NCI Director Speaks at NPC

Speaking at a September 25^th Newsmaker event at the National Press Club in Washington D.C., Harold Varmus M.D., Director of the National Cancer Institute and co-recipient of a Nobel Prize reported that there has been a slow but steady decline of cancer by 1 to 2 percent per year for several decades.

Some of the progress is attributable to prevention, early detection, the ability to assess genetic risks, improvement in drugs, and over the decades, improvements in surgical procedures, chemotherapy, and radiation.

Today, the NCI National Cancer Program conducts and supports research through grants and cooperative agreements, conducts research in NCI’s labs and clinics, supports a national network of cancer centers, collaborates with other national and foreign institutions engaged in research and training, and disseminates health information.

This year NCI consolidated a number of its genomics initiatives including the program “The Cancer Genome Atlas” (TCGA) into a single Center for Cancer Genomics. The new Center is working with other components of NCI to ensure that the findings are applied to developing new diagnostics and therapeutics and integrated into medical practice.

Within the past two weeks, NIH reported that TCGA found that breast cancer shares genetic features with high grade serous ovarian cancer, a cancer that is very difficult to treat. The researchers found that by using the data generated as part of TCGA, they were able to gain insights into the four standard molecular subtypes based on a comprehensive characterization of samples from 825 breast cancer patients.

The research a collaborative effort funded by NCI and the National Human Genome Research Institute was published online and is now in print in the journal “Nature”. The hope is that the researcher’s findings will be a crucial step toward improving breast cancer therapies.

Yet even with the good news, there hasn’t been as much progress as hoped for through the years and researchers are trying to understand why treating the disease does not always produce the best outcomes.

Several factors are hindering researchers:

·        Researchers have to deal with a collection of hundreds of genetically distinct diseases each with its unique vulnerabilities

·        Researchers are dealing with a complex set of behavioral and environmental factors

·        Societal and cultural issues can impede progress

·        Financing of research is slower than it could or should be

·        The accuracy of research is sometimes challenged

·        There is an inherent aversion to risk so the emphasis is on safe scientific research

·        There is a wave of data relating to genetic and clinical data which needs to be brought together

In spite of the issues facing the cancer research community, Dr. Varmus looks to the future and sees how all of the recent technological advances in genomics, molecular biology, and computational sciences, are making it possible today for researchers to achieve results to improve the lives of cancer patients and their families.

FCC mHealth Report Released

Last June, the FCC convened a mHealth Summit with senior executives and leaders from the healthcare technology industry, academia, and government to discuss the new opportunities and challenges of mobile and wireless health products. The outcome of the Summit was the creation of a Task Force to develop recommendations to the FCC, other federal agencies, and industry on how to accelerate the adoption of mHealth technologies so that the use of mHealth will be routine medical best practice by 2017.

FCC Chairman Genachowski announced plans based on the recommendations included in the mHealth Task Force report that was unveiled on September 24^th at an event hosted at the Information Technology and Innovations Foundation (ITIF).

Recommendations include actions to increase interagency collaboration and information sharing, expand on existing programs to encourage mHealth adoption, and build on government and industry efforts to increase capacity, reliability, interoperability, and safety of mHealth technologies.

Chairman Genachowksi announced that the FCC would consider the following actions based on the report.

·        Work with industry and federal partners to reach the mHealth Task Force’s goal that mHealth technology become a routine medical best practice within five years

·        Consider streamlining the FCC’s experimental licensing rules to promote and encourage the creation of wireless health device “test beds” to permit easier testing of mHealth technologies

·        Comprehensively reform and modernize the Rural Health Care (RHC) Program to include rules to permit networks of hospital and healthcare facilities to jointly apply for RHC Program funds to boost broadband capacity and enable EHRs

·        Collect richer data on broadband and telehealth applications from RHC Program participants to enable more targeted support for telemedicine

·        FCC’s International Bureau will work with FCC counterparts in other countries to encourage making spectrum available for MBANs and discuss possible spectrum harmonization efforts to allow for medically safe cross-border patient travel

·        Develop and execute a healthcare stakeholder outreach plan to those who many not be aware of FCC opportunities and procedures

·        Renew the search for a permanent FCC Health Care Director to function as the central point of contact to external groups on all health related issues

The FCC report can be accessed at www.itif.org/events/recommendations-mhealth-task-force.

UC Davis IPHI Launches CHeQ

The Institute for Population Health Improvement (IPHI) at UC Davis Health System has established the California Health eQuality (CHeQ) program. CHeQ seeks to improve healthcare quality and coordinate care by using HIE technology to facilitate the rapid flow of information to physicians, hospitals, and other healthcare providers.

Through a 16 month $17.5 million interagency agreement with the California Health and Human Services Agency (CHHS), CHeQ will develop and implement HIE programs according to the state’s cooperative Grant Agreement with ONC. From March 2010 to August 2012, CHHS had used CaleConnect, a nonprofit corporation as California’s state-designated governance entity

Care will be expanded to underserved communities and enable the exchange of health information or access to Direct, a simple standards-based way for senders to push secure encrypted health information directly to trusted recipients over the internet. CHeQ also will improve sharing of immunization, laboratory, and care information and provide tools to assist providers in identifying private, secure, standardized, and trusted systems.

Kenneth W. Kizer, Director of the IPHI will lead CHeQ. He has served as Chair, President, and CEO of Medsphere Systems Corporation and Founding President and CEO of the National Quality Forum, a Washington D.C. quality improvement and consensus standards-setting organization. He also served as the Under Secretary for Health for the VA.

“We want care-related information to flow safely and quickly between and among healthcare providers. No more printing, scanning, and faxing laboratory and X-ray results,” Kizer said. “Through CHeQ, we are committed to advancing use of secure electronic exchanges of information so that care for the patient is better and the job of providing high quality care is easier for the caregiver.”

Pamela Lane, CHHS Deputy Secretary for HIE, responsible for the state’s Cooperative Grant Agreement, said, “Under IPHI, the new organization will enable CHHS to achieve an important long term goal for HIE to use data to improve population health outcomes in California.”

CHeQ will be a collaborative effort among CHHS, other state agencies, state healthcare stakeholders, patients, healthcare professionals, payers, provider, and health plans. Additionally, on November 1-2, 2012, CHHS and CHeQ will convene the state’s HIE meeting “Transforming Healthcare: 2012 California HIE Stakeholder Summit” to be held in Sacramento.

For more information, go to http://healthsystem.ucdavis.edu or email iphi@ucdmc.ucdavis.edu.  

Addressing Adverse Events Reporting

The FDA’s Center for Devices and Radiological Health (CDRH) just published the report “Strengthening Our National System for Medical Device Postmarket Surveillance” that addresses the need for a Unique Device Identification (UDI) system to report adverse events. Developing the UDI system would help the FDA, the healthcare community, and industry to more accurately report and analyze device-related adverse events.

The Report mentions four specific actions:

• Establish the UDI system and promote its incorporation into electronic health information
• Promote the development of national and international registries for selected products
• Develop and use new methods for evidence generation, synthesis, and appraisal
• Modernize adverse event reporting and analyses

Right now, FDA reports that there are serious problems in reporting adverse events involving medical devices. Today, information on adverse events is contained in the Manufacturer and User Facility Device Experience (MAUDE) database which contains voluntary reports received since 1993.

However, after many years use, the number of adverse event records contained in MAUDE is now exceeding its design capacity plus there are limitations in using spontaneous reporting systems. Therefore, modernizing adverse event reporting is a key requirement to developing a comprehensive medical device postmarket surveillance system and requires the use of the UDI system.

The “Adverse Spontaneous Triggered Events Reporting (ASTER) study has demonstrated that facilitated, “triggered reporting” increases the number of adverse events reported by clinicians. CDRH is piloting ASTER-D to help hospital EHRs and Incident Reporting Systems detect and automatically report devices associated with adverse events to the FDA.

FDA is presently working on a new system called the “FDA Adverse Event Reporting System” (FAERS) that will have expanded capacity and modern analytic capability for identifying and extracting relevant information in automated fashion and in more versatile reporting formats.

FDA is also addressing mobile applications for adverse event reporting. CDRH has partnered with Boston Children’s Hospital to develop and implement a mobile app to use to securely report medical device adverse events. Work is currently underway to refine the app so that CDRH can receive reports via FDA’s electronic submission gateway.

Go to www.fda.gov/MedicalDevices/default.htm for more information.

CTA Launches Online Toolkit

The Center for Technology and Aging launched their online “ADOPT Toolkit©” and associated technical advisory and consulting services. The ADOPT Toolkit website includes free, practical “how to” resources to guide providers, ranging from hospitals and health systems to aging services organizations, through the often complex technology adoption maze which can involve planning and development to implementation and evaluation. ADOPT can be used by organizations to improve care or reduce re-hospitalizations for individuals with chronic conditions, such as heart disease or COPD.

“Accelerating diffusion of proven technologies such as ADOPT has been our mission since we started sponsoring technology demonstration grants several years ago,” said David Lindeman, PhD, Director of CTA. “We’re taking our expertise to the next level by offering consulting services to the broader healthcare community and therefore we created the online ADOPT Toolkit.”

“The website builds on CTA’s research and real-world experience and is designed for organizations committed to using technology to dramatically improve chronic disease management,” said Wendy Everett, President of NEHI, a national health policy Institute with expertise identifying barriers to adoption of technologies for patients with chronic illnesses.

The website will offer tools in four discreet technology areas such as remote patient monitoring, medication optimization, care transition, and mobile health. RPM tools are available online and tools for mobile health technologies will be available in November.

The toolkit templates and guides are organized into work streams that support both program sustainability and scalability to simplify the steps required to successfully deploy a technology such as program planning technology, patient management, clinical management, finance, administration, marketing, and evaluation, and performance improvement. A starter kit set of RPM tools, including an Organizational Readiness Assessment is available to organizations new to technology adoption.

A free one hour nationwide webinar is scheduled for October 17the, 10a.m PDT (1p.m EDT) to introduce healthcare provider and systems on how to use the new ADOPT Toolkit. To register, go to bit.ly/04o95X.

For more information, go to http://toolkit.techandaging.org.

Colorado Awarded Healthcare Grants

The Caring for Colorado Foundation www.caringforcolorado.org has awarded nearly $2.9 million in grant funds to go to 65 non-profit organizations throughout Colorado to boost healthcare in several areas. Funding will address programs concerned with mental and dental health, prevention programs, case management, care coordination, infrastructure, transportation, safety net facilities, and the health professions workforce.

Several of the grants are going to:

·        Denver Children’s Home ($30,000) to provide comprehensive therapeutic and educational care for the state’s abused, neglected, and traumatized children and their families. The funding will support an intensive, home-based, mental health treatment program for vulnerable children and families

·        Regis University ($70,000) to expand the health simulation lab and to train nursing, pharmacy, physical therapy, and health administration students in inter-professional teams

·        University of Colorado Foundation on behalf of Health Policy Solutions ($25,000) to support development of a health policy solutions website to provide coverage of healthcare issues and to promote informed debate among policy makers, healthcare practitioners, opinion leaders, and interested citizens

In other grant funding in the state, the Colorado Department of Public Health and Environment and the Cancer, Cardiovascular Disease, and Pulmonary Disease grant program awarded the Colorado Rural Health Center (CRHC) $1.5 million in grant funding to support their “Improving Communication and Readmissions” (iCARE) program. 

CRHC is using the funding to partner with the Southeastern Colorado Area Health Education Center to develop a number of direct delivery and indirect delivery strategies tailored to improve diabetes outcomes in rural Colorado.

The iCARE Rural Diabetes Collaborative will provide self-management programs and education, improve the use of disease registries and EHRs to track data, identify high risk individuals, and implement referral systems to improve the early detection of diabetes.

CRHC began improving the iCARE program in 2010 in response to heightened scrutiny nationally and statewide on the need for hospitals to prevent avoidable readmission rates. As a result, ICARE brought together Critical Access Hospitals from across the state to focus on not only reducing readmission rates, but also to improve communication in transitioning care.

Michelle Mills, CRHC CEO says, “Receiving this grant award brings statewide recognition of the important work happening in our rural communities with a focus on disease prevention and management, education, communication, and collaboration.”

Fourteen rural communities are currently participating in ICARE representing all parts of the state from the Eastern Plains to the Western Slope including La Jara, Estes Park, Gunison, Salida, Kremmling, Holyoke, Woodland Park, Meeker, Del Norte, Julesburg, Springfield, Cortez, Walsenburg, and Leadville.

For more information, go to www.coruralhealth.org or call (303) 832-7493.

EHRs Tracking Blood Pressure

HHS and the “Million Hearts Initiative” co-led by CDC and CMS, recognized Kaiser Permanente Colorado, Denver, and Ellsworth Medical Clinic in Wisconsin as “Million Hearts High Blood Pressure Control Champions” for achieving blood pressure control rates of greater than 80 percent among their patients with high blood pressure.

CDC reports that nearly one in three American adults (67 million) has high blood pressure and more than half (36 million) don’t have it under control. High blood pressure is responsible for direct healthcare costs of almost $131 billion each year.

Both systems credit the improvement to using EHRs to track and monitor patients, sending email and phone reminders to increase medication adherence and encourage healthy lifestyle changes, and working closely with staff to prioritize high blood pressure.

Since 2008, Kaiser Permanente Colorado’s focus on managing hypertension has improved the blood pressure control rate of its patients from 61 percent to 82.6 percent. Between 2007 and 2011, the Ellsworth Medical Clinic in Western Wisconsin improved blood pressure control among patients with cardiovascular disease from 68 percent to 97 percent. As of August 2012, the practice had achieved a 90 percent control rate for all patients with hypertension.

Christopher Tashjian, M.D., a physician at the Ellsworth Medical Clinic and President of the group, said “Improvement in the practice came when the entire staff including other caregivers and administrative staff, not just doctors were involved in quality improvement initiatives. We now realize disease management is a team sport.”

NCI/FDA Seeks Ideas

The National Cancer Institute’s Cancer Diagnostic Program and FDA’s Center for Devices and Radiological Health seek parties interested in doing collaborative research. The goal is to further develop, evaluate, or commercialize a simple portable biosensor platform based on the semiconductor electrical percolation of single-walled carbon nanotubes. There is also the need to develop electronics, microfluidics, and software to utilize the chip.

There are several potential commercial applications that can result in:

• Miniaturized biosensors for various biomedical applications to diagnose human diseases such as cancer, cardiovascular, or other biomarkers
• Point-of-care diagnostics and personalized medicine
• Rapid or real-time diagnostics
• Methods to monitor food safety and to detect environmental pollution
• Methods to regulate and activate implantable biomedical devices such as insulin pumps or artificial hearts
• A new generation of personal detectors for food allergens and cardiovascular events etc

The advantages to developing electrical percolation Biological Semiconductors (BSC) is that they are relatively simple to assemble and do not require specialized fabrication facilities or experience.

Other advantages include:

• BSCs can be fabricated into the same chip enabling simultaneous detection of many analytes
• Electronic-based BSC detection enables simple digital signal amplification and analysis
• BSCs enable rapid or real-time measurements
• BSCs are relatively stable with respect to retention of biological viability and can be stored for long periods of time
• BSCs are relatively low cost devices, simple to use, and may not require special equipment of a skilled operator.

U.S. and international patents have been filed. For more information email John D. Hewes PhD, at hewesj@mail.nih.gov and reference announcement #887.

Integrating Behavioral Health Services

The State of Maryland’s draft report published August 2012, titled “Maryland Recommending an Integration Model for Medicaid-Financed Behavioral Health Services” describes the problems facing the state to help individuals with mental illness and also suffering from addiction.

According to the Substance Abuse and Mental Health Services Administration, only 7.4 percent of individuals in the U.S. with co-occurring disorders are treated for both conditions and more than half do not receive treatment for either.

In addition, many individuals with mental illness, addiction, or have a dual diagnosis, have significant chronic conditions such as diabetes or heart disease. These conditions are largely responsible for a 25 year gap in life expectancy between those with serious behavioral health disorders and those in other populations.

Many Marylanders suffer from mental illness, substance abuse and chronic health conditions, but the financing system that provides services in the state is fractured and consists of three paths:

• One path is to access medical treatment and some behavioral health services in primary care through Medicaid
• The second path is to access addiction services through local jurisdictional grants
• The third path is to seek specialized mental healthcare through the Mental Hygiene Administration’s fee-for-service program

These disparate paths rarely meet to provide coordinated care for patients. The combined cost of medical, substance abuse treatment, and mental health care for high-cost individuals can reach hundreds of thousands of dollars per patient per year.

Since many private insurance options do not currently cover behavioral health services, low-income individuals that rely on publically-funded services have difficulty receiving appropriate care. Many low-income individuals are not eligible for Medicaid since they make too much money or do not have children.

Beginning in 2014, most individuals under 138 percent of the federal poverty line will be eligible for Medicaid under Medicaid Expansion. In addition, all health plans will be required to cover behavioral health services. This means that the need for grant-funded services will decrease as private and public insurance take its place. As a result of the changes under healthcare reform, Medicaid is going to be the predominant avenue to behavioral health services for individuals below the 138 percent federal poverty line.

Recently, the State of Maryland initiated several actions to deal with the issue:

• A working group was convened by the Department of Health and Mental Hygiene to recommend how to develop a system of integrated care for individuals with co-occurring serious mental illness and substance abuse issues

• The Department worked with stakeholders and engaged a consultant to examine options for the integration of Medicaid-Financed behavioral healthcare in the state
• In early 2012, the state established a Steering Committee led by the Deputy Secretary for Health Care Financing to review the financing and integration options
• Between March and September 2012, large public stakeholder meetings were held to discuss financing and integration models

Three documents describing three proposed finance and integration models to be considered for adoption by the state were developed by the Steering Committee and included in the draft report which has been circulated for comment.

CTO to Deliver Keynote 11/9/2012

Bryan Sivak, HHS Chief Technology Officer to deliver the keynote address on Friday, November 9, 2012 on “Federal HIT Initiatives to Accelerate the Movement from Volume to Value Based Care”. This vital and important keynote address and panel discussion will be featured at the 8^th Annual World Healthcare Innovation and Technology Congress to be held in Washington D.C. at the Ritz Carlton in Pentagon City November 7-9, 2012.

The panel will also include Niall Brennan, Director, Policy and Data Analysis Group from CMS and Joshua Rosenthal, Co-founder and CSO from Rowdmap, the Health Profit Intelligence leader.

This highly interactive games-based session will enable government and private sector thought leaders to separate buzz from fact by accessing how both healthcare market leaders and their members and patients are changing the way they ‘play’.

The session attendees will discuss how payer and health system management can pivot to take advantage of the new profit paradigm by using simple, top-down, ‘tiny’ data structure to gain visibility to make better bets, improve accountability to better manage vendors, move quickly and avoid IT implementation clusters, and change business value in a perverse market.

Attendees will also be able to:

·        Gain first post-election insights on the future of healthcare from a panel of industry leading CEOs

·        Participate in Pre-Congress In-Depth Workshops focused on disruptive innovation and keeping data private and secure in the cloud

·        Attend stakeholder-driven summits presenting evidence based case studies for provider and health plan executives

·        Connect in the downtown venue with new accommodations including free Wi-Fi and the WHIT Mobile app

·        Hear from selected entrepreneurs on the latest innovations accelerating the adoption of HIT in the Health IT Innovation Exchange Summit

Participants will be able to network with over 400 Hospital, Health System, Medical Center, Physician Practice and Health Insurance IT decision makers. This presents the perfect environment to find answers to pressing questions, while learning about partners and solutions providers who can take your organization to the next level.

To register and for more details, go to www.healthitcongress.com

NHCSL to Increase Telehealth

The National Hispanic Caucus of State Legislators (NHCSL) www.nhcsl.org recently approved a resolution to educate federal and state policy makers on how to create a workable framework for telehealth programs. These programs within the Medicare program can benefit the elderly and communities of color.

Over 50 million Americans lack access to primary care services due to doctor and provider shortages at local practices, community health centers, and hospitals in extremely rural areas. Patients are forced to travel distances of over an hour to receive treatment from their healthcare providers and in some cases are frequently treated by different doctors. Lack of proper treatment or doctors unfamiliar with the latest medical data can potentially lead to further health risks.

Joel White, Executive Director of the Health IT Now, a coalition of more than 60 patient, provider, employer, and payer organizations at www.healthitnow.org, applauds NHCSL in their efforts to provide the more than 50 million Americans lacking access to primary care services with the quality healthcare they need and deserve.

He notes, “As technological capabilities continue to dramatically evolve, the healthcare sector has yet to fully reap the rewards that telemedicine offers. This resolution is a positive step in ensuring that Hispanic and elderly communities are able to communicate more efficiently and effectively with their doctors, no matter where they are.”

In researching Hispanic issues, CMS in their Center for Medicare & Medicaid Innovation issued a funding announcement last June detailing information on their Hispanic Health Services Research Grant Program.

Researchers receiving grants will conduct small applied research projects and are expected to become involved in the design, implementation, and operation of research projects that address healthcare issues such as financing, delivery, access, quality, and barriers affecting Hispanics.

CMS is seeking these research projects because of the need to find solutions to the many difficult health issues that have a significant impact on the health of Hispanics. One of the goals for the funding is to foster a network for communication and collaboration regarding Hispanic healthcare issues.

For more information, go to www.cms.gov or www.grants.gov.

Diabetes Management via Apps

According to a new study from the eHealth Initiative (eHI), mobile health (mHealth) applications are helping socially disadvantaged populations with diabetes better manage their condition. The study supported by the California HealthCare Foundation (CHCF), reports that disadvantaged patients are using smart phones and mobile devices to overcome obstacles that often contribute to poor diabetes management, such as lack of access to healthcare providers.

More than 25 million Americans have diabetes today and many of them are uninsured or underinsured. As a result, these populations often have difficulty managing their condition, which can lead to numerous complications. The study looked at applications that can monitor medication adherence and healthy blood glucose levels to help patients better manage their diabetes.

The study is a literature review of 107 published articles since 2005 which evaluated the use of mHealth tools for diabetes management in medical practices. These tools enable patients to take a proactive approach to diabetes management by frequently monitoring their glucose values and healthy weight levels.

eHI identified a significant amount of research that demonstrated that by using these types of tools, patients were able to make positive changes in systolic blood pressure, improve glucose values, and reduce cholesterol.

Although smart phones tend to be the most common devices for today’s mHealth tools, there are also applications and programs available on the internet and through email, fax, or text messaging. Being readily available in various online and digital formats, mHealth applications are able to provide greater access to care regardless of an individual’s socioeconomic status, age, education level, or geographical location.

“Research shows that the majority of patients, including those who are disadvantaged have access to a mobile device or smart phone. These patients have tools at their fingertips to help manage their diabetes more effectively,” said Jennifer Covich Bordenick, CEO of eHI. “The use of mHealth tools provides a straightforward way for all populations to access information that assists in reducing risk factors.”

Currently, mHealth applications are the fastest growing sector of patient-centered tools industry. Over the past three years, the number of smart phone applications for diabetes has increased by almost 400 percent.

For more information, go to www.ehealthinitiative.org or go to www.chcf.org.

SSA Receiving Info Electronically

The Social Security Administration (SSA) is partnering with Kaiser Permanente to electronically transmit complete medical records for Kaiser’s patients to SSA with the appropriate consent. Social Security requests about 70,000 patient files from Kaiser each year so this seamless new system will save time and money for both partners as well as allow SSA to make faster and more accurate decisions. The agreement with Kaiser marks the agency’s first move into using health information technology on a large scale basis.

In April 2012, SSA and DOD implemented a new process to improve efficiency for service members applying for disability benefits. Today, a nationwide project enables Social Security disability case processing sites to receive military medical records from multiple DOD facilities with a single request to a centralized DOD site. Originally, the pilot program included five states and more than 60 military treatment facilities and now these states can receive EMRs within 72 hours.

Over the last few years, SSA has entered into similar agreements with several smaller providers to exchange medical records electronically over the Nationwide Health Information Network.

Some of the other SSA partnerships include:

• Beth Israel Deaconess Medical Center started exchanging medical records with SSA in 2008. To protect patient confidentiality, the first step is to include the patient’s consent to release information in the medical record
• Centra went live in 2011 with SSA but a problem developed because several types of data were involved and those problems had to be resolved
• Community Health Information Collaborative found it a challenge to provide a Continuity of Care Document to meet SSA’s requirements
• Douglas County Independent Practice Association found that in order to transfer information, it was necessary to map data to the database so that information wasn’t missing
• EHR Doctors starting in 2011 was able to connect with SSA but did not always find the process easy, but found that working closely with SSA’s team of technical experts produced good results
• Inland Northwest Health Services first collects and then collates the records into a single document to send the document for disability determination
• Marshfield Clinic found that reconciling the difference in state and federal law for medical information requirements is not always easy
• MedVirginia an original pilot partner with SSA exchanged data electronically over the NwHIN. In two years, this health IT partnership has generated more than $6,000,000 in revenue for MedVirginia partner Bon Secours Richmond Health System
• LCF Research created the New Mexico Health Information Collaborative to help develop the NwHIN standards, services, and policies but found the project difficult in terms of developing the technology needed
• Oregon Community Health Information Network (OCHIN) worked on a NwHIN pilot project and was able to send information electronically to quickly make disability determinations especially for the at-risk and vulnerable populations that OCHIN providers often serve
• Regenstrief found that while the project had its share of technical and coding challenges, they were able to achieve good results

For more information, go to www.socialsecurity.gov/hit.  

Sharing Health Information

HHS and the VA conducted a standards demonstration among providers using EHRs to enable sensitive health information to be shared that complies with confidentiality laws and regulations. The demonstration showed how sensitive information can be tagged so when it is sent to another provider with the patient’s permission, the receiving provider will know that they need to obtain the patient’s authorization to further disclose the information to others.

“This project helps demonstrate that with proper standards in place, existing privacy laws and policies can be implemented appropriately in an electronic environment,” said Chief Privacy Officer Joy Pritts for ONC.

The demonstration was developed as part of the Data Segmentation for Privacy (DS4P) Initiative created in response to the work of the President’s Council of Advisors on Science and Technology and supported by ONC.

Using standards identified in the DS4P Initiative, SAMSHA within HHS and the VA safely and securely transmitted a mock patient’s substance abuse treatment records tagged with privacy metadata from one EHR to a different EHR system after electronically verifying that the mock patient had consented to the transmission.

Privacy metadata from the SAMSHA EHR electronically explained to the VA EHR system that substance abuse treatment information within the clinical document is protected by federal confidentiality laws and can only be used for certain authorized purposes and can’t be further disclosed without the patient’s consent. By varying the disclosure of electronic health information, providers and patients can better balance treatment and privacy.

According to John “Mike” Davis, VA Project Lead and VHA Security Architect, “Data Segmentation based on industry standards such as Health Level Seven, make it possible for the first time to consistently apply and enforce individual privacy choices whether in the primary care physician’s office, shared with other provider’s, returned in reports from outside labs or wherever privacy protected health information is used.”

“Privacy and the protection of sensitive health information are paramount for many patients with behavioral health conditions,” said SAMHSA Administrator Pamela Hyde. “The tools developed in this pilot will be critical for building trust and capacity in EHRs and HIEs especially for patients with behavioral health problems.”

For more information, go to http://wiki.siframework.org/SAMSHA-VA-Pilot.

Bills Introduced in Congress

Representative Jerry Moran (R-KS) on September 13^th introduced the “Surveillance, Tracking, Observation, and Prevention of Obesity Act of 2012” (H.R.6402) that would authorize grants for ten states. The funding would be used to set up demonstration projects for the expansion of State registries on childhood immunizations which would include Body Mass Index (BMI) data to be submitted to the State by healthcare providers.

The robust monitoring of local obesity prevalence rates in children is an essential first step in dealing with epidemic prevention and control. There is an urgent need for accurate population-based data systems to understand obesity, prevalence, trends, and disparities among youth. Since there is a lack of data, planners and researchers have a difficult time evaluating the effectiveness of intervention efforts.

Existing immunization information systems with data on BMI can provide an assessment for childhood obesity prevalence more accurately than from existing survey data and would be able to measure the effectiveness of obesity intervention, wellness policies, and programs already underway. The data collected would also be required to be interoperable between each state and would be analyzed at the local level.

Senator John Kerry (D-MA) also on September 13^th introduced the “Medicaid Information Technology to Enhance Community Health Act of 2012” (S 3539) or referred to as the MITECH Act to encourage the adoption and use of certified electronic health record technology by safety net providers and clinics.

The bill states that by January 1, 2015, the States and other relevant stakeholders will need to publish regulations that would establish a procedure to help qualified safety net clinics demonstrate meaningful use of certified EHR technology.

For more information, go to http://thomas.loc.gov.

Monitoring Responder's Health

Emergency responders have to deal with an increasing number of natural and man-made disasters. As each large-scale disaster occurs, the need to ensure the safety and health of professional and volunteer emergency responders, before, during, and after a disaster has grown.

While some guidance has been developed on how to prepare response workers before and during deployment, less attention has been placed on monitoring the health of responders after they are finished dealing with the disaster.

Post-deployment monitoring and assessment is important because long-term health effects on responders following disasters may not be readily apparent for many years, and reconstruction of exposure information needed for long-term health monitoring and surveillance program can be difficult.

The information on responders can be used both during the incident to mitigate acute safety and health concerns, as well as provide the critical information needed to set up long-term health monitoring and surveillance systems quickly and effectively.

Recognizing the issue, CDC’s National Institute for Occupational Safety and Health convened a multidisciplinary public health workgroup. The workgroup include the U.S. National Response Team and a number of federal agencies, state health departments, labor unions, and volunteer emergency responder groups to develop the Emergency Responder Health Monitoring and Surveillance (ERHMS) system in 2011.

The next step in the developing this system was to implement and field-test ERHMS in real-world emergency response events, practice exercises, and training venues. NIOSH tested implementing ERHMS in a large scale interagency training exercise last year, which also tested the utility of hand-held electronic data collection techniques.

The document “Emergency Responder Health Monitoring and Surveillance” is now available that addresses a variety of public health measures that includes:

• Providing for medical screening that focuses on fitness and ability to safely and effectively deploy
• Providing for training regarding hazards on the site
• Developing approaches to centralized tracking
• Providing follow-up or long-term surveillance or monitoring for potential delayed or long-term adverse effects

 The data needs to be acquired through electronic transfer systems, records review, and surveys. The information for worker related data should include personal information along with medical information.

For more information on ERHMS, go to www.cdc.gov/niosh/topics/erhms.

News for Stroke Patients

Residents in need of emergency medical care for a stroke may now benefit from a Mayo Clinic “telestroke” program available at Casa Grande Regional Medical Center serving Pinal County in Arizona. Today, Mayo clinic serves as the hub in a network of ten other spoke centers all but one in Arizona. Casa Grande will become the 11^th hospital to be part of the telestroke service from Mayo Clinic.

According to Bart Demaerschalk, MD., Professor of Neurology and Medical Director of Mayo Clinic Telestroke, “At least 45 percent of Americans live more than 60 minutes away from a primary stroke center.”

A major benefit of the collaboration is that patients with stroke symptoms can often be administered clot-busting medications within the narrow window of time necessary to minimize permanent injury to the brain.

In providing telestroke care, a telestroke robot located in a rural hospital allows a stroke patient to be evaluated in real-time by a neurology specialist at the Mayo Clinic in Phoenix. The Mayo clinic stroke neurologist whose face appears on the screen of the portable self-propelled robot consults with emergency room physicians at the rural site and then evaluates the patient.

Patients showing signs of stroke can be examined by the neurologist who may use a computer, smart phone technology, portable tablets, or laptops. In addition to assessing the patient, the neurologist can view scans of the patient’s brain to detect possible damage from a hemorrhage or blocked artery.

To date, more than 1,000 emergency consultations for stroke between the Mayo Clinic stroke neurologist and physicians at the spoke centers has taken place which has resulted in significant reductions in terms of costs to use ground and air ambulance to transfer patients to other medical centers.

In other news related to helping stroke patients, the State of Wisconsin, the American Heart Association, and the American Stroke Association announced a new $1 million federally funded statewide initiative to improve survival and decrease disability from stroke.

Wisconsin is one of 11 states to receive the funding over the next three years to participate in the Paul Coverdell Program, a model shown to improve Emergency Medical Services (EMS) response and hospital-based treatment for individuals experiencing acute stroke. This is the first time that the state has been selected to participate in the registry and is going to help stroke centers compare the quality of their stroke care relative to national and regional benchmarks.

In addition, to the State Department of Health Services and the associations, the collaboration will include the Wisconsin Stroke Committee, a multi-disciplinary group of neurologists, emergency physicians, nurses, professional associations, DHS Emergency Medical Services, and healthcare quality improvement organizations. These organizations will collaborate on recommending a statewide stroke system of care and share the project’s results statewide.

The program will work with 20 hospitals certified as Primary Stroke Centers and EMS providers that service state areas. Stroke teams will use the American Stroke Association’s “Get with the Guidelines-Stroke” online tracking tool to monitor their performance.

EMS providers will improve their procedures based on data analysis in the “Wisconsin Ambulance Run Data System”. All of the collaborators will assist with quality improvement plans and coordinate educational events to help stroke and EMS teams share progress and best practices.

Senate Panel Approves Cancer Bill

The Senate Health, Education, Labor, and Pensions (HELP) Committee reported out on Senator Sheldon Whitehouse’s “Recalcitrant Cancer Research Act of 2012”, a bill to support focused research efforts on cancers with five year relative survival rates below fifty percent.

Recalcitrant cancers are those that develop in the pancreas, lung, liver, and ovaries and are difficult to detect and where substantial progress has not been made toward their diagnosis and treatment. Under the Act, the National Cancer Institute (NCI) will convene working groups of federal and non-federal representatives, each focusing on a specific recalcitrant cancer to develop scientific frameworks.

These frameworks will identify promising scientific advances, assess the sufficiency of qualified researchers working in relevant specialties, outline a plan to coordinate research, and include recommendations for actions to advance research, including appropriate benchmarks for measuring progress.

The Senator has introduced similar legislation such as the “Pancreatic Cancer Research and Education Act” during previous Congressional sessions. That bill would require NIH to develop and sustain a coordinated national strategy to address pancreatic cancer.

The bill recently introduced builds upon the Senator’s original legislation to cover other recalcitrant cancers, and includes key improvements recommended by medical experts and patient advocacy groups.

NSF Issues Grant Notice for NRI

The National Science Foundation (NSF) on September 11^th issued a grants notice for the “National Robotics Initiative” (NRI) with an estimated program funding of $50,000,000 with the award ceiling of $5,000,000. The goal for NRI is to accelerate the development and use of robots in the U.S and develop the next generation of robotics.

NIH supports the development of robotic applications for surgery, health interventions, prostheses, rehabilitation, behavioral therapy, personalized care, and wellness and health promotion. The most significant challenges will be to address safety issues especially for applications to be used in home and surgical settings where integration of complex systems will be required.

Human assistive devices will revolutionize healthcare in the next 20 years as much as personal electronics have changed our daily lives in the past two decades. Human assistive devices have the potential to improve healthcare and promote independent living by providing assistance to healthcare providers and to individuals needing the care.

Robotic applications will be able to provide:

·        Home care and/or personalized care for special-needs populations

·        Improvement in surgical procedures

·        Robotic wellness/health promotion

·        Robot-assisted recovery and rehabilitation

·        Robotic behavioral therapy

·        Surgical and interventional robots

·        Robotic replacement of diminished or lost functions

·        High throughput robotic technologies.

Eligibility for the funding is available to universities and colleges, non-profit and non-academic organizations, for-profit organizations, state and local governments, unaffiliated individuals, foreign organizations, and other federal agencies and federally funded R&D centers.

Current closing date for full proposal applications is December 11, 2012. Go to www.grants.gov or to www.nsf.gov/pubs/2012/nsf12607/nsf12607.pdf for more information.  

EHNAC Releases Certification Programs

The Electronic Healthcare Network Accreditation Commission (EHNAC), a non-profit standards development organization and accrediting body has released their new certification programs for vendors handling Electronic Prescription of Controlled Substances (EPCS).

The two certification programs evaluate pharmacy and prescribing companies that support electronic prescription of controlled substances. These programs are designed to demonstrate that vendors meet detailed DEA regulations as well as EHNAC core criteria addressing privacy, confidentiality, technical performance, business practices, resources, and security.

“EHNAC’s new EPCS programs were developed through the collaboration of healthcare prescription vendor and network experts,” says Mark Gingrich, Commissioner and Criteria Committee Chair of EHNAC. “We are excited about the level of detail provided in these programs, which effectively address the requirements of the DEA regulations. Customers of organizations achieving this certification can be confident their vendors have a very strong compliance framework in place.” 

EHNAC is undergoing the application process with the DEA to become an approved EPCS certifier. Until finalized, these programs will be administered exclusively by the Certified Information System Auditors (CISAs) to meet requirements of the DEA EPCS regulations.

EHAC accreditation recognizes excellence in health data processing and transactions and confirms compliance with industry-established standards as well as HIPAA and ARRA/HITECH regulations.

For more information on EHNAC accreditation programs, go to www.ehnac.org.

Open Source EHR Summit Coming

Seong K. Mun, PhD, President and CEO for the “Open Source Electronic Health Record Agent” (OSEHRA) just announced that the first annual Open Source EHR Summit and Workshop will be held at the Gaylord National Resort and Convention Center at National Harbor, Maryland on October 17-18, 2012.

According to Dr. Mun, “The Summit is being organized to share the work of the OSEHRA community which is beginning to continue to chart a bold new course for the most innovative EHR platforms that will be made available.”

Developments are rapidly taking place. The VA has fully adopted the open source approach to modernizing their EHR system VistA and also the OSEHRA certified “Gold Version” of VistA, will soon be installed in VA medical centers nationwide.

OSEHRA’s code repository is being populated daily with innovative open source tools and modules. Organizations with commercial products based on VistA code are now working with federal agencies to converge various versions of the codes into a single codebase.

It is projected that more than 200 hospitals and 1000 clinics within the federal sector alone will be managing and maintaining their EHRs using open source codes within the next few years. An increasing number of state agencies are deploying open source solutions as well. All of these open source activities have created a huge market opportunity for both the private and public sectors.

To take part in the evolving discussion, cutting edge speakers with upfront ideas on business models, technologies, and clinical applications that are going to drive the progress for open source software development and health IT will speak at the Summit. 

The Honorable James Peake, MD, Chairman, Board of Directors, OSEHRA, and Former Secretary, of the Department of Veterans Affairs, will Chair the Opening Session “Defining the Future of Open Source Software and the EHR.”

Some of the other esteemed experts include:

• Todd Park, U.S. Chief Technology Officer, OSTP, Executive Office of the President
• W. Scott Gould, Deputy Secretary, Department of Veterans Affairs
• Steven Van Roekel, Federal CIO for the Office of Management and Budget, Executive Office of the President
• Roger W. Baker, Assistant Secretary for Information and Technology, Department of Veterans Affairs
• Karen S. Guice, MD, Principal Deputy Assistant Secretary of Defense for Health Affairs, Department of Defense
• Robert I. Jesse, MD, PhD, Principal Deputy Under Secretary for Health, Department of Veterans Affairs

 Day one will include presentations on health IT innovations, industry trends, why these issues matter to the open source EHR community, plus discussions on open source business models. Day two will include breakout sessions with speakers presenting ideas on interoperability, open source development tools and methods, new clinical tools, big data & clinical genomics, OS ecosystems, innovations OS VistA, OS mobile health, genome-enabled EHRs, sustainable models, data mining and data analytics, certification and testing, VistA code activities, working with OSEHRA, and coping with open science and data. 

For more information go to www.osehra.org or call Conrad Clyburn, Director, Community Development, OSEHRA at 571-858-3205.

JHU's Partnering Opportunities

The Technology Transfer program at Johns Hopkins University is offering several partnering opportunities. JHU has developed a novel way to easily obtain multichannel ECG readings for remote monitoring and diagnosis of cardiac disease and is looking for partners to develop and commercialize the technology as a portable multichannel ECG system.

Multichannel ECG recording offers an advantage over normal ECG in that it is more detailed and presents more precise diagnostics by utilizing more sensing electrodes. Currently, there is no simple method for obtaining multichannel ECG readings in a remote setting such as in an ambulance. Additionally, the device has the ability to store data and to transfer the data wirelessly and is especially suited to diagnose arrhythmia and ischemia. For more information on the Portable Multichannel ECG Device (JHU Ref: C11755), email Heather Bakalyar at hbakaly1@jhmi.edu.  

JHU is also looking to partner to further develop a “Personal Remote Network PC Control Device” (JHU Ref: C10651) a wireless device that will authenticate a user on a PC and launch predefined applications on the PC to enable a busy physician to quickly access a nearby workstation.

This invention would enable the busy physician in the clinic to immediately access the nearby PC without sitting down and logging in by just using a few device clicks while doing other tasks. The invention helps to solve problems faced in a shared-computer environment, and provides the user with wireless access to selected network applications. For more information, email Eugene Yelden at geney@jhu.edu.

LSDF Announces Grants

The Life Sciences Discovery Fund (LSDF) provides funding to advance sciences, promote health, and strengthen Washington State’s economy. Currently, LSDF is offering two different types of grants for both for-profit and non-profit organizations located in Washington State.

The award program “Proof of Concept Grants” is open to both non-profit and for-profit entities with the maximum award of $250,000. These grants are meant to reduce the risk of commercialization for potential new products. The goal is to support highly targeted research and development activities and then be able to commercialize these products but only to find that federal funds are not available. At the same time, these potential tools and products under development are probably considered too risky for private investment.

LSDF funded work does not have to result in a market ready commercial product by the end of the grant term, but the proposals must demonstrate potential for creating and retaining jobs in Washington state.

The funding will go to ideas or products that will:

·        Develop tools with the potential to lead to breakthroughs in health-related research

·        Provide for products to use to diagnose, treat, prevent, or manage disease

·        Better manage healthcare delivery environments and systems

·        Promote healthy patient behaviors and patient compliance with care provider’s recommendations

·        Better integrate care providers, patients, and healthcare systems

·        Accomplish any of the above at a lower cost with equal or better patient outcomes

The second award program titled “2012-2013 Opportunity Grants” has the maximum award of $1,400,000 to use to significantly leverage LSDF dollars against money from other sources. Up to $7,000,000 will be available for funding through June 2013.

For both grant programs, all applicants must submit a pre-proposal to be considered and both grant program are accepting year round applications. The Request for Proposal was released August 9^th, with proposals due quarterly.

Go to www.lsdfa.org/documents/pdfs/LSDF_2012-2012_Granting_Programs_RFP.pdf to view the RFP.

NC State to Lead Center

North Carolina State University is leading a national nanotechnology research effort funded by NSF for a new NSF Engineering Research Center. The goal is to do research to create self-powered devices to help people monitor their health. The NSF “Nanosystems Engineering Research Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies” (ASSIST) is funded by an initial five-year $18.5 million NSF grant with the research to be headquartered on NC State’s campus.

The research effort is between NC State and partner institutions such as Florida International University, Pennsylvania State University, and the University of Virginia, plus affiliated universities such as the University of Michigan and the University of North Carolina. In addition, about 30 industry domestic partners will participate plus foreign partners such as the University of Adelaide, the Korea Advanced Institute of Science and Technology, and the Tokyo Institute of Technology.

ASSIST researchers will use the tiniest materials to develop the self-powered devices. These devices can be worn on the chest like a patch, on the wrist like a watch, or as a cap that fits over a tooth, or in other ways depending on the biological system being monitored.

Wireless health monitoring is already a fast-growing industry, but the self-powered technology being developed will mean that changing and recharging batteries on current devices could soon be thing of the past.

By using nanomaterials and nano structures and thermoelectric and piezoelectric materials that use body heat and motion, respectively as power sources, the researchers contemplate making devices that can operate on very small amounts of energy.

These devices could transform healthcare by improving the way doctors, patients, and researchers gather and interpret important health data. Patients could be better managed with uninterrupted streams of heart rate readings, respiration rates, and other health indicators, as well as personalized exposure data for environmental pollution. In addition, the data obtained from research studies can be used by lawmakers to craft environmental policy. Researchers will create new piezoelectric materials and energy-efficient transistors.

The team from the University of Virginia will develop ways to make the systems work on very small amounts of power, while the group from Florida International University will create sensors that gather biochemical signals from the body such as stress levels

The results of that work, coupled with low-power radios developed by the University of Michigan will be used to process and transmit health data gathered by the sensors that will go to computers and consumer devices. The University of North Carolina at Chapel Hill will provide ASSIST with medical guidance and arrange for the testing of the technology.

ASSIST will also draw on the expertise of 30 industry partners to help guide the center’s work to enter the marketplace. These industry partners both large and small include companies and agencies involved in nanomaterials and nanodevices, integrated chip manufacturing, software development, bioengineering, and healthcare. The Center will also interact closely with complementary research centers and organizations specializing in technology transfer to stimulate innovation based on the research.

For more NSF information, email Lynn Preston at lpreston@nsf.gov  or Barbara Kenny, at bkenny@nsf.gov.

$1.9 Million for Sensor Research

Early detection of blood loss to save the lives of soldiers wounded on the battlefield and to help civilian trauma victims is the goal for a three year R&D project just launched at the Worcester Polytechnic Institute (WPI). Funded by an Army grant, the research will be conducted in collaboration with the University of Massachusetts Medical School (UMMS) in their Biomedical Engineering Department.

The team will work on two projects. Ki Chon, PhD, Professor and Head of WPI’s Biomedical Engineering Department and Yitzhak Mendelson, PhD, Associate Professor of Biomedical Engineering are going to develop miniaturized wireless sensors that soldiers can wear.

At the same time, they will also create the mathematical algorithms needed to process signals from those sensors to simultaneously measure seven physiological parameters, including a novel way to detect bleeding.

In addition to sensors worn on the body, the WPI team will place the same monitoring capabilities on smart phones so that Army medics will be able to have the use of hand-held diagnostic tools. Both the wearable sensor and smart phone technologies will be evaluated at the medical school in an observational study of trauma patients to be directed by Chad Darling, M.D. Assistant Professor of Emergency Medicine, and David McManus, M.D., Assistant Professor of Medicine.

To do the research, Chon’s lab will focus on signal processing and adapting the technology for use on a smart phone, while Mendelson’s team will lead the wearable sensor device development.

The monitoring system under development will use light to measure vital signs. Small sensors will shine infrared and visible light through the skin and detect how different frequencies of light are absorbed by pulsing arterial blood. A series of algorithms will correlate subtle shifts in the spectra to a wide range of physiological parameters. On the smart phone platform, the built-in video camera will provide the light and record the reflections.

This is the same basic technology used in pulse oximeters, those now familiar devices that clip on a patient’s finger to measure blood oxygen levels. Chon and Mendelson’s approach takes the technology to a far more sophisticated level.

The WPI team will continue hardware, software, and algorithm development to optimize the sensors’ size, durability, and accuracy. They will also evaluate where best to place sensors on the body simultaneously. The sensors will also include embedded accelerometers to measure body movement and posture, along with a wireless link to allow a medic to monitor the health of soldiers.

According to Mendelson, one of the biggest challenges of sensor development for battlefield conditions is maintaining accurate measurements while soldiers are moving. Motion artifact contamination, which is interference caused by body movements, degrades the quality of the signals being measured and can lead to erroneous readings.

Beginning in the second project year, prototypes developed at WPI will be used by the UMass Memorial Medical Center’s emergency department to monitor trauma patients’ vital signs to detect blood loss. Severely injured patients will be monitored as they are transported by the medical center’s “Life-Flight” helicopter.

Other patients will be monitored when they arrive in the center’s emergency room by ambulance, using both wearable sensors and the smart phone application. In addition, the U Mass Medical Center’s clinical team will develop decision support tools to be embedded in the smart phone.