eHI Unveils HIT Cancer Guide

On February 12^th, the eHealth Initiative (eHI) unveiled the “Health IT Cancer Resources Guide”, a comprehensive overview of the digital tools and technologies available to help patients and their families, caregivers, and networks understand, treat, and cope with cancer.

More than half a million Americans die from cancer each year. The leading causes of cancer deaths are lung, prostate, and colon in men, and lung, breast, and colon in women. In 2013, a total of 1,660,290 new cancer cases and 580,350 deaths from cancer are projected to occur in the U.S. according to the American Cancer Society.

The “Health IT Cancer Resources Guide” will help patients become aware of and take advantage of the many outstanding digital resources available today that can help them understand their condition, make informed treatment decisions, anticipate their care needs, and connect with others who have had similar experiences,” said Jennifer Covich Bordenick, Chief Executive Officer of eHI. “It is our sincere hope that patients will use these tools to help alleviate the physical, emotional, and psychological effects that are oftentimes associated with cancer.”

The guide lists 76 tools ranging from mobile applications to web sites to social networks aiming to improve cancer care. It was developed by eHI’s National Council on Cancer and Technology which includes representatives from the American Cancer Society, and the American Society of Clinical Oncologists, and is organized in five sections. These sections include decision making, education, treatment management, social support, and lifestyle management.

eHI developed the guide based on the findings of the “Issue Brief on eHealth Tools and Cancer Care,” a review of 124 articles that examined how telemedicine, mobile health, internet-based technologies, and social media are used in cancer care today.

The issue brief highlighted the meaningful impact that eHealth tools have on care including the removal of geographic barriers, enhanced decision-making capabilities, and improved patient-provider communication.

Peter Yu, President of the American Society of Clinical Oncology commented, “The breadth of these resources is outstanding, sourced as they are from the full spectrum of the cancer community, including physician driven professional organizations, patient organizations, and government agencies.”

Go to www.ehealthinitiative.org/health-it-cancer-resource to view the full report.

CA Tech Agency Releases RFI

The California Technology Agency has released a Request for Information (RFI) seeking information from vendors on “Text-to-9-1-1” technologies that can be used to develop the state’s public safety response and accessibility.

Individuals with disabilities are text messaging every day. The availability of Text-to-9-1-1 has become an important accessibility issue for individuals who are deaf, deaf-blind, hard of hearing, and individuals with speech disabilities.

Text-to-9-1-1 would also be an alternative to voice calls to 9-1-1 in certain circumstances where speaking aloud might expose and endanger the caller in times of domestic violence, burglary, or during certain terrorism situations. Wireless text and/or data services may also operate in locations where radio coverage is too weak to support a voice call to 9-1-1 or if calls are made in wilderness areas.

In the case of Short Message Services, the actual deployment of SMS-to-9-1-1 is all but non-existent. For liability protection and for the education of SMS users, the major wireless carriers have implemented automatic replies to the sender for inbound SMS messages to 9-1-1 to indicate that the service is not available and that the caller should make a voice call to 9-1-1.

The FCC is in the final stages of issuing Text-to-9-1-1 rules and the FCC’s four major mobile phone carriers, AT&T, Sprint, Verizon Wireless, and T-Mobile USA have agreed to implement 9-1-1 testing nationwide by May 2014. By June 2013 where texting is not yet supported, automatic replies will begin alerting citizens to call 9-1-1 instead of texting.

In response to the need to be able to request emergency services using text messaging, the California’s Technology Agency, released an RFI on February 5, 2013. The agency seeks information and suggestions on how to help their California 9-1-1 Emergency Communications Division with their planning efforts to plan and improve requests for emergency services. The agency is interested in Text-to-9-1-1 solutions, technologies, and associated costs, regardless of the originating device, application, or network. The Technology Agency is scheduled to launch its first Text-to-911 Pilot Project by the fall of 2013.

The RFI response is due March 20, 2013. To view the RFI, go to http://techblog.ca.gov/?p=3045. For more details on the RFI, email Justin Ericson, Procurement Analyst, for the California Technology Agency at justin.ericson@state.ca.gov.

SAMHSA Seeks Applications

On February 12^th, the Substance Abuse and Mental Health Services Administration (SAMHSA) within HHS, issued a request for applications for “Enhancing Opioid Treatment Program Patient Continuity of Care through Data Interoperability” (OTP-CoC) grants.

SAMHSA wants to provide more resources to Opioid Treatment Programs (OTP). The goal is have the OTPs develop EHRs to fulfill regulatory requirements, achieve certified status, and become interoperable with other patient health record systems.

As behavioral health service providers, OTPs face challenges in recordkeeping systems as they must conform to federal confidentiality rules which significantly restrict the distribution of patient health information. Also OTPs face special needs to continue care to patients displaced by disasters.

OTPs have been slow to develop and adopt integrated EHR systems. There are few multi-state and multi-provider EHR software systems. Many OTPs are using EHR systems developed and customized to provide electronic medical systems for just one OTP.

In addition, the majority of programs are patient self-pay and have not historically accessed either private insurance benefits or Medicaid benefits for patient care coverage. Since that is the case, only a few OTPs have explored or taken steps to achieve “meaningful use” incentives under the HITECH Act. OTP as a subset of behavioral healthcare provide is going to require substantial assistance to migrate to interoperable EHR systems.

It is anticipated that grant funding will be $1 million to provide for up to 20 awards with an award amount up to $50,000 each. The funding will be used to:

·        Adopt, enhance, or upgrade certified EHRs and software systems

·         Assure continuity of care and inter-OTP information sharing during disasters

·        Improve linkages to primary care providers including FQHCs

·        Modify systems to enable interaction with  HIEs and PDMPs

·        Adopt new certified EHR systems or modify to achieve interoperability and ONC certification

·        Train staff on the use of the system

Eligible applicants can be domestic public and private non-profit OTPs. There are 1,260 SAMHSA certified OTPs so an estimated 593 programs are eligible to apply.

To view the RFA, go to www.samhsa.gov/grants/2013/ti-13-010.aspx or go to www.grants.gov published February 12, 2013. Applications are due April 3, 2013. For questions, email Nichole Smith at Nichole.Smith@samhsa.hhs.gov 

Approaches to Managing Diabetes

A Wayne State University researcher received $36,000 in grants from the Southeastern Michigan Health Association and from Greater Cincinnati HealthBridge Inc. to help determine the success of a Type 2 diabetes intervention program called “txT4Health” currently being piloted in Southeast Michigan, greater Cincinnati, and New Orleans

The “txT4Health” program, a 14 week test message-based behavioral intervention targeting Type 2 diabetes, is a joint venture of the American Diabetes Association, CDC, ONC, Voxiva, and the Southeast Michigan Beacon Community, Greater Cincinnati Beacon Community, and Crescent City Beacon Community in New Orleans.

“Txt4health” delivers tailored messages to users based on their individual risk for developing Type 2 diabetes. The program includes several different approaches to promoting lifestyle and behavioral changes, including physical activity self-monitoring, weight goal setting, nutritional information, and motivational messaging.

In another research study, NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) supports research at Columbia University Medical Center, in their Department of Biomedical Informatics. The researchers are developing new decision-support tools to help facilitate problem solving in diabetes. The tool will use a combination of an interactive website and SMS messaging server.

Past research has shown that well developed problem solving abilities are essential to successful diabetes management and results in better diabetes self-care behaviors, which helps individuals improve their health. Health IT can help individuals develop the necessary problem solving abilities. Many health IT interventions target improved patient clinician communication along with improved monitoring, rather than focusing more specifically on fostering problem solving skills. 

This research is using the strategies used by diabetes educators to foster problem solving but the researchers will go one step further and develop a decision support tool called the Mobile Diabetes Detective (MoDD). This tool will help diabetics identify specific, personally significant challenges in diabetes management, generate alternative strategies for addressing these challenges, evaluate strategies through simple experiments, and be able to monitor outcomes.

A wizard-like interface on an interactive website will help individuals develop personal learning plans. SMS messages will be sent to people’s mobile phones to remind them of planned experiments and enable the individual to report the results.

MoDD will be built using an open source platform on chronic disease self-management developed by the research team and the team will then release the resulting tool to the research community. The effectiveness of MoDD will be evaluated in a randomized controlled trial and researchers will assess the tool’s potential public health impact using the RE-AIM framework.

Tool Supports Patient Safety

The Durham VA Medical Center (VAMC) is using the new “Electronic Patient Event Report” (ePER) tool to bring a whole new level of patient safety to the medical center. The Durham VAMC is the first medical center in the VA Mid-Atlantic Health Care Network (VISN 6) to deploy the web-based patient event reporting system.

By using this tool, the entire staff can now submit event reports to the staff as compared to the previous reporting system that was limited to certain clinical staff. The staff has been trained at all nine sites of care under the Durham VAMC to use the system.

New functionality gives supervisors access to daily reports and saves staff time because the ePER is easier to use than the VistA based system. Staff will still report events to supervisors as soon as possible, but this new tool provides a safety net to assure that information does not slip through the cracks.

Falls, medication errors, and other events unfortunately can occur, but the ePER helps identify these events, mitigate their effects, and develop processes to prevent re-occurrences. The system is able to evaluate other patient safety interventions such as patient safety reviews, perform root cause analysis, sentinel event reporting, clinical focus reviews, and peer reviews. It is now possible to track and trend data, analyze the information, and implement real changes in a thoughtful data driven manner.

The tool helps the staff understand the circumstances around incidents and the timing of events. “It enables us to drill down into data to better enable safe, patient care,” said Sue Benware, Associate Chief Nurse for Performance Improvement and Practice at the medical center. “The system provides the data needed to drive decisions around patient care, Benware added.

EMRs to Advance Research

The University of Rochester Medical Center (URMC) is starting a project that may lead to important advancements. The researchers very often find that they need more information when they are doing their research so they are creating an electronic data network to help not only researchers and also the growing biotechnology sector in the state of New York.

“The reason for the network is to help researchers when they are testing drugs to be able to define and categorize people, according to their condition, their medications, and their treatments,” reports Anton P. Porsteinsson, M.D., who is leading the study at URMC.

In most clinical studies, investigators sift through reams of patient records by hand. After identifying potential candidates, researchers need to track down additional data to complete each person’s profile.

The process can be lengthy and does not always keep up with a subject’s health or lifestyle changes. This lack of information that is not available to the researchers can expose a participant in the study to unexpected risks and negatively affect the quality of a study.

The university is taking part in a statewide partnership called “Partnership to Advance Clinical electronic Research” (PACeR). The partnership is working to improve the subject selection process by using electronic medical records for research purposes and the information obtained from the EMRs is used to create a robust data network.

PACeR includes pharmaceutical companies, clinical research organizations, patient advocates, technology firms, hospitals, physicians, and patients. In addition, the initiative has built a networking platform for physicians to use to communicate with each other.

By using the PACeR project in the university’s Alzheimer’s study, URMC is becoming one of the first research organizations to demonstrate the PACeR network’s potential value. Project organizers hope the developing network will eventually serve as a model for other states, regions, and the nation to allow for the seamless integration between EMRs and databases”. 

USPTO to Select Winners

Teresa Stanek Rea, Deputy Under Secretary of Commerce for IP & Deputy Director of the U.S. Patent and Trademark Office, delivered remarks at the Combined Medical Device & Biotechnology Partnership Meeting held January 29, 2013.

Rea explained that the USPTO 12 month pilot program called “Patents for Humanity” underway since last February, was initiated to reward companies that are able to bring life saving technologies to underserved regions of the world. The program’s goal is to highlight positive examples of humanitarian actions that are compatible with business interests and strong patent rights.

The program is structured as a prize competition. Applicants must describe how they have used their patented technology or products to address humanitarian needs in four categories to include medical technology, food and nutrition, clean technology, and information technology. As Rea said, “From life saving medicine to medical diagnostic equipment to delivering potable water, technology can play a critical role in improving lives.”

To help facilitate the process “Patents for Humanity” winners will receive a certificate that the winner can redeem to use to accelerate any patent application from their portfolio. It is anticipated that winners of the competition will be announced this spring.

Rea told the meeting attendees that there are stories behind the people who apply for patents and how these patents can change lives. For example, a company called “Second Sight” based in Sylmar California was in a position to develop, manufacture, and market visual prosthetics. The company was established to help the blind and visually impaired see in a new way. Their patented Argus II device allows individuals to overcome their visual disability by interacting with their surroundings in unprecedented ways.

Rea gave another example of how patents can help humanity. Dr. Gholam Peyman, the LASIK surgery inventor was recently named by President Obama as one of 12 recipients of the National Medal of Technology and Innovations. Dr Peyman is an ophthalmologist and vitreoretinal surgeon who has more than 135 patents.

His inventions cover a broad range of novel medical devices, intra-ocular drug delivery, surgical techniques, laser and optical instruments, as well as new methods of diagnosis and treatment. He has won numerous honors and awards, including induction into the Ophthalmology Hall of Fame.

Studies Explore Patient Engagement

The February issue of “Health Affairs” explores the burgeoning field of activating and engaging patients in their health and healthcare. Studies show that more informed and empowered patients have better outcomes and there is some evidence that they also have lower healthcare costs. A briefing titled “New Era of Patient Engagement” held February 6^th in Washington D.C, presented a series of six panels moderated by Susan Dentzer, Editor-in-Chief for Health Affairs.

The February issue was supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation.

One of the studies published in the February issue titled “What the Evidence Shows about Patient Activation: Better Health Outcomes and Care Experiences” by Judith Hibbard PhD, Professor Emeritus at the University of Oregon and her coauthors found an interesting statistic. The research found that individuals lacking in the skills and confidence to be actively engaged in their healthcare had average costs that were 8 percent to 21 percent higher as compared to patients with the highest level of activation.

In another study “HealthPartners’ Online Clinic for Simple Conditions Delivers Savings” conducted by Patrick Courneya of HealthPartners in Minneapolis reported that the HealthPartners’ online clinic called “virtuwell” launched in 2010, provides online access 24/7 to treatment by nurse practitioners for 40 simple conditions.

The author notes that “virtuwell” is the first online service to be authorized for coverage under Medicare. After 40,000 cases where patients used online care, the company saw savings of $88 per episode over care in traditional settings, the care was clinically effective, and 98 percent of patients were willing to recommend the service.

Jonathan B Perlin, MD, PhD, President, Clinical and Physicians Services Group, and Chief Medical Officer at the Hospital Corporation of America, a panelist at the briefing, discussed some of the ideas that  leading organizations have initiated.

• Kaiser Permanente—(Health Bones Program) developed measures to identify and proactively treat patients at risk for osteoporosis and hip fractures. Used standardized practice guidelines for osteoporosis management, plus education, and home health programs. Over five years, there was a 30 percent reduction in hip fracture rates for at-risk patients

• Virginia Mason Health System—(Reduced Workflow Inefficiencies Through Rapid Process Improvement) set up nursing teams to work with patient care technicians in cells (groups of rooms located near each other) rather than spread across a unit. The result is that nurses spent 99 percent of their time on direct patient care as compared to 35 percent previously which resulted in an 18 percent improvement in timeliness of care

• Cincinnati Children’s Hospital Medical Center—(Patient Flow Improvement) implemented a series of operations management interventions to improve patient flow through the ICU. As a result, there are fewer delays and cancellations of elective surgeries due to unavailable beds, more predictable flow of patients, the need for 75 new beds has been eliminated, and $100 million has been saved in capital costs

• The Cleveland Clinic—(Care Enhancement Program for Lung Transplant Patients) engaged patients through daily huddles with caregivers to help understand the patient’s prognosis and to create a shared care plan. The total length of stay was reduced by 1.54 days, costs of care decreased by 6 percent, patient satisfaction improved by 28 percent, and 30 day survival improved by 3 percent

The application of strategies to empower patients, improve outcomes, and lower costs is important, and as a result, research in this field is being pursued. The Patient-Centered Outcomes Research Institute (PCORI) as authorized by ACA, funds research to assist patients, caregivers, clinicians, payers, and policy makers on how to make informed health decisions.

Joe Selby Executive Director for PCORI pointed out that PCORI has joined with several federal agencies such as AHRQ, NIH, and FDA to begin to involve patients and stakeholders in a meaningful way to generate and review research questions.

Last December, PCORI issued a broad funding announcement and announced their first 25 awards for a total of $40.7 over three years. The projects range from studying ways to care for people with cardiovascular disease and stroke, studying certain cancers, chronic kidney disease, chronic pain, depression, and pediatric diabetes as well as caring for people with multiple conditions.

Health Affairs is published by Project HOPE. Additional web first papers are published periodically and health policy briefs published twice monthly, The Health Affairs journal can be found on Facebook and Twitter.

For more information, go to www.healthaffairs.org.

State Issues RFA for NJHIN

In January, the New Jersey Department of Health (DOH) issued a Request for Applications (RFA) to solicit proposals to supply technology services to establish and operate the New Jersey Health Information Network (NJHIN). The DOH intends to award a grant to operate the technology infrastructure of the NJHIN.

The goal is to electronically exchange patient health information with health information organizations and state health data sources and eventually connect to the state eHealth Exchange. To begin the process, the state will award up to $1.6 million for the initial development and implementation of NJHIN. To be eligible, applicants must be a New Jersey State University or a New Jersey not for profit organization. Eligible applicants may partner with an experienced Health IT solutions provider.

The state’s model is to develop a network of networks model. This approach is to build upon the existing capabilities of the state’s regional Health Information Organizations (HIO). Each HIO has its own network of member hospitals, physicians, and other healthcare providers. A majority of the $11.4 million in State HIE Cooperative Agreement funds has been sub-granted to selected HIOs in the state to build regional HIE capability.

Currently, there are five regional HIOs:

·        Jersey Health Connect is the state’s largest HIO comprised of hospitals, health systems, physician practice groups, and long term care facilities spanning across 11 of the state’s 21 counties. Initial HIO efforts focused on obtaining 501c3 status, developing internal processes and systems, and laying the foundation for implementation efforts. The plan for 2013 and beyond is to implement HIO to HIO exchange

·        Camden HIE became active in 2010. In 2013 and beyond, the Camden HIE will work to expand HIE services to other healthcare providers, enhance capabilities, expand to other partners including long term care facilities, pursue other services for members and partnerships, and implement HIO to HIO exchange

·        Health-e-cITi-NJ was first implemented during a pilot phase. The pilot phase was a live production exchange of health information between Newark’s Beth Israel Hospital, the Visiting Nurses Association, and Newark’s FQHCs. In 2013, the HIO will  focus on training physicians and other HIE users on how to use HIE tools and expand real-time data exchange to other hospitals and FQHCs

·        NJSHINE, the state’s newest HIE received a $1 million grant award from the DOH in December 2012. The HIO will serve a diverse population in seven county areas, connect to hospitals, and connect to other area health providers and long term care facilities

·        Trenton HIE is working to transform healthcare for the City of Trenton by expanding access to high quality coordinated healthcare. The membership includes hospitals, FQHCs, and 90 percent of the primary care physicians in the area. Plans are for the HIE to be operational in 2013

NJHIN will also establish and maintain a gateway to the Nationwide Health Information Network and will be upgraded over time to take into account evolving eHealth Exchange standards and policies. This connection will provide bidirectional access between NJHIN, participating entities, and other Federal agencies participating in the eHealth Exchange such as DOD, VA, HHS, and others.

Go to www.nj.gov/health/bc/njhit/documents/njhin_rfa_01132013.pdf to view the RFA for the Health Information Network for the State of NJ Department of Health. Applications must be submitted by March 22, 2012. For more information email Miriam Bolger, HIT Project Manager at mbolger@njhcffa.com.

New Ideas at University of Utah

The University of Utah’s Center for Alzheimer’s Care, Imaging, and Research (CACIR) and a related startup company called Proactive Memory Services are developing an app for mobile devices to help people with Alzheimer’s.

The application is still in its infancy, but Norman Foster Director of CACIR and Troy Andersen the researchers behind the development of the  tablet computer and smartphone application have received a $125,000 Small Business Technology Transfer grant from NIH. They are eligible for an additional $1 million from the federal government if they meet their goals under the initial funding.

The team is getting assistance from the university’s Technology Commercialization Office and Software Development Center. The researchers want to develop several application modules, which will be downloadable onto any mobile device. The price and date of availability for each module has not been determined.

In another project, Professor Stacy Bamberg in the University of Utah’s Department of Mechanical Engineering is developing a shoe insole that will be able to gather comparable data to Nike’s popular line of high tech sneakers but will do more than track laps and airtime. The new insole called the “Rapid Rehab” system will help correct walking problems for people with artificial legs, hip replacements, and broken legs.

Bamberg is developing the new smart insole through her startup company called Veristride. She has received a $150,000 SBIR grant and a $40,000 Technology Commercialization and Innovation grant from the Utah’s Governor’s Office of Economic Development.

The real-time “Rapid Rehab” system uses a custom gel insole with force sensors, accelerometers and gyroscopes to detect a person’s gait or walking pattern. Bamberg and her colleagues developed a smartphone application that wirelessly tracks data from the insole and provides a variety of instantaneous feedback. The immediate use is for amputees who would like to reduce how much they limp when using prosthetic legs.

Also, at the university, a new biodegradable drug-delivery nerve conduit has been developed using a novel local drug-delivery system to continuously administer proteins or small molecules at controlled rates to an injured nerve.

The technology is a cost effective method to accelerate nerve regeneration leading to improved patient care. The University of Utah’s inventor is Dr. Agarwal, Assistant Professor in the Department of Surgery, at the School of Medicine and the Huntsman Cancer Institute.

Today, the current standard of care for repairing nerve gaps includes autologous nerve grafts and artificial nerve conduits. Autologous nerve grafts are harvested from donor sensory nerves which can cause a loss of sensation at the donor site and require additional surgery.

As an alternative, commercially available artificial poly-glycolic acid nerve conduits can be used to repair nerve gaps. These hollow tubes act as axon guides for the regenerating nerves and can allow for tension free bridging without the need to harvest donor nerve tissue.

However, it has been shown that locally delivering growth factors or other small molecules may enhance axon sprouting and peripheral nerve recovery. Therefore, a novel nerve conduit has been developed that can simultaneously delivers small molecules or proteins in a controlled manner which should lead to significantly improved peripheral nerve regeneration compared to existing methods.

This approach has the potential to impact a broad spectrum of patients including those with nerve tumors, trauma patients, localized nerve inflammation, and to perform nerve repairs associated with many other medical procedures that should open up market opportunities.

The medical device technology (U-5205) is available on an exclusive or nonexclusive basis. PCT patent application has been filed with the USPTO. For more information, contact Leena Bhoite at the University of Utah at (801) 581-7792.

Telehealth Summit Coming Soon

The 2013 Mid-Atlantic Telehealth Resource Center’s (MATRC) Annual Summit will be held March 17-19 in conjunction with the Virginia Telehealth Network. This premier event will be held at the Jefferson Hotel in historic Richmond Virginia.

The Summit will explore how the Affordable Care Act is impacting ways that healthcare will be provided in the next two to three years. Key provisions of the law occurring in 2013 and 2014 will be described and attendees will learn how well designed telehealth programs can improve patient outcomes, decrease penalties for providers, build a stronger continuum of care, increase patient engagement and satisfaction, and lower escalating costs.

Carl W. Taylor, JD Executive Director, Fraser Institute for Health Research will be the plenary speaker and will discuss the enormous challenges facing healthcare delivery systems.

The plenary speakers and their response to the challenges will include:

·        Len Nichols, PhD, Director, Center for Health Policy Research and Ethics, George Mason University

·        Tracey Causey, CEO, Capital Area Health Network

·        Alex Nason, Program Director, for JHU’s Office of Telehealth and Interactive Learning

The Summit will have breakout sessions. Part 1 will present topics to improve the quality of care by reducing readmissions, improve quality by engaging patients in telehealth-enabled care, and find ways to help seniors to age in place.

Speakers in Breakout Session Part 1 will include:

·        Bonnie Britton, Telehealth Program Administrator , Vidant Health

·        Seth VanEssendelft, VP for Financial Services, Vidant Health

·        Andrew R. Watson, MD, Department of Surgery UPMC, Medical Director, Center for Connected Medicine

·        Charlene C. Quinn, PhD, RN, Associate Professor, Epidemiology and Public Health, University of Maryland, School of Medicine

·        Sally Okun, RN, VP for Advocacy, Policy & Patient Safety, PatientsLikeMe

·        Mike Brett MD, Medical Director for LIFE Programs, Lutheran Senior Life

·        Kelly Besecker, Sales & Marketing, A-Frame Digital

The Keynote Luncheon Address will be given by John F. Duval, CEO MCV Hospitals, VCU Health System

Breakout sessions Part 2 will discuss how to combat the rising cost of care by utilizing care coordination and chronic disease management, developing ways to overcome provider shortages, bringing care and education directly to the patient, and overcoming provider shortages by moving towards new models of care.

Speakers in Part 2 breakout sessions will include:

·        Adam Darkins, MD, Chief Consultant Care Coordination Services, Department of Veterans Affairs

·        Kim A Schwartz, CEO, Roanoke Chowan Community Health Center

·        Joyce Green Pastors, Diabetes Nutrition Specialist for the Virginia Center for Diabetes Professional Education at the University of Virginia School of Medicine

·        E. Ray Dorsey, MD, Associate Professor of Neurology, and Director, for the Johns Hopkins Parkinson’s Disease and Movement Disorders Center

·        Lashanna Brunson, Research Coordinator, Parent Implemented Training for Autism through Telemedicine Center for Excellence in Disabilities, West Virginia University

·        Fred Summerfeit, Associate Professor of Dental Hygiene, Northern Arizona University

The third breakout session will discuss the return on investment, overcoming policy challenges, and developing the telehealth workforce.

Speakers in the third breakout session will include:

·        Kamal Jethwani, MD, Corporate Manager, Research and Innovation, Center for Connected Health, Partners Healthcare

·        Kirby Farrell, President and CEO, Broad Axe Technology Partners

·        Jonathan Linkous, CEO, ATA

·        Mark Walker, JD, Attorney Advisor, for the Telecommunications Access Policy Division, within the  Wireline Competition Bureau at FCC

·        Anthony T. Pavel, JD, Partner, Morgan, Lewis & Bockius, LLP

·        Jordan Berg, Telehealth Coordinator, ANTHC

·        David Cattell-Gordon, Director, Office of Telemedicine, Center for Telehealth at the University of Virginia

There will also be a panel discussion on transforming healthcare through innovations with panelists Janet S. Wright, MD, Executive Director Million Hearts Initiative, CMMI, and Robin A. Felder PhD, Professor and Associate Director of Clinical Chemistry and Pathology and Former Director for the Medical Automation Research Center

Karen Rheuban MD, Senior Associate Dean for CME and External Affairs, Medical Director, Office of Telemedicine, and Director for the Center for Telehealth at the University of Virginia will be the Wrap Up speaker for the Summit.

For more details on the meeting, go to www.matrc.org/2013-summit. For questions contact Anita Browning at Anita.Browning@virginia.edu or call 434-270-5338. 

NIH's Tech Transfer Plan

NIH’s Office of Technology Transfer (OTT) has developed plans for technology transfer and commercialization innovations for the years 2013 to 2018. These ideas were recently put into the NIH plan “Accelerating Technology Transfer and Commercialization of Federal Research in Support of High Growth Businesses (2013-2018).”

The overall aim for Technology Transfer future plans is to increase the number and pace for technology transfer and commercialization activities in partnership with non-federal entities, including private firms, research organizations, and nonprofit entities.

To facilitate the exchange of proprietary materials and information needed to advance biomedical research, NIH has developed an electronic Transfer Agreement Dashboard at http://techtransferagreements.nih.gov/Pages/Tad.aspx.  The dashboard enables NIH developed research materials to be transferred to the biomedical research community via Material Transfer Agreements.

Also, NIH has launched the site “electronic Research Materials” (eRMA) at www.ott.nih.gov/erma.  This system licenses unpatented research materials to for-profit entities. These two web based systems are expected to reduce the transaction time for transferring NIH-developed materials.

NIH has been streamlining licensing procedures and has been reviewing all of the model license agreements to simplify the process. NIH has also implemented pay.gov a web-based application allowing licensees to make payments by debit from a checking or savings account. This process speeds licensing especially when an initial payment is required prior to shipping biological materials under a license.

NIH has created a Start-Up license to expedite the process for start-up companies to license their technologies to use for drugs, vaccines, and therapeutics. NIH has developed a similar license for non-profit institutions, such as NGOs and for Product Development Partnerships (PDP) to help develop new products for low income regions of the world.

To promote NIH inventions and technologies for development and commercialization, NIH has developed electronic and social media tools to promote inventions that are available for licensing and collaboration. This includes websites, RSS feeds, iPhones, and iPad apps, email subscriptions, Twitter, and Facebook. NIH also participates in www.ctsaip.com, a website that aggregates technologies from across the NIH-supported Clinical and Translational Science Awards.

NIH is facilitating commercialization through local and regional partnerships:

• NIH has established an agreement between OTT and Tech Commercialization, a Texas-based entity established to provide regional small businesses and educational institutions with technical assistance to develop federal technologies for licensing and commercialization
• NIH has developed an agreement between the National Cancer Institute and the Maryland Technology Development Corporation (TEDCO)
• NIH has developed an agreement between OTT and BioHealth Innovation (BHI) located in Maryland to translate market-relevant research into commercial success

 Go to www.ott.nih.gov/NIH-TT-Plan-2013 to view the plan.

DOD in the Pacific Region

In the coming years, the U.S. is going to develop medical partnerships and play a larger role in the geographically dispersed Asia-Pacific region. DOD will need to strengthen its military presence by training allies and provide humanitarian assistance where needed.

From the military medical perspective, this means a need to provide care and medical services to service members and beneficiaries in the region. At the same time, DOD will need to sustain military medical humanitarian assistance capabilities and also integrate and advance technology across the region.

“We need to reorganize and integrate across the services to deliver excellent care wherever and however it may be needed”, said Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs.

Several months ago, Woodson visited the Pacific region to meet with senior line and medical leaders. The trip included stops in Hawaii, Guam, South Korea, Singapore, and Japan. Discussions took place on how to meet the challenge of providing care in spite of the sweeping geographic distances between military medical facilities in the region.

According to Woodson, “We have to help alleviate the geographic challenge by using telehealth technology to advance and set a standard for care in the region. Telemedicine is allowing healthcare providers to deliver clinical care and provide emergency assistance plus additional medical services to remote locations that might otherwise not have access to specialized and full spectrum care.”

Woodson continued to say, “The medical profession in each of these countries in the Pacific can be slightly different so it is important to partner with host nations. All in all, it is going well, but we need to look at the pressures of what’s happening with private medical systems in these areas and make sure that we have plans in place so that there are no vulnerabilities in the care provided to beneficiaries.”

Another priority in the region is to provide humanitarian aid. DOD conducts a number of regular humanitarian missions, such as the Pacific Partnership which is the largest annual humanitarian and civic assistance mission in the region.

During the 2012 Pacific Partnership mission, personnel aboard the hospital ship USNS Mercy provided medical and dental care to more than 49,000 people and assisted in refurbishing health clinics and delivering medical supplies. The annual mission which is rotated yearly between the Mercy and the USNS Comfort partners with nations in the region and works with a variety of non-governmental organizations.

Telehealth Coordinator Position Available

Cheyenne Regional Medical Center has just announced the opening of a Telehealth Coordinator Position. The coordinator will interact with physicians, staff, community members, and healthcare professionals in the process of planning, providing, promoting, and supporting Cheyenne Regional Medical Center’s telehealth operations, programs, and services.

Go to www.nrtrc.org/wp-content/uploads/Telehealth-Coordinator-job-description-brief-Feb-20131.pdf for the job description. You may also apply online at www.cheyenneregional.org. For other details contact Bob Wolverton, NRTC Program Director by email at Bob@ntrc.org or call (406) 237-8660.

Spotlight on Rural Issues

Over 400 conference participants from rural areas throughout the country gathered in Washington D.C. February 4-6 to attend the National Rural Health Association’s 24^th annual Rural Health Policy Institute. The attendees participated in discussions on NRHA’s 2013 Legislative and Regulatory Agenda and listened to ideas on how to effectively promote actions for rural communities that will be accepted by Congress, federal regulatory agencies, the White House, states, and the healthcare industry.

Speaking at the General Session, Doug McKalip, White House Domestic Policy Council Senior Policy Advisor for Rural Affairs, recounted how he grew up in Northwest Pennsylvania in a rural community and he knows first-hand the gaps in finding healthcare in the community. One of the most serious problems to obtaining care is the lack of broadband coverage and even where the internet exists; there are too many gaps in transmission.

To work with the White House on rural issues, NRHA in 2012 participated with HRSA’s Office of Rural Health Policy and the White House Rural Council to discuss a number of initiatives including the future of primary care, the expansion of the National Health Service Corps eligibility, and how to achieve coordination between various rural health providers.

At the NRHA Institute, telehealth was on the agenda. Mary Wakefield PhD, RN, HRSA Administrator recalled how HRSA in 2012 funded an Institute of Medicine (IOM) meeting with telehealth leaders to discuss all of the recent telehealth accomplishments and future goals. The report is available on the IOM website at www.iom.edu/Reports.aspx.

Dr. Wakefield discussed two telehealth grant program announcements that were released in December 2012. One grant program the “Telehealth Network Grant Program with the closing date of February 13, 2013 will fund projects that demonstrate the use of telehealth networks to improve healthcare services for medically underserved populations in urban, rural, and frontier communities.

The other grant program the “Telehealth Resource Center Grant Program” supports the establishment, development, and strengthening of Telehealth Resource Centers. The response is due February 25, 2013.

NRHA’s 2013 legislative and regulatory document includes specific ideas on what the Administration and Congress needs to do in rural communities as it relates to telehealth such as:

• Reimbursement for services provided through telehealth should be made based upon medical effectiveness and utilization and not based on particular delivery platforms or locations
• Medicare law should be expanded to allow anything currently covered by Medicare to be reimbursed when provided by telehealth
• A telemedicine payment methodology should be provided for conventionally delivered services
• The Regional and National Telehealth Resource funded by the Office for the Advancement of Telehealth within HRSA should be expanded
• The federal government should adopt a policy to allow telemedicine providers to receive deemed status and allow healthcare facilities receiving telehealth services to perform credentialing by proxy or delegated credentialing
• Geographical patient requirements for receiving care in a HPSA and non Metropolitan Statistical Areas should be lifted
• Separate billing procedures for telemedicine should be eliminated
• Care provided by a physical therapist, respiratory therapist, occupational therapist, speech therapist, and social worker should be reimbursed
• A fair market reimbursement system for originating telehealth sites should be implemented
• Reimbursement for store-and-forward applications should be provided.
• EMTALA regulations should be changed to allow a telehealth physician to meet the physician requirements for emergency care   

 NRHA would like to see a number of other changes related to health IT:

• A redesign of the present telecom subsidy models and universal access polices to enable all citizens to have access to an affordable and appropriately configured broadband system
• The development of integrative partnerships with informatics resources to support adoption of EHR technology
• Medicare EHR incentive payments should also be available for facilities to participate in electronic Health Information Exchanges
• Support of emergency medical services to be coordinated and supported by federal agencies through policy development, data systems appropriate curricula, and access to grants
• Emergency preparedness must have information systems to meet the needs of local rural communities
• Congress should require vendors of IT systems used in rural communities to incorporate national standards for health IT into their systems and Federal and state governments should enable the infrastructure and policy framework so more networks can be formed
• More funding for rural hospitals and eligible professionals to purchase and support health IT
• Funding should be provided through a combination of grants, loan guarantees, and/or principal and interest forgivable loans to support health IT

 For more information, go to www.RuralHealthWeb.org.

$121.5 Million for Grants

On February 6^th, the National Telecommunications and Information Administration (NTIA) made $121.5 million in grants available to assist states as they prepare for a nationwide public safety broadband network.

The grants will be available to all 56 states and territories and will support planning, consultation, education, and outreach activities as well as help fund efforts to collect information on infrastructure and equipment that can be used by the First Responder Network Authority (FirstNet) to build a wireless public safety broadband network.

The Middle Class Tax Relief and Job Creation Act of 2012 directed FirstNet to deploy a nationwide wireless broadband network to enable first responders to better communicate with each other during emergencies and save lives.

The Act directed NTIA to establish the “State and Local Implementation Grant Program” (SLIGP) to make grants available to states in collaboration with regional, tribal, and local jurisdictions, so that  FirstNet can take steps to help make this nationwide interoperable network a reality.

The SLIGP is designed as a formula-based matching grant program. The Federal share of the grant program represents 80 percent of the total project costs, while recipients will contribute at least 20 percent.

Applications are due to NTIA from the states and territories by March 19, 2012 with grants to be awarded by July 15, 2013.

Go to www.ntia.doc.gov/other-publication/2013/sligp-federal-funding-opportunity or go to www.grants.gov for more details on NTIA’s Funding Opportunity Announcement 2013-NTIA-SLIGP-01.

Monitoring Pilots & Patients

Technology originally designed by NASA’s Glenn Research Center scientists to monitor the health of astronauts is finding new applications on Earth that could significantly impact the safety of pilots and be used to rehabilitate cardio-pulmonary patients.

A NASA engineer and a team of scientists at Glenn developed the “Portable Unit for Metabolic Analysis (PUMA) to monitor the oxygen consumption and carbon dioxide production rates of astronauts exercising during long missions. The portable unit was designed to give the crew the ability to move around the spacecraft without being tethered to a large immovable unit. The units are wearable, versatile, small, uses low power, minimally invasive, and able to address the monitoring requirements of multiple scenarios.

PUMA measures six components to evaluate metabolic function such as oxygen and carbon dioxide partial pressure, volume flow rate, heart rate, gas pressure, and temperature. From those measurements, PUMA can compute the oxygen uptake, carbon dioxide output, and ventilation. A small embedded computer takes readings of each sensor and relays the data wirelessly to a remote computer via Bluetooth.

Orbital Research Inc. is currently testing hardware that uses technology to monitor the oxygen levels of Air Force F-22 pilots. A series of accidents involving pilot suffering from hypoxia or a lack of oxygen led the military and the manufacturer of PUMA to approach Orbital for hardware capable of answering why those events occurred.

Today, the first prototype system featuring a fleet of sensors in the pilot’s oxygen mask is flying with the pilots and offers warning signals if the sensors detect the onset of hypoxia before symptoms occur. The goal is to give the pilots a warning so they can take countermeasures to start supplemental oxygen or lower their altitude. After 40 flights, data is being analyzed to further understand the problem.

“We have expanded the PUMA technology to create new devices for specific work with the warfighter,” reports Aaron Rood, Medical Products Manager at Orbital. “The company has just finished the first phase of a project with the Navy SEALs to develop a sensor suite in diving gear that provides biometric data to both the diver and support staff in the boat during actual combat missions”, according to Rood.

In the meantime, the healthcare industry is investing in PUMA technology to use to monitor patients. “Summa Health system has just signed an agreement with NASA to use their headgear to assess patients with COPD. PUMA will help them make physiological measurements to assess rehabilitation efforts,” explains NASA Engineer Dan Dietrich lead engineer on the team that developed PUMA.

In addition, the Cleveland Clinic wants to use PUMA to measure the metabolic functions of pulmonary patients. The idea is to have a portable easy to use unit to take measurements during a six minute walk test in the hospital. University Hospital physicians in Cleveland think the technology might work to monitor epileptic patients during severe episodes which would lead to a better understanding of the physiological effects of seizures.

The possible applications for the use of PUMA technology for human health continues to grow and in the future, PUMA could be used to determine the caloric requirements of daily living activities in order to develop nutrition and weight loss programs and to assess the nutritional needs of critical care patients. This would be useful in the case of the critically ill to determine the impact of certain foods on metabolic rate and to quantify the field training of athletes to design effective training programs.

Calling for Better Mobile Privacy

The FTC published the February 2013 report “Mobile Privacy Disclosures: Building Trust through Transparency” with recommendations for critical players in the mobile marketplace. Most of the recommendations would help consumers get timely, easy-to-understand disclosures about the data collected and how it is used.

“This is important since we are in the midst of a mobile revolution. The mobile world is expanding and innovating at breathtaking speed, allowing consumers to do things that would have been hard to imagine only a few years ago. At the same time, mobile technology presents unique privacy challenges” said FTC Chairman Jon Leibowitz.

He further commented, “In the complicated mobile ecosystem, multiple companies may have access to an individual’s information including wireless providers, mobile operating systems, handset manufacturers, application developers, analytics companies, and advertisers. Many wonder how their privacy interests are being protected.”

The report describes the explosive growth of mobile services but at the same time, the report states that mobile technology raises unique privacy concerns. More than other types of technology, mobile devices are typically personal to an individual, almost always on, and with the user.

When mobile devices are used in this way this means that unprecedented amounts of data collection is always available. In addition, since a single mobile device can facilitate data collection and sharing among many entities, consumers may wonder where they should turn if they have questions about their privacy.

The report cites recent data showing that consumers increasingly are concerned about their privacy on mobile devices. For example, 57 percent of all app users have either uninstalled an app over concerns about having to share their personal information, or declined to install an app in the first place for similar reasons. Less than one-third of Americans feel they are in control of their personal information on their mobile devices.

At a press event to present the report, FCC Chairman highlighted some key recommendations. The report urges platforms like Apple, Google, Microsoft, and Blackberry to provide just-in-time disclosures to consumers and obtain their affirmative express consent before allowing apps to access sensitive content. The report also encourages these platforms to promote best practices among app developers and to offer a Do Not Track mechanism for smart phone users.

In addition, the report urges app developers to disclose their privacy practices and obtain affirmative express consent from consumers before sharing sensitive data with ad networks and other third parties. The report makes recommendations also for advertising networks and other third parties, app developer trade associations, along with academics, usability experts, and privacy researchers.

Go to www.ftc.gov/os/2013/02/130201mobileprivacyreport.pdf to view the report.

Cell Phones to Fight Epidemics

The Office of Naval Research (ONR) manages a program to find out about epidemic outbreaks in real-time using new healthcare monitoring and information collection technology in South America and Africa.

Building off of an original project funded by ONR, researchers are collecting data through a text message-based system set up to take advantage of widespread access to handheld devices in Columbia and Zambia.

Through the collection of photos, videos, texts, and geo-location information from cell phones in a given population, researchers are able to perform complex data analysis, track, and map a fluid situation such as an earthquake or the spread of disease.

Limited technical infrastructure in developing countries often can slow humanitarian aid and hamper responses to disasters. ONR seeks to use smartphone apps since more people in developing countries have cell phone subscriptions than access to the internet throughout the world especially in lower income populations.

According to Commander Joseph Cohn, Program Officer in ONR’s Warfighter Performance Department, “Real time epidemiological data allows military decision-makers to be medically prepared and more locally able to provide quicker responses to potential disease outbreaks in close quarters which is common in military facilities like ships.”

The project also includes funding from Naval Sea Systems Command working in partnership with the Zambian Ministry of Health, the University of South Alabama, and Tiny People Matter, a global medical relief team that provides care for children and infants in developing countries.

“This effort shows it doesn’t require expensive solutions to effectively collect highly structured data from local populations in some of the least networked locations around the globe,” according to Commander Cohn.

Children's EHR Format Announced

NIST is actively involved in EHR usability design to meet the needs of children and published the report “Human Factors Guide to Enhance EHR Usability of Critical User Interactions when Supporting Pediatric Patient Care.” 

The NIST report goes into detail concerning specific pediatric considerations such as the need to develop acceptable growth charts, provide more detailed medication records, provide access to complete information for multiple birth patients, develop specific records for high risk low weight neonates, plus provide special information to caregivers for the pediatric patient population.

According to Thomas McInerny M.D President of the American Academy of Pediatrics, “Until now many EHRs have lacked child-specific functionality such as the ability to record age-appropriate development, nutrition, immunizations, or growth”

On February 6^th, AHRQ and CMS announced that they have developed a new children’s EHR format. The new EHR format includes recommendations for child-specific data elements such as vaccines and functionality that will enable EHR developers to broaden their products to include modules tailored to children’s health.

“Healthcare for children is a calling that presents special challenges,” said AHRQ Director Carolyn Clancy, M.D. “The new children’s EHR format will help software developers meet the needs of healthcare providers for children by combining best practices in clinical care and information technology, with contributions from healthcare providers who treat children every day.”

Specific topic areas in the new EHR format include prenatal and newborn screening tests, immunizations, growth data, information for children with special healthcare needs, and reporting child abuse.

The EHR format provides guidance on the interoperable exchange of data including data collected in school-based primary and inpatient care settings. The format is compatible with other EHR standards and facilitates quality measurement and improvement through the collection of clinical quality data.

Next steps include testing by two CHIPRA quality demonstration grantees that will include the Commonwealth of Pennsylvania and the State of North Carolina. Also, CMS will work toward integration of the format into future editions of the ONC’s EHR Standards and Certification Criteria. This would be required to receive “meaningful use” of certified EHR technology in future stages of the Medicare and Medicaid EHR incentive programs.

Go to www.nist.gov/healthcare/usability/upload/NIST-IR-7865.pdf to view the NIST report. For more information on the AHRQ & CMS development of the children’s EHR format, go to http://healthit.ahrq.gov/childehrFormat.

Actions to Advance Health Technology

On January 31^st, the FCC held an Open Meeting to discuss recent FCC actions to advance health technology. FCC Chairman Julius Genachowksi opened the discussion by reporting that his agency is proud of the recent creation of a new Healthcare Connect Fund with $400 million in annual funding. The funding will help to expand healthcare provider access to broadband especially in rural areas, support telemedicine, and encourage the creation of state and regional broadband healthcare networks.

Other recent FCC actions include allocating spectrum for Medical Body Area Networks which consist of networks of wireless sensors able to transmit data on a patient’s vital health indicators to their doctor or hospital. As reported, the U.S. is the first country to make spectrum available for this specific usage.

In another agency action, the FCC approved an Order that will reform the experimental licensing program by increasing spectrum flexibility for testing new wireless health innovations. This flexible approach will help to speed new wireless health technologies to market.

To address the needs of low income households, fourteen projects were selected to participate in the FCC’s Broadband Adoption Lifeline pilot that authorized $13.8 million to support rural, urban, and suburban projects spanning 21 states and Puerto Rico. The data resulting from the projects will help the FCC structure the Lifeline program to promote the adoption and retention of broadband services by low-income households.

To speed regulatory reviews, last July, the “Food and Drug Administration Safety and Innovation Act” reauthorized the FDA’s collection of user fees. The statute includes a requirement for the FCC to participate with HHS and the Office of the National Coordinator and FDA to draft a report outlining strategy and recommendations for a risk-based regulatory framework that will include mobile medical applications.

In another open meeting presentation, Julius Knapp, Chief, of the Office of Engineering and Technology and Linda Oliver, Deputy Chief, Telecommunications Access Policy Division of the Wireline Competition Bureau, discussed how effectively the FCC’s June 2012 mHealth Summit provided direction on how to further develop the adoption of wireless health technology.

The FCC as host of the Summit brought together academia, industry, and government. Attending were senior executives and leaders from health technology companies including established companies, startups, non-profits such as the West Wireless Health Institute , hospital leaders, and government leaders from the FCC, FDA, HHS, VA, CMS, and NIH.

Following the event, participants came together to create an independent mHealth Task Force that collaborated on several policy recommendations presented to the FCC, other federal agencies, and to industry. Overall, the recommendations are to increase interagency collaboration and information-sharing, expand existing programs to encourage mHealth adoption, and to build on government and industry efforts to increase capacity, reliability interoperability and the safety of mHealth technologies.

The FCC’s mHealth Task Force overall goal is to collaborate with federal partners and the private sector to enable mHealth technology to be a routine medical best practice within five years.   So far, the FCC has taken action on 85 percent of the recommendations.

Another recommendation was to develop the hiring process for a permanent Director of Health Care Initiatives to function as the central point of contact to external groups on all health-related issues and work to improving interagency data sharing and cooperation.

Also, the mHealth Task Force seeks to have the FCC consider a Rural Health Care (RHC) program modernization order that would permit networks of hospital and healthcare facilities to jointly apply for RHC Program funds to boost broadband capacity and enable EHRs.

As part of the RHC modernization order, the goal would be to collect richer data on broadband and telehealth applications from the RHC Program participants and this in turn, could target more support for telemedicine.

The January FCC Open Meeting concluded with a telemedicine demonstration presented by the Georgia Telehealth Partnership. The demonstration held both in person and via telehealth included a simulated patient examination with the Coffee Regional Medical Center located in Bacon County, Georgia, a participant in the Rural Health Care Pilot Program.