Thursday, May 29, 2008

Maine Governor Releases Health Plan

The Governor of Maine John E. Baldacci released the 2008-2009 State Health Plan developed to make healthcare delivery more efficient and effective and slow the growth in healthcare spending. There were a number of findings presented in the plan.

Among the Findings:

  • Nearly 37% or $1.2 billion increased spending in healthcare between 1998-2005 is the result of chronic illnesses
  • Maine is above the national average in supplying healthcare services that include MRIs and staffed hospital beds
  • It was found that excess capacity drives utilization which increases costs while doing nothing to improve patient outcomes
  • Nearly 85% of premium dollars is spent on medical claims, 11% on insurance administration, and 4% on profit.
  • The most effective way to reduce premium growth is to reduce medical claims

The 2008-2009 State Health Plan will have several tasks to:

  • Implement a pilot program to redesign how medical care is delivered by creating patient centered medical homes to focus on prevention, chronic care management, and care coordination
  • Start using Maine’s just completed payer claims database to develop a detailed regional analysis of healthcare cost drivers
  • Analyze and advocate for national solutions to achieve universal access to healthcare
  • Address issues in oral health
  • Increase the access to healthcare services through the use of telemedicine
  • Find ways for the Veterans Health Services to be offered locally through federally qualified health centers
  • Strengthen the system of local health officers and develop regional health plans
  • Review DirigoChoice to find options on how to reduce costs and increase efficiencies to cover more people
  • Investigate the costs and causes for the state’s high emergency department use
  • Examine strategies needed to stem the rising cost of insurance in the small business market
  • Reduce cost shifting and increase the flow of federal funds to the state
  • Reduce the rates of hospital acquired infections through a hospital collaborative and strengthen Maine’s medical errors reporting

For more information, go to

Incorporating HIT into the Workflow

AHRQ has issued a Sources Sought Announcement (AHRQ-08-10036) posted on May 28, 2008, to find potential Small Business companies to develop a tookit on workflow analysis and redesign. The Small Business needs to be able to develop the toolkit so it can be used by both small and large practices as well as in other ambulatory settings and at the same time support health IT. AHRQ is searching for ways to successfully adopt clinical health IT so that evidence-based decision support can be brought to the point-of-care.

The company will need to be able to conduct a literature review, synthesize results from a request for information, develop a toolkit based on findings, and write reports while engaging relevant experts and reviewers on an ongoing basis. The company will need to produce products that can be used to facilitate decisions on when to implement health IT as part of a larger practice redesign effort. The small business should be familiar with the research information available on workflow analysis and redesign, ambulatory clinical workflow, and health IT and HIE.

Interested Small Businesses need to submit their capability statements to Linda Simpson, Contract Specialist by June 11, 2008. For more information, go to and search HHS, or email or call (301) 427-1705.

AHRQ Publishes Handbook

Nurses play a vital role in improving the safety and quality of patient care and need to know what proven techniques and interventions can be used to enhance patient outcomes. To address this need, AHRQ with additional funding from the Robert Wood Johnson Foundation just published a comprehensive 1,400 page handbook for nurses to address these issues.

The publication “AHRQ Patient Safety and Quality: An Evidence-Based Handbook for Nurses” contains peer-reviewed discussions and reviews a wide range of issues and literature regarding patient safety and quality healthcare. Owing to the complex nature of healthcare, the handbook provides insight into the multiple factors that determine the quality and safety of healthcare as well as patient, nurse, and systems outcomes.

The publication examines the state of the science behind quality and safety concepts and challenges the reader to not only use evidence to change practices but also to actively engage in developing the evidence base to address critical knowledge gaps.

Experts in the field reviewed the literature and grouped the contributions into sections on:

  • Patient safety and quality
  • Evidence-based practice
  • Patient centered care
  • Working conditions
  • Work environment
  • Critical opportunities for patient safety and quality
  • Tools

Chapter 48 on Patient Safety, Telenursing, and Telehealth authored by Loretta Schlachta-Fairchild, Victoria Elfrink, and Andrea Deickman, contains evidence-based review and recommendations for the use of telehealth and telenursing as tools for patient safety.

The chapter discusses several themes on diagnosis and teleconsultation, monitoring and surveillance, and clinical and health services outcomes. The chapter also suggests that infrared technology offers perhaps the most continuous method of telehealth monitoring equipment. Infrared scanners are effective in reporting deviations from a daily routine and can monitor elderly or dependent patients from a remote location. Safety of the patient can be assessed without the patient purposely getting in front of a camera or logging on to speak to a nurse.

Chapter 48 is available at

The complete handbook is available at http://www/ The handbook can also be ordered on a single CD-ROM (AHRQ Publication No. 08-0043-CD) or as a set of three printed volumes.

For more information, email Ronda Hughes PhD, Editor of the Handbook at

Sunday, May 25, 2008

Health Technologies Hill Topic

Representative Allyson Y. Schwartz (D-PA), Honorary Co-Chair of the Committee, a member of the Ways and Means Committee, and a member of the New Democrat Coalition, opened the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics session held on May 21, 2008. She is championing E-prescribing because it can reduce medical errors in filling prescriptions and is not expensive.

In December 2007, Representative Schwartz introduced the E-MEDS Act of 2007 (H.R. 4296) that would require physicians to use the Medicare electronic prescription drug program and provide incentive payments for physicians.

The author of the study “The Telehealth Promise: Better Health Care and Cost Savings for the 21st Century” Dr. Alexander Vo, AT&T Center for Telehealth Research and Policy at the University of Texas Medical Branch (UTMB), spoke at the session. He reported that the UTMB telemedicine program providing healthcare to correctional facilities, is now serving over two thirds of the state’s prison population with all types of services.

UTMB has built 8 virtual physician suites with numerous telemedicine stations and conducts over 200 remote medical exams each day to enable physicians to treat inmates at correctional facilities without transporting them to a healthcare facility. Since 1994, the UTMB program has provided inmates with over 250,000 consultations at a net savings to taxpayers of about $780 million.

UTMB wanted to test its belief that their success with using telemedicine has a broader implication for national healthcare. Working with the Center for Information Technology Leadership on the study, they wanted to find out the extent of cost savings possible by embracing telemedicine nationally.

Dr Vo said that the study indicates that the benefits of nationally implementing telehealth technologies can far outweigh the costs. However, using telehealth nationally would require substantial infrastructure investment and therefore benefits would not exceed costs until the fourth year of implementation. By year six, the cost-benefit ratio would reach steady state and achieve a peak level of net savings that would continue year after year.

According to the study, telemedicine can be very effectively used in emergency departments since it reduces the frequency of transportation from one emergency department to another emergency department. UTMB found that telehealth avoided at least one trip in caring for 95% of the prisoners examined. Just reducing transfers from correctional facilities to physicians’ offices and emergency rooms would reduce costs by $270.3 million annually.

As for nursing facilities, the savings would be $327 million a year by just avoiding the emergency department all together and another $479 million by cutting transfers from nursing homes to physicians’ offices.

In the outpatient setting, provider to provider consultations via telehealth would enable patients to have medical care sooner with a specialist and $3.61 billion would result in cost savings since there would be less redundant testing and fewer face-to-face visits.

Dr. Vo pointed out that the study looked specifically at what needed to be addressed to fully integrate telehealth into the healthcare system. The study concluded that there needs to be standardized Medicare and Medicaid reimbursement models, cases involving telehealth interventions needs to be addressed. Other issues that need to be addressed include studying the licensure rules that prevent telehealth consultations across state lines, finding the best ways to develop HIT infrastructure, and examine state and local initiatives to find ways to provide cost sharing measures along with pooling resources.

Walter Grant, Director, Government Affairs and IT Integration, INRange Systems, described the current eRX picture. One of the biggest influences increasing the use of eRX has been the regional based adoption programs sponsored by payers, health systems, large clinics, and state departments of health. In addition, Executive Orders have been issued from a number of state and federal officials to eliminate paper prescriptions. Lastly, physician technology vendors have made efforts to convert existing user base from faxing to e-prescribing.

Grant suggested that there are some actions that could have an impact on e-prescribing adoption. For example, DEA needs to allow e-prescribing for controlled substances. Secondly, authority should be granted to CMS to mandate e-prescribing, and lastly, health plans should base adoption programs incentives for prescribers.

According to Grant, the “Hospital at Home” concept is going to become very important with the rising number of patients with chronic diseases and the growing aging population. In order to enable more services at home, more medical devices and equipment will be essential and bi-directional communications will play an important role.

One of the most critical factors in delivering care at home is the need to practice good medicine management. Good medicine management systems improve patient outcomes by delivering the right pill at the right time, documenting compliance and adherence, documenting interventions, and a good medical management system enables physicians to coordinate treatments. INRange’s medical management system “EMMA” is successful at managing outpatient medical delivery because the system can select and deliver individual doses of medicine for the patient according to instructions.

One of the major issues holding up the passage of HIT legislation so far has been the ability to provide patient guarantees to privacy and security, according to David Roberts, MPA, FHIMSS, Vice President Government Relations, HIMSS.

Robert reported that the “Wired for Health Care Quality Act” (S.1693) has passed the Senate HELP Committee and is now awaiting full Senate action. So far, there is no House action on the companion bill (H.R. 3800). In addition, e-prescribing legislation (S.2408 and H.R 4296) have been introduced on both sides of the aisle. Roberts suggests that e-prescribing legislation will probably be attached to the Medicare Physician Reimbursement Reform.

He continued to say that the Senate Finance Committee leaders continue to hash out the Medicare package to delay the 10% physician pay cut set to take effect July 1. Some health groups are trying to attach their issues to the must pass bill, while others are hoping lawmakers won’t seek offsets for the bill’s possibly $18 billion price tag from their specialties. The bill would require pharmacy benefit managers to reimburse for Medicare prescription drug claims in 14 days and would delay a cut in Medicaid reimbursement for generic drugs for one year.

Also, a new rule to provide for tamper proof Rx pad law implementation was attached to the May 25, 2007 appropriations bill. The goal is to reduce expenditures for fraudulent Medicaid prescriptions by requiring non-electronic Rx use tamper resistant pads to be used.

According to Roberts, a number of pieces of legislation have been introduced in 45 states legislatures to address HIT. In 2007, 250 plus bills were introduced in 38 state legislatures and the District of Columbia, with 74 bills passing and becoming law.

Christine Bechtel, Vice President, Government Relations eHealth Initiative, gave her analysis of state legislative activities. She reported that HIT state activity is on the rise and in 2008, 92 bills were introduced in 27 states. Also, 9 executive orders were issued by governors calling for HIT and HIE in 2007, and 4 so far in 2008. Fifty seven bills in the states were proposed in 2007 calling for establishing committees, taskforces, commissions, or working groups within the states. States have begun to dictate certain interoperability levels in the proposed state legislation as it concerns state agencies.

According to Bechtel, key issues need to be addressed in legislation that relate to privacy, funding, ICD 9/ICD10, and the Stark and Anti-Kickback statues. Currently, the House Energy and Commerce Committee is developing a “Chairman’s Package HIT bill. The bill will be a compilation of past, existing, and new legislative provisions.

Jon Linkous, Executive Director, American Telemedicine Association enthusiastically supports the Medicare Telehealth Improvement Act of 2008 (S. 2812) and wants to see the telemedicine community rally behind this important legislation introduced by Senators Kent Conrad (D-ND), Debbie Stabenow (D-MI), and John Thune (R-SD).

The legislation would add skilled nursing facilities, dialysis centers, and community mental health centers to the list of originating sites and would allow patients to receive the benefits of telemedicine. The legislation would also make additional healthcare providers eligible to provide telemedicine care under Medicare, and very importantly create an advisory committee to aid CMS in assessing what telemedicine services should be eligible for Medicare reimbursement.

In general, Linkous thinks that telemedicine is moving in the right direction but there still are regulatory issues that need to be addressed. As he sees it, most of the progress right now is happening within the states and although the state activities are very important, he would also like to see the federal government catch up and expand their efforts.

He also reports that there have been a number of advances internationally with medical services being provided to other countries with telecommunications capabilities. Hospitals are linking all the time to hospitals in other countries but not always using the term telemedicine or telehealth. There has been a huge outpouring from NGOs concerning healthcare and everyday new developments and new projects are taking place internationally.

Neal Neuberger, President, Health Tech Strategies and Chair, ATA Public Policy Committee, recommends that everyone take part in the 3rd Annual National Health IT Week to be held on June 9-13, 2008 and attend the Health Information Technology all Day Showcase and e-Health Panel Discussion to be held on Capitol Hill in Room 902 Hart Senate Office Building on June 12th from 10am to 3pm.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), Allyson Y. Schwartz (D-PA), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

For more information on the Capitol Hill sessions and the HIT all day Showcase, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email

VA Secretary Speaks at NPC

The Secretary of Veterans Affairs, James Peake both an Army Lieutenant General and a cardiac surgeon spoke at the National Press Club on May 20, 2008 to discuss his priorities as Secretary. A few of the priorities include improving information technology, utilizing home telehealth, continuing partnerships and affiliations with academic learning centers and DOD, and helping veterans with mental health issues.

In discussing IT, the Secretary pointed out that although the VA’s current electronic medical record system is considered one of the best systems available, as he explained, the system is a multi-tiered old system. The VA has work to do in IT whether it is with financial systems, human resource systems, or in applying modern technology to the claims process.

There is a need to really make significant improvements in sharing information, not only from doctor to doctor, but sharing information with family members. Also, the Secretary stressed the need to migrate the electronic record system as this will offer a greater opportunity for DOD and the VA to work together. Presently, the VA is working with DOD representatives and has an Army officer on staff to provide the links to bring the agencies together.

Right now the VA has a separate appropriations line for IT. This means that for the first time, the VA is starting to figure out how much the agency is really spending on IT and how much it really takes to run an organization with the VA’s complexity and size.

As for telehealth, the VA now has 32,000 people using home telehealth. Recently the Secretary went to Salisbury, North Carolina and looked at home telehealth in action and noted how powerful it can be in treating patients, but also in helping patients have a comfortable relationship with their doctors and nurses.

The VA is trying to find ways to help the veteran population easily access care and not need to drive 500 miles to see a doctor. The VA is looking at a variety of models to provide better care for patients.

The Secretary thinks that an important strength for the VA is to have academic affiliations with some of the greatest medical facilities, universities, and academic centers in the world. According to the Secretary, these partnerships like any other business relationship may at times need to be restructured so that the VA, the veterans, and academic affiliates get what they need. These partnerships need to be expanded to be able to share more information and services.

When the Secretary was asked specifically about mental issues such as PTSD, TBI, and suicides, the Secretary told the audience that trying to understand how to deal with these issues in not something new. Last year, the VA saw some 400,000 people with PTSD in the VA system. Only about 57,000 of those veterans afflicted with mental issues were returning soldiers from Iraq.

In addition, Brigadier General Loree Sutton has the lead in DOD and will help move forward with PTSD, and TBI, and the VA has also provided a deputy to confer on these specific issues.

When questioned, the Secretary stressed that the VA greatly encourages veterans to seek psychiatric counseling for wartime mental health problems. To help the veterans deal with mental health problems, the VA has opened a call center to reach out. About 300,000 out of the 800,000, who have separated and have come to the VA for health care, have touched the call system one way or the other. And when they do, they are screened for PTSD and TBI, and asked about suicidal tendencies. As part of the program, the call center is reaching out to approximately 17,000 veterans who potentially could benefit from case management but may not be aware of it or have access.

Telemedicine for Infant Audiology

As reported in an April “Federal Telemedicine News” article, HRSA is very interested in developing a model infant audiology diagnostic protocol using telemedicine particularly in rural areas. This is vital because diagnostic audiology needs to occur between the ages of one to three months. However, only half of the infants are generally evaluated due to the shortage of pediatric audiologists and equipment. It has been found that an infant with a significant hearing impairment who receives intervention by six months will perform significantly better in language development that the infant who is identified after six months of age.

HRSA published a Sources Sought Announcement that was due April 21st. This announcement has been followed by a pre-solicitation announcement (08-N240-6009-dm) posted on May 21, 2008. The response date for the pre-solicitation announcement is July 07, 2008.

The full solicitation will be issued on or about June 5, 2008 and will be available at under HHS. The purpose of the contract will be to develop a diagnostic and management protocol for using telemedicine to deliver hearing services in rural and underserved areas and to assist with the implementation of the protocol among selected grantees.

The primary point of contact for the program is Daniel Matusiewicz at or call (301) 443-4703.

E-Prescribing Report Coming

The eHealth Initiative and the Center for Improving Medication Management are going to release the report “Health IT, Electronic Medical Records, Personal Health Records, Transforming Patient Care” on June 11, 2008. The report will be released in conjunction with a conference organized by the National Association of Chain Drug Stores and the eHealth Initiative in Washington D.C.

The report details the impact of e-prescribing on physicians, consumers, employers, health plans, and policy makers nationwide. Based on research as well as on the actual use of paperless prescribing since 2004, the report summarizes the national experience with e-prescribing technology from pilot phase in several states such as California, Massachusetts, Michigan, and Rhode Island, to present day use in all 50 states and Washington D.C.

The report is based on the combined efforts and experience of over 35,000 prescribers and approximately 40,000 pharmacies. The report offers clinicians and other healthcare providers’ guidelines for successful adoption, the best ways to gain safety and quality benefits from e-prescribing systems, as well as independent information regarding what they can and should expect from their healthcare IT system providers. The report also includes three practical guides: one for physicians, one for consumers, and one for health plans and employers.

For more information, go to or email

Tuesday, May 20, 2008

Simulation Helps Treat Burn Patients

An emergency burn care pilot program was conducted for first responders from rural areas. The first responders used teleconferencing and medical simulation during their training at the Western Pennsylvania Hospital in Pittsburgh and in Loretto and Johnstown. The program “Emergency Burn Care: First 24 Hours” was sponsored by the Simulation, Teaching and Academic Research Center (STAR) at the Western Pennsylvania Hospital, and Saint Francis University’s Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA).

Twenty eight Emergency Medical Technicians and Paramedics from Blair, Cambria, and Somerset counties, as well as EMTs and Paramedics from the Greater Pittsburgh Area attended the course. The four hour program included two hours of hands-on clinical practice using medical simulators positioned at STAR in Pittsburgh and the CERMUSA site in Johnstown. The participants in Loretto were able to observe the sessions via VTC.

The simulated clinical experience began with participants learning and practicing the skills that are needed to assess and stabilize patients during the critical first hours following a burn injury. The participants in the training sessions need to know how to do a primary assessment of an acute burn victim, how to calculate initial fluid needs for the patient, and how to transfer a seriously burned patient using a teamwork approach.

STAR opened in September 2007, funded by a $500,000 grant from Highmark, $105,000 from the Eastern Pennsylvania Hospital Foundation, and nearly $200,000 from the Commonwealth of Pennsylvania. The STAR Center houses two “SimMan” mannequins that mimic real-life health conditions and serve a variety of medical professionals.

STAR will soon be home to a stationary ambulance that will be able to recreate and simulate a realistic emergency response down to the lights and sirens of the ambulance as it travels the streets. The ambulance will enable EMS providers to train for important skills such as intraosseous infusions, chest decompression, external jugular cannulations or cricos in an ambulance. The new STAR ambulance should be completed and ready to provide simulation training by the end of July.

For more information, email or phone (412) 578-4470.

NIH Launches Program

NIH researchers in a new clinical research program are aiming to provide answers to patients with mysterious conditions that have long eluded diagnosis. The program called the “Undiagnosed Diseases Program” will tackle the most puzzling medical cases that have long eluded diagnosis. Physicians across the nation will now be able to refer these difficult cases to the NIH Clinical Center in Bethesda MD.

According to NIH director Elias A. Zerhouni, M.D., the goal of the program is to improve disease management for individual patients and to advance medical knowledge in general. With the program infrastructure now in place, the program is ready to accept patients as of July 2008.

NIH will use the expertise of more than 25 senior attending physicians, whose specialties include endocrinology, immunology, oncology, dermatology, dentistry, cardiology, and genetics to evaluate each patient. William A. Gahl. M.D., PhD Clinical Director, National Human Genome Research Institute (NHGRI), an expert in rare genetic diseases will serve as the director for the new program.

To be considered for the NIH pilot program, a patient must be referred by a physician and provide all medical records and diagnostic test results that will be requested by NIH. As many as 100 patients will be accepted each year and will need to undergo additional evaluation during a visit to the NIH Clinical Center.

For more information, go to http://rarediseases, or call the NIH research line at 1-866-444-8806.

Electronic Exchange in EDs

Ten Oklahoma City metro hospital organizations have just finalized an electronic data sharing network agreement. The hospitals will use the Secure Medical Records Transfer Network (SMRTNET) available through an AHRQ grant established by the Cherokee County Health Service Council to share electronic records for emergency department patients.

The system will exchange patient demographics, medications, allergies, and reactions, diagnosis history, laboratory results, procedures, immunizations, and health care providers. SMRTNET is operating successfully in northeast Oklahoma and handles more than 4000,000 medical records in the network. It is anticipated that there will be $14 million in savings and quality improvement in 30 out of 90 hospitals.

According to Dr. George Foster, Dean, Oklahoma College of Optometry, and a member organization of SMRTNET, this is the only Oklahoma county health authority to explore policies and health changing opportunities at a local level that can then be modeled at the national level.

The initial implementation of the electronic records exchange will be complete in about 120 days and will provide a backbone to construct a more expanded community network in the future. The system will be launched in the emergency departments initially, but will be expanded to include additional ancillary tests and procedures in coming years. The group also hopes to expand the network to community free clinics.

Sunday, May 18, 2008

Stroke Care Discussed on the Hill

A total of 750,000 strokes occur in North America each year and the projected cost of stroke care in 2008 is expected to be $65 billion. To help the nation deal with this enormous health issue, experts in the field gathered in Washington D.C. on May 15th to speak at a special session of the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics. The American Heart Association and the American Telemedicine Association collaborated on the session.

The speakers were in agreement that there is a tremendous opportunity to reduce disabilities from stroke by simply treating patients within the three hour window after the stroke has occurred. However, only 2 to 5 percent of eligible stroke patients are currently able to receive these treatments.

Neal Neuberger, President Health Tech Strategies and Chair, ATA Public Policy Committee pointed out that a number of Telestroke Networks have been established throughout the country. One network, the Virginia Acute Stroke Telehealth (VAST) Network was recently launched to develop HIT solutions for each of the five areas within the “Stroke Continuum of Care”.

Karen S. Rheuban MD, President-elect ATA, and Medical Director, Office of Telemedicine, Professor of Pediatrics and Senior Associate Dean for CME and External Affairs, University of Virginia, emphasized that telehealth plays an important role in helping during the critical time immediately after a stroke by improving access to care and the quality of the treatment.

Sue Nelson, Vice President of Federal Advocacy, American Heart Association/American Stroke Association, said “stroke is the nation’s number three killer, on the average one person in the U.S. has a stroke every 40 seconds, with death and disability from strokes expected to double by 2032.

Nelson wants to see the “STOP Stroke Act” that was passed by the House also be passed by the Senate. The Act would authorize a grant program to help states ensure that patients have access to quality stroke prevention, treatment, and rehabilitation services. The act would also raise public awareness concerning stroke warning signs and would continue the Coverdell Stroke Registry and Clearinghouse to collect data.

Trisha Carney came from her home in New York State to put a face on patients that have had strokes. Most people think that stroke victims are elderly but this is not always the case. Trisha is a 38 mother and never pictured having a stroke at her age. It’s been a very difficult experience and every day can be a challenge but she is moving forward and working towards gaining her life back.

Darwin R. Labarthe, MD, MPH, PhD, Director, Division for Heart Disease and Stroke Prevention, CDC, explained that the “2008 Atlas of Stroke Hospitalizations among Medicare Beneficiaries” recently published, is the fifth in a series of CDC atlases related to cardiovascular disease. The atlas was developed in collaboration with CMS and includes county-level maps of stroke hospitalizations by stroke-subtype, race/ethnicity, discharge status, and co-morbidity within the Medicare population.

Dr. Labarthe pointed out that an important strength of the Atlas is the examination of geographic disparities in stroke hospitalizations for blacks, Hispanics, and whites in the U.S. Previous reports have focused predominantly on blacks and whites.

Paul M. Katz.MD, Medical Director, Renown Health System Institute for Neurosciences Comprehensive Stroke Center, Reno, Nevada discussed stroke care in rural areas. Dr. Katz reports that there are challenges in delivering acute stroke care in the large rural areas in the state, since there is limited stroke awareness, few specialists in the field, narrow therapeutic time windows, there are traditional patterns of practice in the communities, competitive hospital systems, and costs are high for treatment.

A study done by Renown looked at stoke care to determine if the care were organized and standardized, would the use of thrombolytic therapy improve care in the greater Reno metropolitan area and the 27 rural hospitals serviced by Renown.

They found the solution for improving care was to organize a 24 hour regional stroke team with a stroke neurologist, along with a neuroradiologist, neurosurgeon, nurse, pharmacist, and emergency department personnel. Also, standard pre-hospital and hospital protocols were put into place in all communities, and each rural hospital and EMS provider was personally visited and received information on the protocols.

Teleradiology is currently being used for CT interpretations, and Dr. Katz reports that ultimately telemedicine will really be able to effectively optimize the evaluation of patients. Presently, an internet-based system is now being piloted at Renown Regional Medical Center and in three rural hospitals.

Dr. Katz stressed that the success of a regional comprehensive stroke center involving many rural hospitals depends upon having standardized protocols for the pre-hospital and hospital settings, and a careful assessment by the regional stroke team on the capabilities and limitations in each rural area.

Adnan H. Siddiqui, MD, PhD, Assistant Professor of Neurosurgery, University at Buffalo, State University of New York, agrees with the other speakers that caring for stroke patients is greatly impacted by the fact that there are not enough neurologists, neurosurgeons, and stroke specialists. Added to the problems, there is low use of IV-tPA at 0.6%, hospitals have no leverage over specialists to take emergency department calls, and emergency department physicians are not comfortable using tPA.

Dr. Siddiqui explained how the medical community realizing that there is an enormous problem in the state, established a rural telemedicine initiative for stroke treatment. They set up the REACH stroke system originally developed at the Medical College of Georgia. This system is a 100% web-based service that provides decision support solutions for remote diagnosis and evaluates acute diseases such as stroke. The system permits real-time interactive consultations service to take place from different sites with twelve hospitals in the network.

Dr Siddiqui is pressing for regional development of Comprehensive Stroke Centers that are modeled after Regional Level 1 trauma centers. The requirements for the centers are to have a stroke team available 24/7, an imaging center, rapid response capabilities, endovascular team available 24/7, and a neuro ICU.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), Allyson Y. Schwartz (D-PA), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

The next session will be held on May 21st. The topic is “Moving Toward an E-Enabled Healthcare Environment: Telehealth, EMR, PHR, eRX, and Related Technology Tools from 30,000 Feet.” The session will be held at noon in Room 2325 Rayburn House Office Building (House Science and Technology Committee Hearing Room). For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email

RWJF Issues Call for Proposal

RWJF seeks proposals for projects to examine the effects of public reporting and pay for performance on healthcare quality. The proposals need to demonstrate the potential to produce high quality, scientifically good research. The foundation is interested in demonstration projects, retrospective studies, case studies, and secondary data analyses.
In late 2008, approximately $4 million will be available for the projects with grants between $200,000 and $400,000 each to be awarded.

RWJF is looking for proposals that are able to:

  • Measure the effects of public reporting programs for individual physicians and for larger medical groups
  • Measure the effects of pay for performance programs on the quality of care that people of various races and ethnicities receive, and whether these programs can be designed so that they actually reduce disparities in healthcare quality

Interdisciplinary teams are eligible to apply as long as investigators are focused on public reporting and pay for performance. Preference will be given to applicants who are either public entities or non-profit organizations with tax exempt status.

The proposals are due June 12, 2008 for a brief proposal and applicants will be notified on July 28-31 2008 if they are invited to submit a full proposal. Full proposals are due September 4, 2008 and the grants will start December 1, 2008.

For more information, go to or contact Helen Mathew

SDO to Develop Standards

AHRQ intends to award a project to Health Level Seven to coordinate and develop standard value sets (i.e. code sets) needed to implement common reporting formats for patient safety event reporting. Specifically the organization is to develop standards for interoperability, optimize workflow, reduce ambiguity, and provide for knowledge transfer of information to all stakeholders.

If other interested Standard Development Organizations (SDO) want to response to this notice, and feel that they can perform the work and have the qualifications and expertise; they should response to the notice on titled “Patient Safety Taxonomy Standard Lists” (AHRQ-08-10034) posted May 13, 2008. Organizations responding need to submit a statement of capabilities. The responding SDO must be ANSI accredited, operate in the clinical and health administrative data domain, and have knowledge of complex databases.

The Patient Safety and Quality Improvement Act of 2005 required the Secretary of HHS to create and maintain a network of patient safety databases and to determine common formats for reporting this information. AHRQ led the initiative to coordinate the development of the common formats through an interagency Work Group that included CDC, CMS, FDA, HRSA, NIH, VA, IHS, and DOD.

Organizations submitting statement of capabilities must have them to AHRQ by May 28, 2008 and the information needs to be sent to For more information, go to, or contact Sharon Williams at (301) 427-1781

Tuesday, May 13, 2008

New Devices Detect Toxins

In a recent article published in the Department of Homeland Security newsletter “R-TECH”, an ocular imaging device is able to detect toxins in the system, if terrorist’s attacks should become more deadly with the use of more chemical and biological agents. The effects of these toxins are not always immediately recognizable and testing can take hours to days to complete.

To make rapid detection possible, EyeMarker Systems, Inc. located in West Virginia developed an ocular imaging device referred to as RTD1000 to detect markers in individuals if they are exposed to certain chemicals and nerve agents. The Defense Advanced Research Projects Agency (DARPA) SBIR program initially funded the company to develop the technology through the prototype stage.

Dr. Chris Kolanko, Chief Scientific Officer at EyeMarker Systems, reports that the effect of toxins on the body can be seen in various physiological responses within the eyes. When the symptoms for carbon monoxide or cyanide exposure show up, the patient is already in major distress and the device can help detect cases almost pre-symptomatically. Also, it is easy to develop and to keep adding detection software to the device if needed.

Using RTD 1000 could help to relieve strain on the medical system since responders would be able to assess the state of exposure rapidly and treat and reassure patients quickly. Besides being able to quickly assess toxin exposure, the ocular device has other advantages since it is lightweight, portable, and doesn’t require specially trained personnel to use it, works within minutes, and is non-invasive.

Eventually, it is hoped that the scanner can be further developed to detect traumatic brain injury from blast forces at explosion scenes. TBI results in changes to the neurological system and these changes could be detected by examining the dilation and contraction of the pupils to light response. This research is about a year behind the toxin research and is being conducted cooperatively with the Navy Medical Research Center in Silver Spring, Maryland.

DARPA has helped the company acquire additional funding from the federal interagency Technical Support Working Group (TSWG) to help get the device ready for commercialization. The Department of Homeland’s Security Science and Technology Directorate’s TechSolutions program has partnered with TSWG to add funding for additional software development and testing. For more information, go to

On the West coast, the Department of Energy’s Pacific Northwest National Laboratory has developed a new rapid, portable, and inexpensive detection system to identify personal exposures to toxic lead and other dangerous heavy metals. The device can provide accurate blood sample measurements from a simple finger prick, which is especially important when sampling children.

A bit larger than a lunchbox, the new detection system is field deployable with plug-and-play features that allow different sensors to detect a variety of heavy metal toxins. The system is battery operated and requires about one and one-half times the power of a typical laptop computer. The system is able to deliver reliable measurements within a rapid 2 to 5 minute analysis period. Early production cost estimates indicate that the device may be as much as 10 times less expensive than plasma mass spectrometry systems.

Joint Program Established

The Department of Veterans Affairs, DOD, and HHS have recently established the Federal Recovery Coordination Program to help severely injured patients identify sources for help and the services that they may need. The program was set up to help patients connect with a coordinator for information and contacts so that they have access to all needed clinical and non-clinical care. Participating patients can include those with seriously debilitating burns, spinal cord injuries, amputations, visual impairments, traumatic brain injuries, and PTSD.

When a veteran settles in a remote area, the VA is now able to use multimedia systems to integrate video and audio teleconferencing. This lets veterans visit a federal clinic or private center near their homes and then link up with their case coordinator for a meeting.

The agencies are discussing ideas for ongoing improvements to incorporate into the program that may include monitoring. Other improvements could include possible adjustments to staffing, improvements in web-based information to help the service member adjust to civilian life, and links to governmental and private sector services so that the patient’s individual recovery plan can be incorporated into their health records.

Currently, the program is serving 85 patients and their families. Federal recovery coordinators are based at three military hospitals. These hospitals are the hospitals that are most likely to receive severely wounded service members evacuated from the combat theater. The hospitals include Walter Reed Army Medical Center, National Naval Medical Center, and the Brooke Army Medical Center and are now working with seven coordinators and recruiting six additional coordinators and one nurse. A fourth site, the Naval Medical Center San Diego will receive two of the additional four field staff expected to be appointed soon.

FTC Holding Workshops

The FTC will host a one day workshop on “Clinical Integration in Health Care: a Check-Up” on May 29th at the FTC Satellite Conference Center in Washington D.C. The workshop will examine current activities aimed at fostering high quality, cost-effective care through collaborations among independent providers, including an examination of programs already operating as well as those in development.

The workshop participants will include physicians, hospitals, government purchasers, private health plans, and employers, as well as health policy researchers, analysts, and legal counsel. For more information contact Ken field at (202) 326-2868.

On April 24, 2008, the FTC hosted a one day workshop that examined recent trends in healthcare delivery. Workshop participants from physician and healthcare associations, industry, government, privacy groups, and academics considered competition and consumer protection issues with much of the workshop focused on access to healthcare information and innovations in HIT.

Other topics discussed included:
  • The growth of limited service or retail clinics
  • Transparency issues for healthcare price and quality information
  • Health IT provider issues including development, standard-setting, payment, and interoperability
  • Health IT consumer issues including health information privacy, and data security

For more information and how to file comments regarding topics explored at the April 24 workshop, go to

Saturday, May 10, 2008

HIT Discussed on the Hill

Senator Sheldon Whitehouse (D-RI), stopped by the May 7th Capitol Hill Steering Committee on Telehealth and Healthcare Informatics session to discuss his interests in HIT. He has sponsored three interrelated bills to help move HIT forward and one of the bills (S.1455) would develop a private, non-profit National Corporation for Health Information Technology and Privacy.

The Corporation would be tasked with developing a national, interoperable, secure health IT system. According to the Senator, the Corporation would be a central entity that would set up licensing access to networks, establish a pool of capital, and be effective in putting the right incentives in the right place.

The Senator wants to see the model for the Corporation to be based on previous developments in this country. John Kennedy as President, wanted to see this country advance in developing communication satellites, so he established Comsat as a private corporation to carry out that specific mission. When the goals for that program were accomplished, Comsat was phased out.

He continued to say how important it is to establish standards for HIT, provide for significant investment in quality improvements, and change the way that reimbursement is handled. As he explained, today’s physicians are faced with difficult workflow issues, returns for physicians are small and most of the return goes to BCBS and Medicare, plus the fact that the relationship between health insurers and providers can be difficult to manage.

As the Senator said, he wants to see changes made in the near future by solving the problems now and not in ten to fifteen years. This country needs to protect the American healthcare system against dangerous outcomes and let the market behave as the market should.

Elliot Menschik, MD, PhD, President, Hx Technologies Inc made the case that Health Information Exchanges (HIE) driven by business and clinical needs are emerging as a rapid deployment cost effective service and sustainable alternative to RHIOs. Dr. Menschik explained that a business driven for profit HIE would enable choices on what clinical data to share and would be designed around the business needs of the participants. When developing the model, not everyone has to agree on every policy, since different ideas can co-exist as long as the right technology is in place.

According to Dr. Menschik, for profit HIEs are able to provide benefits to the patient, provider, and payer in terms of more efficient streamlined services and lower costs. Both the patient and provider end up with more accurate information on hand so that the provider is better able to diagnose medical problems and provide for more timely intervention in critical medical situations.

Hx Technologies Inc is actively involved in exchanging medical imaging data and is now operating the Philadelphia Health Information Exchange (PHIE) that links unaffiliated even competing medical facilities together and provides for the seamless movement of patient digital medical records. Now providers are able to act upon their patient’s results quickly regardless of where the data may be geographically.

Also, moving imaging rapidly helps the payer and provider have a better relationship with their health plans. By delivering images in real time, health plans do not have to deal with diagnostic uncertainty that can lead to additional imaging and may cause the patient to receive additional radiation exposure. It also has been shown that redundant exams can be costly to employers and insurers.

W. Ob Soonthornsima, Senior Vice President and Chief Information Officer, Blue Cross Blue Shield of Louisiana, reports that Louisiana’s goals to deliver healthcare were changed and shaped by Katrina and Rita. The devastating storms produced a wake up call for the state to redesign and establish an evidence-based quality driven healthcare model. According to the Soonthornsima, collaboration is needed at the local, state, and national level to deliver a quality driven patient centric model of healthcare.

In 2006, the Louisiana Health Information Exchange demonstration project was launched to establish an operating HIE entity. HHS contracted with DHH to develop an HIE that could demonstrate interoperability, clinical information exchange, develop security and privacy models, exchange clinical information, be web-based, and provide uniform access to emergency rooms and primary care providers.

Soonthornisima pointed out that the ongoing activities are to identify strategic partnership opportunities and work with the Louisiana DHH, state Medicaid, and key hospitals to establish an operating HIE. Also, the Louisiana Health Care Quality Forum (LHCQF), a non profit organization formed to promote standards for healthcare quality would play an important part in the process. LHCQF now has four working committees with qualified volunteer stakeholders focusing on quality measures, HIT, patient centered medical homes, along with public outreach and education.

BCBSLA is actively involved in technology and has launched an e-Rx program with over 500 physicians participating. Now the state wants to see wide adoption especially among small to medium size physician groups. This summer, Medicaid is launching a similar e-prescribing program for 500 of the highest prescribing Medicaid doctors.

According to Soonthornsima, the HIE should to set up with the EHR at the center. In addition, the system needs to:

  • House a clinical system EMR containing provider clinical data with information on patients from ambulatory or hospital settings
  • House a computerized-based patient record, with Rx information, physician notes, and lab results
  • Contain claims-based data along with administration data to give a longitudinal view of medical histories, episodes of care, and information on prescriptions
  • Develop a PHR system to provide demographic information, personal and family histories, allergies, medical conditions, risk assessment information, and other personal health management data

As part of the rebuilding in the state, the Louisiana Health Care Redesign Collaboration a private collaboration led by the DHH was formed to develop a blueprint for evidence-based quality driven healthcare and look at the future of the delivery system. Critical components were outlined such as the need for medical homes so that patients will have access to primary and specialized care, and the need for patient centric health records to enable care coordination capabilities.

Barbara Massoudi, MPh, PhD, Health Informatics Program, RTI International, described the progress of the Health Information Security and Privacy Collaboration (HISPC) that began with 34 states and territories. Organizations were subcontracted in each state and designated by the government. Then each state identified a steering committee composed of leaders from state governments and stakeholder organizations.

To accomplish their goals, work groups were set up to examine:

  • The variations in policies that can create barriers to the widespread use of HIEs
  • The existing paradigm for privacy and security protections that do not fully accommodate active consumer participation in HIE
  • Legal and regulatory drivers along with standards
  • How to involve consumer organizations, state, and federal entities in sharing their concerns as they relate to privacy and security for health information and how to achieve broad based acceptance
  • Developing plans to implement changes where feasible
  • Providing for international agreements

The state teams have completed their assessment of the different business practices, policies, and laws within the states. This will help to understand the effects that privacy and security can have on the landscape and how these issues affect the development of electronic health information exchanges.

In further collaboration HISPC has worked with the National Governors Association to develop exchange scenarios in terms of treatments, payments, operations and marketing, RHIOs, research data use, law enforcement bioterrorism, employee health information, public health prescription drug use, and state governance oversight. In addition, regional meetings were held in 2006 in HISPC states as well as in other states, and now there are plans to implement collaborative projects in 42 participating states and territories.

Lisa M. Santelli, Esq., Senior Legal Counsel, Health Plan Affairs, Excellus BCBS & the Greater Rochester Regional Health Information Organization, explained how the Rochester RHIO, a non profit organization provides for the secure exchange for health information but also for timely access to clinical information and improved decision making. The RHIO now provides a community-based Virtual Health Record, EMR light (with e-prescribing), and third party EMR connectivity.

The RHIO uses data from local payers, hospitals, laboratories, and radiology practices, and the system based on affirmative patient consent. Santelli pointed out that the system is successful because there is key stakeholder participation, state government support through the New York State Office of Health Information Technology, Heal NY and NYS HISPC and Axolotl’s Elysium has played an important part. She continued to say that the RHIO leadership is able to navigate stakeholder’s interests, encourage collaboration, and maintain focus. This is never an easy mix but in the case of the Rochester RHIO, it works.

In the next phase there will be full program implementation. In the immediate future, the Virtual Health Record now in the pilot phase will be implemented. Future activities and plans will be to support EMR adoption across the area, develop a patient portal, and go completely electronic. Hopes are that the expansion of information sharing across the healthcare continuum will include long term care facilities and home care agencies.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

A special session in collaboration with the American Heart Association and the American Stroke Association will be held on Thursday May 15, 2008 in Room 124 in the Dirksen Senate Office Building to discuss “Innovative Uses of Telehealth in the Treatment of Acute Stroke”. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email

Assisting First Responders

San Diego’s Center for Commercialization of Advanced Technology (CCAT) plans to provide technology transition assistance to small companies working on DOD funded technologies. These companies are eligible if they are working on technologies geared to the First Responder market either though SBIR awards and DARPA grants or other DOD projects. However, the technologies must fit within the Command, Control, and Communication (C3) focus areas.

The technologies may include biomedical health monitors to check heart rate, pulse rate, and temperature but the data needs to be transmitted to the command center using cell phones. The technologies may also address automated audio, visual and intelligence gathering sensors, voice and data processing technologies, real-time personnel and vehicle location devices, and systems for real time monitoring.

Companies with selected technologies will have the opportunity via the 1401 Program initiative to participate in demonstrations and/or beta tests conducted by first responder agencies within the Southern California region. The resulting evaluations will be available to the 1401 program sponsors, first responder agencies, and the participating companies.

If an organization’s technology is selected, CCAT San Diego will provide services to help transition the technologies to the marketplace. These services will depend on the amount of funding but can be in the form of in-depth market studies, business and commercialization planning, and also provide mentoring on how to find venture and angel investment capital, plus help with other business development services.

In addition, small grants ($20k to $50K) may be provided to support technology integration, adaptation, or help design modifications to make the products more suitable for transition to the marketplace.

CCAT is funded by DOD through the Office of Naval Research as a public-private collaborative partnership among academia, industry, and government with Centers located at California State University (San Bernardino) and San Diego State University.

Awards will be accepted from April 1 to May 1, 2008 and will be announced by July 1, 2008. The performance period will be approximately 5 months (July 1 through November 30, 2008).For more information or to submit an application on CCAT and the 1401 program initiative, go to

Previously, CCAT had announced another solicitation in January 2008 that focused on advanced robotic systems, force health protection, and other key technologies needed to meet urgent DOD requirements. Applications were accepted until the end of February 2008, and the awards are scheduled to be announced by April 30, 2008. These technologies and products will be put into the hands of military customers and where appropriate into the civilian community. Technology assistance will be provided to the awardees to make the products appropriate for military applications and then ready them for smooth transition to the civilian marketplace.

Florida Funds HIT

The Florida Office of Rural Health has awarded over $200,000 in pharmacy health information technology grants to nine critical access rural hospitals. The HRSA grant funding is part of an ongoing effort to help Florida’s small rural hospitals improve the quality of care by helping the hospitals implement information technologies.

The total cost for the equipment to be acquired by the hospitals is over $400,000. The grant funds will help the hospitals purchase computerized pharmacy management information systems, automated medication dispensing cabinets, and computerized medication infusion pumps.

The program is being conducted in cooperation with Florida’s Medicare Quality Improvement Organization, within the University of Florida’s College of Pharmacy and Shands Teaching Hospital. A recent survey showed that ten of Florida’s eleven critical access hospitals have implemented automated medication dispensing equipment.

In addition to providing the funding for pharmacy HIT equipment, over the past five years, the program has worked with hospital nursing and pharmacy staff to establish functioning hospital medication safety committees, established processes for identifying and reconciling medications that patients are taking when they are admitted to the hospital, implemented procedures for screening and providing patients with immunizations without a doctor’s order, developed processes, systems and staff skills for reporting, analyzing and addressing the causes of medication errors, and initiated efforts to report medication errors in emergency rooms.

The Florida ePrescribe Clearinghouse web site ( created by state legislation is an effort of the Office of Health Information Technology located within the Agency for Health Care Administration, and other groups to provide information on the process of e-prescribing. The site provides information and on the availability of electronic prescribing products, links to federal and private sector websites that help to select an electronic prescribing product and links to state, federal, and private sector incentive programs to implement e-prescribing. The web site also links to e-prescribing programs being used by the Florida RHIOs.

For example, the Big Bend Regional Healthcare Organization in North Florida is using e-prescribing and now has an innovative new product called an Automated Medication Dispenser that enables a physician through the use of an ePrescriber to dispense prescription medications directly to their patients at the point of care.

The Tampa Bay HIO uses eMPowerx from Gold Standard, which is the same application used in the Florida Medicaid e-prescribing pilot. In the Northeast Florida Health Information collaborative, the Duval County Health Department uses an electronic pharmacy record system available from Interactive Systems Management, Inc. A second link on the website is currently dedicated to the Florida Electronic Prescribing Advisory Panel with links to meeting agendas, minutes and related materials.

Tuesday, May 6, 2008

Texas Initiating Health Passport

In April 2008, the Texas Health and Human Services Commission launched STAR Health to help children in the state’s foster care program. Like other Medicaid managed care systems, STAR Health features a network of doctors, nurses, specialists, and other healthcare professionals to provide medical, dental, and behavioral health services.

This Medicaid managed care system differs in size from other systems since the network covers the entire state. According to Deb Norris, Policy Analysts with HHSC’s Medicaid CHIP Division, because the system covers the entire state, there is consistency in caring for children who may move to different parts of the state while they are in foster care.

Central to STAR Health is the development of Health Passport, a secure web site that will be the repository for each foster child’s health record. Automated feeds will supply information from Medicaid claims for services and prescriptions as well as basic diagnostic information from providers in the STAR Health network.

Providers can also manually enter information about a child’s vital signs, allergies, Texas Health Steps exams, and behavioral health assessments. This information will create an up-to-date medical context available to any provider who treats that child in the statewide STAR Health network.

The web site will be secure with access limited primarily to physicians, Department of Family and Protective Services (DFRS) caseworkers, and each child’s “medical consenter” which is usually the foster parents. When STAR Health launches the Health Passport, the system will contain two years of medical, dental, and prescription claims for children in the foster care system that have been on CHIP or Children’s Medicaid.

Starting April 1, Medicaid claims and information entered by providers in the STAR Health network are now added to each child’s medical record. This information gives providers information on each child’s medical history and makes it easier to develop a plan of treatment.

The team developing STAR Health has added value into the program and is planning to marry Health Passport’s web-based technology with street level social work. Service management teams made up of behavioral health clinicians, nurse practitioners and community connection specialists will help avert a mental health crisis within the foster families by talking to the families and they will provide the necessary information on all the social services that are available in the community. These service management teams will enable caseworkers in the community to have the time to make certain that the family dynamics in their cases support their foster care placement.

Summit Tackles Issues

According to Darrell G. Kirch, President and CEO, Association of American Medical Colleges (AAMC), we need to embrace a new culture in healthcare and we can only do this by changing our traditional thinking. He expressed his views at the “Collaborative Communications Summit” held May 5-6 in Washington D.C.

The present healthcare system was built on individualism that is competitive, focused, and scholarly. What we now need is a system that is collaborative, transparent, focuses on outcomes, and uses evidence-based medicine. The ideal situation would be to create a culture where teaching and learning produces an integrated world of education resulting in collaborations that will put the patient at the center.

Collaborating on ideas and information in today’s world are needed to use technology to the fullest extent possible. Dr. Kirch reported that a recent collaborative effort just undertaken by AAMC and the American Dental Education Association (AEDA) shows for the first time how academic medicine and dentistry can come together to share teaching resources across universities.

He continued to say that since AAMC launched MEDEdPORTAL in 2006, it has been a source for free, high quality educational resources, and a place for educators to receive recognition for their scholarly work. MEDEdPORTAL along with this new partnership will help AAMC and ADEA obtain a higher degree of collaboration and integration between medicine and dentistry. This partnership will enable medical and dental faculties to benefit from one another’s knowledge, expertise, and excellence to improve medical and dental education.

One of the many panel discussions held at the Summit examined how disruptive innovation can help in healthcare. David Kibbee, MD, AAFP, defined disruptive innovation as some product or service that enables a large portion of the population consisting of less wealthy people to receive care in a lower cost setting. Disruptive technology is now providing healthcare in a less traditional way and combines new business and clinical models with technology.

The reason that delivering healthcare in this way is becoming popular is that consumers can obtain their healthcare in more convenient settings such as in the workplace, retail centers, or at home. A prime example is the “Minute Clinic” concept. The Clinics bring healthcare to the consumer with no appointment necessary, prices are announced beforehand, sites are located in a retail location such as a drugstore where consumers can also shop for other items, and the Clinics provide continuity of care by sending a summary of the visit to the patient’s doctor.

Another speaker on the panel, Majad Alwan, PhD, Director, Center for Aging Services Technologies, pointed out how important it is to provide care to the growing aging population. Seniors very often have multiple diseases, a decline in cognitive abilities, receive care in multiple care settings, and have six to nine prescriptions filled by different doctors. With the future trends, seniors including baby boomers will turn to disruptive innovation as they are very willing to use technology to provide convenience and to save money. As a result, seniors will become increasingly more vocal for the need for low cost behaviorial monitoring systems to be used in the home.

At another panel discussion, several leaders in the field discussed healthcare from the perspective of the hospital. Steve Messinger, a hospital strategist with ECG Management Consultants, pointed out that the gap between the demand for physicians and the supply is catching up.

Doctors are attracted to working for hospitals because of changing regulatory requirements, malpractice issues, opportunity for financial security, and the ability to balance their family life with their work at the hospital. This massive integration of doctors into hospital settings will continue to create a wave of culture change in the years to come along with the development of an integrated delivery system.

Gina Cameron, Director, Physician Billing, Mercy Health System in Conshohocken, PA., explained that in order for hospitals to move to technology, culture change will require perseverance. She pointed out that Mercy Health Care is moving forward in the use of technology, but does not yet have an electronic medical record in place in the acute areas. However, the hospital has rolled out Electronic Medical Records and e-prescribing in a limited way, and lessons have been learned that will be helpful in incorporating subsequent roll outs.

Carolyn Clancy, MD, Director, AHRQ speaking at a session concerning the consumer and the use of technology, reported that her agency is very involved in patient engagement and the use of HIT. For example, AHRQ awarded a grant for approximately one million to Temple University to advance the treatment for hypertension.

The grant funds are supporting telemedicine technologies to be used to promote patient care for hypertension among the underserved African Americans in the North Philadelphia community. The funding will provide treatment guidelines, quality measurements, automatic reminders, and feedback for both patients and healthcare providers.

For more information on the Collaborative Communications Summit, call +1 648 502 7563 or go to The next Collaborative Communication Summit will be held October 27-29, 2008 in Beverly Hills California

NIH Issues RFI

NIH established three Government-Wide Acquisition Contracts called (GWACs) to support IT needs across the federal government with a particular emphasis on agencies such as NIH. The purpose for this Request for Information (RFI) is to open a dialogue with industry and potential federal government customer agencies such as NIH to formulate sourcing strategies and develop an RFP for the next generation contract that will support government IT efforts on health and research IT.

Using current contracts as a baseline, the government may award one or more GWACs in several functional areas. Contractors will be given an opportunity to qualify in one or more areas. The government is also interested in ways that will maximize opportunities for small and disadvantaged business concerns.

The government currently envisions ten functional task areas to develop innovative technology and solutions to meet the future healthcare IT needs of NIH and the government-wide IT community.

Some of the Task areas included in the RFI document are:

  • Task area 4—(Integration Services) To develop information systems for medical imaging systems, EHRs, patient management, clinical management, and laboratory management systems
  • Task area 6—(Digital Government) To provide government services through digital electronic means. This may include business intelligence, data mining, warehousing, electronic commerce, electronic data exchanges, IT-enhanced public outreach services, knowledge management, and web development and support
  • Task area 8—(Healthcare and Bioinformatics Research) To help support researchers and clinicians. This may include providing bioinformatics software, natural language processing software, services focusing on biology and medicine, biomedical information services, patient management systems, EMR software, laboratory management systems, clinical support, and medical decision software systems
  • Task area 10—(Imaging) To provide for systems and services that collect, store, and retrieve digital images. Examples are PACs, geographical information systems and their applications, and computationally intensive surveillance and related systems

The RFI solicitation notice for the “New Government-Wide Acquisition Contract for CIO SP2i and Iw2nd (CIO-SPNEW)” was posted on April 30, 2008, and the response to the RFI is due on May 15, 2008. The primary point of contact is Wanda F. Russell, Contracting Officer at To find the complete Solicitation, go to, click on search, type in HHS, and scroll down to the posted date of April 30, 2008.

International Roadmap Published

The American Telemedicine Association Global Forum on Telemedicine: Connecting the World through Partnerships was held in September 2007. The forum presented the “International Roadmap for Action” including recommendations for improving health and healthcare delivery through telemedicine and information technology.

The goal of the forum was to bring together key stakeholders interested in global healthcare outreach to explore a flexible framework and develop sustainable business models. This will make it possible to leverage telemedicine and information technology to extend outreach efforts.

The document is going to be used to start a dialogue to explore the ways that the telemedicine community can work to improve global disparity in healthcare. The recommendations will be presented to governmental and non-governmental organizations for comments and further development.

The recommendations fall into six categories:

  • Continue the dialogue to create the telemedicine framework for multiple stakeholders
  • Provide stakeholders with ways to identify and leverage existing resources
  • Educate grantors on the value of telemedicine in order to expand medical outreach and training programs
  • Work to align international policy to support the integration of telemedicine into country plans and to support cross country partnerships
  • Develop the communication infrastructure
    Integrate telemedicine programs for disaster relief

To see the complete report, go to . An article will be published shortly on the subject in the “Telemedicine and eHealth Journal.”

Saturday, May 3, 2008

MN e-Health Initiatives

The Minnesota e-Health Initiative’s advisory committee along with consumers and industry representatives are working on a statewide plan to have all providers and care delivery settings use electronic health records by 2015. The advisory committee is working on health data standards, ways to ensure that HIT will lead to improvements in quality, and ways to modernize the public health information system.

A report submitted in February 2008 outlined advances occurring in 2007. Nearly all the hospitals and two thirds of the primary care clinics have implemented or are in the process of implementing EHRs.

The state has made progress with their e-Health grants that support the adoption of interoperable EHRs in rural settings and in inner city community clinics. Seven million dollars was made available in grants over the biennium for planning and implementation projects. Another $6.3 million was made available in no interest loans.

So far, $3.5 million in grants have been awarded to 16 community e-health collaboratives. Seven planning projects up to $50,000 each and nine implementation grants for up to $750,000 were awarded.

$1.5 million was appropriated in FY 07 to fund six collaboratives to help assess and plan projects. Of the six assessment/planning grants awarded in 2007, three received implementation grants in 2008.

In addition, eligibility criteria and application instructions have been developed for the no interest loans program with the initial round of preliminary loan requests reviewed. Efforts have been made to leverage federal and other funds to augment legislative appropriations.

The initial e-health grant projects provided critical information such as:

  • Implementing HIT is very complex and almost always takes longer than anticipated
  • Collaboration is essential among health information “trading partners” within a community and should be initiated early in the planning process
  • Thorough and systematic planning is critical and must engage the staff that will be impacted by the EHRs early in the process
  • Using existing tools, tips, and templates saves time and resources
  • Contracting with a trusted consultant familiar with EHR planning and implementation is indispensable in saving time and avoiding costly mistakes
  • Funding HIT adoption in addition to other capital expenditures is a major financial strain for rural and small health organizations
  • Adequately preparing and engaging the workforce is a critical success factor
  • The best implementations are those that don’t just automate existing paper process but take the time to completely re-design how business is done

To read the entire report, go to

DOD Funds Eye Research

The Bascom Palmer Eye Institute and two other Centers of Excellence from the University Of Miami Miller School Of Medicine were recognized for their innovative work in clinical and scientific medical practices. DOD awarded the group $4.8 million with Bascom Palmer’s share totaling $2 million.

DOD is interested in eye research since at least 16% of war casualties are due to eye trauma, and millions of active and retired military personnel suffer from eye disorders. The funding will support traumatic eye injury and visual restoration, hereditary eye diseases, and ophthalmic imaging and telemedicine.

The funding will be directed toward Bascom Palmer’s Center for Ophthalmic Innovation to help join science, engineering, and medicine find practical solutions for better eye health. This funding will enable physicians, scientists, and engineers to work together to conduct critical vision research and use cutting edge technology across medicine, biotechnology, and biomedical engineering.

Presently, Bascom Palmer’s Advanced Retinal Image Reading Center uses a non invasive imaging technology called Optical Coherence Tomography as a secondary outcome measure for ophthalmic clinical trials, and for telemedicine applications. The Center is led by medical retina specialists who care for patients at the Bascom Palmer Eye Institute’s hospital and clinics advancing the technological frontiers. The Center’s telemedicine applications are being developed in partnership with Anne E. Burdick, MD, Associate Dean for Telehealth and Clinical Outreach at the Miller School of Medicine with start-up funding provided by TATRC.

The other University of Miami centers to receive DOD funding are the William Lehman Injury Research Center and the Gordon Center for Research in Medical Education.

Cell Phones Enable Imaging

Engineers at the University of California, Berkeley have made it possible for cell phones to make medical imaging accessible to billions of people in the world. Boris Rubinsky, UC Berkeley Professor of Bioengineering and Mechanical Engineering, head of the team that developed this new application for cell phones said “more than half of the medical equipment in developing countries is left unused or broken because it is too complicated or expensive to operate and repair.” The World Health Organization reports that three quarters of the world’s population do not have access to ultrasounds, x-rays, magnetic resonance images, and other medical imaging technology.

The National Center for Research Resources at NIH supported the university research along with the Israeli Science Foundation and the Florida Hospital in Orlando.

According to Professor Rubinsky, most medical imaging devices have the data acquisition hardware connected to the patient, image processing software, and a monitor to display the image. When these components are combined into one unit, machine parts often become redundant and this substantially increases the cost of the device.

Professor Rubinsky and his team came up with the idea of physically separating these components so that the processing software used to reconstruct the raw data into a meaningful image can reside at an offsite central location where resources are available operation and maintenance. These offsite central locations would be able to service multiple remote sites where far simpler machines would collect the raw data from the patients.

In developing cell phone technology for use in medical imaging, the researchers used Electrical Impedance Tomography (EIT) which is based upon the principle that diseased tissue transmits electrical currents differently than healthy tissues. These electric current differences in resistance can then be translated into an image.

In use, the cell phone would be hooked up to a data acquisition device to transmit the raw data to the central server where the information would be used to create an image. The server would then relay the image back to the cell phone, where it would be viewed on the cell phone’s screen. Using the cell phone significantly lowers the cost of medical imaging because the apparatus at the patient site is simplified and highly trained personnel in imaging processing do not have to be available.

The data acquisition device can be made with off-the-shelf parts that people with basic technical training can operate. The device that the research team built was a simple data acquisition device with 32 stainless steel electrodes for the experiment. Half of the electrodes were used to inject the electrical current and the other half of the electrodes were used to measure the voltage. A total of 225 voltage measurements were taken and uploaded to a cell phone which was hooked up to the device with a USB cable.

This system can work with any cell phone capable of sending and receiving multimedia messages such as graphics, video, and audio clips. As for the concern about dropped calls, the researchers say that there is no medical application that would not allow the user to redial a line.

This new technique for medical imaging is described in the April 30 issue of the peer-reviewed, open-access journal, Public Library of Science ONE (PloS ONE).