“Caring for the complex chronically ill accounts for a high proportion of national spending and spans the healthcare system” according to Cathy Schoen, Senior Vice President for the Commonwealth Fund. She was speaking at the Alliance for Health Reform briefing “Improving Care and Managing Costs: Team-based Care of the Chronically Ill” held on Capitol Hill August 11th.
Schoen reports, “Twenty one percent of spending is for the five percent of the population that has five or more chronic conditions. Payment changes, team-based care, and system innovations including the use of registries and EHRs are key to achieving better outcomes and lowering costs.”
How to provide team-based care for dual eligible seniors with complex chronic conditions was described by Lois Simon, M.P.H., Co-Founder and Chief Operating Officer for the Commonwealth Care Alliance (CCA). CCA is a Massachusetts state-wide not-for-profit consumer governed prepaid care delivery system taking care of Medicaid and/or dual eligible seniors with the most complex and expensive chronic conditions.
CCA put in place a primary care and care coordination model by deploying multidisciplinary primary care teams. To further explain, Simon presented a case which needed a fundamental primary care redesign.
Anna C. a 55 year old woman SSI eligible Medicaid beneficiary, was ill with long standing Multiple Sclerosis resulting in completer paralysis in both legs, partial paralysis in both arms, and impaired bladder function. This has resulted in a long standing history of depression, a prior major suicide attempt, and a history of severe asthma exacerbated by heavy smoking.
For many years, Anna was able to use a manual wheelchair and perform self catheterizations but with slowly progressive upper extremity weakness this became impossible for Anna. To help her, Anna received two hours of care from a Personal Care Assistant each morning and each evening for the past five years without any adjustment despite her functional decline.
During the past two years, there have been multiple hospitalizations for urinary tract infections, asthma exacerbations, and two long sub-acute hospital stays for pressure sore management caused by extended hours in bed and from a poorly fitted manual wheelchair.
Anna was found to have no consistent primary care or behavioral health relationship and as a result, she was severely depressed, emotionally withdrawn, functionally bedbound, incontinent, and experiencing rapidly worsening ulcers.
Obviously, continuity clinical management in Anna’s care was non-existent and not only reflected in her lack of care, but also influenced the cost factor. Costs and service use patterns with individuals such as Anna’s represent 12 percent of Medicaid beneficiaries, and represent 30 percent of Medicare expenditures. Anna’s predicted monthly total medical expenditures are about $3800 per month with nearly 50 percent going to recurrent hospital care for predictable complications from her chronic illnesses.
At this point, a primary care redesign was implemented for Anna. A team was put in place to include an in-home nurse practitioner, a behavioral health clinician, plus physical therapy is provided, along with durable medical equipment to enable the following individualized care plan:
• 72 hours of personal care assistant support per week was instituted to help with daily living activities but was later reduced to 40 hours a week over time
• A consultation with an in-home wound care nurse specialist provided a clinical management plan
• A specialized air mattress was delivered within 24 hours along with a motorized wheelchair with needed seating adaptations
• An in-home behavioral health assessment was made along with an individualized care plan that includes medications and counseling
• Transportation was arranged for specialty appointments, dental care, and other activities
• Smoking cessation strategies were instituted
• A primary care physician with support by a nurse practitioner responds first to new problems via home visits.
One year later, Anna was engaged with life, family, community and was able to self manage her care which greatly improved. Also, ulcers were healed, behavior health, psychopharmacology. and in-home counseling was established, smoking cessation efforts were partially effective, asthma exacerbations were greatly diminished, and a continuous relationship with the primary care physician was established although more primary care occurs via a nurse practitioner in the home.
Most importantly, there were only two emergency department visits for asthma exacerbation management and one three day hospitalization for urinary tract infection management, and as a result, hospital utilization was markedly lower than before.
The CCA team-based approach works well with Medicare and Medicaid patients with five or more chronic conditions. According to an AHRQ report “The roles of “Patient-Centered Medical Homes and Accountable Care Organization in Coordinating Patient Care” published December 2010 discusses in detail what has not worked in providing coordinated care.
The report finds that targeted care coordination services provided to low-risk Medicare patients have not been shown to improve the quality or utilization of care and at times have increased overall costs. However, well-designed, targeted care coordination interventions delivered to the right people with multiple chronic conditions can improve patient, provider, and payer outcomes.
Several successful coordinated care models in the U.S show major reductions in emergency room visits, reductions in all-cause hospital admissions, readmissions, nursing home days, and indicate that these care models have achieved net savings and improved quality outcomes especially for high risk patients.
Wednesday, August 17, 2011
Managing Patient Transitions Effectively
Preventing readmissions and shortening the time to do preadmission screenings is very important to Northeast Rehabilitation Hospital located in New Hampshire since the hospital specializes in stroke and traumatic neurological injuries very often resulting in timely and complex patient transitions.
When Patricia Buiocchi, joined Northeast Rehabilitation Hospital, as Vice President of Business Development and Strategic Planning, she was surprised to find liaison clinicians spending most of their day doing data entry work as part of pre-admission screening. The team handles referrals for two acute hospitals with a third on the way, 23 outpatient facilities, and a home care service in southern New Hampshire and northern Massachusetts.
One of Buiocchi’s first moves as was to turn to Curaspan’s “ReferralCentral” a web based referral management software to speed up the process. By using the software, it no longer takes hours of phone calls, emails, and faxes to communicate and find the answers to specific questions.
“It used to take liaisons two hours to input information for each incoming patient. By using “ReferralCentral”, data is delivered in a complete legible referral package. As a result, referrals have jumped 15 percent in 12 months.
In another case, Laura Davie, Project Director for the University of New Hampshire Institute for Health Policy and Practice, has been working with community partners on behalf of the New Hampshire Bureau of Elderly and Adult Services to develop and implement a long term patient-centric hospital discharge planning model to discharge individuals back into the community and hopefully prevent unnecessary readmissions.
Specifically, several models such as the “Better Outcomes for Older Adults through Safe Transitions” (BOOST) and “Care Transitions Intervention” (CTI) developed at the University of Colorado Denver are used to help patients when they are discharged.
New Hampshire’s ServiceLink Aging and Disability Resource Centers are supported by a strong technology-based infrastructure and a team-based approach for operations management. They operate as a single point of entry for all long term care and the transitions specialists provide follow up support intended to prevent readmissions.
Using technology such as the BOOST model enables ServiceLink staff to follow discharges with individuals in high need of social support, and follows patients with complex medications and needs. Under the CTI model, transition coaches are trained to help individuals identify goals and problems but the coaches don’t provide direct medical care to the patient when they leave the hospital
In addition, a workshop held in New Hampshire has been organized that includes three hospitals, three ServiceLink Aging and Disability Resource Centers, several community and case management agencies covering three counties, to support individuals so that they can make informed choices and find access to long-term support including a wide range of in-home, community-based, and institutional services and programs.
When Patricia Buiocchi, joined Northeast Rehabilitation Hospital, as Vice President of Business Development and Strategic Planning, she was surprised to find liaison clinicians spending most of their day doing data entry work as part of pre-admission screening. The team handles referrals for two acute hospitals with a third on the way, 23 outpatient facilities, and a home care service in southern New Hampshire and northern Massachusetts.
One of Buiocchi’s first moves as was to turn to Curaspan’s “ReferralCentral” a web based referral management software to speed up the process. By using the software, it no longer takes hours of phone calls, emails, and faxes to communicate and find the answers to specific questions.
“It used to take liaisons two hours to input information for each incoming patient. By using “ReferralCentral”, data is delivered in a complete legible referral package. As a result, referrals have jumped 15 percent in 12 months.
In another case, Laura Davie, Project Director for the University of New Hampshire Institute for Health Policy and Practice, has been working with community partners on behalf of the New Hampshire Bureau of Elderly and Adult Services to develop and implement a long term patient-centric hospital discharge planning model to discharge individuals back into the community and hopefully prevent unnecessary readmissions.
Specifically, several models such as the “Better Outcomes for Older Adults through Safe Transitions” (BOOST) and “Care Transitions Intervention” (CTI) developed at the University of Colorado Denver are used to help patients when they are discharged.
New Hampshire’s ServiceLink Aging and Disability Resource Centers are supported by a strong technology-based infrastructure and a team-based approach for operations management. They operate as a single point of entry for all long term care and the transitions specialists provide follow up support intended to prevent readmissions.
Using technology such as the BOOST model enables ServiceLink staff to follow discharges with individuals in high need of social support, and follows patients with complex medications and needs. Under the CTI model, transition coaches are trained to help individuals identify goals and problems but the coaches don’t provide direct medical care to the patient when they leave the hospital
In addition, a workshop held in New Hampshire has been organized that includes three hospitals, three ServiceLink Aging and Disability Resource Centers, several community and case management agencies covering three counties, to support individuals so that they can make informed choices and find access to long-term support including a wide range of in-home, community-based, and institutional services and programs.
RFPs for Inmate Health Services
Two states have issued RFPs to find qualified vendors to manage and operate healthcare services for their state Departments of Corrections. Both RFPs include requirements for Electronic Health Records and telemedicine to efficiently deliver healthcare to inmates in the prison setting.
The North Carolina Department of Corrections on July 21, 2011 issued RFP (201100607) with will proposals accepted until May 16, 2012. Services are to be provided onsite but specialized services may be provided through agreements with area providers such as hospitals, clinics, medical specialties, and laboratories.
The North Carolina Department of Corrections would like to increase the number of inmates using telemedicine clinics presently held at two correctional facilities and expand these services to other prison facilities. The Department encourages the use and expansion of telemedicine to the extent possible if used without jeopardizing inmate health status and security.
Presently, telemedicine services are available in cardiology, dermatology, endocrinology, ear, nose, and throat, gastroenterology, infectious disease, internal medicine, pulmonary, physical therapy, speech pathology, rheumatology, podiatry, sound management, and psychiatry.
The Unified Electronic Health Record System with a data integrated software application in the correctional facility must comply with the Reform Act to allow access to patient information at all North Carolina Department of Corrections facilities. The system needs to be able to integrate all clinical patient data plus any treatment data from any external providers. The system needs to support at a minimum 40,000 active patients dispersed over a minimum of 70 geographic locations.
For more information, contact Mildred Christmas, Division of Purchase and Contract at mildred.christmas@doa.nc.gov or call (919) 807-4525. To view the RFP, go to www.ips.state.nc.us/ips/AGENCY/PDF/08403200.pdf.
The state of Maryland on July 8, 2011 issued a Request for Proposals for Inmate Medical Healthcare and Utilization Services RFP (DPSCSQ0012013) to be delivered September 7, 2011.
Telemedicine has priority for inmates located in the western and eastern parts of the state. The contractor will need to continue to maintain the Department’s Hepatitis Tele-medical program as required by the department’s infectious disease manual. Telemedicine specialty care will need to be available within the first 6 months of the contract award for cardiology, wound care orthopedic optometry, dermatology, and for trauma care. The contractor will need to maintain the electronic log documenting the use of telemedicine.
Presently, the EHR system known as NextGen maintains demographics notes, outside consults, dialysis flow sheets, obstetrical prenatal flow shees, and data on specialty care, diabetics, cardiology patients, and patients with infectious diseases.
For more information, contact Andrea R. Lockett at alockett@dbm.state.md.us or call (410) 260-7374. To view the RFP, go to www.dbm.maryland.gov/agencies/procurement/Pages/InamteMedHealthCare.aspx.
The North Carolina Department of Corrections on July 21, 2011 issued RFP (201100607) with will proposals accepted until May 16, 2012. Services are to be provided onsite but specialized services may be provided through agreements with area providers such as hospitals, clinics, medical specialties, and laboratories.
The North Carolina Department of Corrections would like to increase the number of inmates using telemedicine clinics presently held at two correctional facilities and expand these services to other prison facilities. The Department encourages the use and expansion of telemedicine to the extent possible if used without jeopardizing inmate health status and security.
Presently, telemedicine services are available in cardiology, dermatology, endocrinology, ear, nose, and throat, gastroenterology, infectious disease, internal medicine, pulmonary, physical therapy, speech pathology, rheumatology, podiatry, sound management, and psychiatry.
The Unified Electronic Health Record System with a data integrated software application in the correctional facility must comply with the Reform Act to allow access to patient information at all North Carolina Department of Corrections facilities. The system needs to be able to integrate all clinical patient data plus any treatment data from any external providers. The system needs to support at a minimum 40,000 active patients dispersed over a minimum of 70 geographic locations.
For more information, contact Mildred Christmas, Division of Purchase and Contract at mildred.christmas@doa.nc.gov or call (919) 807-4525. To view the RFP, go to www.ips.state.nc.us/ips/AGENCY/PDF/08403200.pdf.
The state of Maryland on July 8, 2011 issued a Request for Proposals for Inmate Medical Healthcare and Utilization Services RFP (DPSCSQ0012013) to be delivered September 7, 2011.
Telemedicine has priority for inmates located in the western and eastern parts of the state. The contractor will need to continue to maintain the Department’s Hepatitis Tele-medical program as required by the department’s infectious disease manual. Telemedicine specialty care will need to be available within the first 6 months of the contract award for cardiology, wound care orthopedic optometry, dermatology, and for trauma care. The contractor will need to maintain the electronic log documenting the use of telemedicine.
Presently, the EHR system known as NextGen maintains demographics notes, outside consults, dialysis flow sheets, obstetrical prenatal flow shees, and data on specialty care, diabetics, cardiology patients, and patients with infectious diseases.
For more information, contact Andrea R. Lockett at alockett@dbm.state.md.us or call (410) 260-7374. To view the RFP, go to www.dbm.maryland.gov/agencies/procurement/Pages/InamteMedHealthCare.aspx.
CMS Issues Presolicitation
CMS plans to award multiple “Indefinite Delivery/Indefinite Quantity” (ID/IQ) contracts to support Virtual Data Centers (VDC) to do complex operations with fairly simple hardware. The VDCs will provide the IT infrastructure and services to operate CMS business systems and safeguard the data.
The original presolicitation was posted on www.fbo.gov on August 4, 2011 with a new posting on August 8, 2011. The presolicitation number is (APP130023).
Some of the RFPs will award contracts to manage all the activities while other RFPs will provide desk support, funding to maintain the centers and provide the training as needed. Task Order 1 is the Large Umbrella ID/IQ and Task Order 2 provides for a national data warehouse.
CMS will conduct an Industry Day Webinar at 9:00A.M (Eastern) time on October 14, 2011. If vendors wish to participate in this webinar, vendors must RSVP by 12 noon (Eastern) on August 26, 2011 with an email. The words “VDC WEBINAR RSVP” must be in the subject line and send to OAGM_dsc@cms.hhs.gov.
In preparation for the VDC Industry Day Webinar, questions and comments need to be submitted by 12 noon (Eastern) September 2, 2011 with the words “VDC WEBINAR Questions/Comments” in the subject line. Send the email to OAGM_dsc@cms.hhs.gov.
Participating parties will be limited to 5 access lines, so conferencing at the vendor’s sites is encouraged. Additional detailed information about the VDC Industry Day Webinar will be provided to those vendors that RSVP.
The original presolicitation was posted on www.fbo.gov on August 4, 2011 with a new posting on August 8, 2011. The presolicitation number is (APP130023).
Some of the RFPs will award contracts to manage all the activities while other RFPs will provide desk support, funding to maintain the centers and provide the training as needed. Task Order 1 is the Large Umbrella ID/IQ and Task Order 2 provides for a national data warehouse.
CMS will conduct an Industry Day Webinar at 9:00A.M (Eastern) time on October 14, 2011. If vendors wish to participate in this webinar, vendors must RSVP by 12 noon (Eastern) on August 26, 2011 with an email. The words “VDC WEBINAR RSVP” must be in the subject line and send to OAGM_dsc@cms.hhs.gov.
In preparation for the VDC Industry Day Webinar, questions and comments need to be submitted by 12 noon (Eastern) September 2, 2011 with the words “VDC WEBINAR Questions/Comments” in the subject line. Send the email to OAGM_dsc@cms.hhs.gov.
Participating parties will be limited to 5 access lines, so conferencing at the vendor’s sites is encouraged. Additional detailed information about the VDC Industry Day Webinar will be provided to those vendors that RSVP.
Sunday, August 14, 2011
FCC's 5 Step NG9-1-1 Plan
The FCC’s 5 Step Action Plan charting the transition to Next Generation 9-1-1 (NG9-1-1) services, was presented by FCC Chairman Julius Genachowski at the Association of Public Safety Communications Officials conference held in Philadelphia. He told the attendees how he used to work in emergency response. In the 1980s, he was a certified EMT, worked on ambulances in Manhattan, and taught CPR. Like many others, he was in New York on 9/11, walking to work on 8th Avenue when the planes struck.
He explained how NG9-1-1 allows consumers to use any communication device that is available in an emergency. People are going to reach out for help with whatever means of communications they are accustomed to using. A growing number of people use texting but unfortunately the current emergency system doesn’t support texting. It’s hard to imagine that airlines can send text messages if your flight is delayed, but you can’t send a text message to 9-1-1 in an emergency. NG9-1-1 will make sure that your call for help in an emergency is delivered.
Imagine if someone is in a car accident. With NG9-1-1, someone in the car could send pictures of the injuries and the scene to 9-1-1, which EMTs could review in advance. Once on the scene, EMTs could send critical information back to the hospital, including on-site scans and diagnostic information.
With NG9-1-1, dispatchers could access hospital capacity data, real-time road and traffic conditions, and videos from the crash scene available from traffic cameras to decide who to dispatch and where to transport the crash victims.
In another possible scenario, if a patient wearing a 27/7 cardiac monitoring device experiences a cardiac event at home, the device could automatically send a wireless signal to the NG9-1-1 system to request aid, and be able to transmit the patient’s location, identifying data, and relevant medical information.
At the conference, Genachowski presented FCC’s new five stop plan to meet the future needs for NG9-1-1:
• NG9-1-1 location accuracy mechanisms need to be developed. The FCC has already taken steps to improve the accuracy of mobile 9-1-1 and is tackling NG9-1-1 location accuracy.
Last month, the FCC strengthened existing enhanced 9-1-1 location accuracy rules, by requiring all wireless carriers to meet more stringent metrics
• NG9-1-1 technical standards defining the system’s architecture needs to be implemented. Hardware and software has to help carriers and Public Safety Answering Points (PSAP) communicate NG9-1-1 information seamlessly. The 9-1-1 community has completed much of the necessary standards work, but some issues remain on how the architecture will be implemented
• A NG9-1-1 governance framework needs to be developed but the biggest challenge facing NG9-1-1 deployment is that no single entity has jurisdiction. The FCC is working with other federal agencies and 9-1-1 authorities to create a governing framework
• Ways to fund NG9-1-1 in a cost-efficient way needs to be established. The FCC’s Public Safety Bureau is preparing a cost model to identify the expenses associated with deploying the network infrastructure to link PSAPs and carriers.
• The FCC will consider a Notice of Proposed Rulemaking to accelerate NG9-1-1 adoption. The intent is to help answer the practical and technical questions on how to enable the transmission of text, photos, and videos to 9-1-1. The rulemaking will also consider how to ensure adequate broadband infrastructure to deliver the bandwidth that PSAPs will need to provide NG9-1-1
Genachowski commented that not only is the FCC working on building a 21st century 9-1-1 system, but industry is taking part in trials. For example, The City of Durham, North Carolina, Verizon and Intrado have launched a six month text-to-9-1-1 trial. In addition, Neustar has been demonstrating “Text Everywhere” a text-to-wireline solution holding real promise for NG9-1-1.
The FCC Chairman explained how the FCC’s five step action plan builds on the launching a few months ago of the Personal Localized Alerting Network (PLAN). PLAN will enable government officials to send text-like alerts to everyone in a targeted geographic area with an enabled mobile device. Since the alerts are geographically targeted, they will reach the right people, at the right time, with the right messages. He announced that PLAN will launch nationwide in April 2012.
He explained how NG9-1-1 allows consumers to use any communication device that is available in an emergency. People are going to reach out for help with whatever means of communications they are accustomed to using. A growing number of people use texting but unfortunately the current emergency system doesn’t support texting. It’s hard to imagine that airlines can send text messages if your flight is delayed, but you can’t send a text message to 9-1-1 in an emergency. NG9-1-1 will make sure that your call for help in an emergency is delivered.
Imagine if someone is in a car accident. With NG9-1-1, someone in the car could send pictures of the injuries and the scene to 9-1-1, which EMTs could review in advance. Once on the scene, EMTs could send critical information back to the hospital, including on-site scans and diagnostic information.
With NG9-1-1, dispatchers could access hospital capacity data, real-time road and traffic conditions, and videos from the crash scene available from traffic cameras to decide who to dispatch and where to transport the crash victims.
In another possible scenario, if a patient wearing a 27/7 cardiac monitoring device experiences a cardiac event at home, the device could automatically send a wireless signal to the NG9-1-1 system to request aid, and be able to transmit the patient’s location, identifying data, and relevant medical information.
At the conference, Genachowski presented FCC’s new five stop plan to meet the future needs for NG9-1-1:
• NG9-1-1 location accuracy mechanisms need to be developed. The FCC has already taken steps to improve the accuracy of mobile 9-1-1 and is tackling NG9-1-1 location accuracy.
Last month, the FCC strengthened existing enhanced 9-1-1 location accuracy rules, by requiring all wireless carriers to meet more stringent metrics
• NG9-1-1 technical standards defining the system’s architecture needs to be implemented. Hardware and software has to help carriers and Public Safety Answering Points (PSAP) communicate NG9-1-1 information seamlessly. The 9-1-1 community has completed much of the necessary standards work, but some issues remain on how the architecture will be implemented
• A NG9-1-1 governance framework needs to be developed but the biggest challenge facing NG9-1-1 deployment is that no single entity has jurisdiction. The FCC is working with other federal agencies and 9-1-1 authorities to create a governing framework
• Ways to fund NG9-1-1 in a cost-efficient way needs to be established. The FCC’s Public Safety Bureau is preparing a cost model to identify the expenses associated with deploying the network infrastructure to link PSAPs and carriers.
• The FCC will consider a Notice of Proposed Rulemaking to accelerate NG9-1-1 adoption. The intent is to help answer the practical and technical questions on how to enable the transmission of text, photos, and videos to 9-1-1. The rulemaking will also consider how to ensure adequate broadband infrastructure to deliver the bandwidth that PSAPs will need to provide NG9-1-1
Genachowski commented that not only is the FCC working on building a 21st century 9-1-1 system, but industry is taking part in trials. For example, The City of Durham, North Carolina, Verizon and Intrado have launched a six month text-to-9-1-1 trial. In addition, Neustar has been demonstrating “Text Everywhere” a text-to-wireline solution holding real promise for NG9-1-1.
The FCC Chairman explained how the FCC’s five step action plan builds on the launching a few months ago of the Personal Localized Alerting Network (PLAN). PLAN will enable government officials to send text-like alerts to everyone in a targeted geographic area with an enabled mobile device. Since the alerts are geographically targeted, they will reach the right people, at the right time, with the right messages. He announced that PLAN will launch nationwide in April 2012.
Northa Dakota HIT Update
North Dakota is involved in several initiatives and rapidly providing essential broadband services and health technology needs in the state. Today, the Dakota Carrier Network (DCN) CCI Broadband project provides high-speed fiber connectivity to more than 175 largely rural and underserved areas where many community anchor organizations lack access to necessary last mile broadband speeds. DCN received $10.7 million in grant dollars but will provide a cash match of $4.6 million. DCN will complete 100 percent of the project by August 2013.
DCN intends to deploy 169 miles of new fiber with backhaul speeds as fast as 1 gigabit per second (Gbps) to enable last-mile service across the state. The project also proposes to enhance e-health in the state by deploying a dedicated 10 Gbps healthcare network to over 200 hospitals, clinics, and other healthcare providers. They are committed to providing telemedicine, teleradiology, telepharmacy, and enabling the exchange of health information electronically. For more information on DCN, email Seth Arndorfer at seth@dakotacarrier.com
The procurement of an HIE system began in late 2010 with the release of a RFP. At that time, the proposals and demonstrations by the top three vendors were reviewed. In June 2011, the team recommended to the Health Information Technology Advisory Committee (HITAC) that the contract be awarded to Optuminsight.
The first phase of the HIE project will deploy “Direct” functionality by November 2011. “Direct” is a bridge to meaningful use while the state HIE is being implemented. Direct is a simple and secure method for participants to send encrypted health information directly to known trusted recipients.
Once the HIE is fully implemented in 2011-2012, participants will be able to use a robust bi-directional HIE to fully support meaningful use and health IT requirements. The state Department of Health, Division of Disease Control, will be able to receive electronic messages to include laboratory results, surveillance data, and be able to update immunization registries.
HITAC has formed HIE Domain Workgroups currently being rolled out. These workgroup teams are playing a key role in planning, advising, and providing guidelines that will cover topics related to governance, business opportunities, legalities and policies, technical infrastructure, and also tackle issues related to the clinical workforce, communications and education, and finance.
The Clinical Workforce Team was specifically formed to:
• Support HIT and HIE adoption and meaningful use among state providers
• Develop and evaluate the project in terms of data collection and performance measurements
• Define and address high-value/high priority uses and/or use cases for HIE consistent with proposed meaningful use of certified EHR technology and additional clinical priorities
To help providers obtain the skills and tools needed to make technology changes in their practices, the Regional Extension Assistance Center for HIT (REACH), a nonprofit federal HIT Center is helping Minnesota and North Dakota primary care providers advance HIT. REACH provides readiness assessments, practice and workflow redesigns, help selecting a certified EHR product, help connecting with vendors, and provides information on privacy and security best practices. For more information, go to http://www.khareach.org/.
To provide financing assistance, Senate Bill 2332 established a HIT planning revolving loan fund with the Bank of North Dakota to provide low-interest loans to healthcare entities to help build their HIT infrastructure. The loan fund can assist with the purchase, installation, and be used to support functional standards based interoperable HIT systems.
It is anticipated that available funds for loans could be $5.4 million which includes the additional $5 million appropriated by the 2011 Legislature. The maximum loan amount per applicant is $100,000 for standalone individual practitioners not affiliated with a multi-professional entity, provider system, or network, $400,000 for hospitals and multi-professional entities, and $800,000 for entities with three or more provider-owned facilities as in the case of a hospital with two or more clinics or three hospitals all under common ownership/governance.
North Dakota residents are eligible for the loans to purchase install and/or support software and hardware required to implement a fully functional, standards-based, interoperable EHR system certified by ONC. The loans can be used towards systems containing patient medical histories, electronic personal health records for people with chronic diseases, along with using the system for electronic prescribing.
Initial applications are due by August 22, 2011 with applicants to be notified by September 9, 2011 if their loan has been approved. For more information, go to www.healthit.nd.gov/loan-program.
There is also a Federal financing option available to help meet the expense for EMR software to help rural areas and towns with up to 20,000 in population. The USDA Community Facilities Program provides flexible financial tools including the Community Facilities Guaranteed Loan Program, the Community Facilities Direct Loan Program, and the Community Facilities Grant Program. For more information, email info@nd.usda.gov or call (701) 530-2037.
For more information on North Dakota’s progress, go to http://www.healthit.nd.gov/.
DCN intends to deploy 169 miles of new fiber with backhaul speeds as fast as 1 gigabit per second (Gbps) to enable last-mile service across the state. The project also proposes to enhance e-health in the state by deploying a dedicated 10 Gbps healthcare network to over 200 hospitals, clinics, and other healthcare providers. They are committed to providing telemedicine, teleradiology, telepharmacy, and enabling the exchange of health information electronically. For more information on DCN, email Seth Arndorfer at seth@dakotacarrier.com
The procurement of an HIE system began in late 2010 with the release of a RFP. At that time, the proposals and demonstrations by the top three vendors were reviewed. In June 2011, the team recommended to the Health Information Technology Advisory Committee (HITAC) that the contract be awarded to Optuminsight.
The first phase of the HIE project will deploy “Direct” functionality by November 2011. “Direct” is a bridge to meaningful use while the state HIE is being implemented. Direct is a simple and secure method for participants to send encrypted health information directly to known trusted recipients.
Once the HIE is fully implemented in 2011-2012, participants will be able to use a robust bi-directional HIE to fully support meaningful use and health IT requirements. The state Department of Health, Division of Disease Control, will be able to receive electronic messages to include laboratory results, surveillance data, and be able to update immunization registries.
HITAC has formed HIE Domain Workgroups currently being rolled out. These workgroup teams are playing a key role in planning, advising, and providing guidelines that will cover topics related to governance, business opportunities, legalities and policies, technical infrastructure, and also tackle issues related to the clinical workforce, communications and education, and finance.
The Clinical Workforce Team was specifically formed to:
• Support HIT and HIE adoption and meaningful use among state providers
• Develop and evaluate the project in terms of data collection and performance measurements
• Define and address high-value/high priority uses and/or use cases for HIE consistent with proposed meaningful use of certified EHR technology and additional clinical priorities
To help providers obtain the skills and tools needed to make technology changes in their practices, the Regional Extension Assistance Center for HIT (REACH), a nonprofit federal HIT Center is helping Minnesota and North Dakota primary care providers advance HIT. REACH provides readiness assessments, practice and workflow redesigns, help selecting a certified EHR product, help connecting with vendors, and provides information on privacy and security best practices. For more information, go to http://www.khareach.org/.
To provide financing assistance, Senate Bill 2332 established a HIT planning revolving loan fund with the Bank of North Dakota to provide low-interest loans to healthcare entities to help build their HIT infrastructure. The loan fund can assist with the purchase, installation, and be used to support functional standards based interoperable HIT systems.
It is anticipated that available funds for loans could be $5.4 million which includes the additional $5 million appropriated by the 2011 Legislature. The maximum loan amount per applicant is $100,000 for standalone individual practitioners not affiliated with a multi-professional entity, provider system, or network, $400,000 for hospitals and multi-professional entities, and $800,000 for entities with three or more provider-owned facilities as in the case of a hospital with two or more clinics or three hospitals all under common ownership/governance.
North Dakota residents are eligible for the loans to purchase install and/or support software and hardware required to implement a fully functional, standards-based, interoperable EHR system certified by ONC. The loans can be used towards systems containing patient medical histories, electronic personal health records for people with chronic diseases, along with using the system for electronic prescribing.
Initial applications are due by August 22, 2011 with applicants to be notified by September 9, 2011 if their loan has been approved. For more information, go to www.healthit.nd.gov/loan-program.
There is also a Federal financing option available to help meet the expense for EMR software to help rural areas and towns with up to 20,000 in population. The USDA Community Facilities Program provides flexible financial tools including the Community Facilities Guaranteed Loan Program, the Community Facilities Direct Loan Program, and the Community Facilities Grant Program. For more information, email info@nd.usda.gov or call (701) 530-2037.
For more information on North Dakota’s progress, go to http://www.healthit.nd.gov/.
States Announce Funding
The New York State Department of Health, Bureau of Community Chronic Disease Prevention’s Asthma Program seeks applications to establish and/or expand Regional Asthma Coalitions (RAC) in high-risk geographic areas of New York State. The overall goal is to control asthma through a regional, population-based and sustainable systems approach. The objective is to decrease the number of hospitalizations and emergency department visits, decrease the number of school/work days lost, and decrease the number of clinic/provider office urgent care visits.
The RACs will implement interventions outlined by the “National Asthma Education Prevention Program”, “Expert Panel Report”, and “Guidelines for the Diagnosis and Management of Asthma” into practices in their regions.
Eligible applicants must be public and private not-for-profit organizations in New York State including but not limited to hospitals, primary care practices and networks, clinics, physician groups, health plans, local public health agencies, universities and colleges, schools and school districts, voluntary associations, foundations, scientific or professional associations, and community-based organizations with experience and expertise in the administration of coalitions or collaborative partnerships to address public health problems.
Applicants applying must have experience with:
• Engaging stakeholders and leading a coalition/collaborative on a regional level
• Using data to assess local asthma burden
• Developing a strategic plan to address local health problems
• Monitoring, evaluating, and reporting the results on collaborative efforts
• Applying the “Chronic Care Model”
• Utilizing process and outcome data to make system improvements
Up to eight contracts will be awarded. The estimated annual funding amount per contract is $18,000. The final number of awards and final award amounts will depend on funds available.
RFA (1012090253) was released in June with applications due August 29, 2011. To view the RFA, go to www.health.state.ny.us/funding/rfa/1012090253.pdf. For more information, email Marianne Heigel, RN at RACRFA@health.state.ny.us.
The Mississippi Department of Information Technology Services has released (RFP 3660) seeking proposals to enhance or replace an existing clinical Laboratory Information Management system (LIMS) for the Mississippi Public Health Laboratory (MPHL). The MPHL performs over 600,000 tests annually to support public health activities in the state and has two laboratory facilities located within three miles of each other in Jackson Mississippi.
The LIMS needs to improve the MPHL’s level of automation by improving the functionality of current testing algorithms to meet the needs of changing laboratory practices, create new test-specific configurations to enable additional test data to be released electronically through HL7 technology, create user-specified data retrieval reports, and provide additional instrument/LIMS interfaces to automatically release data from the instrumentation into the LIMS.
The RFP released August 2, 2011 requires the proposal to be submitted September 1, 2011. For more information, contact Donna Hamilton at (601) 432-8114 or email Donna.Hamilton@its.ms.gov.
The Minnesota Department of Human Services (DHS) is interested in an integrated service delivery and payment system to support all DHS programs. DHS on August 1, 2011 issued a Request for Information (RFI) to find out about available commercial-off-the-shelf software. This RFI is the first step in the possible development and implementation of a comprehensive, fully integrated human services delivery management system.
The software will be used to support case management, eligibility determinations, benefit payments, provider payments, healthcare enrollments, and child support collections. DHS seeks a product designed to be easily installed and to be interoperable with existing system components.
The RFI in writing is due August 29, 2011 with presentations or demonstrations if applicable to be held in September/October 2011. For more information, email Jennifer Trombley at Jennifer.Trombley@state.mn.us or go to www.dhs.state.mn.us/id_000102.
The RACs will implement interventions outlined by the “National Asthma Education Prevention Program”, “Expert Panel Report”, and “Guidelines for the Diagnosis and Management of Asthma” into practices in their regions.
Eligible applicants must be public and private not-for-profit organizations in New York State including but not limited to hospitals, primary care practices and networks, clinics, physician groups, health plans, local public health agencies, universities and colleges, schools and school districts, voluntary associations, foundations, scientific or professional associations, and community-based organizations with experience and expertise in the administration of coalitions or collaborative partnerships to address public health problems.
Applicants applying must have experience with:
• Engaging stakeholders and leading a coalition/collaborative on a regional level
• Using data to assess local asthma burden
• Developing a strategic plan to address local health problems
• Monitoring, evaluating, and reporting the results on collaborative efforts
• Applying the “Chronic Care Model”
• Utilizing process and outcome data to make system improvements
Up to eight contracts will be awarded. The estimated annual funding amount per contract is $18,000. The final number of awards and final award amounts will depend on funds available.
RFA (1012090253) was released in June with applications due August 29, 2011. To view the RFA, go to www.health.state.ny.us/funding/rfa/1012090253.pdf. For more information, email Marianne Heigel, RN at RACRFA@health.state.ny.us.
The Mississippi Department of Information Technology Services has released (RFP 3660) seeking proposals to enhance or replace an existing clinical Laboratory Information Management system (LIMS) for the Mississippi Public Health Laboratory (MPHL). The MPHL performs over 600,000 tests annually to support public health activities in the state and has two laboratory facilities located within three miles of each other in Jackson Mississippi.
The LIMS needs to improve the MPHL’s level of automation by improving the functionality of current testing algorithms to meet the needs of changing laboratory practices, create new test-specific configurations to enable additional test data to be released electronically through HL7 technology, create user-specified data retrieval reports, and provide additional instrument/LIMS interfaces to automatically release data from the instrumentation into the LIMS.
The RFP released August 2, 2011 requires the proposal to be submitted September 1, 2011. For more information, contact Donna Hamilton at (601) 432-8114 or email Donna.Hamilton@its.ms.gov.
The Minnesota Department of Human Services (DHS) is interested in an integrated service delivery and payment system to support all DHS programs. DHS on August 1, 2011 issued a Request for Information (RFI) to find out about available commercial-off-the-shelf software. This RFI is the first step in the possible development and implementation of a comprehensive, fully integrated human services delivery management system.
The software will be used to support case management, eligibility determinations, benefit payments, provider payments, healthcare enrollments, and child support collections. DHS seeks a product designed to be easily installed and to be interoperable with existing system components.
The RFI in writing is due August 29, 2011 with presentations or demonstrations if applicable to be held in September/October 2011. For more information, email Jennifer Trombley at Jennifer.Trombley@state.mn.us or go to www.dhs.state.mn.us/id_000102.
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