Wednesday, August 29, 2012

UC's Wireless Health Initiative

The University of California’s (Davis) “Research Investments in Science and Engineering” (RISE) grants were awarded to the “Wireless Health and Wellness” program. The funding for $800,000 will be used to investigate the use of wireless technologies, mobile sensors, and how telemedicine impacts people’s health.

The university’s RISE grants were awarded through the Office of Research with a program total of $10 million to be awarded to twelve highly innovative interdisciplinary RISE themes over a three year period.

Jay Han, Medical Director of the “Center for Information Technology Research in the Interest of Society” (CITRIS) and Associate Professor of Physical Medicine and Rehabilitation at UC Davis, reports that the research will develop wireless sensor and mobile health technologies to especially empower individuals dealing with chronic diseases. 

The program is collaborating with the UC Davis Computer Science Department, the Center for Health and Technology, Clinical and Translational Science Center, and the Betty Irene Moore School of Nursing. In addition to studying chronic diseases, Professor Edmund Seto of UC Berkeley and the CITRIS Associate Faculty Healthcare Director is looking for new ideas on how to use mobile phones and sensors for public health purposes.

Initially participants in the study will use smart phones to gather data on how they move, how much they exercise, and how many calories they expend during the course of their daily life. This research will assess technological barriers in terms of usability, privacy, security issues, how to integrate patient data into EHRs, and how to store large data sets with the objective to broaden the use of mobile health technologies. The data will be uploaded to be analyzed and reviewed by medical professionals to include physicians, nurses, and allied health professionals.

VHA's Simulation Activities

The VHA’s “Simulation Learning, Education, and Research Network” (SimLEARN), program used for healthcare training is involved in new efforts to improve training. The simulation program is developing a national simulation center, establishing the IT infrastructure, and collaborating with DOD, academic affiliates, and other non-VHA entities to advance mutual interests in simulation.

According to an article appearing in the summer 2012 SimLEARN newsletter, Jeffrey Cluver, M.D, Staff Psychiatrist at the Ralph H. Johnson VA Medical is finding ways to use simulation training to treat veterans who have delirium.

When the Medical University of South Carolina (MUSC) opened their state-of-the-art simulation center, a call went out to develop a module to treat delirium. Students are working to treat the simulated patient that they call “SimMan” who acts incoherent and sometimes shouts abrasively or even sometimes acts somewhat normal. So far, several modules have been developed using “SimMan” to treat the causes for delirium.

To add realism, “SimMan” will become agitated if not treated appropriately. Additionally, if the students do not manage the case effectively “SimMan” may have a seizure, develop an arrhythmia, or become unresponsive. So far, the students using the simulated patient have said they feel more confident in their ability to recognize and treat delirium.

In another effort to improve the simulation experience, the Boise VA Medical Center (BVAMC) was looking for a way to enhance and increase realism in-situ simulation experiences. They simulated monitoring babies in the hospital units during mock code using wireless transmitters for voice but found there still wasn’t an acceptable way to hear or see what was happening in the room without physically being at the bedside.

Some facilities have tried using standard operating baby monitors during simulation so that the mannequin operator could hear what was happening and respond appropriately. The simulation education team however, decided to use a color video and audio baby monitor instead which makes it possible to see as well as hear what is happening in real-time during the simulation.

Since both the mannequin and the baby monitor were wireless, the operator was able to control the simulation and respond to the learner’s actions from two rooms away. Being able to remotely run in-situ scenarios without an immediate physical presence at the bedside opens up many options and increases the realism of training without incurring a big price tag.

Additional benefits to using this particular baby monitor is the ability to see in the dark since using infrared light allows for continuous monitoring during power outages and has the ability to record and capture images and sounds from the monitor onto an attached computer.

Also, VHA is addressing the simulation needs of women veterans by training thousands of VHA providers in women’s health care partly by using state-of-the-art simulation equipment. The simulator is a tactually accurate breast model placed on a pressure-sensitive tablet. The simulator gives trainees feedback on proper palpation methods and how to examine the breast in a thorough systematic manner. Women’s Health in partnership with SimLEARN has purchased MammaCare® Clinical Breast Exam Simulators for all of the VHA’s 21 VISNs.

Exchange to be Ready 2013

The State of Maryland has just received a $123 million Level Two Establishment Federal grant to support the state’s Health Benefit Exchange to be called the “Maryland Health Connection” and scheduled to be operational by October 2013. The grant funding will be used by the state to support the continued development of policies, administration, and operations, as well as consumer outreach, assistance, and education.

A substantial portion of the grant funding will support the IT system being developed in collaboration with the Maryland Health Benefit Exchange, Department of Health and Mental Hygiene (Medicaid), and the Department of Human Resources. This collaboration will help to ensure that all federal and state functions are operational as well as have the capability to transfer information between individuals, employers, and plan issuers as well as state and federal agencies.

Maryland Health Connection enrollment will begin with coverage January 2014 and will cover as many as 150,000 individuals expected to enroll in qualified health plans during the first year. This is expected to increase to 275,000 by 2020 with Medicaid enrollment is expected to increase by 101,000 in the first year, growing to 187,275 by 2020 according to figures by the Hilltop Institute.

The Level Two Establishment Grant is the fourth federal grant Maryland has received to support the implementation of the state-based exchange making a total of $157 million. Prior to this award, the state received $34.4 million in grants for research, planning IT development, and implementation.

The grant funding included a Planning Grant for $1 million for initial research and planning, a $6.2 million Early Innovator Grant to design and implement an IT model for the State, and a $27.7 million Level One Establishment Grant for policy development, technology, and to develop the operational infrastructure and IT platform.

A critical element in making the Exchange operational is to procure the appropriate personnel to develop the detailed planning documents, project plans, as well as be able to track the completion of key operational, IT, finance, marketing, and communication activities. To meet these needs, a Request for Proposal was issued on August 23, 2012 seeking a Project Manager/Scheduler. The RFP is due September 13, 2012.

For more information and to view the RFP on this firm fixed price contract go to

In other state news, the State Mental Hygiene Administration (MHA) and their Administrative Services Organization, ValueOptions® just launched a new web-based reporting system “Outcomes Measurement System (OMS) at  to do a better job in understanding the outcomes for individuals receiving mental health outpatient services. The new tool enables MHA, ValueOptions, and behavioral healthcare providers to track the progress of consumers and identify specific areas that need provider or system of care improvements.

UM Technology to Help Patients

The University of Michigan Health System portal along with the corresponding MyChart app at available for iPhones and androids, offers patients electronic access to portions of their own health records. Dubbed the online banking of healthcare, the new system is expected to enhance communication between patients and providers.

Many patients will benefit from the new self-service records system. People with asthma and other conditions requiring frequent prescription renewals can fill out online requests instantly and parents can print out their child’s vaccination records the night before the first day of school.

It makes it possible for patients who are anxiously awaiting results of tests such as patients undergoing chemotherapy or fertility treatment, they no longer have to wait for office hours to find out results.

Also, for families whose children have special needs and conditions requiring multiple doctor appointments—quick access to medical information is crucial. Parents can gain proxy access to their child’s information, however, there still are some restrictions based on Michigan laws and the child’s age.

To sum up, the app enables patients and caregivers to review and print out medications, dates for immunizations, and other medical history at any time of day from any location. It is also possible to receive test results and doctor opinions online, review discharge instructions provided by providers, provided with secure messaging, request prescription renewals, and pay bills online.

The University is also creating a future for personalized medicine and has formed a nonprofit joint venture to advance DNA diagnostics. This key step will enable patients to receive treatments based on their own DNA profiles.

The joint venture was launched through the university’s Michigan Health Corporation that helped to form the outside partnership and the International Genomics Consortium (IGC) referred to as Paradigm. Beginning with cancer and then extending to other disease groups, Paradigm will offer doctors and healthcare organizations anywhere/anytime access to whole gene and multi-gene sequencing and molecular diagnostics.

“Paradigm builds on our ever increasing understanding of the interplay of multiple disease causing genes and how this affects sensitivity to specific treatment regimens”, says Robert Penny, M.D. PhD, and the CEO and Co-Founder of Paradigm and IGC.

ECMO Machine Saving Lives

The “Extracorporeal Membrane Oxygenation (ECMO), a life-saving device is very similar to a heart-lung bypass machine used for open-heart surgery. It mimics the natural function of the heart and lungs, allowing an infant or child to rest while natural healing of the affected organ takes place. It is commonly used for newborns and children suffering from respiratory and/or cardiac failure as a result of birth defects, trauma, or severe infection.

In December 2011, the ECMO program transferred to the San Antonio Military Medical Center (SAMMC) due to the implementation of the 2005 Base Realignment and Closure rules. “SAMMC is the only DOD facility that provides this type of medical procedure for infants plus the 59th Medical Wing provides world-wide air support to transport patients from and to the medical center.

To see the results in action, one patient so far has been treated at SAMMC with the ECMO machine. Brianna was born on January 13th in a Honduras hospital. Her mother is Honduran and her father is active duty stationed in Ft. Lewis Washington. She was born with undiagnosed ruptured abdominal wall defect.

She had some surgical repairs in Honduras but remained very ill and had developed a bloodstream infection. She was scheduled to be transferred from Honduras to Seattle Children’s Hospital, but en route to Seattle, she developed a collapsed lung and blood collected between the chest wall and the lungs. Immediately, the flight was diverted to SAMMC.

As Air Force (Dr.) Lt. Col. Michael Shoemaker, SAMMC neonatologist and ECMO Director explained “Without the use of the ECMO machine, Brianna had no chance of survival. So in February, she was placed on the ECMO machine and removed from the machine one week later, and by March 21st, her health had improved. At that time, she was transferred to Madigan Army Medical Center and with surgery performed on her bowel, she is doing very well.”

Sunday, August 26, 2012

MU: Transforming Patient Engagement

The final long awaited requirements for the Stage 2 EHR Incentive program have just been released by the Office of the National Coordinator for Health IT and CMS. The announcement specifies what requirements hospitals and healthcare providers must meet in order to qualify for incentives and the criteria that EHRs must meet to achieve certification.

The new rules specific to patient engagement include:

  • The objective “provide patients with an electronic copy of their information” is being replaced with an “electronic/online access” core objective
  • A new core objective for eligible providers is to “use secure messaging to communicate with patients on relevant health information”
  • CMS proposed two new core objectives related to patient engagement with measures that require patients to take specific actions in order for a provider to achieve meaningful use and receive an EHR incentive payment. For both, the threshold was lowered from the proposed 10 percent of patients to 5 percent in the final rule. CMS also recognizes broadband availability limitations in some provider practice areas and introduced an exclusion
  • Patient and family engagement is one of the six key healthcare policy domains of which all providers must select at least three for Clinical Quality Measures (CQM) and reporting. These are the CQMs that reflect the potential to improve patient-centered care and the quality of care delivered to patients. They emphasize the importance of collecting patient-reported data and the ability to impact care at the individual level as well as the population level through greater involvement of patients and families in decision making, self care, activation, and understanding of their health condition and effective management \
  • More than 50 percent of all unique patients seen by the eligible provider are provided timely (within 4 business days) online access to their health information. More than 50 percent of all patients who are discharged from the inpatient or emergency department of an eligible hospital or Critical Access Hospital have their information available online within 36 hours of discharge
As hospitals and other providers prepare to comply, they must first acknowledge that this isn’t just an issue for their IT departments to address. Instead, attaining meaningful use of an individual’s EHR system for patient engagement will require the collective involvement and collaboration of disciplines from across the organization to include clinical, operations, information services, and communications/marketing.

“Healthcare leaders will need to be strategic and put every decision in the context of the patient experience. Having an effective patient strategy will lead to happy customers, staff, and a healthcare organization exceeding their business objectives”, said Dr. Sue Sutton, CEO at Tower ( a patient experience consulting group based in Los Angeles, California.

“The approach required is one of re-defining patient engagement across all touch points, both physical and virtual, to positively transform the patient’s experience as perceived by the patient. The research tells us where the patients are going, but institutions aren’t paying attention. If the approach taken doesn’t actually engage patients, the organization won’t meet the meaningful use criteria and they may actually lose some patients to healthcare providers who have implemented more patient-centered engagement strategies”, added Dr. Sutton.

Enterprise portals can facilitate electronic access by making information within existing systems available in a more patient-friendly manner. The portal helps accomplish the goal of compliance with the meaningful use criteria, but it does so at the same time it can accommodate additional features and personalization for enhanced engagement and a better patient experience. Ultimately, this is what will lead to improved outcomes—the ultimate goal of meaningful use.

Go to the CMS EHR Incentive Programs website at for more information on the Stage 2 rule.

For more information, email Christina Thielst at or call (805) 845-2450.

NTIA & FCC Broadband News

Last February, the “Middle Class Tax Relief and Job Creation Act of 2012” was signed to create a single nationwide interoperable public safety broadband network to enable police, fire fighters, emergency medical service professionals, and other public safety officials communicate across agencies and jurisdictions.

The Act requires NTIA to establish a grant program. NTIA on August 21st published a notice in the Federal Register to announce requirements for the “State and Local Implementation Grant Program” with up to $135 million in funding.

The grants would assist state, regional, tribal, and local jurisdictions to find the most efficient and effective means to use and integrate the infrastructure, equipment plus the other architecture associated with establishing the Public Safety Broadband Network (PSBN).

The Act also establishes the First Responder Network Authority referred to as First Net as an independent authority within NTIA to design, construct, and operate the PSBN based on national network architecture. Recently, Acting Secretary Rebecca Blank appointed 12 individuals to the Board of Directors to First Net.

In other actions, NTIA has updated the National Broadband Map an interactive map showing the high speed internet service that is available in the U.S. The map includes data from 1,865 broadband providers nationwide with more than 20 million records.

Since its launch last year the National Broadband Map has attracted more than 650,000 users. By using the map, a Utah mid-sized company in the healthcare field that was losing time and money due to frequent broadband outages at a rural office needed to find another broadband provider. The company was able to use the Map to identify other broadband providers in their rural county and avoid many outages.

In another move, FCC has just published their “Eighth Broadband Progress Report” available at According to the report, there has been major progress made to accelerate deployment of broadband in the U.S.

However, even with the progress made, the report finds that approximately 19 million Americans still lack access to “fixed broadband service” at threshold speeds. Fixed wireless broadband is a type of high speed internet access where connections to service providers use radio signal rather than cable.

In rural areas, nearly one-fourth of the population of 14.5 million people lack access to broadband and in tribal areas, nearly one-third of the population still lack access. Even in areas where broadband is available, 100 million Americans still do not subscribe. The report concludes that until the Commission’s “Connect America” reforms are fully implemented, these gaps are unlikely to close.

The report includes online interactive maps which show exactly where broadband is available by technology type for every county in the nation. The map showing the availability of fixed broadband can be viewed at 

However, there is some disagreement on the FCC’s viewpoint as stated in their recent report on U.S. Broadband progress. According to a press release sent out by Richard Bennett, Senior Research Fellow at the Information Technology and Innovation Foundation (ITIF), he strongly feels that America’s broadband infrastructure is moving in the right direction and is accomplishing this feat at a reasonable and even commendable rate.

He further notes that the average broadband connection speed in the U.S. has risen from 22nd to 15th in the last two years. He further states “We are never going to bring wired broadband connections to the far reaches of rural America without massive subsidies, so the goal should be to deploy appropriate technologies at a reasonable subsidy level.

For more information, email Alexis Fearon at

Contract to Develop Smart Suit

The Wyss Institute for Biologically Inspired Engineering at Harvard received $2.6 million in DARPA funding to advance the development of a smart suit to help improve physical endurance for soldiers in the field. The novel wearable system would potentially delay the onset of fatigue, enabling soldiers to walk longer distances, and potentially help the body avoid injuries when carrying heavy loads.

The proposed suit will be made from soft wearable assistive devices that integrate several novel Wyss technologies. One technology is a stretchable sensor that would monitor the body’s biomechanics without the need for the typical rigid components that often interfere with motion.

This system could also potentially detect the onset of fatigue. Additionally, one of the technologies in the suit may help the wearer maintain balance by providing low level mechanical vibrations that boost the body’s sensory functions.

The new suit will be designed to overcome several of the problems typically associated with current wearable systems, including their large power requirements and rigid overall structures, which restrict normal movement and can be uncomfortable.

While the DARPA project is focused on assisting and protecting soldiers in the field, the technologies under development can have many other applications. For instance, similar soft wearable devices could possible increase endurance in the elderly and help improve mobility for people with physical disabilities.

Also working on the project will be several members of the Wyss Advanced Technology Team who will provide expertise in product development to ensure the rapid completion of prototypes. They will oversee the testing of prototypes in the Wyss Institute’s biomechanics lab, using motion capture capabilities to measure the impact of the suit on specific muscles and joints.  

New Imaging Under Development

The U.S. Army Medical Research and Materiel Command’s Telemedicine and Advanced Technology Research Center (TATRC) manages a project to detect a new dimension in imaging. The new technology is able to detect minute levels of vascular damage in the form of bleeding, clots, and reduced levels of oxygenation to give military and medical experts better information on brain injuries especially related to trauma.

Dr. E. Mark Haacke of Wayne State University is managing the research project primarily focusing on imaging veins as veins have relatively more fragile vessel walls than arteries and are more susceptible to damage during head injuries.

The researchers are exploring advanced magnetic resonance imaging methods and “Susceptibility Weighted Imaging and Mapping” referred to as SWIM to improve the diagnosis and outcome prediction of mild traumatic brain injury. Dr. Haacke and Dr Zhifeng Kou are now working to complete a larger database of normal and mildly brain-injured imaging scans so that SWIM can be run at most clinical sites.

This project has demonstrated that there is a lower impact load, either inertia or direct impact forces which may damage only veins, and researchers have determined medullary vein damage that was not visualized with other techniques. The medullary veins drain the frontal white matter of the brain, so reduced blood flow could possibly impair the higher level frontal neurocognitive functions.

According to Anthony Pacifico, Manager of TATRC’s Medical Imaging Technologies Portfolio, ‘Dr. Haacke’s team has a different slant for studying these injury regions that may lead to a new avenue in diagnosis and treatment for traumatic or other types of brain injuries.” As Dr. Haacke reports the study of dementia could well benefit from the research since as much as one-third of all dementia is vascular dementia.”

Boosting Vaccination Rates

In 1992, the El Rio Center in Tucson Arizona in an effort to boost vaccination rates implemented a program to develop a comprehensive vaccine program especially geared to increasing pediatric immunizations among minorities and people living at the poverty level. A number of barriers exist due to transportation problems, scheduling conflicts, and/or financial constraints. In addition, many parents only have their child vaccinated when they take their child to a well- child visit.

Although great progress has been made over the past 20 years, overall immunization rates remain below established goals, and disparities still exist. For example, 86 percent of white children have received the diphtheria, tetanus, poliomyelitis, and pertussis vaccines as compared to 79 percent of black children and 80 percent of those children live below the poverty level.

The El Rio Health Center a Federally Qualified Health Center felt action was needed to increase the rate of vaccinations in their county. El Rio located in Tucson is the largest provider of healthcare for uninsured individuals and Medicaid enrollees in Pima County Arizona. The center serves 70,000 people and is the largest pediatric practice in Tucson. The program staff includes one full time medical assistant and El Rio employs 20 pediatricians and nurses across 6 locations.

Recognizing the organization’s low immunization rates, Andrew Arthur M.D, the Center’s Associate Medical Director approached administrators with a proposal to examine the barriers to achieving higher immunization rates.

To help the project get started, CDC and the American Academy of Pediatricians formed a community coalition to train physicians and community members on the benefits of increasing immunizations rates. At the same time multimedia educations materials for the general public were also developed.

The El Rio Health Center studied the issue and worked to address the problem. Since the initial problem was recognized, the Center has developed a comprehensive program to increase pediatric immunization rates. This is being accomplished by providing more training for pediatricians and nurses, developing an efficient computerized data system to track immunizations, providing electronic reminders for both parents and providers as needed for immunizations, and opening nurse-run immunization clinics in the center and community.

Technology has helped greatly to increase immunization rates. The data tracking system tracks each patient and includes information on the types of vaccines received and the specific dosages given. The registry assists with providing patient and provider reminders.

Record keeping for patient immunizations is now kept in the immunization module within the commercial EMR system used at the Center. The nursing staff routinely consults a patient’s immunization module when a child comes for a well-child visit and for the majority of other pediatric clinic appointment types.

However, there have been issues. In 2009 and 2010, El Rio implemented their EHR system but some problems occurred with immunization record-keeping as errors occurred when information was abstracted from the paper charts and inserted electronically into the EHR. To fix the problem, a program was put in place to correct the EHR immunization data.

Today, the program has more than tripled the Center’s immunization rates. During the first 3 to 5 years of the program, immunization rates for two year old children increased from 30 to go to 94 percent. By 2006, rates reached 97 percent. The program has maintained the high rates each year providing that adequate supplies of vaccines are available. As of 2012, all El Rio pediatric clinics have achieved immunization rate of 90 percent for the combo of the three vaccines for two year old patients who remain in the clinic’s care.

Source: AHRQ Health Care Innovations Exchange at    

500 Primary Care Practices Selected

The CMS Innovation Center has selected 500 primary care practices in seven regions representing over two thousand primary care doctors in seven markets across the country to participate in their Comprehensive Primary Care Initiative.

Under the Initiative, CMS will pay primary care practices a care management fee to support enhanced coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are offering enhanced payment to primary care practices designed to provide quality primary care to their members.

The Initiative started in the fall of 2011 with CMS soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care.

At this point, public and private health plans in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Cincinnati-Dayton region, and the Greater Tulsa region of Oklahoma signed letters of intent with CMS to participate. The markets were selected in April 2012 based on the percentage of the total population covered by payers who expressed interest in joining this partnership.

The next step was for eligible practices in each market to apply to participate and now they will start to deliver healthcare services in the fall of 2012. CMS estimates that over 300,000 Medicare beneficiaries will be served by providers through this initiative.

Thursday, August 23, 2012

News Flash from OSEHRA

Open Source Electronic Health Record Agent (OSEHRA) serving as the central governing body of an Open Source EHR community just announced that Alumni, Matt McCall will be honored at the White House as a Presidential Innovation Fellow on August 23, 2012. McCall is lending his talents to the White House supported “Blue Button for America” project.

Todd Park, U.S. Chief Technology Officer, Jeff Zients, Acting Director for OMB, John Berry, Director of the Office of Personnel Management, and Steve VanRoekel, U.S. Chief Information Officer will be leading the event at the White House. The event begins at 10AM and will be streamed live on 

The Presidential Innovation Fellows program was established to bring in top innovators from outside of government to work with top innovators inside of government to create real and substantial changes that will in a very short time frame will be able to benefit the American people.

The “Blue Button for America” project will enable millions of Americans to easily and securely download their own health information electronically with information on medications, claims and treatment data, and lab reports so they can take their complete record with them should they change insurers or providers and share the information with their families or doctors if they choose.

The Department of Veterans Affairs worked with HHS, DOD and others on the project. Today, Blue Button is available to veterans, uniformed service members, and Medicare beneficiaries with almost a million people having downloaded their own health information.

To learn more about Open Source Health IT and to meet some of the key people involved in these initiatives, OSEHRA is holding their first “Annual OSEHRA Open Source EHR Summit & Workshop” at the Gaylord Convention Center, National Harbor Maryland on October 17-18, 2012. For more information, go to

Wednesday, August 22, 2012

Research to Help Humans in Space

Health problems associated with space travel may be related to the effects of microgravity, radiation, or to toxic environmental exposure or trauma. Complex interactions between these factors, as well as potential differences in the way disorders present and respond in microgravity relative to Earth, pose formidable challenges.

Since unique medical circumstances can occur in space and with limited healthcare resources novel strategies are required for in-flight physiological monitoring and medical assessment, diagnosis, and treatment.

NSBRI funded by NASA a consortium of institutions studying the health risks related to long duration spaceflights is developing medical technologies needed for long missions. On July 30, 2012, NSBRI and NASA’s Human Research Program began soliciting proposals for six of their seven research teams. One of the NSBRI team’s topics ready for research involves “Smart Medical Systems and Technology”.

The “Smart Medical Systems and Technology (SMST) Team is leading the research and development for advanced, integrated and autonomous systems needed for astronaut health assessment, and maintenance of health. These systems must be small, use low-power, noninvasive, versatile, and highly automated.

Possible technologies needed include ultrasound diagnostics and therapeutics, lab-on-a-chip systems, patient and health physiologic monitors, and automated systems and devices to aid in decision-making, training, and diagnosis. For more information, go to

Another NSBRI research topic “Neurobehavioral and Psychosocial Factors” deals with methods needed for crews to use to deal with stress, isolation, confinement, and the challenges of long-duration space missions.

Team objectives include developing methods to monitor cognitive function, behavior, and countermeasures to enhance performance, motivation and quality of life. Also, leadership style, crew composition and cohesion, organization, and adequate communication are being investigated to optimize crew effectiveness and mission success. For more information, go to

Other NSBRI team research areas include cardiovascular alterations, human factors and performance, musculoskeletal alterations, and sensorimotor adaption.

Depending on available funding, up to seven research investigations will be selected by NASA. It is anticipated that NASA awards will average $350,000 per year but not exceed $400,000 per year. There are two steps to the proposals. Step 1 is due September 4, 2012, and if asked to submit Step 2, proposals are due December 3, 2012.

All categories of U.S. institutions are eligible to submit proposals in response to this NASA Research Announcement. Principal Investigators may collaborate with universities, Federal government laboratories, the private sector, and state and local government laboratories.

Go to to view the NASA Research Announcement NNJ12ZSA002N entitled “Research and Technology Development to Support Crew Health and Performance in Space Exploration Missions”.  Or go to NASA Research Opportunities homepage at and then link to Solicitations.

HRSA Issues Rural Health FOA

HRSA’s Office of Rural Health Policy on August 16, 2012 issued their “Rural Health Network Development Planning Program” (HRSA-13-912) Funding Opportunity Announcement (FOA). This Network Planning Program promotes the development of integrated healthcare networks.

The program brings together key parts of a rural healthcare delivery system particularly those entities that may not have collaborated in the past and were not able to work together. There is a need for these entities to work together to establish or improve local capacity and coordination of care.

For the purposes of this grant program, a rural health network is defined as an organizational arrangement among at least three separately owned healthcare providers that come together to develop strategies for improving health services delivery systems in a community.

The grant program supports one year of planning to develop and assist healthcare networks to become operational. These networks can include a wide range of community partners including social service agencies, faith-based organizations, mental health agencies, charitable organizations, educational institutions, employers, local government agencies or other entities with an interest in a community’s healthcare system.

The lead applicant organization must be a rural, non-profit, or public entity representing a consortium/network of three or more healthcare providers.

This grant program will be funded during FY 2013. Approximately $1,275,000 is expected to be available annually to fund fifteen grantees. Applicants can apply for up to $85,000 per year.

To view the Funding Opportunity Announcement, go to For more information, email Sheila Warren at

Penn State Medical News

Physicians at Penn State Hershey Stroke Center can now communicate with stroke patients at St. Joseph Medical Center in Reading using LionNet, a system utilizing on-demand patient data and live two-way audio and video. LioNet is the first telemedicine system for stroke patients to be implemented in south-central Pennsylvania.

Plans are for the LionNet team to collaborate with partner hospitals to educate surrounding communities on the symptoms of stroke and the importance of getting to the hospital in a timely manner. The network of LionNet partners is due to grow and put in place at other community hospitals.

In other news, all thirteen of the Penn State Hershey Medical Group’s adult primary care sites have been awarded Patient-Centered Medical Home (PCMH) certifications from the National Committee for Quality Assurance recognizing their transition toward the new care model. 

One important development is that the Penn State College of Medicine will lead the state-level infrastructure for the new national Primary Care Extension Service. AHRQ has chosen only four states to lay the groundwork for the extension service to spread the Medical Home model nationwide. This infrastructure will follow a model similar to the cooperative extension network developed in the early 20th century to educate farmers about the latest farming methods.

“Pennsylvania Spreading Primary Care Enhanced Delivery Infrastructure” referred to as PA SPREAD will work to disseminate Pennsylvania’s model plus the lessons learned from the other three states that includes New Jersey, New York, and Vermont.

Environmental Scans are being conducted in the four states to identify key messengers to being together the necessary state-level multi-sector representatives to implement large scale primary care transformation. Physicians in Pennsylvania are participating in a statewide survey that is aimed towards identifying what services a primary care physician needs during a practice transformation.

A successful PCMH program to help diabetics was implemented in 25 practices in southeast Pennsylvania as part of the statewide initiative and has expanded to more than 150 practices.

Penn State Hershey received a grant from the Pennsylvania Academy of Family Physicians to evaluate and identify best practices to help residency programs train the next generation of primary care physicians on the PCMH concept. In addition, funding provided under ARRA has helped to incorporate the PCMH concept into the curriculum for medical students and enable the physicians see first-hand how to apply PCMH in a clinical setting.

Tennessee Issues RFI

As part of the ARRA award to the State of Tennessee’s Office of eHealth Initiatives, one of the objectives of the State Health Information Exchange strategy is to create the necessary infrastructure to help in the adoption of Direct technology across the entire spectrum of healthcare professionals. The plan is to provide Direct Health Internet Services and Direct Health Identity Services.

The State of Tennessee is exploring a market-based Direct approach where the State would define the Health Information Service Providers (HISP) certification criteria and where the State would work with a nonprofit third party entity to help providers adopt Direct technology.

The State envisions that HISPs may be responsible for registration authority, certificate authority, help desk, password recovery, provisioning and de-provisioning of users, trouble shooting of help tickets, and for signing participation agreements for services between customer and service providers.

The State in seeking guidance from the vendor community on August 13, 2012 released a Request for Information (RFI) to find the best way to establish a minimum set of requirements for HISP certification.

Vendor responses will be reviewed for planning purposes. The State is particularly interested in analyzing various HISP services, and software, and infrastructure options. The State wants to understand the marketplace in terms of industry capabilities, innovative delivery approaches, and performance strategies and measures.

Go to to view RFI (31865-00510) due September 7, 2012. For questions, email Eric Harkness at  

NIH/CDC Issue SBIR Solicitation

On August 15th, NIH and CDC released the 2013 Omnibus NIH/CDC SBIR Solicitation (NOT-OD-12-137) due on November 13, 2012. The SBIR program is a set-aside program for small business concerns to engage in federal R&D with potential for commercialization.

The SBIR legislation requires the Public Health Service, HHS, and certain other Federal agencies to reserve 2.6 percent of their FY 2012 extramural research or R&D budgets for an SBIR program.

SBIR Phase I determines the scientific and technical feasibility and the potential for commercialization of the proposed research but not to exceed $150,000 for direct costs. Phase II is to continue the research or R&D efforts initiated in Phase I but not to exceed $1,000,000 for direct costs. Phase III helps small businesses pursue with non-SBIR funds, ways to commercialize the research funded in Phase and Phase II.

A few of the research topics contained in the solicitation are:

·        (NIH) National Cancer Institute—Real-time integration of sensor and self-report data for clinical and research applications

·        (NIH) National Institute on Drug Abuse—A mobile application to help patients take their medications as prescribed to improve medication adherence

·        (CDC) Center for Global Health—Rapid screening tests to prevent congenital infections and ensure blood safety

·        (CDC) National Center on Birth Defects and Developmental Disabilities—Smartphone application for global birth defects surveillance

·        (CDC) National Center for Chronic Disease Prevention and Health Promotion—A  mobile phone application for advancing teen pregnancy prevention

ONR to Enhance DOD System

A web-based application developed by the Office of Naval Research (ONR) is going to form the basis for the DOD-wide system to track and manage human subject studies funded by the Federal government. ONR provides the science and technology necessary to maintain the Navy and Marine Corps and works with states, countries, universities, and industry partners

The Navy conducts research studies with human subjects to support warfighter training and operational capability as well as naval medical department’s competency. DOD employs a number of database tools to track their research programs, such as the “electronic Institutional Review Board” (eIRB) management system, which is a preferred application within the military health system to document protocols.

However, a December 2011 report by the Presidential Commission for the Study of Bioethical Issues, found that the government lacks a centralized database to track experiments.  In early July, the Navy Deputy Surgeon General, Rear Adm. Michael Mittelman and the Deputy Assistant Secretary for Defense Force Health Protection and Readiness, Dr. George Peach Taylor Jr. signed a Memorandum of Record.

The Memorandum designates the “Protections in Research, Oversight Management Information System” (PROMIS) as the baseline for the future DOD system.  Plans are to move selected eIRB functions into one consolidated system.

ONR is developing enhancements to PROMIS so it can function as a unified platform to serve the needs across DOD’s user community.  Users will be able to track and manage their studies using the Microsoft SharePoint-based system.

The Navy’s Research Protections Division is responsible for overseeing investigations involving human subjects conducted by Navy and Marine Corps operational forces and non-operational commands. The division also monitors Navy –sponsored experiments by non-governmental institutions, such as universities and contractors.

“PROMIS gives a near real-time in-depth view of protocols,” said Dr. Andy Jones, Deputy Director of the Research Protections Division, “As the basis of the DOD-wide system, PROMIS will enable a wide cross section of users from principle investigators to departmental leaders to monitor and manage projects to ensure that the research complies with regulations.”

According to Dr. Timothy Singer, Director of the Research Protections Division, “PROMIS offers a way for DOD to gain greater insight into protocol submissions, offer better tools to manage active projects, and report on current and historical research.”

PROMIS is currently employed by 16 DOD commands including fifteen Navy commands and one Army command to oversee or conduct research with human subjects. The Research Protections Division is training personnel in its use at additional commands.

Sunday, August 19, 2012

ARC Issues RFP

The Appalachian Regional Commission’s recently released RFP “Program Evaluation of the Appalachian Regional Commission’s Health Projects” seeks proposals from researchers and consultants. The program evaluation will examine roughly 230 projects located throughout all 13 Appalachian states funded from FY 2004 to FY 2010 for $30 million.

The program evaluation will include a range of health-related projects in areas including primary care, dental care, workforce, health planning, research, community facilities, health education, telemedicine, and mental health.

ARC is increasingly funding health-related projects in Appalachia but has not commissioned an evaluation of health projects in recent years. The primary goal is to evaluate the performance of ARC health investments from FY 2004 through FY 2010, using contractor-gathered data on project-specific performance measures.

This evaluation will help to enhance and standardize performance measures for ARC health projects and also help ARC more effectively develop, assess, manage health projects and investments, which will help the agency to document and report on the impact of programs.

ARC’s healthcare projects generally fall into three categories:

·        Clinical Services—Activities that support clinical services for underserved populations, populations located in HPSAs or populations experiencing documented health disparities. Usually these are short term programs to support start-up operations, provide gap funding, or address clinical emergencies. Care provided can include primary care and specialty care. Patient services are usually provided in primary care facilities through telemedicine or in specialty clinics

·        Healthcare Access—Activities that improve access to healthcare for underserved populations, especially populations located in HPSAs or experiencing health disparities. Specific activities to be evaluated can include equipment purchases, facilities upgrades or construction, developing telemedicine facilities or providing equipment, and how effectively workforce development efforts have been undertaken

·        Health Promotion and Disease Preventions—Interventions are commonly community-based efforts to change unhealthy behaviors, to promote new policies or services, or to address specific disease conditions of local concern

The RFP’s Scope of Work includes developing and implementing data collection methods to obtain updated, accurate project performance data for ARC health projects. Also, the contractor must have the ability to prepare a database with project information along with key performance data to be uploaded to a web site for viewing by the public.

Go to 2012.pdf to view the RFP. Proposals are due September 6, 2012. For additional information on ARC’s health projects, go to For questions, email Kostas Skordas at

Protecting Patients Data

Safeguarding patient-generated health information was discussed at the Alliance for Health Reform August 13th lunch briefing on Capitol Hill. Joy Pritts, JD, Chief Privacy Officer for ONC pointed out that patients need to understand their rights along with privacy and security issues related to their personal health information especially when using today’s mobile technologies.

Deven McGraw, Director of the Health Privacy Project for the Center for Democracy & Technology, reported that one of the major problems in receiving patient-generated data is that HIPAA doesn’t apply to all data collection and exchange. HIPAA applies to the collection, use, and disclosure of data by providers but doesn’t apply when the patient collects, uses, and discloses data.

Pritts mentioned recent studies that have been undertaken related to communicating and protecting patient information. A whitepaper released in April published by RTI for ONC on patient-generated data, discusses technical operations, legal issues, plus cultural, and educational issues. Also, a study conducted by NORC at Geisinger is examining patient access to EMRs and is looking at what types of errors and omissions are found in electronic medical records. This study is due to be released in the first quarter of 2013. 

Steve Downs, Chief Technology and Information Officer and Co-Developer of Project HealthDesign part of the Robert Wood Johnson Foundation’s Pioneer Portfolio, discussed how collecting data from mobile devices requires a new vision for patient-generated health data.

Downs explained that Project HealthDesign helps clinicians understand patients’ everyday lives. This is accomplished by receiving information from their patients on their Observations of Daily Life or (ODL) which is very often sent on mobile devices. This can include information received from patients on their moods, sleep, diet, exercise, medication adherence etc. to help providers give feedback to patients. The question is how safe and secure is the data sent from the patient to the provider?

Patricia Flatley Brennan, R.N., PhD and Project HealthDesign National Program Director at the University of Wisconsin-Madison speaking at the HIT Policy Committee Hearing pointed out as available technologies change and evolve over time, many different combinations of technologies will provide for workable solutions. In any event, it is necessary to provide for a safe and stable storage place for patient-generated data. Once a safe storage solution is in place, many apps could run off of the same data.

For more information on the Capitol Hill event, go to

FCC Issues Progress Report

A FCC report released on August 13th provides details on the benefits as well as the lessons learned from the Commission’s Rural Health Care Pilot Program. So far, the program supports 50 active projects in 38 states and the territories of Guam, American Samoa, and the Northern Mariana Islands. The five largest statewide networks are located in California, Colorado, Oregon, South Carolina, and West Virginia and on target to connect over 800 healthcare providers. 

Key facts about the Pilot Program:

  • As of January 2012, 2,107 healthcare providers were to receive $217 million in universal service support
  • Projects range in size from fewer than ten to over 150 healthcare provider sites
  • Forty-four of the 50 projects receiving support include urban healthcare providers
  • Leaders of pilot projects often come from large medical institutions and universities which frequently are located in urban areas
  • Pilot project participants purchase higher bandwidth connections than do participants in the FCC’s existing program
A wide range of pilot projects involving telehealth and telemedicine applications have been deployed over broadband networks. Using these networks, healthcare providers are able to exchange EHRs and send X-rays, MRIs, and CT scans along with other medical images over the networks.

However, since many of the pilot projects are not yet fully implemented, and because not all pilot projects describe their telemedicine and telehealth activities in their quarterly reports, the figures in the report show a small percentage of projects that have implemented utilizing specific telehealth applications to date. When all the pilot projects are fully implemented, there is likely to be an even wider adoption of telehealth and telemedicine applications over the networks.

The most commonly reported telemedicine applications include telepsychiatry, telepsychology, teleradiology, tele-echocardiology and telestroke but the most commonly reported telehealth applications include medical training, using EHRs, and telepharmacy.

Some specific examples of telehealth and telemedicine applications include:

  • Palmetto State Providers Network (PSPN) has performed 6,600 telepsychiatry consults over the network and conducts 100 tele-OB/GYN maternal and fetal care visits per week
  • Geisinger Health System uses its network for numerous telemedicine applications such as teletrauma, telestroke, tele-echocardiology, tele-electroencephalograms, tele-ICU, telepsychology, teleradiology, telematernal fetal monitoring, and telepathology
  • Heartland Unified Broadband Network (HUBNet) installed the HUBNet connection so that Horizon Health Care is able to serve a consortium of rural clinics in South Dakota
 Go to to view the report “Wireline Competition Bureau Evaluation of Rural Health Care Pilot Program”—Staff report.

Nicholas Valeriani Named to West Health

Gary and Mary West have announced that Nicholas J. Valeriani, with Johnson & Johnson for 34 years has been appointed Chief Executive of the collective West Health effort and CEO of the West Health Institute formerly called the West Wireless Health Institute. West Health brings together the Institute, West Health Policy Center, West Health Investment Fund, and West Health Incubator.

Valeriani as Chair the Executive Committee of the West Health Initiative will direct West Health’s efforts to lower healthcare costs through innovative, cost-effective technologies, and address medical research, policy issues, investments, and entrepreneurship.

The newly launched West Health Incubator located in La Jolla provides infrastructure, strategic guidance, and access to an extensive network of key partners, to permit the transfer to industry of research technologies developed at the Institute and elsewhere. Prior to acceptance or admission, companies in the Incubator must receive an investment commitment from the West Health Investment Fund.

“Early stage healthcare companies face multiple challenges in their efforts to develop and deploy innovative technologies,” said Gary West. “We are offering both significant intellectual and economic capital through our investment fund. At the same time, we are de-risking technologies and creating a lunch pad for disruptive cost-lowering technologies so they can reach the public.”

For more information, go to

Marshfield Clinic Receives Grant

 Marshfield Clinic received a $39,675 grant to increase patient access to healthcare through telecommunications and videoconferencing. The grant was awarded by the Public Service Commission (PSC) of Wisconsin to fund new interactive videoconferencing technology to connect patients in rural areas to healthcare providers at Marshfield.

This funding will enable the Clinic to expand its telehealth capabilities within areas such as telepharmacy and telestroke according to Nina M. Antoniotti, Director of Telehealth at Marshfield Clinic.

The telepharmacy services allow pharmacists at Clinic locations to remotely oversee the mixing of drugs which includes chemotherapy drugs at other locations. The Clinic has eleven telepharmacy sites throughout the system. As for treating strokes, telehealth enables a neurologist to videoconference into a hospital to make urgent treatment decisions without delay.

The PSC grant is also going to support the Clinic’s initiative to incorporate mobile services into telehealth to allow physicians to video conference using mobile devices such as smart phones and tablets.

This grant is one of 23 grants awarded to healthcare providers in Wisconsin, and funded by the state’s universal service fund. The grants target projects that demonstrate the use of advance telecommunications services to extend medical care in rural areas and among underserved populations.

Allscripts Integrating Telehealth into EHR

Allscripts is integrating American Well Corporation’s Online Care telehealth platform into their EHR so that providers will be able to offer high quality online voice and video interactions. The University of South Florida Health, a partnership of USF’s colleges of medicine, nursing, public health, and pharmacy as well as the USF Physician Group is planning to use this new offering with “The Village”, the country’s largest over 55 residential community located near Tampa.

“Allscripts telehealth solutions will help provide convenient, safer and secure access to care and enable that care to be documented in the EHR so that providers can have up-to-date information. It will also give physicians an opportunity to get paid for telehealth, something that was a hurdle in the past,” said Glen Tullman, Chief Executive Officer of Allscripts. “Our open platform architecture enables this integration which we expect to be available in January.”

“The momentum behind the telehealth movement is growing at a remarkable pace. As patients demand improved access to care, providers are seeking alternative delivery methods to deliver care efficiently and effectively as payment models trend away from fee-for-service,” said Ido Schoenberg, MD, Chairman and CEO of American Well Corporation.

“Meanwhile legislative and regulatory barriers are being removed”, Schoenberg added. “Today forty state Medicaid plans reimburse for telehealth services and 16 states mandate private insurer coverage for telehealth including four states which have passed such laws since March.”

Reforming Device Databases

Representative Edward J. Markey (D-MA) and Senator Jeff Merkley (D-OR) sent a letter to FDA calling on the agency to streamline federal databases that provide information to the public on the safety of medical devices. However, these devices may not have undergone clinical trials in humans before being sold on the market.

In the absence of legislation that would close the current loophole in federal law that allows defective devices to enter the market, the lawmakers are urging reforms be made immediately to the FDA’s main medical device databases. The updates would provide device manufacturers, the public, and medical professionals better information about devices recalled for serious design flaws and help avoid future injuries.

Last February, a group of Representatives introduced the “Safety of Untested and New Devices Act of 2012” or referred to as the “SOUND Devices Act”. The legislation would close the major loophole in the 510(k) device approval process by allowing FDA to reject an application for a new device if it was modeled after an earlier product that was pulled from the market for causing serious harm to patients. The legislation is pending in the House of Representatives.

The federal loophole in the 510(k) device approval process requires the FDA to clear medical devices that demonstrate their similarity to an earlier model, even if that previous model was recalled for a major safety defect.

This loophole has enabled a number of defective products, such as bladder mesh implants, to enter the market and cause serious harm and in some cases even death. The updates to the 510(k) databases requested by the lawmakers would reflect if a medical device was subject to a recall due to a design flaw and if the medical device was cleared by FDA based on a previous design recalled for a serious flaw.

Go to to view a copy of the letter sent to FDA.

Wednesday, August 15, 2012

Diagnosing & Treating TBI

The Department of Defense and the Veterans Administration are very concerned about brain injuries since so many service members are coming back from Iraq and Afghanistan with Traumatic Brain Injuries (TBI). The Army alone is involved in 472 active research TBI projects alone and is driving the science behind the public health problem that affects everyone from kids involved in sports to service members in Afghanistan.

Severe brain injuries aren’t difficult to diagnose, but it’s more difficult to diagnose mild to moderate TBI. To improve the spectrum of diagnosis-to-treatment of mild TBI, the Army is working with university researchers and organizations like the National Football League and the National Hockey League since their players are a risk for concussions.

The Army and the NFL are both interested in developing helmet sensors that can be used to evaluate concussive events that could lead to TBI. The sensors would be able to measure the severity of impact to a soldier’s head and the data could be collected and incorporated into further TBI research and medical reports.

The current TBI research being funded includes a range of research on neuroimaging or brain scanning technologies, a quantitative electroencephalography or brain mapping, blood tests for biomarkers for brain injury, and drugs that could prevent injuries from mild brain trauma.

The Veterans Administration’s Office of R&D is very actively pursuing ways to help veterans with TBI. The VA has established a VA Rehabilitation Research Center of Excellence at the Michael E. DeBakey VA Medical Center in Houston Texas to focus on mild TBI.

At the center, researchers in the Genetics Core Program are studying the possible link between genetics and the effects of blast exposure during combat. Individuals who meet certain criteria may be asked to participate in studies using a functional MRI to view their brain as they complete computer tasks.

NIH is actively funding and involved in brain research. Researchers at NIH’s Center for Neuroscience and Regenerative Medicine have developed a prototype for a hematoma detector with a motion based sensor. The device images the brain by using near-infrared light to penetrate the skull and characterizes the amount of blood pooling by measuring how much the changing light is absorbed.

An existing handheld device called the InfraScanner developed by the Office of Naval Research has been FDA approved and is used in Europe but this device differs from the NIH device in that the patient has to remain motionless. 

NIH scientists have developed a device to simulate the effects of pressure waves resulting from explosions or blasts on biological tissue. This device would permit real-time monitoring of tissue damage while it is occurring and be able to track the secondary effects of pressure damage after tissue insult. The device is in the prototype stage but for more information, email Michael Shmilovich at at the NIH Office of Technology Transfer.

David Hage, a Professor of Chemistry at the University of Nebraska at Lincoln (UNL) is developing a handheld tool to diagnose TBI on the spot to yield critical and in some cases life-saving information to guide triage decisions from the battlefield to the football field.

SFC Fluidics, a Fayetteville Arkansas based-biotechnology company recently entered into a licensing agreement with UNL’s nonprofit affiliate NUtech Ventures to use the technology developed by Hage.

Hage a bioanalytical chemist has developed the technology to separate and measure specific compounds in complex fluids at a rapid rate. Hage’s methods can measure specific proteins in blood serum released by the brain which would enable the severity of brain injury to be diagnosed with a simple blood test.

Hage has spent two decades designing separation and measurement techniques, many of which are patented for a wide range of applications. These applications have ranged from new clinical tests to improved methods for forensic testing, drug development, and environmental monitoring.

The research is being supported by NIH, EPA, the Nebraska EPSCoR program, the Nebraska Center for Nanohybrid Functional Materials, and DOD. Clinical trials for the device are expected to begin in spring 2014. For more information, call (402) 472-2744.  

In other research, BrainScope Company Inc, a privately held medical neurotechnology company is developing a new generation of handheld, portable simple to use, non invasive tools to rapidly and objectively assess brain function and TBI at the point-of-care.

Clinical studies have been conducted over three years with collegiate and high school football players who sustained concussions. The findings indicate that BrainScope’s technology may be able to detect TBI, categorize the severity of TBI, and provide an indication of the length of time needed for recovery before the players can return to play. For more information, go to   

NIH to Help Newborns

Newborn screening programs currently genetically screen more than 4 million U.S. infants per year due to the passage of the 2008 Newborn Screening Saves Lives Act. This screening program saves lives by identifying infants who are at risk for congenital disorders so that early interventions and treatments can be started.

NIH released a Funding Opportunity Notice “Genomic Sequencing and Newborn Screening Disorders” (RFA-HD-13-010) on August 9, 2012. The project will be a five year program with $25 million in funding co-funded by NICHD and the National Human Genome Research Institute within NIH. Pilot studies will be funded to determine whether or not having genome sequence information contributes to improved clinical care of newborns.

Funds will be used to stimulate research in three component projects specifically applicable to newborn screening. These component projects would provide for the acquisition and analysis of genomic datasets, perform clinical research, and perform research related to the ethical, legal, and social implementation of genomic sequencing of newborns.

Whole genome sequencing is a laboratory method that can determine the entire DNA sequence of a person’s genetic material or genome from a DNA sample. In recent years, genomic technologies have advanced sufficiently so that it may be possible to use individuals’ whole genome information to enhance medical care, including the care and treatment of newborns.

Eligible organizations to apply for the funding include public, state, and private state institutions of higher education, nonprofits, for-profits to include small businesses, and state and local governments.

The letter of Intent is due October 19, 2012 with the application due November 19, 2012. The earliest start date will be July 1, 2012.

Tech Helps Nurse Practitioners

A project initiated to serve seniors has twenty full time cross-trained nurse practitioners employed by a Medicare Advantage plan called CareMore running twenty disease-specific clinics supported by high technology.

Using technology helps the nurse practitioners work with the patients to educate them on how to self-manage and coordinate their care as it relates to diabetes, wounds, CHF, hypertension, pulmonary disease, and CAD. Although caseloads vary across conditions, the typical nurse practitioner takes responsibility for roughly 1,500 patients.

CareMore operates network-model Medicare Advantage plans for seniors in Northern and Southern California, Arizona, and Nevada. The nurse-practitioner-led clinic program developed after one nurse practitioner with expertise in diabetes and wound care began seeing seniors with diabetes on a regular basis in one CareMore center.

CareMore’s IT systems include EMRs that support the nurse practitioners as they see patients, while other groups of four nurse practitioners monitor incoming data and then are able proactively to reach out to patients with CHF and hypertension if they require in-home monitoring.

For select CHF, hypertensive, and diabetics members, nurse practitioners have access to additional data provided by in-home monitoring and biometric telemetry devices. Members with diabetes receive a home glucometer to periodically measure blood glucose levels that are automatically stored in the device and can be downloaded by diabetes clinic staff to help monitor the patient.

Members with high blood pressure regularly use biometric telemetry devices to measure blood pressure and then transmit this information over the internet. CHF patients have a similar device to monitor weight. All of these systems tie into an internet-based interface which has built-in applications to provide real-time alerts and decision support to nurse practitioners and other clinicians.

A team of nurse practitioners and medical assistants regularly review the data and the alerts from the CHF and hypertension monitoring devices. If necessary, phone calls are made to encourage members who may be at risk to come to the nurse practitioner-led clinics. A separate call center reaches out to at-risk members with diabetes who register two consecutive hemoglobin A1C tests over eight percent.

To further help guide visits, nurse practitioners through CareMore’s EMR system have access to disease and condition-specific templates based on established guidelines and protocols related to self-management, education, and treatment. For a patient suffering from more than one disease/condition, the nurse practitioner can call up multiple templates during the visit so that all health issues can be addressed. As protocols are updated, IT staff updates the corresponding templates.

The results in the program show significantly improved outcomes and reductions in blood pressure, lower blood glucose levels, lower readmission rates for CHF patients, and lower amputation rates for those suffering from vascular and other types of wounds.

For more information, go to or email Henry Do, MD, Senior Medical officer at CareMore at