Tuesday, September 27, 2011

Hill Examines Cloud Computing

The House Committee on Science, Space, and Technology’s Subcommittee on Technology and Innovation held a hearing September 21, 2011 on “The Next IT Revolution: Cloud Computing Opportunities and Challenges”. The hearing examined the benefits and risks of cloud computing and the role of the federal government in fostering the adoption of cloud computing services.

Daniel A. Reed, Corporate Vice President, for Microsoft Corporation’s Technology Policy Group appeared before the Committee to explain that cloud services are not a sudden or new development.

Each time we share digital photos, shop online, use an email service, download and use applications, or query a search engine, we are connecting to the cloud. Every day the combination of wired and wireless broadband networks, PCs and smart phones, and online services hosted in remote data centers connect individuals, deliver valuable data and insights, and drive business efficiency and innovations.

The number of devices used today is projected to exceed 50 billion with most connected to the internet to produce a world of seamlessly connected devices and services. With this in mind, Reed suggested that there are specific steps the U.S. government should take to realize the opportunities that the cloud creates for research, business, government, and individuals.

The federal government should move to adopt cloud capabilities and explore how clouds could allow data from different agencies, different levels of government, and even the private sector, to be combined and used in powerful new ways.

Federal research agencies should host large-scale data sets, accelerate scientific discoveries, and create new opportunities for data intensive exploration and multidisciplinary collaborations. In addition, federal rules for allowable research expenses should be encouraged and IT services should be used in the cloud where appropriate.

The web and cloud services depend on broadband communications. Today with the phenomenal growth of digital data, the rise of streaming media series, and the explosive growth of internet-connected devices, our nation’s broadband infrastructure is being strained, so the country must have adequate wired and wireless connectivity.

Lastly, revise policies in light of technology changes since many of our current policies and regulations have not kept pace with new technology developments. Revising policies affecting technology is vital to accelerate and implement the benefits for using the cloud.

For more details on the hearing, go to http://democrats.science.house.gov.

Massachusetts & Israeli Partnership

Massachusetts Governor Deval Patrick, Israel’s Chief Scientist Avi Hasson, the U.S. Israel Science and Technology Foundation (USISTF), and three Massachusetts economic development agencies are now accepting applications for projects under the “Massachusetts-Israel Innovation Partnership” (MIIP).

Today there are nearly 100 companies with Israeli founders or Israeli-licensed technologies in Massachusetts. Local firms exported over $180 million worth of goods to Israel in 2009 where 377 hospitals and 37,000 practicing physicians are located.

The partnership is a formal collaboration between Israel and the commonwealth to encourage and support innovation and entrepreneurship between Massachusetts and Israel’s life sciences, clean energy, and technology sectors. Massachusetts is the first U.S. state to establish such a program with the State of Israel.

The partnership is designed to establish Israel as a hub of hi-tech industry and to help companies in both Massachusetts and Israeli accelerate development cycles and promote mutually beneficial business-to-business cooperation and opportunities in the marketplace.

The three Massachusetts economic development agencies participating, the Massachusetts Life Sciences Center, the Massachusetts Technology Collaborative, and the Massachusetts Clean Energy Center are committing nearly $1 million in collective funding for companies in Massachusetts engaged in cooperative industrial research and development projects with an identified Israeli partner company. The Israeli Office of the Chief Scientist will provide up to $1 million in matching dollars for corresponding Israeli partner companies.

Specific types of life sciences projects are eligible for the funding. The joint R&D projects must be in biotechnology, pharmaceuticals, medical devices, medical diagnostics, or bioinformatics. The projects must aim to develop a new or significantly improved product or process for commercialization in global markets but also be beneficial to Massachusetts in terms of additional jobs and income.

Massachusetts applicants must be registered to do business in the state, have established a partnership with an Israeli company to pursue an R&D project, but the two companies must not have had a prior R&D partnership. Applications are not accepted from companies that have 500 or more employees worldwide.

Applications are due February 6, 2012. For more information, go to www.masslifesciences.com or email Angus McQuilken at amcquilken@masslifesciences.com or Bridget Scrimenti at scrimenti@masstech.org.

NMRC Works with Industry

Researchers have found that many fevers of unknown origin throughout the world fall into a subgroup of rickettsial diseases which includes Q fever, Scrub Typhus, Murine Typhus, and Rocky Mountain spotted fever caused by ticks, fleas, and mites. According to an article in the Naval Medical Research Center’s publication “NMR&D News,” rickettsial infections can seriously impact operational readiness since individuals can develop severe to mild illnesses to even fatal attacks.

For example, Scrub Typhus which historically affected populations from Afghanistan and further east is now spreading to the Middle East and even South America. As a result, there is an immediate need for rapid sensitive “real-time” identification and diagnostic tools to detect infections.

The NMRC’s Viral Diseases Department located in Silver Spring Maryland, has developed new and innovative effective rickettsial diagnostic tests and potential vaccine solutions that are now ready for commercial development.

NMRC’s legal and technology transfer team has crafted multiple collaboration and licensing agreements with U.S. and international businesses to commercialize NMRC’s inventions. Currently, private industry is expressing interest in NMRC’s new generation of nucleic acid and antibody-based assays to rapidly detect infection.

NMRC is interested in hearing from companies that want to commercialize vaccines or diagnostic devices. The NMRC Office of Legal and Technology Services will work with interested companies to navigate the commercialization process.

Go to www.med.navy.mil/sites/nmrc/Pages/ott_ttf.htm for more information.

Collecting Pregnancy Data

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of CDC’s National Center for Chronic Disease Prevention and Health Promotion and State health departments. The PRAMS collects state-specific population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy.

Data is provided that is not available from other sources about pregnancy and data is collected for the first few months after birth. This state-specific data can be used to identify groups of women and infants at high risk for health problems, used to monitor changes in health status, and to measure progress towards goals in improving the health of mothers and infants.

PRAMS was initiated in 1987 because infant mortality rates were no longer declining as rapidly as they had in prior years and the incidence of low birth weight infants had changed little in the previous 20 years. Research has indicated that maternal behaviors during pregnancy may influence infant birth weight, infant mortality, and maternal morbidity rates.

Specifically, PRAMS enables CDC and the states to monitor changes in maternal and child health indicators and monitor information obtained from birth certificates. The findings can be applied to the state’s entire population of women who have recently delivered a live-born infant, but the system not only provides state-specific data but also allows for comparisons among participating states.

Also the data can be used by researchers to investigate emerging issues in the field of maternal and child health. Researchers may request the PRAMS Analytic Research File for studies that involve multiple states by submitting a proposal to CDC.

The system also enables states and local governments to plan and identify other agencies that have the capability to plan maternal and infant health programs and then be able to develop partnerships with those agencies.

For more information, go to www.cdc.gov/prams.

SAMHSA Awards HIT Grants

The Substance Abuse and Mental Health Services Administration (SAMHSA) within HHS awarded $13.2 million in new grants to support expanding HIT in healthcare settings serving people with mental and substance use disorders.

As part of the initiative, 47 community health centers working to integrate primary care and behavioral health services will receive a one year grant for $200,000. The funding will be used to develop HIT infrastructure and to expand the use of EHRs. Once the EHR systems are in place, patients and providers will have access to the latest information on effective treatments and support systems and be able to exchange health information through secure means with appropriate patient permission.

In addition, SAMHSA announced that a $3.8 million grant was awarded to assist community health centers and state designated agencies to help implement EHRs. The grant award was made to the National Council on Community Behavioral Health Care to work to integrate primary and behavioral health care in community-based settings.

“Electronic health records improve quality, accountability, and cost effectiveness of healthcare services,” said SAMHSA Administrator, Pamela S. Hyde, J.D. “Persons with behavioral health problems often have significant physical health issues as well. These grants are a critical down payment on the HIT investment needed to ensure that behavioral health service providers are fully interoperable with the general health system.”

Sunday, September 25, 2011

Addressing Healthcare Disparities

Carolyn M. Clancy, MD, Director, AHRQ opened the Plenary Session “Addressing Health Care Disparities, Access, and Quality of Care” at the AHRQ Annual Meeting “Leading Through Innovation & Collaboration” held September 18-21, 2011 in Bethesda Maryland.

To begin the discussion, Gary R. Gunderson, D.Min, Senior Vice President for Faith & Health Division, and Director for the Center of Excellence in Faith & Health for the Methodist Le Bonheur Healthcare in Memphis Tennessee described how Memphis Tennessee is dealing with the issues.

As he reported, Memphis is the first large area north of the Delta where folks are born deep in disparities. The community has taken the first step and created a community network consisting of 376 congregations to effectively support members and their healthcare needs along with the needs in the overall community.

Susan Vega, Manager for Senior Programs at the Alvio Medical Center in Chicago explained that the non-profit Medical Center is a safety net provider for the many low-income and marginalized residents in nine targeted communities. The Center is meeting the needs of over 20,000 Spanish speaking predominantly Mexican immigrants who have fallen through the cracks of our healthcare system.”

According to Vega, Latino elders are the fastest growing segment of the population and this group of people tends to be older than the rest of the population and usually sicker. One reason is that they have done heavy work all their lives and this has resulted in not being as well as they age but in many cases, they still they tend to live longer.

As in other communities, there is a critical need for health and medical providers to be bilingual. However, this is not the case with all providers and as a result, language capabilities are uneven. As Vega summed up, “Alvio has to look not only at the individual but very often needs to work with the entire family. Sometimes the providers are dealing with three generations and since there can be language difficulties, it is not always possible to get the correct information without struggling to understanding what the patient and family are trying to say.

Herbert C. Smitherman, Jr. MD, Assistant Dean for Community and Urban Health, and Associate Professor in the Department of Medicine at Wayne State University School of Medicine, said “Social and economic policy drive disparities and eventually determines how long people will live.”

Dr. Smitherman is actively involved in working with the Detroit community and their health problems. He sees the need to connect the local population to healthcare workers, to advise the community on how they can reduce their visits to the emergency room, plus help the community with other medical issues.

Dr. Smitherman also concurs that it is very difficult to deal with language issues in a diverse community so healthcare professionals need to know several languages, but in many cases, doctors and other health workers aren’t trained in other languages so communicating is difficult. Part of the answer is to provide adequate quality medical interpretation services in the community.

Collecting the right information on populations faced with disparities in the community is very important according to Rhonda M. Johnson, MD, Medical Director for Health Equity & Quality Services at Highmark Inc., in Pittsburgh. She discussed how different states have different rules on collecting data since some states have laws or regulations that restrict a health plan from collecting data on race, and ethnicity, while other states encourage data collection—so it is a confusing issue. To add to the problem, some employers will not permit information to be submitted so the result is that only a small percent of enrollees are supplying data.

Training Emergency Workers

The City University of New York (CUNY) and NYU Langone Medical have opened a new state-of-the-art trauma simulation training center to prepare doctors, nurses, and first responders for major emergencies. The “New York Simulation Center for Health Sciences” just opened at Bellevue Hospital Center in Manhattan, is the largest urban health simulation and training facility to improve the city’s response to medical emergencies in case of terrorist attacks or natural disasters.

What makes the center unique is not only the advanced technology used but the fact that it brings together nurses, doctors, medical students, and first responders in a collaborative multidisciplinary setting.

The 25,000 square foot facility provides the opportunity for healthcare personnel to confront challenging real world scenarios from multiple patient triages to surgical and clinical emergencies using state-of-the-art mannequins and plastic body parts that can bleed, be sedated, or even give birth. Professionally trained actor patients with a variety of ailments will also help trainees on site learn patient management and treatment techniques.

The center features multiple simulation rooms including a disaster training room, a five-bed ICU, two operating rooms, trauma rooms, a labor and delivery room, and 14 patient examination rooms. All the rooms are equipped with more than 100 cameras to record training sessions so they can be played back for students.

The center is also available for training emergency management workers from a variety of city agencies. In addition, New York Downtown Hospital will use the facilities for decontamination and other emergency management training exercises.

According to CUNY Chancellor Matthew Goldstein, “The unusual experience of weathering two natural disasters in the same week such as an earthquake and a hurricane has served as a reminder to all New Yorkers of just how much we rely on trained personnel who can respond to emergencies in an instant. In a disaster, there is no better preparation than to use hands-on-training through simulated real-world scenarios.”

NIH Issues Grant Notice

NIH posted a Funding Opportunity Announcement (FOA) on September 21, 2011 seeking Small Business Innovation Research (SBIR) ideas from small business concerns to develop new methods and technologies to identify individuals at risk of developing Type 1 diabetes.

Current technology used today to identify at risk individuals is costly, requires participation of research laboratories, and is not always suitable for public health screening. More efficient methods are needed to identify individuals that are at risk of developing Type 1 diabetes to participate in prevention techniques provided via low cost, high-throughput, accurate, and predictive assays/devices to be used at the point-of-care.

Some of the topics relevant to the research include:

• Developing tests to not only identify patients at risk but also methods that could be used to monitor the disease progression

• Developing point-of-care low cost portable devices for pre-diabetes and diabetes diagnosis

• Development of non-invasive imaging as well as other methods and biomarkers for the in-vivo measurement and evaluation of pancreatic beta cell mass, function, or inflammation for the prognosis of a pre-diabetic stage and subsequent follow-up

The estimated total program funding for FOA (RFA-DK-11-024) is estimated at $1,200,000 with a $300,000 award ceiling. It is anticipated that three to six awards will be made. Current closing date for applications is December 22, 2011.

Go to www.grants.gov or to http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-11-024.html for more information.


The Minnesota Department of Health issued an RFP for a contractor to operate their statewide Poison Control System. Under Minnesota statute, the state needs to have a single-integrated poison control system consisting of one or more poison control centers to provide statewide information and education services to the public and to health professionals. It is anticipated that $2,443,000 will be awarded for the two year period grant.

The poison control system is in place to reduce poison-related morbidity, mortality, and hospital admissions. In particular, the poison control system is expected to reduce emergency room and physician office treatment for minor poison cases and produce corresponding increases in home management of poisoning under poison service direction. Additionally, the system is expected to increase public awareness of common toxic substances especially as they relate to young children

The components of the system include:

• The call response component to provide accurate, immediate information, and treatment advice about human poisonings and toxic exposures, be available 24/7, and respond to requests at no cost to the caller. The department expects that 52,000 human exposure calls and 9,800 information calls will be received each calendar year of the grant period

• The emergency preparedness component in place needs to implement Minnesota Regional all Hazards Health and Medical Response and Recovery Plans, participate in the development of the interoperable communication system for the state’s Tiered Healthcare Response System, and provide consulting to the DOH on how to detect and treat biological and chemical terrorism

• The professional education component to provide information to health professionals on strategies to use to manage poisoning

• The public awareness component to provide a variety of public education activities statewide on how to deal with poisoning

Eligible applicants can include for-profit and non-profit entities and units of government. For more information, go to www.health.state.mn.us/divs/hpcd/poisoncontrol. The proposal is due October 24, 2011. For more information, email Pati Maier at pati.maier@state.mn.us.

Effective Text Messaging

HHS has been exploring ways to capitalize on the rapid proliferation of mobile phone technology and platforms to help achieve a healthier nation. HHS established the Text4Health Task Force to come up with a report with new ideas on how to develop text messaging initiatives to deliver via mobile phones.

The report recommended that HHS develop and host evidence-based health text message libraries to increase the use of scientifically-based information, develop further evidence on the effectiveness of health text messaging programs, and develop partnerships to implement and disseminate health text messaging and mHealth programs.

Since 2010, HHS has invested $5 million to develop its eHealth/mHealth smoking cessation resources aimed at teens, young adults, and other adults. HHS is launching a new initiative through NCI called the “SmokeFreeTXT” program, a mobile smoking cessation service specifically designed for teens and young adults. The service is an extension of the core smoking cessation web site www.smokefree.gov receiving between 70,000 to 100,000 visits on a monthly basis.

NCI is also launching a library of smoking cessation messages to provide the foundation for an interactive text-based intervention for adult smokers called “QuitNowTXT” to provide through text messages tips, motivation, encouragement, and facts tailored to the user’s response.

HHS is also pursuing opportunities to develop a global public-private partnership to make the “QuitNowTXT” program available to other countries to reach adult tobacco users. Organizations that will be collaborating include the mHealth Alliance hosted by the United Nations Foundation, World Medical Association, Campaign for Tobacco-Free Kids, Center for Global Health at George Washington University, and Johnson & Johnson.

This initiative aims to collaborate with interested countries to support mHealth/text-based demonstration projects using text messaging resources available on mHealth Alliance’s www.HealthUnbound.org web site. By drawing on the experience from three demonstration projects, the countries and partners will identify and disseminate best practices for tobacco cessation mHealth/text-based intervention.
Effective Text Messaging

HHS has been exploring ways to capitalize on the rapid proliferation of mobile phone technology and platforms to help achieve a healthier nation. HHS established the Text4Health Task Force to come up with a report with new ideas on how to develop text messaging initiatives to deliver via mobile phones.

The report recommended that HHS develop and host evidence-based health text message libraries to increase the use of scientifically-based information, develop further evidence on the effectiveness of health text messaging programs, and develop partnerships to implement and disseminate health text messaging and mHealth programs.

Since 2010, HHS has invested $5 million to develop its eHealth/mHealth smoking cessation resources aimed at teens, young adults, and other adults. HHS is launching a new initiative through NCI called the “SmokeFreeTXT” program, a mobile smoking cessation service specifically designed for teens and young adults. The service is an extension of the core smoking cessation web site www.smokefree.gov receiving between 70,000 to 100,000 visits on a monthly basis.

NCI is also launching a library of smoking cessation messages to provide the foundation for an interactive text-based intervention for adult smokers called “QuitNowTXT” to provide through text messages tips, motivation, encouragement, and facts tailored to the user’s response.

HHS is also pursuing opportunities to develop a global public-private partnership to make the “QuitNowTXT” program available to other countries to reach adult tobacco users. Organizations that will be collaborating include the mHealth Alliance hosted by the United Nations Foundation, World Medical Association, Campaign for Tobacco-Free Kids, Center for Global Health at George Washington University, and Johnson & Johnson.

This initiative aims to collaborate with interested countries to support mHealth/text-based demonstration projects using text messaging resources available on mHealth Alliance’s www.HealthUnbound.org web site. By drawing on the experience from three demonstration projects, the countries and partners will identify and disseminate best practices for tobacco cessation mHealth/text-based intervention.

Wednesday, September 21, 2011

CIBOR Focus is on Research

The Center of Innovation for Biomaterials in Orthopedic Research (CBIOR) is working to promote translational research for biomaterials to produce new generation orthopedic devices and applications. CBIOR is sponsored by Via Christi Health and Wichita State University and receives funding from the Kansas Bioscience Authority and the John S. and James L. Knight Foundation.

The researchers are working to develop medical devices that use composite materials embedded with new smart technology to relay information and have the capability to provide for good x-ray penetration. The goal is to have these devices quickly enter the marketplace.

To help move this research further along, Wichita State University’s National Institute for Aviation Research has been awarded a $1.4 million grant from DOD to fund a project involving CIBOR. The research team is going to use the funding to develop a fast-setting composite stabilization device to treat extremity injuries in the battlefield.

The need to develop the right orthopedic care for the military is indicated by a high prevalence and severity of extremity injuries which account for 71 percent of combat casualties. Of these injuries, 51 percent are open wounds and 19 percent are fractures according to study by researchers at e SAIC and the Naval Research Center.

Most of these injuries can be attributed to the use of modern body armor which protects vital organs but has resulted in a pattern of battlefield injuries that produce traumas to the extremities. This is particularly apparent with explosive device injuries which result in extensive tissue damage, a high risk of contamination, and a requirement for orthopedic treatment in over half of the injuries.

CIBOR’s researchers are hoping to:

• Improve x-ray penetration of composites to permit radio frequency throughput a feature not presently possessed by current medical devices

• Develop stretchers, gurneys, and surgical tables using composite materials to enable sensors to be embedded to continuously monitor patient vital signs when the patient is being transported.

• Improve the development of surgical instruments formed from composite materials and then embed Radio Frequency Interference (RFI) sensors in the instrumentation

• Use composite materials to not only align and stabilize fractures and but also to embed sensors to monitor the patient’s healing progress

• Develop external braces made from composite materials with sensors to relay information to a hand-held sensor and enable the sensors to detect the amount of force exerted by the patient so that the brace can be adjusted as needed to make the patient more comfortable

For more information, go to www.ncibor.net/index.htm.

Effectively Using NLP

The Veterans Administration’s EHR databases contain approximately 20,000 unstructured fields containing narrative text and reports with patient-specific information. The databases contain both structured and unstructured data but the unstructured data comprises the majority of the health record.

The unstructured data can include outpatient pharmacy records, laboratory reports, provider notes, nuclear medicine and radiologic reports, electromagnetic images, discharge summaries, physician orders, vital sign measurements, and information on medications administered. This data is rich with information and could provide researchers with a greater opportunity to characterize patients to determine their health status.

Currently, clinical and administrative use of EHR databases largely depends on structured or coded data and researchers are limited to questions that can only be addressed using the structured data. It is also very difficult for researchers to use information from databases without reformatting the text.

One of the solutions is to use Natural Language Processing (NLP) that when fully developed will free up and make it possible to better utilize all of the data both structured and unstructured that is contained in health records. NLP, an invaluable branch of computer science teaches machines to make sense of human language. For example, the science is already at work in internet search engines and translation programs.

The Veterans Administration and university investigators in Nashville and several other sites are conducting studies on NPL, as part of an overall effort known as the “Consortium for Healthcare Informatics Research”.

One study being conducted at six VA medical centers, is working to interpret free text in veterans’ EMRs according to the VA’s September issue of “Research Currents”. In this specific study, researchers are using NLP to interpret doctors’ notes to identify post-surgery complications. The researcher’s findings appeared in the August 24/31 issue of the Journal of the American Medical Association.

The study used data on nearly 3,000 VA patients who underwent surgery between 1999 and 2006. Compared with a standard automated method that scans administrative data, NLP was better at picking up adverse post-surgery events such as lung, kidney or heart problems. To provide a benchmark for both approaches, trained nurses manually reviewed the patient records and carefully looked for any clinical notes indicating complications.

Eventually, the Consortium will collaborate with researchers at the various VA Medical Centers, with appropriate VA offices, VHA offices, non-VA research institutions, and other federal agencies to coordinate and apply accepted technical standards to more effectively use NPL.

Robots Assist in Physical Therapy

The newsletter “NIH Catalyst” reports that the NIH Clinical Center is using robots to provide physical therapy assessment and training to help patients whose muscles have been weakened by cerebral palsy, TBI, and/or other neurological disorders. The robots are able to operate remotely and help patients in their home.

A staff scientist at the NIH Center, Hyung-Soon Park in the Functional and Applied Biomechanics Section (FABS), is leading the design and development of the robots to develop a telerehabilitation system that can remotely assess a patient’s condition.

Park’s laboratory has developed two robotic mechanisms that work together to rehabilitate the elbow joint. The first mechanism resembling a human arm is a “Haptic Mannequin Device” (HMD) that relies on the sense of touch and is attached to a computer in the clinician’s office.

The second is a mechanical arm brace called a “Wearable Stretching Device” (WSD). The patient wears the WSD at home or in some other location but must be near a computer that is connected to the internet to communicate.

Normally a clinician has to have physical contact with a patient who suffers from involuntary muscle spasms caused by neurological impairments to feel the muscles, diagnose problems, and provide physical therapy.

However, with the HMD-WSD setup, the clinician moves the HMD mechanical arm and then a signal travels via the internet to the patient. At this point, the WSD arm brace mimics the movement and stretches the muscles. The WSD records muscle resistance and relays the information back to the HMD so it moves and feels just like the patient’s arm. The two devices talk to each other, sharing information instantaneously as if the patient and the clinician are in the same room.

Clinical trials with the HMD-WSD system are expected to begin in the near future. After the system has been perfected, Park hopes to develop devices that focus on the knee, ankle, wrist, and shoulder.

The robotic arm can also be used as a tool to standardize medical assessments and to train clinicians who want to improve their physical therapy skills. It can be programmed using patient data and can provide realistic consistent movements including imitating spasticity and contracture affecting muscles.

The researchers are also working on a robotic leg to help to eliminate crouch gait in children that can lead to making walking difficult and exhausting for children with cerebral palsy. The robot device works to help strengthen the leg and also helps children stand more upright.

The researchers have also developed a self-paced treadmill that is helping patients who have suffered from TBI relearn how to walk. The machine enables patients to choose their speed via sensors that are attached to the body and linked to a computer program developed by FABS. The treadmill faces a large screen where a virtual world is projected so that patients are able to walk through the mock terrain and learn to navigate in difficult situations.

DOL Protecting Workers Health

OSHA has released their first free smart phone app to enable workers and supervisors to monitor the heat index at their work sites to prevent heat-related illnesses. The app is designed for devices using an android platform but will shortly be available to BlackBerry and iPhone users.

The app is available in English and Spanish and combines heat index data from NOAA with the user’s location to determine necessary protective measures. Based on the risk level of the heat index, the app provides users with information on the precautions that they should take. Users can review the signs and symptoms of heat stroke, heat exhaustion, and other heat related illness and then learn about first aid steps to take in an emergency.

A new web-based tool “Using the Heat Index: Employer Guidance” is available at www.osha.gov/SLTChealthillness/heat_index/index.html.

OSHA is providing resources to help workers prevent noise-related hearing loss which has been listed as one of the most prevalent occupation health concerns in the U.S for more than 25 years. Approximately 30 million people in the U.S. are occupationally exposed to hazardous noise and thousands of workers each year suffer from preventable hearing loss due to high workplace noise levels. A new web page provides information on the health effects of hazardous noise exposure and how to prevent hearing loss is at www.osha.gov/SLTC/noisehearingconservation/index.html.

The National Institute for Occupational Safety and Health (NIOSH) developed its “STOP STICKS” campaign to raise awareness about the risk of exposure to blood borne pathogens such as HIV, hepatitis B, and hepatitis C from needle sticks and other sharp-related injuries in the workplace. CDC estimates that about 385,000 sharp object related injuries occur annually among healthcare workers in hospitals.

OSHA’s Safety and Health Topics page on how to make changes needed to reduce sharp object and needle injures is available at their “Blood Borne Pathogens and Needle Stick Prevention web site at www.osha.gov/SLTC/bloodbornepathogens/index.html.

Summit on Leadership Principles

Be sure to make plans to stay after the “Partners HealthCare 2011 Connected Health Symposium” October 20-21 to attend a special inaugural event. The “Boston Summit on Leadership: A Call for Action” will be held October 22, 2011 at the Boston Park Plaza Hotel. Distinguished faculty from different professions will discuss leadership principles in different domains.

Sanjiv Chopra, M.B.B.S., M.A.C.P. Professor of Medicine, Faulty Dean for Continuing Education, Harvard Medical School will speak on “The Ten Tenets of Leadership” a topic that he is passionate about and has presented to audiences world-wide.
Featured faculty speakers include:

• Jim O’ Connell, MD, President, Boston Health Care for the Homeless Program
• Zunaira Munir, Founder and Managing Director, Strategize Blue

Jim and Zunaira will be joined by:

• Ambassador Swanee Hunt, Adjunct Lecturer at the Kennedy School of Government
• Alvaro Pascual-Leone, MD, Professor of Neurology, Harvard Medical School
• Charles Denham, MD, CEO and Founder HCC Corporation, Chairman and Founder TMIT
• Scott Snook, Senior Lecturer at the Harvard Business School
• Venkat Srinivasan, CEO, Rage Frameworks, Inc, Chairman and Founder of English Helper

Go to www.connected-health.org/events/symposium-2011/post-symposium-workshop.aspx for more information on the Leadership Summit or to register, go to www.connected-health.org/events/symposium2011/register-here.aspx.

Sunday, September 18, 2011

HIT Showcase Draws a Crowd

The Technology Showcase and panel discussion on September 12, 2011 held during HIT week was declared a huge success by a packed room filled with attendees and exhibitors. The Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” each year devotes a day during HIT week to highlight the progress, problems, and future steps needed to deliver better and more effective healthcare.

Introducing Honorary Co-Chair Senator Kent Conrad (D-ND) Chairman of the Senate Budget Committee, and a senior member of the Senate Finance Committee, Neal Neuberger, Executive Director for the Institute for e-Health Policy, expressed appreciation for the Senator’s leadership in forming the Senate’s Steering Committee on Telehealth in1993 and raising awareness about telehealth. Senator Conrad will be leaving the Senate at the end of his term of office.

In appreciation, Neuberger presented the Senator with a legislative leadership award from HIMSS to thank the Senator for all of his past and ongoing efforts to improve the quality and efficiency of rural healthcare. HIMSS applauds Senator Conrad’s efforts to greatly broaden the use of telehealth and health information technologies.

In another important announcement, Paul McRae, Vice President for Public Sector and Healthcare at AT&T announced that the HHS Office of Minority Health, the American Association of Diabetes Educators (ADDE), and AT&T are working together to evaluate the use of mobile devices to deliver Diabetes Self-Management Training (DSMT) within an underserved minority community in Dallas, Texas.

AT&T is contributing $100,000 to the AADE to fund the study and will provide approximately 150 smart phones with voice and data plans for the patients, diabetes educators, and other education personal.

McRae introduced Rochelle Rollins PhD, Director for the Division of Policy and Data at the Office of Minority Health (OMH), so that she could accept an award for Garth N. Graham M.D. the Deputy Assistant Secretary for Minority Health for all the work that OMH is doing to extend the use of Health IT into underserved minority communities.

The Technology Showcase featuring a panel discussion centered on the essential use of health IT to improve patient safety and quality, was moderated by Justin T. Barnes, Vice President of Marketing, Industry and Government Affairs, Greenway Medical Technologies, Inc.

From the federal government perspective, Geoffrey Gerhardt, Senior Advisor to the National Coordinator for HIT was happy to announce that ONC has launched the new website www.HealthIT.gov to provide resources to patients and providers who may have little experience with health IT. He also announced that the revised “Federal Health IT Strategic Plan 2011-2015 has been released after receiving 240 public feedback responses on the first draft.

Gerhardt was pleased to announce that the “meaningful use” program is doing well and so far has made $400 million in incentive payments with 70,000 registered, the e-prescribing program now has about 250,000 users, 62 regional extensions centers are in operation, 3,000 students have graduated from the workforce program, and 56 states are moving to implement HIEs to fill in the connectivity gaps.

Neal Neuberger stressed the important role that data plays in further developing the health technology field. Michael J. Ackerman PhD, Associate Director of the National Library of Medicine (NLM) agreed that technology drives telehealth development by helping researchers and the public find needed information resources.

Dr. Ackerman pointed out that NLM offers the largest collection of online health information through MEDLINE and MEDLINE plus, NLM provides access to over 20,000 journals and provides the NLM Personal Health Record a web-based tool to help consumers track their own health information.

Also, the National Center for Biotechnology Information NCBI) within NLM is a national resource for molecular biology information established to help the research and medical community use the databases and software that NCBI has made available

As Ackerman explained, NLM’s Disaster Information Management Research Center created to aid in disaster management efforts, provides credible and timely information to help government agencies, private organizations, and local communities plan, prepare, respond and recover from disasters and other public health emergencies

Some of the emergency response tools available include the “Radiation Emergency Medical Management” (REMM) system in place in case mass casualty radiological nuclear events take place. The “Wireless Information System for Emergency Responders” (WISER) is also in place to help emergency responders identify and respond to hazardous materials incidents.

Hank Fanberg, Director, Technology Advocacy for CHRISTUS Health which covers 375 care delivery sites across eight states and Mexico, said “Patient safety and quality is paramount in the CHRISTUS Health culture and we are committed to providing high quality healthcare through innovation and by monitoring the quality of care. This is being accomplished by measuring patient satisfaction and then publishing this data to foster a culture of transparency.”

Athenahealth doing usability testing and obtaining feedback from practitioners, has produced an overwhelming amount of information on how best to achieve patient safety according to Lauren Zack, Director of Usability at Athenahealth. She is currently building the usability team at Athenahealth and wants to see improved usability of EHR products that will result in safer and better quality care.

Anthony Amofah, MD, Chief Medical Officer, Community Health of South Florida and Medical Director of the Health Choice Network is proud that the Network provides technology solutions for Community Health Centers by using a state-of-the art system to capture and analyze data that greatly improves the quality and access to care for all patients in the system.

“George Washington University Hospital strives to provide the right information to the right patient at the right time so that false positives and negatives do not occur with the result that patients are receiving safer and more efficient care,” reports Gretchen Tegethoff, GW’s Chief Information Officer. “Also, the Hospital is participating in the D.C. RHIO where an online computer information system is helping not only hospitals but local healthcare providers, health center clinicians, and case users”

“MedRed has integrated their “Balto” clinical decision support technology with their large-scale EMR system to help doctors and patients wherever and whenever needed”, said Ali Qureshi, MedRed’s Chief Operating Officer. Central to the system is a PC-based system capable of automatically generating plug-and-play modules to provide decision support. In addition, MedRed’s “Balto Mobile” provides emergency first responder medical decision support in a hand-held device.

In another project, Med Red is working with DOD to expand their “MedRed Chart” application at Walter Reed Army and Bethesda National Navel Medical Centers to help manage the prevalent and serious cases of TBI that the VA and DOD are now treating.

To address the needs of patients receiving home health care, long term care and rehabilitation, Dan Cobb, Chief Technology Officer at HealthMEDX, Inc, said, “We are at the forefront in developing appropriate software to handle the records needed for each patient. The greatest time for high risk is when the patient is admitted to the hospital or moving from one care setting to another. This is where health IT and EHRs can play an important role to make it possible to have each patient’s medical records electronically available 24/7.”

The lunch briefing and demonstrations were coordinated by HIMSS and the Institute for e-Health Policy.

For more information, email asimmons@e-healthpolicy.org or neal@e-healthpolicy.org.

Collaborative to Develop Safe Drugs

NIH, DARPA, and FDA are going to collaborate to develop a chip to screen for safe and effective drugs more efficiently than current methods used and before they are tested in humans. The chip will contain specific cell types that reflect human biology and designed to allow multiple readouts that will indicate whether a particular compound is likely to be safe or toxic for humans.

Over the next five years, NIH plans to commit up to $70 million for the research and DARPA will commit a comparable amount. DARPA and NIH will run separate and independent programs but work closely together with FDA.

This fall, the two agencies in coordination with FDA will solicit proposals from industry, government labs, academic institutions, and other research organizations on how best to develop the chip. The goal is to bring the latest advances together in engineering, biology, and toxicology to work on this complex problem.

“Drug toxicity is one of the most common reasons why promising compounds fail” according to Francis S. Collins, MD, PhD, NIH Director. “We need to know which ones are safe and effective much earlier in the process.”

This effort is an example of the types of innovative projects that could be led by the proposed “National Center for Advancing Translational Sciences” (NCATS) to provide science-based solutions that would reduce costs and the time required to develop new drugs and diagnostics.

“We know the development pipeline has bottlenecks in it, and everyone would benefit from fixing them,” said Collins. “What we need are entirely novel approaches to translational science to take full advantage of the deluge of new biomedical discoveries that have been made in recent years.”

HRSA Awards Grant to UVA

To help patients, the University of Virginia’s Center for Telehealth is going to collaborate with a coalition of healthcare providers to expand telemedicine services via a grant from HRSA. In September, the Center was awarded nearly $1 million from HRSA to create the “Mid-Atlantic Telehealth Resource Center”.

Starting in October, UVA in partnership with telehealth networks across the region will link rural and urban healthcare providers to expand telehealth capabilities and expertise. Through UVA’s telemedicine network, patients now receive care provided by UVA physicians and other health professionals in more than 40 subspecialties with more than 85 locations across the state.

“We are delighted that HRSA has provided us with this opportunity to share models of care provided via telehealth with our partners across the Mid-Atlantic region”, said Karen Rheuban, MD, Director of UVA’s Center for Telehealth.

Last year, Governor Bob McDonnell signed into law a bill requiring insurance companies to cover clinical services provided through telemedicine which means that the state is the only state in the Mid-Atlantic region that mandates insurance coverage for telemedicine

“While telemedicine provides many benefits to rural communities David Cattell-Gordon, Director of UVA’s Office of Telemedicine, says patients living in urban areas such as the District of Columbia are also positively impacted by advanced technologies.

Moving Technology Forward

Rural health networks are going to receive more than $11.9 million to support their adoption of health IT, EHRs, and qualify for CMS incentive payments. Forty grantee organizations will receive about $300,000 to purchase equipment, install broadband networks, and provide training to their staff. Funding will be distributed through HRSA within HHS.

In another HHS action, HRSA Administrator Dr. Mary Wakefield and National Coordinator for HIT, Dr. Fazad Mostashari have announced that $8.5 million is slated to go to 85 community health center programs located in 15 of the 17 Beacon communities to help them adopt HIT, improve coordinated care, and improve the quality of care in these communities.

In a recent announcement, HHS proposed new rules to help patients access their health information. The new rules would empower patients and enable them to gain access to their test results directly from laboratories. The Notice of Proposed rulemaking jointly developed by CMS, HHS Office of Civil Rights, and CDC, proposes to amend the Clinical Laboratory Improvement Amendments of 1988 regulations and HIPAA privacy regulations to strengthen patients’ rights.

In addition, HHS awarded $10 million made available from the Affordable Care Act to help 129 organizations become community health centers. The funding has been made available so that these health centers will be able to provide a more comprehensive range of primary health care services and be able to expand their services to the larger community.

USDA announced that loans are available to improve 911 and emergency communications services in rural America. USDA in the Federal Register published interim telecommunications loan program eligibility requirements to finance the construction of interoperable and integrated public safety communications networks in rural areas.

Funding will be provided by the Rural Utilities Services (RUS) to enable USDA to speed the rural deployment of dual-use public safety/commercial wireless networks, address homeland security communications needs along rural international borders, and finance enhanced 911 capabilities for carriers and communities.

With these improvements, it will be possible to precisely locate rural wireless 911 calls, contact 911 via text message, or send emergency responders photos or videos of crime scenes or accidents. The new regulation would also give RUS the ability to finance wireless upgrades for public safety and securing.

As for state activities, the Georgia Department of Community Health under the Small Rural Hospital Improvement Program is going to award HRSA funding to small rural hospitals in the state for the amount of $512,024 to help them defray costs to implement the Prospective Payment System, Accountable Care Organizations, Payment Bundling, Value Based Purchasing, and provide up-to-date health information systems.

In another project, a data management tool developed at the University of North Dakota is being offered to State Offices of Rural Health (SORH) in all 50 states through a new non-exclusive license agreement with the National Organization of State Offices of Rural Health (NOSORH). The online tracking system allows organizations to track activities such as information dissemination, presentations, publications, and services. The system can also monitor time, budget, programs, goals, location, and map activities.

Keep Up-To-Date:Wireless Health 2011

The Wireless-Life Sciences Alliance (WLSA) will hold their second annual scientific conference “Wireless Health 2011” October 10-13 at the Hilton La Jolla Torrey Pines. Researchers from MIT, University of Edinburgh, UCLA, and other leading universities will share their best new research and advances in wireless health technologies with thought leaders not only from academia, but also from government and industry. This high level of expertise will be on hand to discuss the new field of wireless health that is rapidly moving forward with new health products and services.

Keynote presentations will be presented by:

• Paul Jacobs, Chairman & CEO Qualcomm

• Gene Frantz, TI Principal Fellow and Business Development Manager, Digital Signal Processing Semiconductor Group, Texas Instruments

• Bruce Dobkin, MD, UCLA Medical Center

• Farnam Jahanian, PhD, Director, NSF Directorate for Computer & Information Science & Engineering

• Chris Van Hoof, PhD, Director HUMAN++, IMEC

• William Riley, PhD, Program Director, NHLB

An outstanding set of peer-reviewed papers, interactive workshops, industrial and academic application demonstrations, with a world-renowned group of invited speakers presenting will be available,” said Robert B. McCray, WLSA President & CEO. “This is a perfect opportunity for learning and networking with engineers, scientists, clinicians, researchers, and government funding agencies such as NIH and NSF.”

The Conference Agenda will incorporate three days of topical panel sessions covering the breadth of the wireless health research landscape. Topics will include:

• Wireless health in the field

• Health and Wellness connectivity services in vehicles on the go

• Innovations to reduce heart failure readmissions

• Advances in biomedical sensing for wireless health

• Context guided wireless health monitoring and classification

• New initiatives and program opportunities in wireless health research

• Energy computing and bandwidth resource efficiency in wireless health systems

In addition to the main conference, a full day of pre-conference sessions will provide technology tutorials. Daily sessions will address wireless health research challenges and other opportunities in computer science, medical informatics, signal processing, human factors, and device technology.

Conference sponsors include the Association for Computing Machinery, Biomedical Engineering Society, University of California San Diego Institute of Engineering in Medicine, and Qualcomm.

For more information, go to www.wirelesshealth2011.org or email Andrea Jackson at ajackson@wirelesslifesciences.org.

Wednesday, September 14, 2011

Lowering Costs Urgent

Donald M. Berwick MD, Administrator, for CMS kicked off the Health Affairs event on September 8th to present their September issue with studies focused on the urgency to lower costs. Berwick best described the CMS approach to reducing costs by using the term “Triple Aim” which refers to better care for individuals, better health for populations, and attaining lower per capita costs without doing any harm to patients.

Berwick talked about the steps that CMS has taken so far. For example, CMS recently launched the ‘Partnership for Patients” an initiative that is going to make an unprecedented investment to support physicians and other health professionals reduce injuries and help avoid hospital readmissions.

Also, to keep more people healthy, the Affordable Care Act (ACA) provides for a free annual wellness visit to enable physicians and patients to develop and update a personalized prevention plan to help Medicare beneficiaries remain healthy. So far this year, over 18.9 million people enrolled in traditional Medicare have used preventive services with no cost to them. Many of these services will help prevent chronic diseases that can cost Medicare billions to treat.

As Berwick mentioned, CMS has been actively trying to lower prescription drug costs. The ACA will phase out the Medicare Part D coverage gap or donut hole for Medicare Beneficiaries by 2020. This year, people on Medicare who do not already receive low-income subsidies will receive approximately a 50 percent discount on covered brand name prescription drugs and biologics while they are in the donut hole. So far, nearly 1.3 million people have received savings on their brand name prescriptions drugs when they hit the donut hole.

Also, this year, the CMS Innovation Center started a new demonstration program called the “Community Based Care Transition Program” to reduce hospital readmissions, test sustainable funding streams for care transition services, maintain or improve quality of care, and document measureable savings for the Medicare Program.

CMS is successfully addressing the issue of fraud to reduce costs. Berwick announced that the Joint Department of Justice-HHS Medicare Fraud Strike Force operating in eight cities has resulted in charges being made against 91 defendants including doctors, nurses, and other medical professionals for their alleged participation in Medicare fraud schemes. The loss due to fraud from the 91 defendants involved would have resulted in about $295 million in false billing.

Another study in the September issue stresses that CMS can further produce savings by integrating telehealth to help Medicare beneficiaries manage chronic diseases. This according to a study by Laurence C. Baker, Professor of Health Research and Policy at Stanford University and his colleagues Scott J. Johnson, Dendy Macaulay, and Howard Birnbaum. The team studied the CMS “Management for High Cost Medicare Beneficiaries Demonstration” to see where it succeeded and failed. The demonstration used the Health Buddy System a telehealth device to integrate care management in treating chronic diseases.

As Baker explained, the demonstration was initiated to see if Medicare beneficiaries with chronic diseases if managed more efficiently could produce savings. The demonstration began in 2006 and used in two clinics in Washington and Oregon, targeted traditional Medicare recipients with CHF, COPD, or diabetes mellitus. The treatment group members were identified and invited to join and if they did accept, they received a free telehealth device as they entered the program.

The team found significant savings among patients who used the Health Buddy telehealth program. Their conclusion based on the results from the demonstration, suggest that carefully designed and implemented care management and telehealth programs can help reduce healthcare spending and such programs should be considered by Medicare.

Another study in the September Health Affairs issue shows how a weight loss program for pre-diabetic adults 60-64 could save Medicare billions. The program implemented in partnership with YMCAs across the country is offering help with the very real problems of weight gain that leads to diabetes, high cholesterol, and high blood pressure.

Under the plan included in the study, the study’s lead author Kenneth E. Thorpe, a Professor at the Rollins School of Public Health at Emory University reports that “Most of the growth in healthcare spending is linked to rising rates of diabetes, high cholesterol, and high blood pressure.”

Under the program, a trained lifestyle coach helps overweight people eat healthier food and increase their physical activity. Studies of the program and others like it have found that participants age 60 and older lose weight and reduce the risk of developing diabetes and other health-related problems by up to 71 percent.

The study’s authors estimate that the program would cost the federal government $590 million and proposed that CDC’s National Diabetes Prevention Program and the Prevention and Public Health Trust Fund provide funding. The authors think that the investment would eventually end up saving Medicare an estimated $3.7 billion over the next 10 years or by $15.1 billion in net lifetime savings if the occurrence of diabetes, high cholesterol and blood pressure were reduced.

The information appearing in the September issues can be found at www.healthaffairs.org or on Facebook and Twitter.

Georgia Tech to Demo "LifeNet"

After the terrorist attacks of 9/11, Irene, and global earthquakes, most communication systems are overwhelmed leaving people without phones and the internet. The standard for post-disaster communications is the satellite phone, which at $600 or more per unit is expensive to own and at 50 cents per text, costly to use.

Georgia Tech College of Computing researchers have developed an innovative wireless system called “LifeNet” designed to help first responders communicate after disasters. “LifeNet” is a mobile ad-hoc network designed for use in highly transient environments that requires no infrastructure such as the internet, cell towers, or traditional landlines.

“LifeNet” can bridge connectivity between a satellite phone or other internet gateways and a WiFi-based network on the ground. It extends the coverage of a satellite phone or a service such as SMS from one computer to the entire independent network in the field.

This means that if several people in the field do not have satellite phones but have smart phones or laptops with WiFi capability, they can connect to the “LifeNet” network, communicate with each other with no other infrastructure, and use the internet as long as any one of them has access.

“LifeNet” is easy to set up. The network starts as soon as a node is put in place. Each “LifeNet” enabled computer acts as both a host client and a router, is able to directly route data to and from any other available wireless device. Nodes can be moved from location to location as needed, and the network remains intact.

Georgia Tech researchers are currently ready to deploy LifeNet for field testing and are looking to expand beyond crisis communications. Santosh Vempala, Georgia Tech Professor of Computer Science and his team recently partnered with Tata Institute of Social Sciences India and are working with Tata’s disaster management center.

Together, the researchers have identified cyclone-affected areas without communications infrastructure that could benefit the most from LifeNet and will be deploying LifeNet in the Mohali region of India over the next several months. The researchers are also planning to pitch LifeNet as a package to FEMA, the Red Cross, and other U.S. relief agencies.

For more information, contact Liz Klipp in Media Relations at (404) 894-6016.

State BBH Releases RFP

New Hampshire’s Department of Health and Human Services acting through the Bureau of Behavioral Health (BBH) released their RFP (2012-053) on August 22, 2011. BBH plans to procure a Commercial-Off-the-Shelf (COTS) software system and associated services with software to be configured for BBH’s specific needs.

The BBH is the State Mental Health Authority that ensures that efficient and effective services are provided to individuals who have a severe mental illness or serious emotional disturbances. At a local level, the majority community-based mental health services are delivered by Community Mental Health Centers that are private non-profit mental health agencies contracting with the Bureau of Behavioral Health.

The plan is to provide a web-based training and data collection system to:

• Provide training to clinicians who administer the state version of the “Child and Adolescent Needs and Strengths Assessment (CANS) and the “Adult Needs and Strengths Assessment (ANSA) instruments

• Collect client demographics information service utilization information and ratings gathered using the state version of CANS and ANSA

• Develop functionality to calculate eligibility for state services

• Develop an interface to import/export client information from the web-based system into and out of Community Mental Health Centers (CMHC)

• Develop an interface to import client information into the Medicaid Management Information system (MMIS)

• Develop an interface to export client data into Excel

• Generate client level, regional, and statewide outcome reports

Go to www.dhhs.state.nh.us/business/rfp/documents/RFP_DHHS_2012_053.pdf to view the RFP. The proposals are due October 10, 2011. For proposal inquiries, email Michele Harlan at Michele.A.Harlan@dhhs.state.nh.us or call (603) 271-8376.

Small Business Tax Credit Update

HHS is encouraging small employers and professional service providers to review the new “Small Business Health Care Tax Credit” to see if they are eligible. The tax credit was included in the Affordable Care Act to allow small employers that pay at least half of the premiums for employee health insurance coverage to be eligible for the small business health care tax credit. The credit is specifically targeted to help small businesses and tax-exempt organizations that primarily employ 25 or fewer workers with average income of $50,000 or less.

The IRS’s new outreach campaign will remind employers about the upcoming extension deadlines and will also provide important details to:

• Businesses who have already filed and let them know that they can still claim the credit by filing an amended 2010 tax return

• Businesses without tax liability this year can still benefit but should still evaluate eligibility for the tax credit

• Businesses that couldn’t use the credit in 2010 can claim it in future years if they have already locked into health insurance plan structures and contributions for 2010. These businesses may be eligible to claim the credit on 2011 returns or in years beyond. Small employers can claim the credit for 2010 through 2013 and for two additional years beginning in 2014

The two tax filing deadlines occur on:

• September 15—Corporations that file on a calendar year basis and request an extension to file to September 15, can calculate the Small Employer Healthcare credit on form 8941 and claim it as part of the general business credit on Form 3800

• October 17—Sole proprietors who file form 1040 and partners and s-corporation shareholders who report their income on Form 1040 have until October 17th to complete their returns

“As the filing deadlines approach, we want to make sure that small business owners don’t leave any money on the table,” said IRS Commissioner Doug Shulman. “Small businesses that offer health insurance should learn about this credit and see if they are eligible.”

The Administration is continuing to encourage private sector outreach. For example, Blue Cross Blue Shield plans have implemented a wide variety of innovative outreach initiatives to promote the program and are encouraging small employers to offer insurance coverage to their workers.

For more information go the IRS web site “Small Business Healthcare Tax Credit for Small Employers” at www.irs.gov/newsroom or go to the HHS web site at www.healthcare.gov/news/blog/smallbusineness09072011.html.

Treating Vets in CA & NV

The VA’s Central California Health Care System provides high tech healthcare in the San Joaquin Valley, a largely rural and agricultural area in the heart of California. Today, rural veterans living in the area are receiving health services in their homes and at community-based outpatient clinics in Merced, Tulare, and Oakhurst in California.

Since opening in spring 2011, the Oakhurst clinic has used telehealth to serve many patients by transmitting skin and wound images, sending real-time heart and lung sounds, and also sending images of the eyes, ears, nose, and throat to providers at remote locations. All three Community-based Outpatient Clinics can store and send retinal screening and skin images to other providers in the VA network.

The VA also provides a van in rural areas five days a week to provide veterans with free transportation to their nearest local clinic or main medical center. There are plans to expand existing programs and begin providing wound care and ear, nose, and throat telehealth services in coming years.

In another part of the state, the VA’s Northern California Health Care System has a telehealth program. The program uses state-of-the-art equipment including specialized cameras, a video system called Global Media Unit, plus the Health Buddy phone-based system.

Currently, telehealth services are available to certain patients for retinal imaging, surgical follow-up, neurology and prosthetics, as well as home-based management of some chronic conditions. More clinics are going to be added in the coming year.

In Nevada, a Veterans Court was established in Reno Nevada to address the unique problems that veterans have to deal with after their war time service. Substance abuse and mental health issues often lead to the arrest and imprisonment of veterans however, many times these Veterans are totally unaware of the services available to them through the VA. The Vet Court brings VA staff into the courtroom where defendants are able to quickly access VA resources and receive help. The judge monitors the progress of the veterans over time.

As soon as a veteran joins the program, they are connected to their Veterans Justice Outreach Coordinator, and also connected to a pretrial service officer. Both help to get the veterans into treatment at the VA Sierra Nevada Health Care System in Reno and in addition, help the veterans secure benefits they may not have known about. Of the 53 veterans who have gone through the program, none have reoffended.

Sunday, September 11, 2011

Alaska's Vision for Healthcare

The Alaska Health Care Commission has recommended that a five year road map to transform Alaska’s health system be developed to make high quality healthcare more available, accessible, and affordable for all Alaskans. The goal is to transform Alaska’s health system and develop the vision for the future of healthcare in the state.

The goals are to strengthen the health information infrastructure in terms of EHRs , develop the state’s HIE, further develop the health workforce by tracking the Alaska Health Workforce Coalition’s planning activities, and to further advance telemedicine adoption in the state.

Alaska’s present and future telemedicine activities will be highlighted by Stewart Ferguson, PhD, President-Elect ATA and Chief Information Officer for the Alaska Native Tribal Health Consortium along with many other leaders at the ATA Forum 2011 to be held in Anchorage Alaska September 19-21, 2011.

The other goals for the state are to support the development of patient-centered medical homes, identify long term care system and trauma system issues, study payment reform strategies in terms of price and quality transparency, provide for price bundling by episode of care or diagnosis, and examine the multi-payer approach.

The state health IT plan was formally approved by ONC on June 9, 2011 and HIE pilot sites are performing live data transfers with Fairbanks Memorial Hospital and Tanana Valley Clinic.

Today, the state has access to a number of health-related data sources related to claims and clinical data, public health surveillance data, population and other data, but there are still some gaps in the area of health workforce data, all-payer claims data, HAI data, syndromic surveillance data, and gaps in broadband in rural areas.

Alaska’s Hospital Discharge Database (HDD) has been maintained since 2001. Since its inception, the HDD has been maintained by the Hospital Industry Data Institute, Inc (HIDI) a subsidiary of the Missouri Hospital Association.

Currently, 27 hospital facilities participate in the database that includes mostly large hospitals but several facilities such as two military hospitals, two mental health hospitals, six regional tribal health system hospitals, and the long-term acute care hospital do not participate.

The discharge data is submitted to the clearinghouse maintained by HIDI on a quarterly basis with smaller hospitals reporting on an annual basis. Hospital billing departments transmit encrypted data to HIDI via a secure network. Unlike some other states, Alaska’s HDD system does not make de-identified data sets available for public use.

Alaska’s HDD system initially gathered inpatient data only but in 2007, outpatient and emergency department databases were added. However, a database for ambulatory surgery is not included in Alaska’s system.

There are challenges since only a portion of the state’s hospitals participate in the HDD system, incomplete data is a problem, and the data in the system is underutilized. Alaska is trying to increase facility participation in the database and also improve the use of HDD data.

The state is also encouraging patients to implement the use of “myAlaska” and personal health records. “myAlaska” is a web service operated by the state to provide single sign-on for multiple state services and provide a framework for electronic signatures for state forms or transactions.

As for e-prescribing, a portal is being implemented for Medicaid prior to the implementation of the new MMIS called the Alaska Medicaid Health Enterprise. The e-prescribing solution is called “CyberAccess” which is a stand-alone portal to deliver basic core functionality with additional Alaska specific customizations.

The primary users of “CyberAccess” will be providers, fiscal agent personnel, and state personnel. The portal is close to implementation but the near term plan is to roll out “Cyber Access” first to the primary care community.

Army Releases RFS

TATRC as part of the U.S Army Medical Department (AMEDD) released their AMEDD Advanced Medical Technology Initiative (AAMTI) “Request for Submissions”(RFS) seeking FY 2012 pre-proposals. Basically, the RFS includes specific areas of interest and needs and describes the Army’s specific plans for their science and technology programs.

Only members that are part of AAMTI are eligible to apply for the funding but collaborations with industry, academia, and other military services are permitted. However, the Principle Investigator must be part of AMEDD personnel and the funding must go to an AMEDD facility or command.

For FY 2012 the following areas are of particular interest:

• Tele-Surgical applications to include real-time surgical consultations from theatre, using telementoring in theatre surgeries, and providing consultation and telementoring between AMEDD medical facilities

• Technologies that address medical issues associated with TBI/PTSD particularly as they relate to screening, diagnostics, and protection

• Development of technologies to improve education for both patients and providers

• Development of applications involving cell phones and other technologies to deliver care, monitor patients, and provide patients with information

• The integration of clinical functionality into AHLTA

• Technologies to support and enable medical care to remote and underserved populations within the AMEDD

• Technologies that reduce the administrative burden associated with the provision of care in the AMEDD

For more information, go to www.tatrc.org/funding_aamti.html or email AAMTI_team@tatrc.org.

Toshiba Funding Grants

AHRA an association representing management at all levels in hospital imaging departments, freestanding imaging centers, plus group practices, is working with Toshiba America Medical Systems on their “Putting Patients First” grant program. The program funded by Toshiba is in place to help healthcare facilities obtain the resources needed to improve imaging quality and safety for patients.

The grant program will provide six grants of up to $7,500 to hospitals and imaging centers. Three of these grants will fund projects to improve the safety and comfort of pediatric imaging and three of the grants will be awarded for projects to improve overall patient care and safety in imaging.

An additional grant of up to $20,000 will be awarded to an Integrated Delivery Network (IDN) or hospital system to fund programs, training, or seminars aimed at improving patient care and safety in imaging across the IDN or hospital system. All winning facilities will develop and share their best practices.

Applicants should propose programs designed to reduce radiation, reduce the need for sedation, improve communication with patients regarding the process, improve patient comfort, and/or improve the overall clinical pathway.

Go to www.ahraonline.org/AM/Template.cfm?Section=Patient_First_Program1 or email smurray@ahraonline.org. Completed applications are due October 11, 2011.

eHI Vendor Report Available

Drawn from data from the eHealth Initiative (eHI) annual survey of 196 HIE initiatives, the just released “2011 HIE Vendors: An Evolving Market” report presents a mixed picture of vendor services provided by 35 different HIT vendors. Overall, groups were satisfied with the services provided by their vendors. Yet, nearly a quarter of respondents are still planning on re-evaluating their vendor in the next 12 months because of poor customer service, configuration and implementation issues, and cost, according to the eHI survey.

In addition, other key findings are:

• Vendors need to provide platform flexibility and experience, but cost was a distant third according to the survey

• Most HIE initiatives report outsourcing the technical work and some or all of the project management responsibilities to their HIE vendor

• HIE investments vary widely with 55 respondents spending less than $100,000 while 23 spent more than $900,000

“While most HIEs (75 percent) appear satisfied with their vendors, 25 percent are having second thoughts and plan to reevaluate their vendor contracts. Clearly everyone is keeping a close watch to make sure that vendors deliver. Fortunately, in most cases they do but these implementations are tough and there are bumps in the road,” said Jennifer Covich Bordenick, CEO at eHealth Initiative.

The report does not recommend or endorse any specific organizations, but eHI provides a list of the vendors that different initiatives selected. The list is available at www.ehealthinitiative.org.

NIH Seeks mHealth Tools

NIH’s National Institute of Nursing Research (NINR) issued Funding Opportunity Announcement (PA-11-330) on September 2, 2011. NIH’s objective is to stimulate research using Mobile Health (mHealth) tools to improve patient-provider communication and to help patients manage chronic diseases in underserved populations.

With the rapid expansion of cellular networks and substantial advancements in smart phone technologies, it is only logical, possible, and affordable to transmit patient data digitally from remote areas to specialists in urban areas and receive real-time feedback. Using mHealth tools will help provide treatment reminders, feedback on patients and their progress, help treat chronic diseases, and improve health outcomes.

Eligible organizations include higher education institutions, non-profits, for-profits, government entities, and others such as independent school districts, Native American Tribal Organizations, faith-based, community-based, and regional organizations.

Two additional companion FOAs were also announced on September 2, 2011 that includes (PA-11-331) as part of the Small Grant Program and (PA-11-332) as part of the Exploratory Developmental Research Grant Award program.

For more information, go to http://grants.nih.gov/grants/guide/pa-files/PA-11-330.html to view the FOA titled “mHealth Tools to Promote Effective Patient-Provider Communication Adherence to Treatment and Self Management of Chronic Diseases in Underserved Populations”.

For the companion FOA (PA-11-331) part of the Small Grant Program, go to http://grants.nih.gov/grants/guide/pa-files/PA-11-331.html and for the Exploratory/Developmental Research Grant Award, go to http://grants.nih.gov/grants/guide/pa-files/PA-11-332.html.

Tackling New Ideas & Thoughts

The Partners Healthcare 2011 Connected Health Symposium at the Boston Park Plaza Hotel on October 20-21, 2011 is going to bring together the most up-to-date thinkers involved in the field of health and technology. This premier opportunity will enable healthcare executives and key thought leaders to have tough in-depth debates on how to handle this tumultuous new era of debt reduction politics, plus talk about healthcare issues that the U.S and other countries all over the world face in the 21st century.

Sessions will demand fresh thinking and will provide attendees with ideas on how to move healthcare technology in new directions:

• Jasper zu Pultitz MD, President, Robert Bosch Healthcare, will square off against Vince Kuriatis, JD, MBA, Principal and Founder of Better Health Technologies, in a symposium debate “Resolved: for Telehealth and Remote Patient Monitoring, the Business Model of the Future Isn’t Direct Reimbursement: It’s Bundled and Global Payments”

• The job of deconstructing Game Mechanics, Gaming Psychology, and New approaches to Designing Health and Wellness Programs will be discussed by Catherine Frederico, Adjunct. Professor of Nutrition Science at Regis College and developer of the computer game “Food Focus”; Debra Lieberman, Director of the Health Games Research National Program funded by the RWJ Foundation and hosted at UC Santa Barbara; Ben Sawyer, Co-Founder of the “Serious Games Initiative” and “Games for Health”; and Tony Tomazic, Director of Consumer Innovations at Humana

• Eileen Bartholomew, Senior Director of Life Sciences Prize Development for the X Prize Foundation will challenge innovators everywhere by asking “Can $10 Million Revolutionize Health Care?

• Moderator Lisa Gualtieri, Assistant Professor of Public Health and Community Medicine at Tufts Medical School, will highlight presentations from four exceptional innovators, to discuss “Facebooking Health: Scouting Out the Latest Trends in Online Patient Communities and Social Media”

• Four Entrepreneurs under the Age of 40 will discuss their ventures in Health IT. Market opportunities will be dissected by Alexandra Drane, Co-Founder and President, Eliza Corporation; Veer Gidwaney, CEO, Daily Feats; Michael Murphy, Founding Partner and Executive Director, MASS Design Group; and Ben Rubin, Co-Founder and Chief Technology Officer, ZEO

• Interviews with two venture capitalists and two leading journalists on the “State of Innovation in Consumer Health”, will provide for spirited commentary from moderator Dave Whitlinger, E.D, New York eHealth Collaborative, and from panelists Brian Dolan, Editor and Co-founder, “MobilHealthNews”; Bill Geary of North Bridge Venture Partners; Scott Kirsner, innovation economy columnist for the Boston Globe; and Halle Tecco, Founder and Managing Director for Rock Health

Go to www.connected-health.org/events/symposium-2011.aspx for more information on sponsorships, exhibiting, and registering for this major Symposium along with registering for the Leadership Summit.

Federal Telemedicine News readers will receive a discount of $100 off the full price ($1095) to register for the Symposium. The code to use is “Telemed News”.

For further details, email Joe Ternullo Organizing Chair for the Symposium at jternullo@partners.org or email Margaret Spinale at mmspinale@partners.org.

Tuesday, September 6, 2011

Database to Help TBI Patients

NIH and the Department of Defense are building a central database containing data on Traumatic Brain Injuries (TBI). The “Federal Interagency Traumatic Brain Injury Research” (FITBIR) database, to be funded at $10 million over four years is designed to accelerate comparative effectiveness research on brain injury treatment and diagnosis. The system will serve as a central repository for new data, link to current databases, and allow for valid comparisons of results across studies.

About 1.7 million people in the U.S. sustain TBIs each year from common causes such as auto accidents and falls. In addition, service members serving in Iraq, Afghanistan, and in other parts of the world face the risk of sustaining a traumatic brain injury. According to DOD, in the past 12 years, more than 200,000 service members deployed worldwide have been diagnosed with TBI. The total cost for treating TBIs in the U.S. including medical care, lost wages, and other expenses, exceeds $60 billion.

Treatments remain limited despite improved surgeries and the use of rehabilitation techniques for people with brain injuries. Also, cases of TBI are highly variable, since there are different causes for the injury, injuries can be in different locations within the brain, and there can be different kinds of damage to brain tissues.

This makes it difficult for clinicians to treat patients, predict long-term outcomes and investigate new therapies. Also, studies often report different kinds of data on patients, obtained through various tests and measures, further impeding comparison of data across studies. The FITBIR databases will address these challenges by collecting uniform and high quality data on TBI, including brain imaging scans and neurological test results.

The database is expected to aid in developing:

• A system to classify different types of TBI
• More targeted studies to determine which treatments are effective
• Diagnostic criteria for concussions and milder injuries
• Predictive markets to identify those at risk of developing conditions linked to TBI
• A clearer understanding of the effects of age, sex, and other medical conditions on injuries and recovery
• Evidence-based guidelines for patient care from the time of injury through rehabilitation

The Division of Computational Bioscience within NIH CIT will build the database because of their experience in developing the “National Database on Autism Research”. Reusing the database structure is expected to save 35-50 percent of the project costs and significantly reduce the time to achieve meaningful results. Plans are for NIH CIT to not only build the database but also provide ongoing system administration and hosting services once the database is complete in about two years.

The Defense Health Program through the Army Medical Research and Materiel Command (USAMRMC) is the lead DOD component funding the FITBIR database. Both USAMRMC and the National Institute of Neurological Disorders and Stroke (NINDS) will provide programmatic support and foster collaborative research to populate the database. Researchers will be given detailed information about the FITBIR database and will be encouraged to participate at the time they submit proposals for new studies.

For more information, email Donna Berry, NIH CIT at donna.berry@nih.gov, call (301) 451-1039 or email Daniel Stimson, NINDS at stimsond@ninds.nih.gov, call (301) 496-5751.

Several Technologies Featured

The U.S. Navy is looking to commercialize via patent licensing an acoustic electronic stethoscope that can selectively amplify sounds of medical importance while suppressing environmental background noise.

This device has several other benefits such as the device can deliver clean electronic output for telemetry, provide archival storage and acoustically-based diagnostic analysis, easy to operate, and competitive in cost to other competing devices.

The Naval Submarine Medical Research Laboratory in Groton, Connecticut developed the device which uses a combination of structural and electronic components to maximize the signal to noise ratio. The stethoscope is complete with a novel diaphragm containing dual piezoelectric sensor elements with opposing polarity.

The electronic stethoscope has been ruggedized for a U.S. Marine Corps field test and has been tested by the Navy on the HSV-2 Swift, a high speed wave piercing catamaran by U.S. Navy medical staff. Interested companies may review additional technical and performance details from the laboratory or receive a demonstration of the technology.

The patent number for “Noise Rejecting Electronic Stethoscope” is (2008/0137876) and available for licensing. For more information, email Laurel Halfpap at lhalfpap@montana.edu or call (406) 994-2051.

The Army seeks to commercialize a web-based system for electronically storing and disseminating dental records and images between generalists and specialists to render a diagnosis or to determine a treatment plan. The major benefit for the system is that it crates electronic records for consultations.

The web-based communication technology can be used to create and transfer dental consult records including images along with diagnosis and treatment records, and helps the referring provider and specialist to communicate. An image manipulation routing enables the consulting dentist to zoom in and out, invert, rotate, flip, and change the contrast and brightness of images. The teledentistry consult system enables expert consultation to theater-based dentists and soldiers.

The patent “Teledentisry Consult Management System and Method” filed by the Army (No. 20030078806) and the software code are available for commercial licensing. For more information, email Dan Swanson at dss@montana.edu or call (406) 994-7736.

VA Launches Open Source EHR Agent

The VA has launched the Open Source Electronic Health Record Agent (OSEHRA) to serve as the central governing body of a new open source EHR community. The VA has contributed its current EHR known as VistA to seed the effort.

OSEHRA will oversee the community of EHR users, developers, and service providers that will deploy and use the EHR software. OSEHRA is putting in place the framework and tools needed to enable the public sector, private industry, and academia collaborate to advance EHR technology.

The Informatics Application Group (tiag) located in Reston Virginia was awarded the design of OSEHRA under a contract awarded by the VA in June 2011. The tiag group currently provides services emphasizing clinical applications, knowledge management, enterprise services management, mobile development technologies and operation, and information architecture.

Seong K. Mun, PhD of Virginia Tech will serve as the acting Senior Program Coordinator of the CA. Kitware and The Washington University Mallinckrodt Institute of Radiology will provide open source software management expertise to provide technical support. The CA will use state-of-the-art social networking tools as developed by the Clymer Group, a D.C based public-private partnership consulting service company.

Individuals and organizations interested in participating in OSEHRA at http://www.osehra.org/ are invited to join through the community website. Draft documents describing key framework components such as the design of its code repository and the definition of its software quality certification process are available on the website. Community feedback is welcome as the OSEHRA team finalizes the designs in preparation of the launch of full technical operations this fall.

EHR Investments Reap Benefits

According to research published in the August 31st “New England Journal of Medicine” federal investments in Electronic Health Records (EHR) could reap major benefits in better patient care and health outcomes.

A study based in the Cleveland Ohio area involving more than 27,000 adults with diabetes found that those in physician practices using EHRs were significantly more likely to have healthcare and outcomes that align with accepted standards than those where doctors rely on paper records.

Improvements in care and outcomes over a three year period also proved greater among patients in EHR practices. The study’s findings remained consistent for patients regardless of insurance type, and included the uninsured as well as patients insured by Medicare, Medicaid, and commercial payers.

The research involved more than 500 primary care physicians in 46 practices partnering in a region-wide collaborative known as “Better Health Greater Cleveland” an alliance of providers, businesses, and other stakeholders dedicated to enhancing the value of care for patients with chronic medical conditions in the region. Better Health launched in 2007 is one of 16 organizations that the Robert Wood Johnson Foundation supports in their initiative, called ‘Aligning Forces for Quality”.

The Better Health study focused on a 12 month window spanning 2009 and 2010 and followed trends over a three year period. The study also measured achievements by age, gender, and racial and ethnic categories as well as language preference and estimated patient income and education.

Better Health’s locally vetted national standards for care included timely measurements of blood sugar, management of kidney problems, eye examinations, and vaccinations for pneumonia. Outcome measures included meeting national benchmarks for blood sugar, blood pressure, and cholesterol control as well as achieving non-obese Body Mass Index, and tobacco avoidance. Patients who visited the same primary care practice at least two times within a single year were included.

The study found:

• Nearly 51 percent of patients in EHR practices received care that met all of the endorsed standards as opposed to 7 percent of patients at paper-based practices receiving the same level of care. After accounting for differences in patient characteristics, EHR patients still received 35 percent more of the care standards

• Nearly 44 percent of patients in EHR practices met at least four of five outcome standards while fewer than 16 percent of patients at paper-based practices had comparable results. After accounting for patient differences, the adjusted gap was 15 percent higher for EHR practices

• EHR practices had annual improvements in care that were 10 percent greater than paper-based practices as well as 4 percent greater annual improvements in outcomes

• Patients in EHR practices showed better results, including improvements over time, in both standards of care and outcomes across all insurance categories including commercial, Medicare, Medicaid, and uninsured

“We were not surprised by these results,” said Randall D. Cebul, M.D. a Professor of Medicine at Case Western Reserve University and the study’s lead author. “The study was influenced by several factors, including our public reporting on agree-upon standards of care and the willingness of our clinical partners to share their EHR-based best practices while simultaneously competing on their execution.”

David L. Bronson, MD President of Cleveland Clinic Regional Hospitals and President-elect of the American College of Physicians, said “As the program moves forward, we expect that EHR-based sharing of information across different healthcare systems and with our patients will help keep our patients healthier and foster more discriminating use of expensive resources such as emergency departments and hospitals.”

Soliciting Applications for Rural Grants

HRSA released a Funding Opportunity Announcement (FOA) for the “Rural Health Network Development Planning Grant Program (Network Planning Grant). These grants promote the development and implementation of integrated healthcare networks by supporting one year of planning. The amount of $1,150, 000 with 15 awards is expected to be funded.

HRSA’s program supports collaborative partnerships that will create strong networks to help strengthen the healthcare infrastructure in communities. For example, a Critical Access Hospital, a Community Health Center, and a social services organization could work together around a shared purpose.

The healthcare needs within the communities could be assessed, sharing clinical or administrative resources would be possible, and local patients could have access to a full continuum of care locally. Grant funding can be used to do community health and/or provider needs assessments, develop business operations, develop strategic plans, and invest more in health IT.

Eligible applicants can include state, county, city or township, special district, and Native American tribal governments. Also non-profits other than institutions of higher education are also eligible to apply. The lead applicant organization must be a rural, non-profit or public entity representing a consortium network of three or more healthcare providers to plan, organize and develop a network. For-profit or urban-based organizations are not eligible to be the lead applicant but can participate in the network.

The FOA (HRSA-12-084) was released August 31st with the application due October 31, 2011. For more information go to www.grants.gov or email Eileen Holloran at eholloran@hrsa.gov or call (301)-443-7529.