warfighter’s health status on the battlefield with sensors designed to be worn and ingested. The primary sensor is a wireless pulse oximetry unit that can measure the amount of oxygen in the blood and able to estimate heart rate and respiration, plus the sensor contains an accelerometer to determine if a person is standing, sitting, lying down, or moving.

This sensor is worn against the forehead and can be worn as a headband or the sensor can be integrated into the helmet. The sensor emits both visible and infrared light that reflects off the skull to obtain the pulse oximetry.

The other sensor in the device is a wireless capsule that when ingested, measures core body temperature. At this point, the information is sent to the pararescue jumpers or other medical personnel through a radio receiver equipped with monitoring software that sends the information to a computer. The capsule that measures core body temperature is an ingestible, medical-grade, FDA approved sensor.

According to Dr. Dianne Popik, Program Manager with the Human Effectiveness Directorate, Warfighter Interface Division, Battlespace Acoustics Branch, “The devices are especially advantageous for Special Operations Forces who may be in an area where they cannot communicate out loud. It can help commanders decide if they have enough healthy troops to continue a mission or if plans need to change. BALSM also could assist in determining rescue versus recovery efforts.”

“BALSM has commercial applications. Remotely measuring core body temperature would be ideal for people who are running triathlons and for use by many other athletes”, said Dr. Popik. “BALSM could also be beneficial to firefighters, when they see persons in extreme situations and you need to know their health status. The device could also assist in field triaging situations where a single medic monitors multiple patients and needs to be alerted to any immediate change in the health status of the patients.”

State Department Issues RFI

On December 1, 2010, the State Department’s Office of Medical Services (MED) released an RFI looking for businesses that can offer a COTS Ambulatory EHR System to be deployed worldwide to health units at embassies and consulates. The Request for Information (RFI) will be used for planning purposes only and a contract will not be awarded from this notice.

MED is centrally staffed in Washington D.C and has physicians, foreign service health practitioners, nurses and medical technologists providing medical care and support to over 50,000 Foreign Service plus other government personnel and their families overseas.

In addition to providing primary medical care, MED provides mental healthcare, coordinates local medical care, medical evacuations, and medical clearance assessments. This is accomplished with185 direct hire clinicians including MDs, nurse practitioners, and physician assistants.

In addition to the overseas health units located in 170 countries varying in size and capabilities, MED is also responsible for small domestic Travel Health and Immunization Clinics staffed by civil service RNs with oversight from regional medical officers. The clinics provide immunizations plus limited occupational healthcare in Washington D.C.

The responses to this RFI (Solicitation Number: SAQMMA 11-1-0001) should not exceed 10 pages and is due by December 30, 2010. For more information, go to or contact William L Ziater, Contracting Officer at (703) 875-6285, email or contact Renee M. Hill at (703) 875-6747, email

Health Technology Efforts

California’s Governor Arnold Schwarzenegger on September 2010 signed legislation funding a telehealth initiative under Proposition 1D (2006) authorizing $200 million for capital improvements. The legislation helps to expand medical education programs emphasizing telemedicine technologies at the University of California Medical School campuses. The plan is to provide the facilities and the state-of-the-art equipment needed to expand the use of telemedicine not only on the campuses but also across the state.

A new telemedicine building funded in part by the Proposition 1D measure is now in use at the University of California, Irvine School of Medicine. This new telemedicine facility includes an interactive televideo center and a clinical simulation laboratory and skills center. Students can use the digitally controlled full body simulators in the operating room and trauma room settings, plus use the televideo room to see medicine practiced at distant locations in real-time and then be able to communicate with clinical instructors.

In another effort, a UCLA-led consortium at five University of California Medical Schools plus Cedars-Sinai Medical Center in Los Angeles received $9.9 million from AHRQ to research the use of wireless and telephone care management to reduce hospital readmissions for heart failure patients.

The three year grant “Variations in Care: Comparing Heart Failure Care Transition Intervention Effects”, with funding under AHRQ’s “Clinical and Health Outcomes Initiative in Comparative Effectiveness” (CHOICE) program will examine managing the inpatient to outpatient care using not only the telephone, but also examine the same transition using wireless remote monitors and telephones.

Heart failure patients have high rates of hospital readmissions, and a critical window for preventing readmissions as the patient transitions from the inpatient to outpatient setting, reports Dr. Michael Ong, Assistant Professor of Medicine at the David Geffen School of Medicine at UCLA and the grant’s principal investigator.

A previous study showed that six month mortality rates were lower for elderly Medicare heart failure patients hospitalized at centers that used more healthcare resources, as compared with hospitals that used fewer resources. The new funding seeks to improve these outcomes even more using innovations that require less intensive care resources.

Sunday, December 5, 2010

Grants for HIE Challenge Program

The Office of the National Coordinator on December 3rd released information on state grants available through ARRA to fund the “Health Information Exchange Challenge Program”. Five challenge areas have been identified to:

• Achieve health goals through health information exchange
• Improve long term and post-acute care transitions
• Enable patients to have access to their own health information
• Develop tools and approaches to search for and share granular patient data such as specific lab results for a given time period
• Foster strategies for population-level analysis

The awards will fund technology and approaches to be developed in pilot sites where the information and data will be shared, reused, and leveraged by other states and communities to increase nationwide interoperability.

Awards will range between $1 million and $2 million each and will be in the form of supplemental funding to the State Health Information Exchange Cooperative Agreements which have provided approximately half a billion dollars to states and State designated entities to enable health information exchange. Total funding for this initiative is approximately $16 million with ten awards anticipated.

State governments are eligible to apply plus current direct grant recipients of State Health Information Exchange Cooperative Agreement Program are also eligible.

Applications for the HHS funding notice (EP-HIT-10-002) are due by January 5, 2010. For more information go to or email Bianca Costa, Grants Management Officer at or call (202) 205-5621.

Broadband for American Indians

USDA’s Rural Development Telecommunications Program is providing broadband services to the Havasupai Reservation located at the bottom of the Grand Canyon. The remote tribe can only be reached by an eight mile mule ride down to the bottom of the southwest corner of the Grand Canyon or by helicopter.

There was very little chance that the private sector would invest in telecommunications infrastructure in such a remote and geographically challenging area. However, a 2004 USDA Rural Development Community Connect grant for $1,247,705 enabled the reservation to use four Bureau of Indian Affairs towers located on the Havasupai and Hualapai Reservations. This enabled the Tribal system to have basic internet connectivity.

As a result of the Tribe’s Community Connect grant, the reservation will now be able to benefit from the USDA Broadband Initiative Program. An award to Niles Radio helped to install a new tower on the border of Havasupai/Grand Canyon National Park. This will enable the Havasupai to move their system towards Flagstaff instead of Peach Springs and the result will be to lower internet connectivity costs.

In the future, it will allow the Tribe to extend broadband services to Supai Camp inside the Grand Canyon National Park (GCNP) which will further strengthen the Tribe’s communication system because Supai Camp is occupied by not only the Havasupai Tribal members working at the park but is also home to Tribal members requiring long term off reservation medical services.

The FCC is also dealing with broadband issues related to American Indians. “High speed broadband is still a stranger to most of Indian Country—even plain old telephone service is at shockingly low levels of penetration resulting in fewer than 70 percent of Native American households connected to basic telephone connectivity” said, FCC Commissioner Michael J. Copps speaking to the National Congress of American Indians in Albuquerque New Mexico in November.

The FCC is working with tribes through the Native Nations Broadband Task Force to identify better methods to use to collect and report on broadband information for native communities. In addition, FCC’s Office of Native Affairs and Policy is also helping to coordinate discussions with broadband providers and tribes.

The National Congress of American Indians wants to see FCC’s Office of Tribal Affairs remain directly involved in the development of the Tribal Broadband Fund. The thought is that only a flexible tribal-centric planning approach used to administer such a fund will allow it to succeed.

Right now, the FCC is moving towards creating funding models for a broadband oriented Universal Service Fund. The Joint Board on Universal Services has just issued recommendations on changes to the Lifeline and Link-Up programs to help low income households get connected.
As Commissioner Copps explained, “Also to tackle the issue of support for services on Tribal lands, we must also ensure that Tribal members living near Tribal lands but not on the lands can benefit from the same Lifeline and Link-Up available to the population living on Tribal lands.

In addition, the FCC is in the process of creating a Mobility Fund to expand mobile connectivity at 3G levels and above in rural areas. In the future, the FCC may want to provide a similar mechanism targeted specifically to Tribal Lands.

He further commented, “A major theme of the National Broadband Plan is the need for spectrum to support new wireless services and also to expand the role of Tribes as policies and rules are developed for spectrum usage in those license areas that overlap with Tribal lands.”

MHIO Announces Plans

The Missouri Health Information Organization (MHIO) a new public-private partnership is slated to receive $13.8 million in federal funds over the next four years to support and develop a statewide HIE. The state HIO plans to implement technical services in 2011 and make services available to providers throughout the state.

Missouri is going to develop an HIE with qualified organizations to provide the core infrastructure and services to providers. These organizations may be a variety of organizations or networks that have relationships with or provide services to providers and may be but are not limited to provider networks, regional HIOs, rural health centers, laboratories, pharmacies, private, non-provider networks, the Medicaid network (Mo HealthNet) or Missouri State Employee Health Plans.

To implement the HIE, a phased rollout approach will be used:
• Phase 1 is designed to meet ONC requirements and implement technologies needed to support sustainable HIE across the state by June 2011
• Phase 2 is to leverage the technologies and expand them to meet key use cases to support anticipated meaningful use requirements by October 2012
• Phase 3 will use future technologies to support use cases to promote sustainability and meet market demands by 2012 and provide for future demands

An RFP for technical services was released on November 12th for vendors to partner with the MHIO to design, implement, and operate the statewide HIE platform. The MHIO is going to select the vendor to help provide the HIE throughout the state and NHIN.

Issuing the RFP is the first step to selecting the technical services partner. The process for the vendors includes submitting written proposals, providing customer references and site visits, demonstrating products and services, and attending technical services partner workshops.

The MHIO timeline includes operating in phases:

• Phase 1—MHIO would launch technical services for securely routing patient care summaries and lab results
• Phase 2—MHIO will provide additional services such as sending patient care summaries to physician’s EHRs, incorporate lab results into the EHR, provide lab ordering, be able to query patient history, retrieve medication history, provide a PHR, and send info for quality reporting, to disease registries and for public health reporting

The technical services partners answering the RFP’s scope of work must address the needs in Phase 1 and Phase 2 in their response. However, since vendors will be entering into an ongoing collaborative relationship with the state, they need to be able to identify and be aware of future services as needed.

The MHIO would also like the technical services partners selected to be familiar with the broadband and telehealth initiatives already existing in the state and to consider ways in which these initiatives may be used to further proposed solutions.

Missouri has several large initiatives underway:

• Missouri Telehealth Network at was one of the nation’s first public-private partnerships in telehealth and provides care to underserved areas, provides education opportunities for healthcare providers, furthers efforts related to disaster preparedness, and provides research opportunities to clinicians studying via telehealth. By the end of 2009, the network had over 175 endpoints in 51 Missouri counties and today this number is expected to grow to 200 endpoints in 56 counties

• MoBroadbandNOW at is a private-public partnership launched in 2009 with the goal to expand broadband accessibility to 95 percent of the total population of the state

Go to for information on the RFP. For other information, go to

Proposals are to be submitted by December 10th. For more information on the RFP, email Mark Belanger at or call (781) 434-7889.


HRSA’s Maternal and Child Health Bureau (MCHB) is working in partnership with states, communities, and public-private partners to help women, infants, children, adolescents, and their families with special healthcare needs. The Emergency Medical Services for Children (EMSC) is administered by MCHB.

There is a growing recognition that children have unique needs in emergency situations that often can vary from those of adults due to physiological developments. The EMSC is in place to enhance the pediatric capability of the emergency systems originally designed for adults.

HRSA/MCHB released the Funding Opportunity Announcement on November 29, 2010 with an application due date January 14, 2011. The funds from this announcement (HRSA-11-059) will be used to establish an EMSC National Resource Center to:

• Improve the infrastructure, quality, and safety of pediatric emergency care
• Assist national, state, and local capacity to improve emergency care by developing a research infrastructure
• Help children in times of emergencies and disasters and help to improve emergency preparedness
• Help to collect, analyze and use pediatric emergency care data

States and/or accredited academic medical centers applying for the funding need to have a proven track record in providing technical assistance and support in this field and knowledge of the emergency care system in the U.S.

One of the duties for the awardee is to coordinate communications. The awardee is to provide electronic communication among EMSC grantees, stakeholders, federal agencies, and then distribute EMSC resources through electronic media.

Funding will be provided in the form of a cooperative agreement. A cooperative agreement, as opposed to a grant is an award instrument where substantial involvement is anticipated between HRSA and the recipient during the time of the contemplated project.

This program will provide funding for fiscal years 2011 2014. Approximately $1,860,000 is expected to be available annually to fund the project. The period of support is up to four years with an optional fifth year based on performance.

For more information, go to or email or email David Heppel, M.D., Director, Division of Child, Adolescent, and Family Health at or call (301) 443-3954.

UA Telemedicine News

The Arizona Geriatric Education Center (AzGEC) housed within the Arizona Center on Aging at the University of Arizona, College of Medicine received $299,200 from HRSA to fund telemedicine equipment to train health professionals on how to team care for older adults. AzGEC will partner with UA’s Institute for Advanced Telemedicine and Telehealth, a division within the Arizona Telemedicine Program.

State-of-the-art stationary and mobile telemedicine units will support AzGEC activities to help build an expanded diverse and prepared geriatric workforce to care for the state’s rapidly aging population. The grants will enable the Arizona Geriatric Education Center to link health professionals at the UA’s Arizona Health Sciences Center with Arizona State University and other sites across the state to present innovative geriatric team training and patient care.

In other news, Janet Major, technical coordinator for the Arizona Telemedicine Program at the University of Arizona, College of Medicine was appointed to the U.S. Distance Learning Association (USDLA) Board of Directors to represent telemedicine interests.

The USDLA supports distance learning research, development and practice across the complete arena of education, training and communications, with a focus on pre K-12, higher education, continuing education, corporate training, military and government training, home schooling, and telemedicine.

Healthy People 2020 Unveiled

Extensive stakeholder feedback helped HHS produce their new “Healthy People 2020” document integrating input from public health, prevention experts, federal, state, and local governments, a consortium 2,000 organizations, and the public. More than 8,000 comments were considered in drafting the document. Some of the new topic areas in “Healthy People 2020” include healthcare-associated infections, preparedness, dementias, genomics, and global health.

“Leveraging information technology in the form of communication strategies and health IT, along with developing innovative approaches will help communities track their progress and improve health for all Americans”, according to Chief Technology Officer Todd Park.

During the coming decade, the speed, scope, and scale of health IT adoption will only increase. Social media and emerging technologies promise to blur the line between expert and peer health information. As a result, monitoring and assessing the impact of the new media including mobile health on public health will be challenging.

Both public and private institutions are increasingly using the internet and other technologies to streamline the delivery of health IT services. This will result in an even greater need for health professionals to develop additional skills in the understanding and use of consumer health information.

Continued feedback, productive interactions, and access to evidence on the effectiveness of treatments and interventions will likely transform the traditional patient-provider relationship. However, it will also change the way people receive, process, and evaluate health information.

Capturing the scope and impact of these changes and the role of health communications and health IT will require multidisciplinary models and data systems. These systems will be critical to expanding the collection of data to better understand the effects of health communications and health IT on the population, along with health outcomes, and data on healthcare quality and health disparities.

Lead points for studying the specific topic Health Communication and Health IT includes the HHS Office of the Secretary, Office of Disease Prevention and Health Promotion, Office of Public Health and Science, and the Office of the National Coordinator. CDC is also playing a lead role in this specific topic area.

Also at this time, HHS has launched a newly redesigned Healthy People website so users will be able to tailor information to their needs and explore evidence-based resources for implementation.

Wednesday, December 1, 2010

Updating 9-1-1 Call Centers

FCC Chairman Julius Genachowski met with emergency officials and responders to talk about what the FCC needs to do to modernize the 9-1-1 emergency system. He told the group “9-1-1 is an indispensible, life-saving tool, but today’s system just doesn’t support the communication tools of tomorrow.”

He announced on November 23rd that FCC will launch an effort to get public input as was requested in the National Broadband Plan on transitioning the current 9-1-1 system to a broadband-enabled next generation system. According to the Chairman, discussions will take place on ways to attract public input at the Commission’s December meeting. This action builds on the FCC’s recent order to beef up 9-1-1 location accuracy requirements so that first responders can quickly find information from people on their mobile phones.

The Chairman explained, “The current 9-1-1 system is efficient and reliable and handles more than 650,000 calls a day. About 450,000 of these calls are made from mobile phones. With today’s advances in commercial mobile broadband technologies, consumers are using their phones less to make calls but using them even more for texting and sending photos.”

The problem is that even though mobile phones are the device of choice for most emergency calls and although people have the capability to use their mobile phones to text, 9-1-1, calls can’t be texted since many 9-1-1 call centers don’t have broadband and some centers are located in communities where broadband isn’t even available.

As Chairman Genachowski, pointed out, when witnesses tried to text 9-1-1 during the Virginia Tech campus shootings in 2007, the messages never went through and were never received by local 9-1-1 dispatchers.

Broadband-enabled next generation 9-1-1 will revolutionize emergency response not only by texting but the system will also enable videos and photos to be sent. This will not only help people with disabilities to communicate with emergency dispatchers but photos and videos will be able to be transmitted while crimes are ongoing along with photos from highway and security cameras.

Also, new devices on the horizon will be able to provide many more details and include information from environmental sensors that are capable of detecting chemicals, information from alarm systems, personal medical devices, and from consumer electronics in cars.

However, Genachowski said, “Although the need for action is clear, modernizing 9-1-1 raises complex challenges that will take not only time but also need significant coordination. We need to help federal, state and local partners, public safety officials, lawmakers, communications and broadband service providers, and equipment manufacturers develop a national framework for next generation 9-1-1 services across the nation.

Redesigning Primary Care

The University of Utah’s Department of Family and Preventative Medicine (DFPM) and the University’s Health Care Community Clinics are collaborating with the David Eccles School of Business, the Department of Economics, and the College of Pharmacy to help redesign primary healthcare for today’s doctors and patients.

With the aid of three new federal grants totaling $4.5 million, they are implementing changes in two key areas. They are going to find ways to use information technology to help the university community clinic physicians better manage chronic diseases and secondly educate patients so people can do a better job controlling their overall health.

Rob Lloyd, Executive Director of the University’s community clinics, said, “Our community clinics are uniquely suited to participate in this innovative project. As an academic healthcare system, part of our mission is to improve the way healthcare is delivered.”

The funding awarded through HHS includes the “Beacon Community Cooperative Agreement”. The Beacon grant program was set up to build and strengthen health IT. The University’s grant was awarded as a subcontract of the $16 million Utah Beacon Cooperative Agreement being led by HealthInsight, a Salt Lake City-based non-profit.

The Beacon Community Grants will focus on using information technology to improve care for a group of patients with diabetes. The funds totaling $960,000 will enable the University community clinics to join a statewide computer information exchange and more care managers will be hired to ensure that patients with diabetes receive the care they need.

Two other grants “Transformed Primary Care—Care by Design” and “Primary Care Practice Redesign—Successful Strategies” both awarded through AHRQ for $3.5 million, will not only help the University’s community clinics expand their present diabetes care-management plan, but also help evaluate and expand “Care by Design”, a new approach to primary care that the clinics put in place in 2004.

This new “Care by Design” approach uses an integrated system in which acute, chronic and preventive care is overseen by a team of providers, including a primary care physician, nurses, physician assistants, pharmacists, medical assistants, and others as needed. Each team member fills a specific role and gives patients more personalized care while allowing physicians more time to discuss preventive care and other issues that can make long-term impacts on a patient’s health.

Patient education is integral to the “Care by Design” program, so community clinics are going to use grant funds to expand the patient education program started several years ago. For example, the health centers will continue to provide education at meetings so that patients with similar chronic illnesses will be able to meet with nurses, pharmacists, physicians, and others to learn how to better manage their conditions through diet, exercise, or in other ways.

The AHRQ grant funding will also help the community clinics evaluate how effective their changes are in providing primary care. The clinics are also going to undertake comparative effectiveness research to look at different healthcare treatments and find the therapies that have the best patient outcomes.

Philips Showcases Ingenia

Royal Philips Electronics showcased Philips Ingenia the first ever digital broadband magnetic resonance imaging solution at the Radiological Society of North America meeting in Chicago on November 28th. The Ingenia MR system is pending U.S. FDA 510(k) and is not available for sale in the U.S.

In order to visualize detailed structures within the human body, MRIs use radio, audio frequency, and static magnetic fields where the strength is measured in Tesla (T) units. Clinicians have long relied on MRIs for their ability to differentiate various soft tissues. Until now, all MRI systems have used analog components for the signal acquisition and processing needed to generate patient images. However, the use of analog components during this process has limited the upper reaches of image clarity and quality.

Now for the first time in MRIs, the Philips Ingenia MR system introduces digital signal acquisition and processing directly in the RF receive coil nearest to the patient. By digitizing the signal directly in the RF receive coil and maintaining the digital connection throughout the entire MRI scanning process, Ingenia is able to generate up to a 40 percent improvement in signal-to-noise ratio.

By improving the signal-to-noise ratio, the system is able to deliver the crisp image clarity that clinicians need to help make informed decisions for a wider range of clinical procedures. Also the system incorporates an integrated hidden posterior coil enabling full body coverage and eliminates the need to place multiple connecting coils around various parts of the body.

“Just as Web 2.0 redefined the way people connect, share, and use the internet, imaging 2.0 represents a new world of possibilities for radiology science. It’s about integration and collaboration to produce new levels of patient focus and safety to help clinicians achieve what was unimaginable just a few short years ago. Radiologists can now integrate information from various sources to make a confident diagnosis and discuss it with all of the clinical partners on the case while putting the radiologist at the center of clinical decision-making,” said Gene Saragnese, General Manager, for Imaging Systems at Philips Healthcare.

This approach eliminates unnecessary prep time while each patient has a more comfortable patient experience. Clinicians find that they spend significantly less time on the logistics related to patient set-up, contributing to as much as a 30 percent increase in throughput. The system is available in 1.5T and 3.0T versions to accommodate varied imaging needs.

For more information, contact, Ian Race, Philips Healthcare at (978) 659-4624 email or contact Caroline Kamerbeek, Philips Healthcare at +31 (0) 40 27 826 82 or email

MC4 Testing Apps

The Army’s Medical Communications for Combat Casualty Care (MC4) is testing specific EMR apps for use on the iPad, iPod Touch, iPhone, HTC EVO, and Samsung Epic. Early results show that apps can technically operate on the Apple iOS and the Droid OS using the devices stretch, tap, and swipe functionality.

However, according to the November online issue of “The Gateway” publication, LTC William E. Geesey, MC4 Product Manager, said, “Initial tests show promise but there is still a long way to go before we can consider fielding these technologies. They must clear a myriad of hurdles, including data-at-rest encryption requirements, clearance for wireless use in theater, and a bevy of DOD and local signal certifications.”

Application upgrades currently underway for the MC4 EMR systems used in Iraq and Afghanistan will provide better methods for capturing and reporting mild traumatic brain injury (mTBI) data. The MC4 program will field the apps upgrades first in Southwest Asia and then to the other 12 countries where MC4 systems remain operational.

“The Army is focusing on the development of effective tracking systems, mechanisms, and business practices to trace soldiers potentially suffering from mTBI,” said LTC Geesey. “This upgrade helps to track and report on exposures of head trauma on the battlefield.”

MC4 is also fielding upgrades to the medical supply application referred to as the Defense Medical Logistics Standard Support Customer Assistance Module. Using an improved user interface, medical logisticians are able to more efficiently manage medical supplies in the combat zone using the application’s new bulk ordering and receipts functionality.

In addition, a new mobile version of the Transportation Regulating and Command and Control Evacuation System (TRAC2ES) application is being added to MC4 systems. Units using TRAC2ES are able to track the movement of sick and injured soldiers in transit. Adding the new TRAC2ES mobile app on MC4 systems provides a store-and-forward capability so users can generate patient movement requests even during times of low-to-no connectivity so that the information will transmit when internet access is restored.

The Patient Movement Items Tracking System (PMITS) also is on the list of additions to MC4 systems. PMITS not only enables patient tracking but also monitors the equipment that travels with wounded service members during medical evacuations. PMITS is able to do this now electronically, but the system was not previously accessible via MC4 systems. Now PMITS as part of the MC4 suite of applications, medical units can access the system on their MC4 laptops.

AF Opens New CVOR

Travis Air Force Base in California has been using equipment found in only four other hospitals in the nation. Surgeons at the USAF David Grant Medical Center (DGMC) in their Heart, Lung, and Vascular Center, have recently performed operations while using a new state-of-the-art hybrid Cardiovascular Operating Room (CVOR). The first surgery was performed at the CVOR in October.

The hybrid operating suite allows multi-specialty collaboration between heart and vascular doctors without relocating the patient to any other area. Cardiac surgeons, cardiologists and vascular surgeons are able to perform open-heart surgeries, vascular surgeries, and minimally invasive procedures in a single operating room.

“Hybrid procedures combine specialty operations that make surgeries quicker so patients aren’t on a heart and lung machine as long and leave the hospital quicker with fewer complications,” said Dr. Jerry Pratt, the Chief of Cardio-Thoracic Surgery at DGMC and the Chief Consultant to the Air Force Surgeon General for Cardiac and Thoracic Surgery. He continued to say “There will be some aortic valve operations that we’ll be able to do with the vascular surgeons simultaneously using the new technologies.”

The operating room, a joint venture between the Department of Defense and Veterans Affairs, contains robotic arm technology and 3-D imaging software that reconstructs images of the heart and vascular systems.

“For cardiac surgery, we like to use the imaging technology at the end of our bypass grafts, to enable us to look at the grafts after we’ve sewn them to the artery to ensure that they are functioning as they should,” said Dr. Pratt.

Traditionally, doctors would look at a cardiac catheterization before they operated, but there wasn’t technology available in the operating room that showed them where they needed to be on the artery. With this new imaging advanced technology, the surgeons are able to see if the graft needs to be moved or if we can do another procedure with the help of another heart or vascular specialist according to Dr. Pratt.

The operating room with the advanced technology also helps the nurses and technicians by making their job more efficient and they no longer have to move equipment in and out of the operating room since everything is already in the room. The set-up of the CVOR decreases the turnover time between patients from 25 to 35 minutes down to 10 to 15 minutes.

Faster Access to Records

The Department of Veterans Affairs (VA) is using health technology and a contractor to reduce the average time needed to obtain healthcare records from private physicians. A private contractor and the internet are being used to speed claims decisions. The VA is going to test about 50,000 records requests among regional benefits offices in Phoenix, New York City, St. Louis, Portland, Oregon, Chicago, Anchorage, Alaska, Indianapolis, and Jackson Mississippi. At the end of the test, VA officials will decide whether to cancel, modify, or expand any changes in procedures nationwide.

When private medical records support a veteran’s application for benefits, a contractor will quickly retrieve the records from the healthcare provider, scan them into a digital format and send the material to the VA via a secure transmission. In all cases, veterans must sign documents approving the release of their medical records to the department from private healthcare providers.

This pilot project hopes to validate initial estimates that a contractor can provide records required to process veterans’ disability compensation claims in 7 to 10 days instead of the VA’s average of 40 days. This also helps the VA staff to focus on core duties and to process claims more quickly.