Wednesday, March 30, 2011

Helping Adolescents

Growing populations of runaway and homeless adolescents face a higher than average risk of physical and mental health problems, but at the same time, have significant difficulties in accessing medical care. When medical issues arise, this group needs help but have few means of financial support.

Compared to the general adolescent population, homeless and runaway teens are significantly less likely to receive routine healthcare and more likely to seek emergency services. In general, they lack health insurance or money to pay for clinic visits, lack transportation to facilities, face insensitive attitudes among providers due to their minor status.

In addition, they often lack acceptable forms of identification and a safe place to keep important documents such as birth certificates and immunization records to help them gain access to care on an ongoing basis.

“Wind Youth Services” with the help of their technology partner “FollowMe” now offer a web-based personal health information service to homeless and runaway adolescents aged 11 to 22 via “Healthshack". This web service enables youths to enter, update, and access critical personal information such as their health history, proof of identity and insurance, hospital visits, immunizations, and laboratory results. The service also helps the youths find needed health resources, such as clinics, physicians, and medical products. Nurses, professional youth advocates, and peer advisors known as “health ambassadors” assist the adolescents in finding services.

“Wind Youth Services” initially received a grant from the Sierra Health Foundation to cover the costs of adapting the software and implementing the service on a pilot basis. Grants for $50,000 and $100,000 were awarded to fund the development of pilot versions of “Healthshack” and to provide ongoing financial support to the program.

Later in 2009, project leaders received a $400,000 grant from United Health Group to cover the costs for developing further versions of the software. The funding enabled the full-scale implementation of “Healthshack”. Today the program is focused on marketing the program’s value to communities and is looking to find other community organizations to offer the program.

As for costs, the chief expense consists of the upfront development costs and the ongoing annual licensing fee for the software. Program-related staffing costs are minimal because the physicians and nurses volunteer their time, and youth advocates participate as part of their regular jobs, with health ambassadors receiving a small monthly stipend for serving as health ambassadors.

Go to or to for more details on the program.

Telemedicine Issues Discussed

A Symposium held in Washington D.C on March 10, 2011 “Balancing Access, Safety, and Quality in a New Era of Telemedicine” hosted by the Federation of State Medical Boards discussed telemedicine’s future and the impact on healthcare.

About 100 participants spent the day exchanging ideas in both large and small group sessions focusing on technology, technology issues relating to patients, providers, and payers, and the role that state and federal policy should play in determining telemedicine’s future.

Vanessa Orlando, Executive Director, of the Rural Maryland Council and Jennifer Witten, Director of Government Relations for the American Heart and Stroke Association recently submitted their summary of the “Thinking Points” presented at the symposium.

Dr. Sachin Jain, Senior Advisor in the Office of the Administrator at CMS in his keynote address discussed the barriers to hindering the development of telehealth. According to Jain, although some of the providers are hesitant to adopt and use technology, the availability of technology is not really the problem. The real issue is reimbursement which has played a much more major role in slowing the adoption of technology.

Added to these problems, the culture in medical education and practice does not encourage physicians to embrace technology. Medical education still follows the traditional method of academic instruction that emphasizes a hands-on model with patients with the result that physicians are not infusing technology into their practices.

Dr Jain mentioned that several gray areas need to be addressed such as major concerns related to licensing and credentialing. It was also mentioned several times at the symposium that it is imperative that licensing and credentialing needs to be made easier, faster, and portable with a comprehensive verification system put in place.

Also, if care is provided across state lines then reimbursement issues must be addressed. Questions are being asked as to which state would be the disciplinary body if several states are involved, how to deal with differences in background standards and practice standards, and how to develop a common language with national definitions of certain words and phrases.

One important question asked is if a critically ill patient is transported to another facility and/or a facility across state lines—then what are the liability issues? Another panel tackled the issues of access, safety, and quality in telemedicine.

One important point was made that telemedicine doesn’t always result in an overall cost savings. Although it often increases access to care for more people and may reduce the per-person cost, using technology does not always reduce over-all costs.

In addition to the “Thinking Point” document recently released, the Federation of State Medical Boards (FSMB) plans to publish a white paper complete with the full scope of the symposium discussions.

The FSMB is also in the process of developing an action plan that is based on the ideas and feedback presented at the break-out sessions. Go to to view the “Thinking Points” summary and other available reports and statements.

Cochlear Implant Research

Many cochlear implant users may soon be able to easily modify the settings on their hearing devices using a smartphone interface such as a PDA. The PDA is easily adaptable to new and emerging technologies without the need to change or build new hardware. The interface used between mobile devices and cochlear implants could replace the speech processor that cochlear implant users now wear behind the ear.

An implant has:

• A Microphone which picks up sound from the environment
• A Speech processor, which selects and arranges sounds picked up by the microphone
• A Transmitter and receiver/stimulator which receives signals from the speech processor and converts the signals into electric impulses
• An electrode array to collect impulses from the stimulator and then sends them to different regions of the auditory nerve

The new technology will provide flexibility so that cochlear implant users will be able to change the programs in their device with a great deal of flexibility. The new technology will also enable cochlear implant users to get additional help by recording speech and other environmental sounds that they find particularly challenging.

Ten healthcare and research facilities are slated to participate in clinical trials of the technology pending FDA approval, reports Dr. Philip Loizou, Director of the Cochlear Implant Lab at the University of Texas at Dallas and Principal Investigator for the $2.5 million project funded by NIH.

The University of California at Irvine in their Cochlear Implant Center are doing some other cutting edge collaborative research to develop the first implantable device to replace the balance function, designing a new generation of cochlear implant electrodes, and developing a cochlear implant sound simulator.

Other ongoing research by the NIH National Institute on Deafness and other Communication Disorders (NIDCD) reports that researchers in the field are working on using a shortened electrode array inserted into a portion of the cochlear for individuals whose hearing loss is limited to the higher frequencies.

Other studies are exploring how to make a cochlear implant convey the sounds of speech more clearly, and researchers are also looking at the potential benefits of pairing a cochlear implant in one ear with either another cochlear implant or a hearing aid in the other ear.

HIN Helps in Rural Kansas

A rural Kansas Health Information Network (KHIN) will help rural medical providers in Kansas exchange digital health records, link individual medical providers, but also link regional exchanges such as the Wichita Health Information and eHealthAlign in Kansas City into a single statewide network.

“Healthcare really is local and regional, and Kansas City is not going to want to do the same thing as Wichita, nor will the rural Health Information Network want to do exactly what the urban organizations are doing, so KHIN has to be responsive to the needs of each organization”, according to Laura McCrary, Director of the Kansas Health Information Network.

As explained by McCrary, “The large urban areas have the resources and the provider base to bring the community together to use the HIE but rural communities and hospitals generally don’t have the required expertise and are located all over the state.”

About a dozen hospitals are ready to begin working with the rural network as reported by McCrary, and have implemented enough of their electronic health record systems that they now are able to begin to exchange information “The new rural network will be comparable to the urban based networks and help providers with similar needs decide how to share data and understand what privacy and security protocols need to be place,” said McCrary.

The Kansas Foundation for Medical Care as the operator of the Regional Extension Center was granted a total of $9.1 million to help the state’s more than 1,900 healthcare providers’ transition to EHRs and help with EHR adoption in both urban and rural communities.

The REC works with healthcare providers to help them select their software vendor. For example, Ness County Administrator Kyle Hahn reports that his 20 bed critical access hospital in western Kansas spent several months evaluating EHR systems. The hospital eventually based their selection of the vendor on cost and the company’s ability to program a custom interface with Ness County’s practice management software.

Sunday, March 27, 2011

Federal HIT Plan Available

The “Federal Health IT Strategic Plan: 2011-2015” released on March 25th is available for public comment until April 22, 2011. The plan last published in 2008, has been updated to take into account the rapidly changing landscape of health IT and health IT policy. The HIT landscape has been altered over the past two years by both the HITECH Act passed as part of ARRA and the Patient Protection and Affordable Care Act since both pieces of legislation committed significant resources to health IT.

Over the past year, ONC has collaborated with its federal partners, the private sector through the health IT Policy Committee, and the public to update the plan. Basically, the plan has five goals to include:

• Goal I: Achieve adoption and information exchange through meaningful use of health IT

• Goal II: Improve Care, improve population health, and reduce health care costs through the use of health IT

• Goal III: Inspire confidence and trust in health IT

• Goal IV: Empower individuals with health IT to improve their health and the healthcare system

• Goal V: Achieve rapid learning and technological advancement

To download the Federal HIT Strategic Plan 2011-2015, go to

Lifeline/Link-UP Modernization

In the March 23, 2011 Federal Register, the FCC presented a set of proposals and recommendations to modernize and reform Lifeline/Link-Up which is part of the FCC’s Universal Service program. The FCC has not systematically re-examined Lifeline/Link-Up since the passage of the 1996 Act but at this time, new technologies and regulatory changes have put a strain on the program. The FCC at the crossroads is examining the strategies needed to increase broadband adoption, but at the same time, not increase the overall program size.

The recommendations published in the Federal Register included ideas and suggestions made by the Federal-State Joint Board on Universal Service, GAO, and from proposals and ideas contained in the National Broadband Plan. The proposed reforms address waste, fraud, abuse, controlling the size of the program, strengthening program administration and accountability, improving enrollment and outreach efforts. The FCC is also thinking of developing pilot programs to assess whether the new ideas and recommendations suggested will work with the program.

An important issue that needs to be addressed, concerns individual states and/or Tribal governments and dealing with their unique technological issues that might make it impractical or burdensome to implement coordinated enrollment. For example, the ability of a state or Tribal government to implement enrollment may depend upon the capabilities of existing but possibly out dated data processing equipment, software, and data communication networks.

One of the other technological issues in the document concerns the development of a national database. A number of questions need to be answered so further development of the database could take place. A sample of the questions on the development of the database concern:

• Who should administer the database? Should it be the USAF or a third-party?

• How should the national database be funded and maintained? Should the database be funded completely or partially from the Universal Service Fund?

• How should privacy issues be addressed? • What functions should be served by a centralized database?

• How to address customer eligibility and how to receive updates in changes in consumer eligibility from appropriate social service agencies?

• How should the database be populated and by whom? • What should the specific system requirements be?

• What costs would the states incur if any if a national database were established?

• Should a state/Regional database be established as opposed to or in addition to a national database?

For more details and information, go to the March 23, 2011 Federal Register. Comments are welcome on the proposed recommendations and are due on or before April 21, 2011.

Screening for Eye Diseases

The National Eye Institute awarded a grant to VisionQuest Biomedical in Albuquerque New Mexico to study how to implement computer-assisted technology to screen for eye diseases. According to CDC, millions of people in the U.S. have some form of eye disease, with 20 million diabetics at risk for retinopathy, 60 million at risk for glaucoma, plus an additional 13 million are diagnosed with age-related macular degeneration.

The goal is to create an affordable and accessible solution in order to provide a comprehensive screening program. Today, people go to ophthalmologists, optometrists, or other trained specialists, but for each professional to grade each case for each person is prohibitively expensive and time consuming.

The solution is to implement a computer-assisted technology similar to other medical applications, such as mammograms and Pap smears that would provide comprehensive periodic screenings for the at-risk population. Eventually, the hope is to implement an automatic eye disease screening system to be made available at centers across the U.S and globally.

To conduct the research, a screening center in South Texas where nearly 200,000 diabetics reside and over 50 percent do not receive annual examinations will document the efficacy of the software. The Center’s plan is to show how many cases screened per time period solely use automation and human screeners and compare this approach to solely human-based screening.

The initial year for the start of the project was 2010 and research will continue until 2013 for the grant RC3EY020749-01. For more information on the technology or project, email VisionQuest Biomedical at Peter Soliz, at or call (505) 508-1994.

WV Issues RFP

West Virginia’s Department of Health and Human Resources within their Bureau for Medical Services (BMS) in February issued an RFP “v10.0-DW/DSS (MED11015)”. The RFP seeks proposers to help design, develop, implement, operate, a “WV Medicaid Data Warehouse/Decision Support System (DW/DSS).”

Systems enhancements are needed so that BMS can meet their data analysis and reporting needs. According to the RFP, BMS is responsible for the overall strategic direction and priorities for the state Medicaid Program. The Bureau wants to streamline the administration to better tailor services to meet the needs of enrolled populations and to better coordinate care especially with individuals with chronic conditions. BMS would like a robust DW/DSS in place as soon as possible.

The Medicaid program provides healthcare benefits to 411,000 people across 55 counties using a network of 24,000 active providers. The MMIS processes about 17.7 million claims per year, 9.5 million medical/dental claims, and 8.2 million pharmacy claims. About 93 percent of claims are received electronically of which 53 percent are pharmacy claims. About 165,000 Medicaid recipients consisting of families with dependent children, low-income children, and pregnant women are enrolled in three Managed Care Organizations (MCOs).

So far, the Medicaid program has paid for certain services for MCO recipients specifically for pharmacy, children’s dental services, and behavioral health services. The Medicaid program also manages a Primary Care Case Management program. The Physician Assured Access System processes claims for two waiver programs and several state funded eligibility programs and functions as their party administrator for other state agencies.

The WV Office of Technology Enterprise Project Management Office (EPMO) manages information technology projects, provides oversight for state agency information technology projects, and will provide oversight for the DW/DSS procurement project BMS plans to reduce redundancy in services and payments by integrating with other entities, plans to automate reporting capabilities, and integrate claims data with clinical data. The Bureau plans to use technology tools and provide training for data analysis to enhance decision and policy making capabilities.

The vendor proposal opening date is May 17, 2011. To view the Request for Proposal, go to

Hudson Valley's PCMH

Nearly half a million patients in New York’s Hudson Valley now refer to their primary care physician offices as Patient Centered Medical Homes (PCMH). This was accomplished when the Taconic Health Information Network and Community (THINC) project was able to get six health plans to participate in PCMH.

The six health plans Aetna, CDPHP, Hudson Health Plan, MVP Health Care, UnitedHealthcare, and Empire Blue Cross Blue Shield, represent 65 percent of the commercial insurance market in the Hudson Valley and 43 percent of Medicaid managed care. The health plans paid $1.5 million to 236 primary care physicians in eleven practices to transform to a PCMH and received recognition from the National Committee for Quality Assurance.

Establishing a medical home requires:

• Redesign of the work flow at practices

• Emphasizing a team-based approach to care • Better access to care through open scheduling • Using electronic health communication tools such as EHRs, and ePrescribing

• Practices to initiate care coordination

• Focus on preventive care

The PCMH transformation project was managed over a one year period by THINC, the not-for-profit organization that enables providers, payers, employers, public health agencies, quality organizations, consumers and local leaders to improve the quality safety and efficiency of healthcare for the community. “The success of this project means we’ve reached critical mass for the medical home in the Hudson Valley,” said Susan Stuard, THINC’s Executive Director.

The health plans provided data to evaluate the project’s outcomes as part of a five year commitment to help practices enhance delivery of services. This project evaluation will give information on physician and patient satisfaction and how to make improvements in quality of care. THINC partners will work with researchers at Weill Cornell Medical College to evaluate the outcomes of the program.

Following on the success of the medical home incentive program, THINC in partnership with Taconic IPA and supported by technical expertise from Geisinger Health System is working to bring a model of embedded care management within NCQA Level 3 patient-centered medical homes. Geiginger’s ProvenHealth Navigator program will be tailored to meet the specific needs of the Hudson Valley. The program will start with a small pilot at several sites with the ultimate goal of rolling out to medical homes that are recognized by primary care providers across the community. For more information, go to or go to

Top Speakers at Med-e-Tel 2011

The Med-e-Tel Exhibition and Conference to be held April 6-8, 2011 in Luxembourg will feature impressive presentations discussing successful business cases, pilot projects, practical experiences, and hold discussions on international issues of vital interest to the global eHealth and telemedicine community.

The variety of presentations, panel discussions, and workshops will allow attendees to listen to all of the experts present a variety of innovative and stimulating ideas that will help organizations and attendees successfully grow in the local or global health technology field.

The opening session will include:

• Mars Di Bartolomeo, Minister of Health and Social Security, Luxembourg
• Najeeb Al-Shorbaji, Director, Knowledge Management and Sharing (KMS) WHO Michael Nerlich, President, International Society for Telemedicine & eHealth
• Frank Lievens, Director, Med-e-Tel • Peteris Zilgalvis, Head of Unit, ICT for Health, DG Information Society and Media, European Commission
• Viktor Kotelnikov, Scientific Affairs Officer, UN, Office for Outer Space Affairs • David Benton, CEO, International Council of Nurses
• Laurent Treluyer, Ministry of Health, France Jan Van Emelen, Head of Working Group on Disease Management Association Internationale de la Mutualite (AIM) and Director of Innovation, Independent Health Insurance Funds, Belgium
• S. Yunkap Kwankam , Executive Director, International Society for Telemedicine & eHealth
• Luis Falcon, CEO & Founder, Thymbra and GNU Solidario

Key sessions will be held on what works, what doesn’t work, as well as on what exists, or what is under development in telemedicine, ehealth, and health ICT systems and solutions.

Key ideas and topics will be on:

• Mobile Health, telecardiology, telemonitoring, distance consultations, EHRs, eLearning and much more
• Gerontechnologies for independent living services for older people or people with loss of autonomy • Benefits of open source software in healthcare
• Debate on evidence of telehealth outcomes in terms of clinical and economic outcomes
• Regional initiatives in telemedicine and eHealth
• Ethical and legal issues in eHealth and telemedicine
• A review of the European project “RENEWING HEALTH-Regions of Europe Working Together for Health” to support implementation of large-scale real-life test beds
• Virtual reality, mental health, stress related disorders and rehabilitation
• Satellite applications to health

Plus much more information and conversation on other stimulating and important topics will be an important part of the three day meeting.

Conference participants will want to take part in great networking opportunities for possible contacts and partnerships. This meeting is the perfect forum to share experiences and knowledge and a great chance to gain new insights. The Med-e-Tel expo and networking area will include many companies with just released and innovative products such as A&D Medical, Aerotel Medical Systems, Aipermon, AMD Global Telemedicine, Andago, Austrian Institute of Technology, BIRDA, Boston Life Labs, eWaveMD, HOPI, i2Cat, MEDGATE, Nonin, Orange Healthcare, South African Telemedicine, Thymbra, Vidyo, and Vitaphone. For more information, go to or email or by telephone +32 2 269 84 56.

Wednesday, March 23, 2011

Developing the Artificial Pancreas

A new strategic plan to guide diabetes-related research over the next decade was announced by NIH. The plan led by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), identifies research opportunities with the greatest potential to help millions living with or at risk for diabetes and its complications. Total costs of diabetes, including medical care disability and premature death reached an estimated $174 billion in 2007 in just the U.S.

The new strategic plan entitled “Advances and Emerging Opportunities in Diabetes Research: A Strategic Planning Report” was developed by the Diabetes Mellitus Interagency Coordinating Committee” (DMICC). The Coordinating Committee facilitates communication and collaboration on diabetes research across the federal government by focusing on ten areas of diabetes research. Input for the strategic plan came from stakeholders both public and private, health advocacy groups, and external scientists who are leaders in the diabetes research field.

One research area is looking for bioengineering approaches to develop an artificial pancreas to improve management of diabetes. An artificial pancreas is a system that mimics as closely as possible the way a healthy pancreas detects changes in blood glucose levels and responds automatically to secrete the appropriate amounts of insulin. An artificial pancreas is based on mechanical devices that require at least three computers, a Continuous Glucose Monitoring (CGM) system, insulin delivery system, and a computer program that can adjust insulin delivery based on changes in glucose levels.

Scientists have taken the first steps to develop a mechanical artificial pancreas. Today, mechanical CGMs are now being used clinically so that diabetics can view real-time glucose levels, see fluctuations in levels, and be alerted when the levels become too high or too low.

These mechanical CGMs combine a continuous glucose sensor with a unit displaying glucose levels. The sensors are inserted under the skin for up to three to seven days and transmit readings of glucose levels in the tissue fluid every 1 to 5 minutes to a receiver carried by the individual.

Today, although current glucose sensors remain less accurate than traditional blood glucose meters, they offer people with diabetes an opportunity to spend more time in the close to normal glucose range without increasing the risk of brain injury from severe hypoglycemia.

The plan stresses the need to develop new sophisticated technological tools and instruments to treat diabetics and suggests looking for telemedicine technologies to find solutions. The thought is that software developers should work with investigators to develop algorithms to provide advice on diabetes management decisions, develop accelerometers to track physical activity to help make diabetes management decisions, and further develop sophisticated global positioning system technology to locate people if they need assistance.

To continue working towards developing and perfecting new monitoring devices that will work towards development of the artificial pancreas, NIH in February 2011 and last May issued Funding Opportunity Notices to do further research to develop the artificial pancreas.

In February 2011, RFA-DK-10-012 was issued by NIDDK to focus on major unanswered questions on Type 1 diabetes research that were mentioned in the NIDDK report “Autoimmunity, Imaging, and Biomarker Development, Diabetic Complications, and Engineering the Artificial Pancreas.” The FOA “Type 1 Diabetes Impact Award” is scheduled to be a $30 million five year program.

The FOA has a section on engineering the artificial pancreas and asks for researchers to develop a closed-loop artificial pancreas system which will combine the principles of engineering, nanotechnology, universal design, computer science, and informatics.

Last year, in May 2010, a FOA was also released by NIDDK and NICHD for a SBIR grant application. The FOA was entitled “SBIR to Develop New Therapeutics and Monitoring Technologies for Type 1 Diabetes Towards an Artificial Pancreas” (RFA-DK-10-008). The research supports innovative technologies to advance progress towards an integrated, long term automated glucose regulated insulin delivery system or artificial pancreas.

The strategic plan to guide diabetes-related research over the next decade is available for downloading at Printed copies will be available from the National Diabetes Information Clearinghouse beginning April 1, 2011 at 1-800-860-8747 or by email at

Veteran Program Launched

The Veterans Administration’s “Million Veteran Program (MVP): A Partnership with Veterans” is researching genetic traits according to an article that appeared in the VA New England Health Care System publication “Veterans Healthy Living.” Over the next five to seven years, MVP will reshape the field of genomics and will be one of the largest databases tracking genetic information with data on one million veterans.

The VA’s goal is to have more information on what causes illnesses by using the massive database to track specific genetic data. Data will be obtained on veterans on a voluntary basis and will include data on their military exposure, their lifestyle, blood samples, and veterans will need to provide their health information for assessment purposes. This means that veterans will need to allow access to all their VA and VA-linked medical and health information.

By collecting so much information on so many participants, VA researchers will have an unprecedented amount of data to compare and identify what genetic traits make veterans more susceptible to illnesses and what preventative measures should be taken. It may also help the VA understand why some veterans respond to a treatment while others do not which will eventually allow for more personalized treatments for veterans.

Confidentiality on priority information will be kept private and secure for the veterans participating. Although researchers will have access to the information, the name, address, date of birth, and social security number will not be available on the participants and all information will be coded to further protect privacy.

MVP was launched within the VA New England Healthcare System starting with the Boston VAHS in January 2011 with the launch of the Connecticut VAHS following and after those rollouts, the program will be launched nationally.

For more information, go to or call (866) 441-6075.

Alaska's Health Tech News

In 2010, the Alaska Department of Health and Social Services (DHHS) signed a cooperative agreement with the HHS Office of the National Coordinator for HIT to create a HIE in the state. The state awarded a contract to the Alaska eHealth Network (AeHN) to procure and manage the development of the HIE network.

According to the AeHN publication “Exchange” the Network has initiated a HIE pilot to include hospitals and ambulatory clinics. The sites include the Alaska Heart Institute, Alaska Native Medical Center, Bartlett Regional Hospital, Fairbanks Memorial Hospital, Providence Hospital, Tanana Valley Clinic in Fairbanks, and Valley Medical Center in Juneau. Upon completion of the pilot phase in April, AeHN will begin to implement HIE services statewide.

The selected HIE vendor, Orion Health has planned a very aggressive implementation schedule for 2011 to include over 300 interfaces. Initial services for the providers will include secure sharing of information on labs, prescriptions, demographics, admission discharges, and permits the transfer of ADT data.

“VacTRAK”, the state immunization system and the “Laboratory Information Management System” will be connected to the HIE through implementation of 20 state interfaces that are included in the agreement between AeHN and Orion Health.

All providers in the state are eventually expected to connect to the statewide HIE, including Medicare, Medicaid, commercial providers as well as the Alaska Tribal Health System and federal partners in Alaska such as the VA, DOD, and Coast Guard.

Alaska’s Regional Extension Center (REC) managed by AeHN opened in 2010. Primary care provider members are eligible for up to $3,000 available from ARRA funds to obtain REC technical services to help adopt or upgrade to certified EHRs, and to improve their competencies in EHR use. Rural or critical access hospitals can qualify for up to $12,000 in ARRA funds and services are also available to all other providers at lower, contracted partners rates.

Alaska’s DHSS is rebuilding the state’s Medicaid claims processing and payment system as the current system is about 20 years old. The new MMIS will be complete with a new claims payment system along with a claims data warehouse information system and is due to go live in the spring of 2012. The new web-enabled Medicaid system will be in place to administer all Medicaid programs and will have a number of self-service features.

The Alaska Primary Care Association (APCA) created the “Alaska Community Health Integrated Network” (ACHIN) to implement HIT resources to serve safety net clinics across the state. The plan is to build a Wide Area Network to support centralized servers, software, video conferencing, and telehealth applications. Nine Community Health Clinics are going to take part and other CHCs are expected to join in the future. APCA received additional funding from HRSA to add ACHIN services and will customize EMR application templates to support behavioral health services.

An FCC contract was filed by the Alaska Native Tribal Health Consortium on behalf of the AeHN with a three year $10.4 million contract award. The objective of the FCC contract is to unify separate electronic health care networks in the state to be able to supply rural health providers with connectivity not only in Alaska, but also in the lower 48. A FCC approved Request for Proposal is expected to be released no later than June, 2011.

The DHHS and their Division of Health Care Services is supporting NHIN along with monitoring the progress of NHIN/CONNECT. This is taking place through dialogue with DOD and the VA and by communicating with EPIC and Kaiser who are significant providers in the healthcare community.

For more information on AeHN, go to, or email Jim Landon at, or call (866) 966-9030 extension 4.

Delivering High Tech Training

Dr. D. Richard Kang and Dr. Gregory Wiet, pediatric otolaryngologists from Nationwide Children’s Hospital in Columbus Ohio and Ohio State University (OSU), visited Escuela Hospital Antonio Lenin Fonseca in Managua, Nicaragua in January. This was their fourth annual trip to the facility which serves as the country’s focal point for medical and surgical training.

When they arrived in Nicaragua, Kang and Wiet presented a “virtual temporal bone dissection” course. Participants were trained on the “Virtual Temporal Bone” surgery simulation system developed at Nationwide and OSU in conjunction with the Ohio Supercomputer Center (OSC) and with NIH funding.

“The system creates real-time, interactive computer simulations for surgeons to learn the difficult and delicate surgical techniques associated with ear surgery, that can involve drilling into a bone in the skull called the temporal bone,” explained Don Stredney, Senior Research Scientist for Biomedical Applications at OSU where his team helped develop the simulation. “Because the temporal bone lies close to a major artery and critical nerves for the face, learning to perform the surgery can be tricky.”

Without a virtual simulation environment, medical residents have to learn how to do the surgery by working on cadavers and through apprenticeships in an operating room. However, in some countries, cadaveric material is not readily available.

The system makes use of a laptop computer with powerful graphics processing capability and a haptic device to provide force feedback. This feature enables the surgical trainee to have a feel for the drill interacting with the temporal bone. “With this type of training, surgeons are not only learning with their eyes, but also with their sense of touch,” noted Wiet.

Stredney and Wiet believe that the simulation technology will increase the efficiency of a resident’s training while raising their proficiency and in addition, provide a safe, cost effective way to help students in the early stages while they are developing surgical techniques.

Kang and Wiet plan to continue to return to Nicaragua on a regular basis not only to provide care for the population but also to continue to deliver high tech training to the region’s otolaryngology community.

HP Receives Medicaid Contract

HP Enterprise Services just announced a five year, $176 million services agreement with the Nevada Division of Health Care Financing and Policy to strengthen Medicaid operations within the state and to position the state for healthcare reform. The new agreement calls for HP to become Nevada’s Medicaid fiscal agent and upgrade and manage the state’s Medicaid Management Information System.

The agency is responsible for Medicaid benefits for almost 300,000 Nevada residents and processes about 12 million Medicaid claims per year. HP administers $95 billion in benefits a year but also serves as fiscal agent or principal IT provider to 21 other Medicaid programs.

HP will process medical and pharmacy claims as well as review and process prior authorization requests. In addition, HP will assist the Medicaid program in connecting healthcare providers with critical health information.

To address the issue of fraud, the company will help the state in detecting potential fraud and abuse cases while at the same time improve the efficiency of claims processing. HP has plans to add new decision-support systems and services to enable better decision-making through more accurate and up-to-date information.

For more information, go to

Sign up Today for ATA 2011

Sign up immediately to attend the American Telemedicine Association’s 16th Annual International Meeting and Exposition on May 1-3, 2011 in Tampa, Florida. ATA 2011, the most important event of the year is the world’s largest scientific meeting and exposition focusing exclusively on telemedicine, telehealth, and remote medical technologies. Come to listen to 450 plus experts discuss many topics and learn how to navigate potential barriers so as not to miss vital opportunities in the field.

To open the meeting, the plenary keynote speaker will feature D. Martin Cooper, inventor of the modern cellphone and also a prominent mHealth advocate.

There will be 260 presentations so that attendees will be able to hear concurrent educational sessions delving into the latest hot topics, policy issues, research, and clinical breakthroughs in telemedicine. Don’t miss a combination of other topics on emergency & disaster response, operations, business & finance, remote monitoring, mHealth, technology & telecommunications, and telemental health.

Attendees will also be able to take advantage of professional development certificate courses with up-to-date information in the field along with the latest administrative, clinical, and technical aspects of telemedicine operations. These courses will be given on April 30th and on May 1st.

Attendees might want to take advantage of the Army Medical Research & Materiel Command and TATRC’s pre-meeting full day program on April 30th to talk to a range of experts and discuss what is emerging in the technology field. The day’s speakers will focus on medical care in austere environments.

ATA 2011 will have 200,000 square feet exhibiting the latest telemedicine, telehealth, and mHealth technology and services. See and handle thousands of cutting edge products and services available from a wide array of vendors. Nowhere else in the world will you be able to see so large a collection of remote medical technology products. Go to to view the Virtual Exhibit Hall and to see the Expo’s mobile webpage.

Online registration is available at and be sure to register before April 1 for discounted early-bird rates. For more information on exhibiting, sponsorship, or advertising opportunities, contact, Sandy Hung at 202-223-4249 or by email at

Sunday, March 20, 2011

Broadband & Public Safety

In times of emergencies, people need to reach emergency responders by phone, by texting, and have the ability to send videos. These capabilities would help emergency responders more effectively do their job but state-of-the-art communication skills can’t be accomplished without broadband.

In discussing broadband progress and the effect it has on public safety and emergency responders, Jennifer Manner, Deputy Chief, Public Safety and Homeland Security Bureau, of the FCC took part in a panel discussion on “Broadband a Year Later” sponsored by the Information Technology & Innovation Foundation on March 16th.

She explained that today although many emergency responders work with all types of emergency situations, many of these responders still do not have broadband available for their use. Today emergency 9-1-1 systems still operate on circuit-switched networks and federal, tribal, state, and local governments are still using outdated alerting systems during emergencies.

To proceed further in developing broadband for public safety use, Manner explained that the FCC has established the Emergency Response Interoperability Center known as ERIC as part of the Public Safety and Homeland Security Bureau. The Center is listening to the advice of a technology advisory committee comprised of 60 public safety officials across government and industry on how to foster nationwide operability and interoperability in wireless broadband communications.

As Manner pointed out, the Next Generation 9-1-1 emergency call system and the Next Generation emergency alerting technologies are extremely critical to put in place so that everyone can reach emergency responders. President Obama in his statement in his budget statement in February is calling for an investment for $10.7 billion to ensure that public safety will be able to benefit from Next Generation and include 4G high-speed wireless services and $3.2 billion to reallocate the “D Block” (the band of spectrum that would be reserved and prioritized for public safety and not auctioned as called for under existing law).

Manner mentioned that several bills have been introduced addressing public safety emergency issues. The “Broadband for First Responders Act of 2011” (H.R.6007) introduced by Representative Peter King would increase the electromagnetic spectrum allocation for commercial use.

A related bill “Public Safety Spectrum and Wireless Innovation Act” (S.28) was introduced in by Senator John D. Rockefeller IV. This bill would require a broadband 700 MHz band to be deployed in both rural and urban areas. The bill would also reallocate and integrate the 700 MHz D Block spectrum for use by public safety entities.

To move broadband forward, NIST and NTIA are presently working on a 700 MHz Public Safety Broadband Demonstration Network to provide manufacturers and first responders a location for early deployment of their systems in a multi-vendor, neutral, host environment. The Demonstration Network has 3 phases including network and test planning (phase 1), deployment (phase 2), and testing and demonstrations (phase 3). The demonstration is helping emergency responders learn how broadband systems perform and working to determine through hands-on-experience how these systems can meet unique needs.

DARPA Releases FOAs

The Defense Advanced Research Project Agency (DARPA) through the Defense Sciences Office released two Funding Opportunity Announcements (FOA) seeking new diagnostic capabilities. DARPA is interested in new devices to deal with unmet clinical needs as well as to decrease the time to design, manufacture, and distribute new assays when future needs arise.

The general name for the two programs is “Autonomous Diagnostics to Enable Prevention and Therapeutics”. The first solicitation in the program “Diagnostics on Demand—Point of Care” (DARPA-BAA-11-38) focuses specifically on developing point-of-care highly multiplexed and reconfigurable devices. DARPA wants to significantly advance point-of-care diagnostics and develop capabilities that far exceed current technologies.

Very often service members in deployed settings have limited access to healthcare therefore new methods and devices are needed to address critical conditions on-site. Very often select critical diagnostic tests may need to be performed using a rapid test carried by soldiers in limited resource settings.

The second solicitation “Diagnostics on Demand—Limited Resource Settings” (DARPA-BAA-11-39) is envisioned by DARPA as an interdisciplinary research effort to develop diagnostic capabilities that are deployable with military personnel in limited resource settings.

This effort will develop and demonstrate clinically valid devices for the detection of multiple critical analytes in relevant self-collected biospecimens. The additional goal is to develop diagnostic devices that can be operated by unskilled users in these settings.

Proposal abstracts are due for BAA-11-38 on April 12, 2011 and for BAA-11-39, the due date for abstracts is April 14, 2011. Full proposals for BAA-11-38 are due May 17, 2011 and for BAA-11-39, the date is May 19, 2011. The contact for both funding announcements is Dr. Daniel Wattendorf, at either or

To view the funding announcements in detail, go to either or

Saving Lives at Birth

An international program addressing the critical need to go beyond conventional approaches could help to advance maternal and newborn health in rural and low resource settings. This is especially important in Africa where pregnant African women are 135 times more likely to die during childbirth than in other regions in the world.

A new program has been introduced to specifically address the period when women and their newborns are most vulnerable and need the most help. That brief window of time is between the onset of labor and 48 hours after birth when women and children die.

Grant funding (RFA-OAA-11-000006) was announced to support the program called “Saving Lives at Birth: A Grand Challenge for Development” to find innovative prevention and treatment approaches to use with pregnant women and newborns, develop new technologies to improve the safety of birth, and to help women with health issues.

To support this program, the USAID, Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the World Bank are partnering to provide funding for $13 million for the grant program’s first round of funding. Over 5 years, the partners aim to invest at least $50 million in groundbreaking and sustainable projects.

The program especially seeks for-profit companies, non-governmental organizations, academic medical research institutions, faith-based organizations, civic groups, and foundations to work together or to form partnerships to help to solve the severe issues women internationally have birthing their babies and then keeping them alive.

The program seeks bold ideas that will help to prevent, detect, or treat maternal and newborn problems at the time of birth. Examples include developing simpler or portable technologies for newborn resuscitation, feeding, warming, to take care of preterm and low birth weight newborns, manage infections, how to develop more efficient ways to transport sick newborns and mothers with complications and how to prevent and treat hypertensive disorders like preeclampsia/eclampsia.

New ways to use information and communication technology is needed to bring new approaches to upgrading health systems in communities. Technology can also be used to recruit and retain skilled personnel and provide training programs for community-based or alternative health workers.

In addition, the Challenge is looking for innovative ways to use technology to incentivize individuals to seek care and /or adopt appropriate health behaviors. This may require development of new mass communication methods to change individual and collective behavior to improve outcomes at birth.

For more information, go to or to

Universities Form Partnerships

FDA and Georgetown University Medical Center have established a new partnership to stimulate innovation in regulatory science, ethics, education, and training. The partnership will do research and public health activities in novel technologies, public health preparedness, and bioinformatics. There will also be joint mentoring of students both doctoral and post-doctoral to help them work together on collaborate research. To complement the program, scientific staff exchanges and professional development opportunities will take place.

Another university program is reaching out to the community. Researchers with the University of California Irvine’s Institute for Clinical & Translational Science (ICTS) are taking their research into the community and used grant funding to establish the Orange County Center for Community Health Research. This Center provides a framework for community-based groups to organize their own research on such issues as childhood obesity, diabetes, and poverty.

“It allows UCI for the first time to have researchers engage with the community in a really meaningful way, “says Dan Cooper, Director of the ICTS and the Orange County Center for Community Health Research. “We now have the infrastructure to build real collaborations and to respond to community interests.”

The Center doesn’t fund any specific studies but acts as a resource hub for community-based research in the county. The Center provides web-based training and video conferencing, team building, workshops, and other services to facilitate networking, education, and mentoring between UCI and the public. The Center also functions as a clearinghouse for healthcare data in Orange County that is currently available from participating studies and can now be shared with community groups.

Tufts University on February 7th launched the “Tufts Institute for Pharmaceutical Partnerships” website that is now operating as their “Global Pharma Strategy and Project Development HUB”. The website at is custom developed and designed to educate and engage pharmaceutical partners, qualify partners, and create distinctive alliances. The website functions as the Institute’s principal commercialization portal, communication vehicle, strategic market resource, and information repository to help form important strategic alliances.

Current information available from the HUB includes five thematic areas of expertise derived from five different schools and one center. The site provides immediate access to nearly 60 research activities driven by more than 50 participating faculty members with navigable information in more than 300 categories.

Still Time to Register

The “2011 Virginia Telehealth Summit” co-sponsored by the Virginia Telehealth Network will be held April 5, 2011 at the beautiful Wintergreen Resort in Central Virginia. A variety of topics important to the leaders and executives in the rural health field will be presented for a full day of non-stop rural health information. Take advantage of the many networking opportunities that will present new ideas and thoughts on how to forge ahead and make a difference to so many people in rural America.

To open the exciting day, Karen Rheuban, MD., President and Chairman of the Virginia Telehealth Network will give an overview of the issues confronting today’s rural health field. This will be followed by Karen Jackson, Deputy Secretary of Technology for the Commonwealth of Virginia who will present the results of the Virginia Healthcare Broadband, HIT, and Telehealth Survey.

Funding in the telehealth field is a very important issue and the attendees will have the fortune to hear top speakers with expertise in this area. The presenters will include Sherilyn Pruitt, Director, Office for the Advancement of Telehealth within the Office of Rural Health Policy at HRSA, Eugene Sullivan, Program Manager, for the Office of Telemedicine, at the University of Virginia, Ellen Matthews Davis, Virginia State Director for Rural Development at USDA, and Paloma Costa, Program Manager of Outreach, Rural Health Care for the Universal Service Administrative Company

Telehealth projects can only proceed so far without sustainable programs. Presenters on sustainable programs in terms of reimbursement and models will be:

• Patrick M. Hamilton, Health Insurance Specialist/Rural Health Coordination for CMS in their Philadelphia Regional Office
• Gregg A. Pane, MD, MPA, Director of the Virginia Department of Medical Assistance Services
• David Selig, CEO, for the Community Care Network of Virginia, Inc.
• Karen Rheuban M.D., Professor of Pediatrics, Senior Associate Dean for External Affairs and Continuing Medical Education and Medical Director for the Office of Telemedicine, at the University of Virginia
• Keven L. Barger, CEBS, FAHM, CPC Network Management Director, Provider Engagement and Contracting Central Virginia, Anthem

Understanding and dealing with legal and regulatory issues is vital to the field and with information to be presented by Brian W. Murray, Attorney with Latham & Watkins, LLP, Washington D.C., Gary Capistrant, Senior Director, Public Policy, ATA, plus two speakers from the Center for Telehealth & E-Health Law (CTeL) to include Greg Billings, Executive Director and Senior Government Relations Director, Drinker, Biddle & Reath along with Rene Quashie, Regulatory Attorney for CTeL, and Government Relations Director/Regulatory Attorney for Drinker, Biddle & Reath.

Edward Brown M.D., CEO of the Ontario Telemedicine Network in Canada will present a northern rural viewpoint on the effectiveness of technologies used in healthcare by our friends in the north.

HIT and Meaningful Use a topic of vital interest to all in the telehealth and health IT field to increase the adoption of EMRs will engage attendees with the subject matter presented by experts:

• Patrick M. Hamilton, Health Insurance Specialist, Rural Health Coordinator, CMS
• Michael Matthews, CEO MedVirginia
• Sallie S. Cook, MD., CMO, VHQC/Virginia HIT Regional Extension Center

The day will include a presentation on the Virginia Health Reform Initiative to be discussed by Karen Rheuban, MD, and Stephen Bowman, Senior Staff Attorney/Methodologist for the Joint Commission on Health Care.

Other speakers will zero in on topics such as telemental health and mHealth/social media:

• Jim B. Tucker, MD., Assistant Professor of Psychiatric Medicine, University of Virginia
• Adrienne Turner, MD., Fellow in Child and Adolescent Psychiatry, University of Virginia Health System
• Felasfa Wodajo, MD, Medical Director of Musculoskeletal Oncology at Virginia Hospital Center in Northern Virginia. Also Senior Editor and Partner of the online: iMedicalApps: Mobile Medical App Reviews & Commentary
• Mark H. Ryan MD, Department of Family Medicine, Virginia Commonwealth University Medical Center. Also a member of the Mayo Clinic Center for Social Media Advisory Board

To conclude, Kathy H. Wibberly, Ph.D., Director, for the Division of Primary Care and Rural Health at the VDH Office of Minority Health and Health Equity will present the wrap up for the day.

Sign up today for this information packed meeting and to actively participate in discussions and networking events. Go to for the complete agenda and how to take part as an exhibitor and sponsor.

Wednesday, March 16, 2011

Hill Hears NIST's Goals

Patrick D. Gallagher, PhD, Under Secretary of Commerce for Standards and Technology, Department of Commerce, appeared before the House Committee on Science, Space and Technology on March 11, 2011. He presented an overview of NIST activities along with details on NIST’s budget request for FY 2012.

The President’s FY 2012 budget request for NIST is $1 billion, a 17 percent increase over the FY 2010 enacted level. Specifically, the NIST budget for the laboratories requests $679 million to accelerate the development of standards, technology, and measurement science in advanced manufacturing technologies, cybersecurity, and infrastructure.

The Under Secretary commented that other critical emerging technologies play an important role in transforming our society and revitalizing the economy. NIST is bringing together stakeholders from industry, government, academia, and standards development organizations to establish consensus-based interoperability standards and conformity tests.

The budget request for NIST’s “Interoperability Standards for Emerging Technologies Initiative” for $23.8 million is to be used to develop standards to accelerate the development of new technologies such as a smart electrical grid (Smart Grid), interoperable electronic healthcare records, and cloud computing.

Funding for $100 million ($500 million over five years) is requested to create the Public Safety Innovation Fund as part of the Administration’s Wireless Innovation and Infrastructure Initiative or W13. The President has called for the National Wireless Initiative to make available high- speed wireless services to at least 98 percent of Americans and to support a nationwide interoperable wireless network for public safety.

Funds would also help develop a next generation Public Safety Communications Network. NIST would in consultation with other agency partners focus on developing and testing requirements, standards, wireless applications, and other wireless technologies in support of an interoperable nationwide Public Safety Broadband Network.

The Under Secretary mentioned several 2012 manufacturing initiatives. Among these initiatives, $9.5 million would go for measurement science and standards to support biomanufacturing. He commented that the high cost of biotechnology medicine is adversely impacting the U.S. healthcare system and economy.

Biotechnology drugs, currently dominated by protein therapeutics, are the fastest growing class of pharmaceuticals and the fastest growing category of healthcare spending as reported in the current literature. However, the problem is that inefficiencies in the manufacturing process contribute to the high cost of these drugs.

Under the biomanufacturing initiative, NIST would work closely with industry, FDA, and other standards organizations to better understand the manufacturing process and work to produce higher quality biologic products by continuously improving the manufacturing processes. It is important to understand the manufacturing process and how to develop better biomanufacturing processes to help next generation products such as stem cells be used to develop personalized biotherapeutics.

The Under Secretary enthusiastically wants to direct help to small and to medium-sized companies. He discussed how the budget request for $75 million to fund the “Technology Innovations Program” (TIP) would help to incentivize innovative R&D projects. The projects would be conducted by small and medium-sized U.S. based companies, alone or as a joint venture with universities, national laboratories, and other non-profit research organizations.

In FY 2012, TIP expects to hold a funding competition in one or more research areas such as advanced robotics and intelligent automation, energy, healthcare, water, civil infrastructure technologies, and manufacturing.

CIMIT Receives 300 Responses

In January, the Center for Integration of Medicine and Innovative Technology (CIMIT) announced a call for FY 2012 pre-proposals for their Innovation Grant program. Over 300 multidisciplinary teams responded producing a 50 percent response increase over the past year. CIMIT is a clinically-based consortium of Boston-area hospitals and engineering schools and supports translational research by multidisciplinary teams for medical devices and clinical technology system applications.

The CIMIT Innovation Grants program supports early stage, collaborative research projects to improve patient care by emphasizing devices, procedures, diagnosis, and the delivery of healthcare to wounded warriors, veterans, and civilian patients.

One hundred fifty five pre-proposals have been selected to advance to the full proposal stage and to compete for the grants up to $100,000. Of the 155 pre-proposals selected various topics were included:

• Innovations in neurohealth—over one-third of the proposed projects offer innovative technologies and approaches in the diagnosis and treatment of neurological and psychiatric disorders and injuries

• Efficiencies in the delivery of care—one third of the submissions addressed how to advance the CIMIT Integrated Clinical Environments initiative. The submissions were focused on integrating clinical workflow redesign with innovative technologies, medical device interoperability, using clinical simulation to enhance the safety and efficiency of clinical care, and ways to provide improved decision support for clinicians at the point-of-care

• Solutions for wounded warriors—nearly two thirds of the pre proposals that were invited to compete in the final review process have direct relevance to improving care for the injured soldier. Some of the pre-proposals provided novel approaches to improve care on the battlefield, during evacuation, and in trauma care settings. Other projects would benefit veterans during rehabilitation and in managing chronic conditions for both the military and civilian populations

All applicants have been notified of the review decision. The full proposals are due March 31, 2011 but will only be accepted from individuals whose pre-proposals have been approved and have been invited to submit a full proposal.

For more information, email Elaine Richardson, Director for Strategic Communications & Marketing at or call (617) 643-3847.

Bills to Help More People

U.S. Senator Sheldon Whitehouse (D-RI) recently introduced the “Behavioral Health Information Technology Act of 2011” (S.539) to make health information technology available to behavioral health, mental health, and substance abuse treatment professionals and facilities.

“By expanding the use of electronic health records, this legislation will give mental health professionals access to comprehensive and up-to-date medical histories which help in diagnosing and help to reduce medication errors,” said Whitehouse.

The act would do the following:

• Expand the types of providers eligible for Medicare and Medicaid incentives when they use electronic health records to include licensed psychologists and clinical social workers

• Expand Medicare hospital incentive funding eligibility to include inpatient psychiatric hospitals

• Expand Medicaid hospital meaningful use incentive funding eligibility to include community mental health centers, mental health treatment facilities, psychiatric hospitals, and substance abuse treatment facilities

• Enable community mental health centers, psychiatric hospitals, behavioral and mental health professionals, substance abuse professionals, mental health treatment facilities, and substance abuse treatment facilities obtain technical assistance from Regional HIT Extension Centers

In another legislative action, Senator John Thune (R-SD) reintroduced the “Fostering Independence Through Technology (FITT) Act (S.501) to expand the use of telehealth technology under Medicare in rural and other underserved communities in the U.S. FITT would create a pilot program to provide incentives for home health agencies across the country to use home monitoring and communications technologies.

Under this legislation, home health agencies participating in the pilot program would receive annual incentive payments based on a percentage of the Medicare savings achieved as a result of using telehealth services.

Licensing Opportunity at NIH

The Office of Technology Transfer at NIH is seeking licensing and development possibilities for a “Handheld Hematoma Detector”. The handheld detector has improved capabilities to accurately diagnose hematoma and can be used either in an emergency room or at the scene of an accident. The device is inexpensive, simple in its design, and easy to operate.

The device has several applications:

• Enables the doctor or EMT to diagnose hematoma for patients with Traumatic Brain Injuries resulting in a better treatments
• Can be used to discriminate between subdural and epidural hematoma
• Can be used to analyze data
• Can determine which tissue is healthy from tissue that contains blood
• Capable of providing on-going patient monitoring
• Helpful in preparing for neurosurgical procedures
• Useful in combat critical care or third world care where CT is not readily available
• Useful if deployed in the battlefield

The National Institute of Child Health and Human Development (NICHD) is interested in collaborative research or interested in parties available to commercialize the invention. The invention is fully developed but a prototype may need to be developed for testing.
The inventor is Jason D. Riley at NICHD. For licensing information on the “Handheld Hematoma Detector” Reference No. 2231, email Michael Shmilovich Esq. at or call (301 435-5019.

Clinical Trial to Test Device

A new clinical trial referred to as PREVAIL, is underway for patients with Atrial Fibrillation. By using an implantable device, the need for a common blood-thinning device may be eliminated according to researchers at Emory University Hospital Midtown.

Atrial fibrillation commonly called A-fib is a heart condition where the upper chambers of the heart beat too fast, causing an irregular heartbeat and ineffective pumping action. This condition can cause blood to stagnate or pool and form clots in the left atrial appendage. If a clot forms in this area, chances increase for having a stroke.

Many patients with A-fib are prescribed blood thinning medications, to prevent blood clotting. While this medication is effective in reducing the risk of stroke, it may cause side effects such as bleeding.

The PREVAIL trial involves implanting via a catheter, a small umbrella-shaped mesh device called the “Watchman Closure Device” into the heart chamber to prevent stroke. This is a confirmatory study and the third study testing the implant but this study will also look at safety and efficacy of the device.

“We have had good success with this device in A-fib patients in two previous studies,” says David De Lurgio, MD, Associate Professor of Medicine in the Division of Cardiology, at the Emory University School of Medicine and Principal Investigator of this clinical trial.

De Lurgio and his colleagues Angel Leon, MD, Professor of Medicine, and Mikhael El Chami, MD, Assistant Professor of Medicine, have had five years of experience with this technology and so far, Emory Healthcare is the only health system in Georgia providing access to this device through participation in this clinical trial.

Patients are randomly selected by computer to either receive the “Watchman Closure Device” or to remain on Coumadin without the device. Those selected will receive the device and physicians will implant the small device following a trans-esophageal echocardiogram, which images the LAA for any blood clots.

After implantation, the patients remain on Coumadin for 45 days, at that time, the heart is again imaged. If the heart tissue has healed, participants will be taken off Coumadin and placed on aspirin therapy and possibly on Plavix an anti-platelet medication.

Researchers will follow the study patients with and without the device for five years, monitoring those that have stopped taking Coumadin very closely. If the FDA approves the device at the end of the clinical trial, those patients in control group will then have the option to receive the device.

For more information, call (404) 686-2504.

Sunday, March 13, 2011

Implementing EHR Systems

The HealthTexas Provider Network with 26 primary care practices in North Texas has successfully implemented electronic health records with funding from AHRQ. Neil S. Fleming, PhD., Vice President, Health Care Research at the Baylor Health Care System in Dallas along with his colleagues authored the study “The Financial and Nonfinancial Costs of Implementing Electronic Health Records in Primary Care Practices” as appears in the March 2011 “Health Affairs” publication.

At the Health Affairs event on “Innovation and Health Care Delivery” held March 8, 2011, Dr. Fleming discussed the details in the study in terms of the costs to the HealthTexas Provider Network that included hardware and software costs plus the time and effort it took to implement the EHR system.

The study’s authors found that hardware costs for one time infrastructure purchases amounted to $25,000 per practice for switches, cables, and wireless internet connections per practice, and $7,000 per physician for personal computers, printers, and scanners. Software and maintenance costs involving licensing, hosting, networking, and technical support for the first 60 days resulted in $2,850 and $17,100 per year. The total costs were $32,409 per physician and $162,047 in a five physician group for the launch of the EHRs through the first 60 days.

The researchers examined how the adoption of EHR systems can affect work flow in terms of numbers of patient visits, staff requirements, practice expenses, revenues, and net income. Other issues examined included patient safety especially related to drug adverse events and the impact on the quality and outcome of diabetes care.

Some economies of scale can be achieved with larger practices due to variable nature of some of the costs. However, smaller practices still make up a large fraction of the U.S. healthcare system, and the resources needed for small practices to implement EHR systems can be quite different than from larger healthcare organizations.

Another report “Realizing the Full Potential of Health Information Technology to Improve Health Care for Americans” was released last December by the President’s Council of Advisors on Science and Technology (PCAST). The report specifically addresses the issue of how small provider practices should approach implementing new electronic medical systems as opposed to how large practices and large hospital systems operate.

According to the PCAST report, one of the major differences is that small organizations need low-cost off-the-shelf products and services to enable them to have the benefits of health IT without having to undergo a costly customization and maintenance process.

The PCAST report also points out that one solution to help small providers implement EHR systems would have the practices adopt a cloud-based EHR product, since cloud-based technology allows software to be run and data to be stored on remote servers. This cloud model would help small providers benefit financially in costs for data storage and processing.

For more information on the March 8th event, go to and to view the PCAST report, go to

Linking Genetics to EMRs

Through genome-wide association studies, researchers have identified hundreds of genetic risk factors predisposing individuals to many complex diseases. Conducting these large scale genetic studies requires large patient cohorts that can be difficult to develop and be costly and time consuming.

Researchers at Brigham and Women’s Hospital (BWH) have demonstrated that there is the potential for using the clinical data from electronic health records to link to biological specimens to do genetic research. The study findings were published online in the “American Journal of Human Genetics.”

In this study, the researchers used software developed by the NIH funded “National Center for Biomedical Computing, Informatics for Integrating Biology and the Bedside” (i2b2) program. The researchers used i2b2 to link anonymous and de-identified biological specimens from a biobank along with corresponding de-identified EHRs to investigate genetic risk factors for an autoimmune disease—rheumatoid arthritis (RA).

The study included experts from MGH, Children’s Hospital Boston, MIT, Broad Institute, Harvard School of Public Health, and the Harvard Medical School, with funding provided in part by NLM.

In another research study, i2bi2 is helping researchers at MGH study obesity. The research on this subject is being conducted by Lee M Kaplan MD, PhD, Director, of the MGH Weight Center and his team. The team is looking at the knowledge already at hand but knows that the understanding of human obesity is still rudimentary.

One reason is that body weight and composition are affected by a multitude of factors including physiological, genetic, psychological, environmental, and developmental influences. Moreover, obesity can be influenced by age of onset, body fat distribution, associated eating behaviors, food preferences, energy expenditure responses, and associated (co-morbid) diseases.

The research project will use large cohorts of patients with obesity that can be identified from the large Partners HealthCare patient data repository with capabilities to efficiently mine data from the EMR. The plan is to identify specific clinical phenotypes that alone or in combination can predict important clinical outcomes and/or responses to therapeutic interventions.

The i2b2 team will work together to sub-stratify the patient cohorts and by using complex queries and statistical approaches try to determine clinically meaningful and statistically distinct subtypes. By using sophisticated query tools to extract data from large populations in combination with well established statistical methods, the team hopes to significantly accelerate the definition and characterization of clinically relevant obesity subtypes. The team is hopeful, that the research will accelerate the development of effective treatments and provide preventive strategies for obesity and its complications.

NQF Issues RFP

The National Quality Forum (NQF) has issued a Request for Proposals (RFP). They are seeking firm fixed price proposals from contractors to support the Measure Applications Partnership (MAP) and the National Priorities Partnership (NPP).

MAP requires NQF to form multi-stakeholder groups to provide information to HHS on setting-specific performance measures for hospitals, clinicians, and post acute care/long term care providers, as well as provide input on cross-setting quality issues specific to dual eligible beneficiaries.

NQF will initiate the National Priorities Partnership to obtain input on priorities and goals for the HHS National Quality Strategy, to identify strategies to achieve the goals, and to recommend associated measures for monitoring national progress.

NQF has issued an RFP with an aggressive timetable calling for research and analytical support for both of these partnerships. Key tasks in the RFP will require project planning, quality setting analysis, and dual eligible beneficiaries analysis.

The deliverables will need to include a project work plan with a description of main tasks, deliverables, timeline, and a staffing plan, description of the MAP tasks and recommendations for measures to improve measures needed in hospitals and physician offices, for post acute and long term care, and for dual eligible beneficiaries tasks.

Questions must be in written format and emailed to by March 17, 2011 with all bids due by April 8, 2011. For more information, contact Natini Pande, Senior director at (202) 783-1300 or for further information, email

State Plans for Exchange

All states must establish a Health Insurance Exchange by 2014 or the federal government will establish an Exchange for the state. To accomplish the goal, the state of New Mexico was awarded one million in grant funding to plan and establish exchanges in the state with funding available through September 2011.

Specific issues are being addressed by legislators and stakeholders with thinking along these lines:

• Should two exchanges that would include an Individual Health Exchange and a Business Health Exchange be established or should the state just establish one exchange
• Should the exchange should be operated by the Feds, operated by a non-profit agency, be operated within a state agency, or join in a regional exchange with other states

To meet all the requirements, the Exchange has to:

• Provide standardized information on insurance products
• Make comparison shopping for insurance easy
• Centralize enrollment and screen individuals for Medicaid and then link to the Medicaid system
• Provide customer service and a call center
• Be able to transition between commercial and government programs
• Determine eligibility
• Determine the cost of coverage after tax and cost sharing
• Be able to enroll individuals and businesses into plans through standardized electronic forms
• Maintain customer confidentiality
• Enforce consumer protections

One of the major requirements in developing the Health Insurance Exchange requires the New Mexico Human Services Department to implement a replacement eligibility system capable of interfacing with the Health Insurance Exchange. The “Integrated Service Delivery (ISD2) replacement system will need to provide automated eligibility determinations, benefits delivery, plus provide for a case management system.

The RFP for the ISD2 System Replacement Project was issued in January 2011 requiring the system to be web-based, easily modifiable, flexible, and scalable to accommodate changing requirements and programs.

The scope of work in the RFP included acquiring proposed hardware, software, and development tools that may be required to implement, operate, and maintain the system plus obtain any professional services deemed necessary. An integrated Electronic Document Management hardware and software solution may be acquired in conjunction with the proposed system. The procurement will result in a single source award to a contractor and the use of subcontractors will be encouraged where appropriate.

For more information, go to

Drug Vocabulary Improvements

NLM’s RxNorm standard clinical drug vocabulary is now more accurate and contains better connections between the National Drug Codes (NDC) and the standard nonproprietary names of medications as recommended for use in EHRs.

NDCs are product identifiers assigned by manufacturers and packagers of drugs in the U.S. They are published on medication labels and packages and are often used in pharmacy inventory control and for dispensing and billing for drugs. If a single manufacturer issues the same medication in packages of different sizes, each size has a different NDC. If more than one manufacturer produces the same medication, then each manufacturer has to assign different NDCs.

In contrast, the RxNorm vocabulary creates standard names and identifiers for the combinations of ingredients, strengths, and dose forms that exist in drugs marketed in the U.S. Doctors include this information when they write a prescription because they often don’t know the specific product that will be used to fill the prescription.

All medication products that contain the same active ingredients, the same strengths, and the same dose forms have the same RxNorm standard name. This standard name is connected to other information in RxNorm that can be used within EHR systems to improve patient safety.

Accurate and complete connections between NDC product codes and RxNorm standard names and identifiers have many potential uses within an individual patient’s EHR. These include the use of an NDC on a medicine bottle to speed standard data entry or to trigger an alert written in the RxNorm standard that could prevent a medication error.

At present, there is no single source that contains the NDCs for all medications currently marketed in the U.S. RxNorm has included NDCs provided by FDA, VA, and also from Cerner Multum and Gold Standard drug information sources for a number of years. RxNorm now includes a revised filtered version of the NDC data that segregates obsolete NDCs from those currently in the marketplace.

For the first time, data to be contributed to RxNorm by First Data Bank, a provider of drug databases widely used in the healthcare industry in the U.S. will improve the utility of drug vocabulary produced by NIH.

Douglas Fridsma MD, PhD, the head of Standards and Interoperability within the Office of the National Coordinator (ONC) applaudes First DataBank’s expanded contribution to RxNorm. He said, “This is a great example of the private sector taking action to ensure that health data standards have the coverage they need to support meaningful use of EHRs, provide robust clinical decision support, plus produce efficient health information exchange.”

Speakers Added to Summit

The 2011 Virginia Telehealth Summit co-sponsored by the Virginia Telehealth Network will be held April 5, 2011 at the beautiful Wintergreen Resort in Central Virginia. A variety of topics important to the leaders and executives in the rural health field will be presented for a full day of non-stop rural health information.

Topics will include the status of broadband, HIT and telehealth in Virginia, funding of telehealth, building sustainable programs, reimbursement and models, legal and regulatory issues, meaningful use, and the Virginia Health Reform Initiative plus many other issues will be discussed.

Take advantage of the many networking opportunities that will present new ideas and thoughts on how to forge ahead and make a difference to so many people in rural America.

To open the exciting day, Karen Rheuban, MD., President and Chairman of the Virginia Telehealth Network will give an overview of the issues confronting today’s rural health field. This will be followed by Karen Jackson, Deputy Secretary of Technology for the Commonwealth of Virginia who will present the results of the Virginia Healthcare Broadband, HIT, and Telehealth Survey.

Funding in the telehealth field is a very important issue and the attendees will have the fortune to hear top speakers with expertise in this area. The presenters will include Sherilyn Pruitt, Director, Office for the Advancement of Telehealth within the Office of Rural Health Policy at HRSA, Eugene Sullivan, Program Manager, for the Office of Telemedicine, at the University of Virginia, Ellen Matthews Davis, Virginia State Director for Rural Development at USDA, and Paloma Costa, Program Manager of Outreach, Rural Health Care for the Universal Service Administrative Company

Telehealth projects can only proceed so far without sustainable programs. Presenters on sustainable programs in terms of reimbursement and models will be:

• Patrick M. Hamilton, Health Insurance Specialist/Rural Health Coordination for CMS in their Philadelphia Regional Office
• Gregg A. Pane, MD, MPA, Director of the Virginia Department of Medical Assistance Services
• David Selig, CEO, for the Community Care Network of Virginia, Inc.
• Karen Rheuban M.D., Professor of Pediatrics, Senior Associate Dean for External Affairs and Continuing Medical Education and Medical Director for the Office of Telemedicine, at the University of Virginia
• Keven L. Barger, CEBS, FAHM, CPC Network Management Director, Provider Engagement and Contracting Central Virginia, Anthem

Understanding and dealing with legal and regulatory issues is vital to the field and with information to be presented by Brian W. Murray, Attorney with Latham & Watkins, LLP, Washington D.C., Gary Capistrant, Senior Director, Public Policy, ATA, plus two speakers from the Center for Telehealth & E-Health Law (CTeL) to include Greg Billings, Executive Director and Senior Government Relations Director, Drinker, Biddle & Reath along with Rene Quashie, Regulatory Attorney for CTeL, and Government Relations Director/Regulatory Attorney for Drinker, Biddle & Reath.

Edward Brown M.D., CEO of the Ontario Telemedicine Network in Canada will present a northern rural viewpoint on the effectiveness of technologies used in healthcare by our friends in the north.

HIT and Meaningful Use a topic of vital interest to all in the telehealth and health IT field to increase the adoption of EMRs will engage attendees with the subject matter presented by experts:

• Patrick M. Hamilton, Health Insurance Specialist, Rural Health Coordinator, CMS
• Michael Matthews, CEO MedVirginia
• Sallie S. Cook, MD., CMO, VHQC/Virginia HIT Regional Extension Center

The day will include a presentation on the Virginia Health Reform Initiative to be discussed by Karen Rheuban, MD, and Stephen Bowman, Senior Staff Attorney/Methodologist for the Joint Commission on Health Care.

Other speakers will zero in on topics such as telemental health and mHealth/social media:

• Jim B. Tucker, MD., Assistant Professor of Psychiatric Medicine, University of Virginia
• Adrienne Turner, MD., Fellow in Child and Adolescent Psychiatry, University of Virginia Health System
• Felasfa Wodajo, MD, Medical Director of Musculoskeletal Oncology at Virginia Hospital Center in Northern Virginia. Also Senior Editor and Partner of the online: iMedicalApps: Mobile Medical App Reviews & Commentary
• Mark H. Ryan MD, Department of Family Medicine, Virginia Commonwealth University Medical Center. Also a member of the Mayo Clinic Center for Social Media Advisory Board

To conclude, Kathy H. Wibberly, Ph.D., Director, for the Division of Primary Care and Rural Health at the VDH Office of Minority Health and Health Equity will present the wrap up for the day.

Sign up today for this information packed meeting and to actively participate in discussions and networking events. Go to for the complete agenda and how to take part as an exhibitor and sponsor.

Wednesday, March 9, 2011

TBI Helps Treat TBI

The number of service members with Traumatic Brain Injuries (TBI) has steadily increased from the year 2000 to the third quarter of 2010 with 195,547 cases reported from information available from electronic medical records. These records proved to be very valuable as this really helps DOD compile the number of service members diagnosed with TBI and also helps to determine the severity of their injuries.

The Defense and Veterans Brain Injury Center (DVBIC) serves active duty military and veterans with TBIs by using state-of-the-art clinical care, and innovative clinical research initiatives. Several years ago, DVBIC’s expanded their care to include force health protection and management through TBI surveillance, maintain a registry, and provide education for families and caregivers.

Also, DVBIC has been able to use the Neurocognitive Assessment Tool (NCAT) to provide cognitive performance baselines to compare with cognitive test scores obtained after an injury. As of 2010, NCAT tests have been administers to nearly 700,000 service members.

According the DVBIC newsletter “Brainwaves”, an effort is being made to step up TBI services at smaller military treatment facilities. DVBIC is now delivering both assessment and treatment via telemedicine. Starting in 2009, DVBIC’s tele-TBI staff rolled out a tele-headache clinic to aid active duty service members at Fort Knox and the equipment is operational at Fort Lee. DVBIC has also made remote neuropsychological testing services available to the Marine Corps Base in Quantico, West Point’s Warrior Transition Unit, and at Fort Sill and Camp Lejeune.

In the past year and a half, the tele-TBI clinic has held over 200 remote sessions run by a team of providers including DVBIC neuropsychologists, neurologists, and other medical staff located at the Walter Reed Army Medical Center. Participation in the tele-TBI program has been high as service members have kept almost 100 percent of their virtual appointments.

Given the demand for TBI rehabilitation services at isolated military treatment facilities, DVBIC plans to expand its tele-TBI clinics to new sites and include new services such as cognitive rehabilitation, pain management, occupational therapy, speech and language assistance, and physical therapy for TMJ.

Cal eConnect Awards Grants

Cal eConnect is awarding $3.46 million in Health Information Exchange (HIE) expansion grants to six organizations in California. The grants will support community level and statewide efforts to expand the use of HIEs to provide patient information where and when it is needed by patients, physicians, health clinics, and hospitals.

Cal eConnect is a non-profit public benefit corporation selected by the California Health and Human Services Agency as the State Governance Entity responsible for deploying funds received from the Office of the National Coordinator for HIT.

The following four organizations will receive grant awards:

• Orange County Partnership Regional Health Information Organization (OCPRHIO) for $795,761
• Los Angeles Network for Enhanced Services (LANES) for $996,070
• Redwood Mednet for $476,900
• North Coast Health Information Network (NCHIN) for $200,105

Cal eConnect has also authorized awards for up to $1 million for the following projects pending further discussion with these organizations:

• The California State Rural Health Association (CSRHA) in partnership with RAIN Telehealth Network will work on the project—“California Rural eHealth Information Network (CAReHIN)”
• EKCITA will work on the project “Connecting the Central Valley through HIE”

For more information, email or call (510) 978-4853.

Addressing Health Disparities

The Office of Behavioral and Social Sciences Research within NIH is contacting with the University of Michigan’s School of Public Health in Ann Arbor to develop a multidisciplinary network of experts to examine ways to reduce health disparities. The plan for the new “Network on Inequality, Complexity, and Health” (NICH) will be to explore new approaches to understanding health disparities and the effect this issue has on population groups.

The network with researchers from the fields of economics, biology, ecology, computer science, education, sociology, mathematics and epidemiology will study how to apply systems science to this field. They will use state-of-the-science conceptual and computational models to identify where interventions could impact the elimination of health disparities. The computational models functioning as computer simulated laboratories will look at the causes of health disparities to find the best possible solutions.

Using systems science methods will help investigators examine the interrelationships of variables at multiple levels and time periods. For example, factors such as access to healthcare, neighborhood environment, educational opportunities, physiology and genetics may interact over the course of a person’s life to influence risk for diseases like diabetes and cardiovascular problems.

Besides exploring hypothesized causes of health inequalities, the researchers will look at simulations that may reveal unexpected causes and this will help researchers predict which interventions have the most potential for reducing or eliminating health disparities.

NICH will produce reports and publications, including possible books or special journal issues on the network’s collaborative work plus include work of other experts. Publications will break new ground by illustrating, explaining, promoting, and translating the application of complex systems approaches to critical health disparities areas that may require trans-disciplinary development.

In other news, the National Institute on Minority Health and Health Disparities at NIH issued several Requests for Applications (RFA) to develop a NIMHD “Comprehensive Center of Excellence” (RFA-MD-11-003) plus an NIMHD “Exploratory Center of Excellence” (RFA-MD-11-002) to study issues on minority health and health disparities.

The Centers will support infrastructure and capacity building, build novel partnerships, do research training, do innovative basic biomedical and behavioral clinical or population based research, and provide intervention and prevention studies. For each RFA, the total amount to be awarded in FY 2012 is anticipated to be $24 to $28 million with 16 to 18 awards to be made.

AHRQ’s 2010 “National Health Care Disparities Report” current as of February 2011, finds that although improvements in the quality of care is being made, gaps based on race/ethnicity and socioeconomic status continue to persist.

The AHRQ report points out that the adoption and use of health IT can be an effective way to manage healthcare costs and improve the quality of care for racial and ethnic subgroups. Information is the key to making progress to address health disparities in healthcare in the U.S.

CDC in their new “CDC Health Disparities and Inequalities Report—United States 2011” underscores the need for more data. The report, the first of a series of consolidated assessments, highlights health disparities by sex, race and ethnicity, income, education, disability status, and other social characteristics. The report points out that although substantial progress has been made to improve the health for most U.S. residents in recent years yet persistent disparities still exist.

CDC’s report complements the contents of the annual “National Healthcare Disparities Report” and other periodic reports on health disparity-related objectives being monitored through the “Health People 2020 planning and evaluation process.

In addition, the “National Partnership for Action to End Health Disparities” report to be published by HHS in 2011 will provide additional scientific support for efforts to implement policies, programs, professional best practices, and individual actions to help to reduce disparities in the shortest timeframe possible.

SBIR Program Shows Results

The Army’s SBIR program is designed to provide high tech businesses the opportunity to propose innovative research and development solutions. Each year, the Army SBIR office allocates over 200 topics to the laboratories. In response to these SBIR topics, small businesses submit over 3000 proposals each year resulting in more than 600 Phase I and Phase II awards valued at $250 million going to small businesses.

Many of the Phase II SBIR projects sometimes move on to become part of the “Commercialization Pilot Program” (CPP). The CPP managed by MILCOM Venture Partners was set up to accelerate the transition of SBIR technology, products, and services to Phase III projects. CPP helps with business and transition plans and helps to match technology with potential government or industry customers. It is anticipated that up to 25 participants will take part in CPP in 2011.

As a result of the CPP, Ascension Technology Corporation located in Vermont was able to expand the use of robotics in surgical procedures. The problem is that physicians need to know where surgical instruments are located within the human body. Ascension was able to develop micro sensors able to track the tip of flexible endoscopes, catheters, probes, and other instruments. By using 3D tracking, instruments can be guided, collisions can be avoided, and systems can be calibrated.

With DARPA providing 20 percent of the funding, the company was able to miniaturize magnetic field sensors from 5mm to 1.8mm, and develop a flat transmitter that when placed under the patient can screen out medals.

By combing these advances with the company’s pulsed DC magnetic technology, the company has produced a commercial medical system called “3D Guidance”. It simultaneously tracks up to eight low-cost, disposable sensors, measures the position and orientation of each sensor in the patient, and then generates data for 3D visualization.

“3D Guidance” is being evaluated by other medical device manufacturers for possible incorporation into minimally invasive and image-guided products. For military applications, DARPA is planning to incorporate 3D tracking technology into a large robotics-based medical systems being developed to triage and treat injured soldiers on the battlefield.

For more information, email Jack Scully at or go to the web site at For more general details on the SBIR program, go to