Growing populations of runaway and homeless adolescents face a higher than average risk of physical and mental health problems, but at the same time, have significant difficulties in accessing medical care. When medical issues arise, this group needs help but have few means of financial support.
Compared to the general adolescent population, homeless and runaway teens are significantly less likely to receive routine healthcare and more likely to seek emergency services. In general, they lack health insurance or money to pay for clinic visits, lack transportation to facilities, face insensitive attitudes among providers due to their minor status.
In addition, they often lack acceptable forms of identification and a safe place to keep important documents such as birth certificates and immunization records to help them gain access to care on an ongoing basis.
“Wind Youth Services” with the help of their technology partner “FollowMe” now offer a web-based personal health information service to homeless and runaway adolescents aged 11 to 22 via “Healthshack". This web service enables youths to enter, update, and access critical personal information such as their health history, proof of identity and insurance, hospital visits, immunizations, and laboratory results. The service also helps the youths find needed health resources, such as clinics, physicians, and medical products. Nurses, professional youth advocates, and peer advisors known as “health ambassadors” assist the adolescents in finding services.
“Wind Youth Services” initially received a grant from the Sierra Health Foundation to cover the costs of adapting the software and implementing the service on a pilot basis. Grants for $50,000 and $100,000 were awarded to fund the development of pilot versions of “Healthshack” and to provide ongoing financial support to the program.
Later in 2009, project leaders received a $400,000 grant from United Health Group to cover the costs for developing further versions of the software. The funding enabled the full-scale implementation of “Healthshack”. Today the program is focused on marketing the program’s value to communities and is looking to find other community organizations to offer the program.
As for costs, the chief expense consists of the upfront development costs and the ongoing annual licensing fee for the software. Program-related staffing costs are minimal because the physicians and nurses volunteer their time, and youth advocates participate as part of their regular jobs, with health ambassadors receiving a small monthly stipend for serving as health ambassadors.
Go to www.innovations.ahrq.gov or to https://www.healthshack.info/Defautl.aspx for more details on the program.
Wednesday, March 30, 2011
Telemedicine Issues Discussed
A Symposium held in Washington D.C on March 10, 2011 “Balancing Access, Safety, and Quality in a New Era of Telemedicine” hosted by the Federation of State Medical Boards discussed telemedicine’s future and the impact on healthcare.
About 100 participants spent the day exchanging ideas in both large and small group sessions focusing on technology, technology issues relating to patients, providers, and payers, and the role that state and federal policy should play in determining telemedicine’s future.
Vanessa Orlando, Executive Director, of the Rural Maryland Council and Jennifer Witten, Director of Government Relations for the American Heart and Stroke Association recently submitted their summary of the “Thinking Points” presented at the symposium.
Dr. Sachin Jain, Senior Advisor in the Office of the Administrator at CMS in his keynote address discussed the barriers to hindering the development of telehealth. According to Jain, although some of the providers are hesitant to adopt and use technology, the availability of technology is not really the problem. The real issue is reimbursement which has played a much more major role in slowing the adoption of technology.
Added to these problems, the culture in medical education and practice does not encourage physicians to embrace technology. Medical education still follows the traditional method of academic instruction that emphasizes a hands-on model with patients with the result that physicians are not infusing technology into their practices.
Dr Jain mentioned that several gray areas need to be addressed such as major concerns related to licensing and credentialing. It was also mentioned several times at the symposium that it is imperative that licensing and credentialing needs to be made easier, faster, and portable with a comprehensive verification system put in place.
Also, if care is provided across state lines then reimbursement issues must be addressed. Questions are being asked as to which state would be the disciplinary body if several states are involved, how to deal with differences in background standards and practice standards, and how to develop a common language with national definitions of certain words and phrases.
One important question asked is if a critically ill patient is transported to another facility and/or a facility across state lines—then what are the liability issues? Another panel tackled the issues of access, safety, and quality in telemedicine.
One important point was made that telemedicine doesn’t always result in an overall cost savings. Although it often increases access to care for more people and may reduce the per-person cost, using technology does not always reduce over-all costs.
In addition to the “Thinking Point” document recently released, the Federation of State Medical Boards (FSMB) plans to publish a white paper complete with the full scope of the symposium discussions.
The FSMB is also in the process of developing an action plan that is based on the ideas and feedback presented at the break-out sessions. Go to www.rural.state.md.us/Publications/?index.html to view the “Thinking Points” summary and other available reports and statements.
About 100 participants spent the day exchanging ideas in both large and small group sessions focusing on technology, technology issues relating to patients, providers, and payers, and the role that state and federal policy should play in determining telemedicine’s future.
Vanessa Orlando, Executive Director, of the Rural Maryland Council and Jennifer Witten, Director of Government Relations for the American Heart and Stroke Association recently submitted their summary of the “Thinking Points” presented at the symposium.
Dr. Sachin Jain, Senior Advisor in the Office of the Administrator at CMS in his keynote address discussed the barriers to hindering the development of telehealth. According to Jain, although some of the providers are hesitant to adopt and use technology, the availability of technology is not really the problem. The real issue is reimbursement which has played a much more major role in slowing the adoption of technology.
Added to these problems, the culture in medical education and practice does not encourage physicians to embrace technology. Medical education still follows the traditional method of academic instruction that emphasizes a hands-on model with patients with the result that physicians are not infusing technology into their practices.
Dr Jain mentioned that several gray areas need to be addressed such as major concerns related to licensing and credentialing. It was also mentioned several times at the symposium that it is imperative that licensing and credentialing needs to be made easier, faster, and portable with a comprehensive verification system put in place.
Also, if care is provided across state lines then reimbursement issues must be addressed. Questions are being asked as to which state would be the disciplinary body if several states are involved, how to deal with differences in background standards and practice standards, and how to develop a common language with national definitions of certain words and phrases.
One important question asked is if a critically ill patient is transported to another facility and/or a facility across state lines—then what are the liability issues? Another panel tackled the issues of access, safety, and quality in telemedicine.
One important point was made that telemedicine doesn’t always result in an overall cost savings. Although it often increases access to care for more people and may reduce the per-person cost, using technology does not always reduce over-all costs.
In addition to the “Thinking Point” document recently released, the Federation of State Medical Boards (FSMB) plans to publish a white paper complete with the full scope of the symposium discussions.
The FSMB is also in the process of developing an action plan that is based on the ideas and feedback presented at the break-out sessions. Go to www.rural.state.md.us/Publications/?index.html to view the “Thinking Points” summary and other available reports and statements.
Cochlear Implant Research
Many cochlear implant users may soon be able to easily modify the settings on their hearing devices using a smartphone interface such as a PDA. The PDA is easily adaptable to new and emerging technologies without the need to change or build new hardware. The interface used between mobile devices and cochlear implants could replace the speech processor that cochlear implant users now wear behind the ear.
An implant has:
• A Microphone which picks up sound from the environment
• A Speech processor, which selects and arranges sounds picked up by the microphone
• A Transmitter and receiver/stimulator which receives signals from the speech processor and converts the signals into electric impulses
• An electrode array to collect impulses from the stimulator and then sends them to different regions of the auditory nerve
The new technology will provide flexibility so that cochlear implant users will be able to change the programs in their device with a great deal of flexibility. The new technology will also enable cochlear implant users to get additional help by recording speech and other environmental sounds that they find particularly challenging.
Ten healthcare and research facilities are slated to participate in clinical trials of the technology pending FDA approval, reports Dr. Philip Loizou, Director of the Cochlear Implant Lab at the University of Texas at Dallas and Principal Investigator for the $2.5 million project funded by NIH.
The University of California at Irvine in their Cochlear Implant Center are doing some other cutting edge collaborative research to develop the first implantable device to replace the balance function, designing a new generation of cochlear implant electrodes, and developing a cochlear implant sound simulator.
Other ongoing research by the NIH National Institute on Deafness and other Communication Disorders (NIDCD) reports that researchers in the field are working on using a shortened electrode array inserted into a portion of the cochlear for individuals whose hearing loss is limited to the higher frequencies.
Other studies are exploring how to make a cochlear implant convey the sounds of speech more clearly, and researchers are also looking at the potential benefits of pairing a cochlear implant in one ear with either another cochlear implant or a hearing aid in the other ear.
An implant has:
• A Microphone which picks up sound from the environment
• A Speech processor, which selects and arranges sounds picked up by the microphone
• A Transmitter and receiver/stimulator which receives signals from the speech processor and converts the signals into electric impulses
• An electrode array to collect impulses from the stimulator and then sends them to different regions of the auditory nerve
The new technology will provide flexibility so that cochlear implant users will be able to change the programs in their device with a great deal of flexibility. The new technology will also enable cochlear implant users to get additional help by recording speech and other environmental sounds that they find particularly challenging.
Ten healthcare and research facilities are slated to participate in clinical trials of the technology pending FDA approval, reports Dr. Philip Loizou, Director of the Cochlear Implant Lab at the University of Texas at Dallas and Principal Investigator for the $2.5 million project funded by NIH.
The University of California at Irvine in their Cochlear Implant Center are doing some other cutting edge collaborative research to develop the first implantable device to replace the balance function, designing a new generation of cochlear implant electrodes, and developing a cochlear implant sound simulator.
Other ongoing research by the NIH National Institute on Deafness and other Communication Disorders (NIDCD) reports that researchers in the field are working on using a shortened electrode array inserted into a portion of the cochlear for individuals whose hearing loss is limited to the higher frequencies.
Other studies are exploring how to make a cochlear implant convey the sounds of speech more clearly, and researchers are also looking at the potential benefits of pairing a cochlear implant in one ear with either another cochlear implant or a hearing aid in the other ear.
HIN Helps in Rural Kansas
A rural Kansas Health Information Network (KHIN) will help rural medical providers in Kansas exchange digital health records, link individual medical providers, but also link regional exchanges such as the Wichita Health Information and eHealthAlign in Kansas City into a single statewide network.
“Healthcare really is local and regional, and Kansas City is not going to want to do the same thing as Wichita, nor will the rural Health Information Network want to do exactly what the urban organizations are doing, so KHIN has to be responsive to the needs of each organization”, according to Laura McCrary, Director of the Kansas Health Information Network.
As explained by McCrary, “The large urban areas have the resources and the provider base to bring the community together to use the HIE but rural communities and hospitals generally don’t have the required expertise and are located all over the state.”
About a dozen hospitals are ready to begin working with the rural network as reported by McCrary, and have implemented enough of their electronic health record systems that they now are able to begin to exchange information “The new rural network will be comparable to the urban based networks and help providers with similar needs decide how to share data and understand what privacy and security protocols need to be place,” said McCrary.
The Kansas Foundation for Medical Care as the operator of the Regional Extension Center was granted a total of $9.1 million to help the state’s more than 1,900 healthcare providers’ transition to EHRs and help with EHR adoption in both urban and rural communities.
The REC works with healthcare providers to help them select their software vendor. For example, Ness County Administrator Kyle Hahn reports that his 20 bed critical access hospital in western Kansas spent several months evaluating EHR systems. The hospital eventually based their selection of the vendor on cost and the company’s ability to program a custom interface with Ness County’s practice management software.
“Healthcare really is local and regional, and Kansas City is not going to want to do the same thing as Wichita, nor will the rural Health Information Network want to do exactly what the urban organizations are doing, so KHIN has to be responsive to the needs of each organization”, according to Laura McCrary, Director of the Kansas Health Information Network.
As explained by McCrary, “The large urban areas have the resources and the provider base to bring the community together to use the HIE but rural communities and hospitals generally don’t have the required expertise and are located all over the state.”
About a dozen hospitals are ready to begin working with the rural network as reported by McCrary, and have implemented enough of their electronic health record systems that they now are able to begin to exchange information “The new rural network will be comparable to the urban based networks and help providers with similar needs decide how to share data and understand what privacy and security protocols need to be place,” said McCrary.
The Kansas Foundation for Medical Care as the operator of the Regional Extension Center was granted a total of $9.1 million to help the state’s more than 1,900 healthcare providers’ transition to EHRs and help with EHR adoption in both urban and rural communities.
The REC works with healthcare providers to help them select their software vendor. For example, Ness County Administrator Kyle Hahn reports that his 20 bed critical access hospital in western Kansas spent several months evaluating EHR systems. The hospital eventually based their selection of the vendor on cost and the company’s ability to program a custom interface with Ness County’s practice management software.
Sunday, March 27, 2011
Federal HIT Plan Available
The “Federal Health IT Strategic Plan: 2011-2015” released on March 25th is available for public comment until April 22, 2011. The plan last published in 2008, has been updated to take into account the rapidly changing landscape of health IT and health IT policy. The HIT landscape has been altered over the past two years by both the HITECH Act passed as part of ARRA and the Patient Protection and Affordable Care Act since both pieces of legislation committed significant resources to health IT.
Over the past year, ONC has collaborated with its federal partners, the private sector through the health IT Policy Committee, and the public to update the plan. Basically, the plan has five goals to include:
• Goal I: Achieve adoption and information exchange through meaningful use of health IT
• Goal II: Improve Care, improve population health, and reduce health care costs through the use of health IT
• Goal III: Inspire confidence and trust in health IT
• Goal IV: Empower individuals with health IT to improve their health and the healthcare system
• Goal V: Achieve rapid learning and technological advancement
To download the Federal HIT Strategic Plan 2011-2015, go to http://healthit.hhs.gov.
Over the past year, ONC has collaborated with its federal partners, the private sector through the health IT Policy Committee, and the public to update the plan. Basically, the plan has five goals to include:
• Goal I: Achieve adoption and information exchange through meaningful use of health IT
• Goal II: Improve Care, improve population health, and reduce health care costs through the use of health IT
• Goal III: Inspire confidence and trust in health IT
• Goal IV: Empower individuals with health IT to improve their health and the healthcare system
• Goal V: Achieve rapid learning and technological advancement
To download the Federal HIT Strategic Plan 2011-2015, go to http://healthit.hhs.gov.
Lifeline/Link-UP Modernization
In the March 23, 2011 Federal Register, the FCC presented a set of proposals and recommendations to modernize and reform Lifeline/Link-Up which is part of the FCC’s Universal Service program. The FCC has not systematically re-examined Lifeline/Link-Up since the passage of the 1996 Act but at this time, new technologies and regulatory changes have put a strain on the program. The FCC at the crossroads is examining the strategies needed to increase broadband adoption, but at the same time, not increase the overall program size.
The recommendations published in the Federal Register included ideas and suggestions made by the Federal-State Joint Board on Universal Service, GAO, and from proposals and ideas contained in the National Broadband Plan. The proposed reforms address waste, fraud, abuse, controlling the size of the program, strengthening program administration and accountability, improving enrollment and outreach efforts. The FCC is also thinking of developing pilot programs to assess whether the new ideas and recommendations suggested will work with the program.
An important issue that needs to be addressed, concerns individual states and/or Tribal governments and dealing with their unique technological issues that might make it impractical or burdensome to implement coordinated enrollment. For example, the ability of a state or Tribal government to implement enrollment may depend upon the capabilities of existing but possibly out dated data processing equipment, software, and data communication networks.
One of the other technological issues in the document concerns the development of a national database. A number of questions need to be answered so further development of the database could take place. A sample of the questions on the development of the database concern:
• Who should administer the database? Should it be the USAF or a third-party?
• How should the national database be funded and maintained? Should the database be funded completely or partially from the Universal Service Fund?
• How should privacy issues be addressed? • What functions should be served by a centralized database?
• How to address customer eligibility and how to receive updates in changes in consumer eligibility from appropriate social service agencies?
• How should the database be populated and by whom? • What should the specific system requirements be?
• What costs would the states incur if any if a national database were established?
• Should a state/Regional database be established as opposed to or in addition to a national database?
For more details and information, go to the March 23, 2011 Federal Register. Comments are welcome on the proposed recommendations and are due on or before April 21, 2011.
The recommendations published in the Federal Register included ideas and suggestions made by the Federal-State Joint Board on Universal Service, GAO, and from proposals and ideas contained in the National Broadband Plan. The proposed reforms address waste, fraud, abuse, controlling the size of the program, strengthening program administration and accountability, improving enrollment and outreach efforts. The FCC is also thinking of developing pilot programs to assess whether the new ideas and recommendations suggested will work with the program.
An important issue that needs to be addressed, concerns individual states and/or Tribal governments and dealing with their unique technological issues that might make it impractical or burdensome to implement coordinated enrollment. For example, the ability of a state or Tribal government to implement enrollment may depend upon the capabilities of existing but possibly out dated data processing equipment, software, and data communication networks.
One of the other technological issues in the document concerns the development of a national database. A number of questions need to be answered so further development of the database could take place. A sample of the questions on the development of the database concern:
• Who should administer the database? Should it be the USAF or a third-party?
• How should the national database be funded and maintained? Should the database be funded completely or partially from the Universal Service Fund?
• How should privacy issues be addressed? • What functions should be served by a centralized database?
• How to address customer eligibility and how to receive updates in changes in consumer eligibility from appropriate social service agencies?
• How should the database be populated and by whom? • What should the specific system requirements be?
• What costs would the states incur if any if a national database were established?
• Should a state/Regional database be established as opposed to or in addition to a national database?
For more details and information, go to the March 23, 2011 Federal Register. Comments are welcome on the proposed recommendations and are due on or before April 21, 2011.
Screening for Eye Diseases
The National Eye Institute awarded a grant to VisionQuest Biomedical in Albuquerque New Mexico to study how to implement computer-assisted technology to screen for eye diseases. According to CDC, millions of people in the U.S. have some form of eye disease, with 20 million diabetics at risk for retinopathy, 60 million at risk for glaucoma, plus an additional 13 million are diagnosed with age-related macular degeneration.
The goal is to create an affordable and accessible solution in order to provide a comprehensive screening program. Today, people go to ophthalmologists, optometrists, or other trained specialists, but for each professional to grade each case for each person is prohibitively expensive and time consuming.
The solution is to implement a computer-assisted technology similar to other medical applications, such as mammograms and Pap smears that would provide comprehensive periodic screenings for the at-risk population. Eventually, the hope is to implement an automatic eye disease screening system to be made available at centers across the U.S and globally.
To conduct the research, a screening center in South Texas where nearly 200,000 diabetics reside and over 50 percent do not receive annual examinations will document the efficacy of the software. The Center’s plan is to show how many cases screened per time period solely use automation and human screeners and compare this approach to solely human-based screening.
The initial year for the start of the project was 2010 and research will continue until 2013 for the grant RC3EY020749-01. For more information on the technology or project, email VisionQuest Biomedical at Peter Soliz, at psoliz@visionquest-bio.com or call (505) 508-1994.
The goal is to create an affordable and accessible solution in order to provide a comprehensive screening program. Today, people go to ophthalmologists, optometrists, or other trained specialists, but for each professional to grade each case for each person is prohibitively expensive and time consuming.
The solution is to implement a computer-assisted technology similar to other medical applications, such as mammograms and Pap smears that would provide comprehensive periodic screenings for the at-risk population. Eventually, the hope is to implement an automatic eye disease screening system to be made available at centers across the U.S and globally.
To conduct the research, a screening center in South Texas where nearly 200,000 diabetics reside and over 50 percent do not receive annual examinations will document the efficacy of the software. The Center’s plan is to show how many cases screened per time period solely use automation and human screeners and compare this approach to solely human-based screening.
The initial year for the start of the project was 2010 and research will continue until 2013 for the grant RC3EY020749-01. For more information on the technology or project, email VisionQuest Biomedical at Peter Soliz, at psoliz@visionquest-bio.com or call (505) 508-1994.
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