Wednesday, July 23, 2008

Medical Device Research

Dr. Keith Kocis, Professor of Pediatrics in the School of Medicine, and a collaborator with the Renaissance Computing Institute (RENCI) at the University of North Carolina at Chapel Hill, received a grant for $188,812 from the University of North Carolina Research Competiveness Fund. The funding will be used to further research and develop a prototype medical device to revolutionize how critically ill infants and children are monitored and cared for in pediatric intensive care units.

The most important and essential function of a PICU is to provide advanced monitoring capabilities to be able to evaluate the clinical status of patients and to be able to track their response to a wide range of interventions. Despite tremendous advancements in computer technology and bioinformatics, critical care monitoring devices so far do not provide any significant new information to the bedside caregivers. Current monitoring systems do not present data in a format that fosters the understanding of the complex dynamic changes occurring instantaneously or over time in a biological system.

Dr. Kocis and the research teams from RENCI and the Department of Biomedical Engineering at the university are working with REALTROMINS, a UNC backed start-up company involved in building next generation medical devices. The funding will enable REALTROMINS to create two additional medical devices that use their predictive modeling technology

In 2010 there will be approximately 5500 PICU beds available and according to the American Board of Pediatrics, there are 1287 board certified pediatric critical care physicians providing 24/7 care. The critical care monitoring industry is a $1.2 billion a year business and growing at 3.9% per year. Most of the market share is adult monitoring plus 8% for neonatal and 2% for pediatric care.

The Research Competiveness Fund created by the North Carolina General Assembly in FY 2007 and 2008 was allotted $3 million to provide funding for research efforts that hold the potential for strong economic development.

HRSA's Rural Grant Program

HRSA’s Office of Rural Health Policy posted the announcement for the “Rural Health Care Services Outreach Grant Program” (HRSA-09-002) on July 14th. This grant program encourages the development of new and innovative healthcare delivery systems in rural communities that lack essential care services. The application deadline is October 16, 2008.

Applicants may propose projects to address the needs of a wide range of population groups including but not limited to low income populations, the elderly, pregnant women, infants, adolescents, rural minority populations, and rural populations with special healthcare needs. To be eligible, applicants must be rural, nonprofit private or public entities that represent a consortium of three or more organizations that deliver healthcare services in rural areas.

It is anticipated that there will be 90 awards totaling $13,500,000. The maximum award, including direct and indirect costs, is $150,000 for the first budget year, $125,000 for the second year, and $100,000 for the third year. $375,000 is the maximum request over three years.

The project is estimated to start May 2009 and end April 2012. ORHP does not anticipate holding a competitive funding cycle for the Outreach program in FY 2010 and FY 2011. However, grantees awarded in FY 2009 may be eligible to apply for the non competitive continuation cycle in FY 2010 and FY 2011. The next competitive cycle for this program is planned for FY 2012.

For more information, contact Nisha Patel at

Systems Needed for Trauma Care

A study found that medication histories recorded for trauma patients in a rural population can be highly inaccurate and incomplete due to communication problems among hospital personnel. In addition, it is very difficult to obtain complete medical histories from patients who have trouble speaking or remembering exactly what medications they take.

The article “Medication Reconciliation in a Rural Trauma Situation” that studied 234 trauma patients was recently published online in the publication “Annals of Emergency Medicine”. “Medication errors are generally the result of the system breaking down and trauma patients are particularly vulnerable because the need for speed when treating them may make obtaining a complete medical history impossible”, said lead study author S. Lee Miller, MD, Conemaugh Memorial Medical Center in Johnstown PA.

The trauma patients in the study were from rural settings and were moderately injured. The medication lists given upon admission to the hospital were inaccurate 85% of the time. The study showed that ten patients received the wrong medications and one adverse drug event occurred. Some of the reasons contributing to the problem was that the medication lists were incomplete because patients were either poorly informed or forgetful, not all pharmacies would divulge patient information, and the doctors at the hospital did not know what the patient’s other doctors were prescribing.

When treating emergency trauma patients having the right information available at the right time is essential according to the American College of Emergency Physicians a national medical society. The society wants to see electronic medical records implemented and the development of an interoperable nationwide health information network linking all of the components of the system.

Realizing that providing effective and efficient trauma care is not presently being done in Arkansas, the Governor and state legislators are making funds available to improve trauma care. Governor Mike Beebe has just released $200,000 in seed money from the Governor’s Emergency Fund to assist in the development of the Arkansas Trauma System.

The Trauma System will be administered through the Arkansas Department of Health with the funding to be used to improve communication and coordination among hospitals and emergency medical services. Also, a statewide trauma registry will be established to identify future needs in trauma response as the overall system develops. The Governor is looking ahead and he wants to see the next legislative session discuss what constitutes a trauma care system and ways to provide the funding for the system in future years.

Sunday, July 20, 2008

AHRQ Plans New HIT Funding

AHRQ has plans to publish three types of Funding Opportunity Announcements (FOA) for Health IT research by the end of August. The FOAs will include:

  • Research demonstration projects to study how to implement health IT to improve the quality, safety, and effectiveness and efficiency of healthcare in ambulatory settings and how to support care transitions between ambulatory settings or non-ambulatory settings
  • Exploratory development research projects that will conduct pilots or feasibility studies to help implement future health IT
  • Small research grants in health IT to perform an economic analyses of health IT implementation and to do a secondary data analyses of health IT research

For the “Notice of Intent to Publish Program Announcements for Health IT” go to Until the FOAs are published, AHRQ cannot provide additional information on the content. For general comments regarding AHRQ’s health IT program, contact Angela Lavanderos, Center for Primary Care, Prevention, and Clinical Partnerships, at

In another announcement published on July 16th, AHRQ released the pre-solicitation notice (AHRQ-2008-10036) “Incorporating Health Information Technology into Workflow Redesign”. The agency wants to develop a practical and easy to use toolkit that will provide a workflow analysis and redesign to be used by both small and large practices as well as in other ambulatory settings. Health IT needs to support the design since the agency’s goal is to encourage the adoption of clinical HIT to bring evidence based decision support to the point of care.

The proposer needs to be able to do literature reviews, synthesize results from a request for information, develop a toolkit based on findings, write reports while contacting relevant experts and reviewers, test the toolkits, and be able to develop websites. The proposer also needs to have experience in research process improvement and redesign, workflow analysis and redesign, ambulatory clinical workflow, HIT, and HIE.

The response date for the pre-solicitation is listed as July 25, 2008. The full solicitation is estimated to be released on July 30th with full proposals due August 30th. The solicitation will be advertised on an open competition basis and will be available on When the solicitation is advertised, it will also be available for downloading from At that time, go to the AHRQ homepage, click on Funding Opportunities, click on Contracts, and go to RFPs. The government estimate for this proposed acquisition is $500,000 and the period of performance will be for 2 years.

For more information on the pre-solicitation or to submit questions, contact Linda Simpson AHRQ contract specialist at

Healthcare and HIT Today

At a breakfast briefing held on July 17th, Karen Davis, President, of the Commonwealth Fund, announced that the “Commonwealth Fund Commission on a High Performance Health System” just updated the national scorecard on the U.S. health system. According to the report, the U.S. scored an average of 65 out of a possible 100 across 37 indicators of health outcomes, quality, access, efficiency, and equity—slightly below the overall score in the 2006 report.

According to James J. Mongan M.D. who chairs the 19 member commission and is CEO of Partners Healthcare in Boston, “It is apparent that overall, the healthcare system is performing unevenly and well below its potential.”

Cathy Schoen, Senior Vice President for the Commonwealth Fund stated how important it is to pursue strategies that take a whole system approach in order to improve access, quality, and efficiency all simultaneously.

In the broader picture the report points out that the country needs to have universal and well designed coverage for care, incentives need to be aligned to promote higher quality and more efficient care, design and organized care needs to be centered around the patient, goals need to meet and exceed benchmarks performance needs to be monitored, and national policies are essential to promote private-public collaboration and high performance.

Specifically, using health information systems to support efficient care is only a part of the overall debate on improving the healthcare system. However, as the report points out, the U.S. lags well behind leading countries that have made a system-wide commitment to invest in interoperable information technology.

Although U.S. physicians have increased their use of EMRs from 17% to 28% from 2001 to 2006, other countries such as the UK use EMRs in nine out of 10 primary practices, plus the fact that the Netherlands use EMRs in 98% of their practices. Furthermore, clinical data systems in these countries are more likely than those in the U.S. to have advanced functions that provide decision support and enable information to flow with patients across sites of care. At the current U.S. rate of dispersion, it would require more than 30 years to expand such tools to physicians.

As pointed out at the briefing, CMS is making several efforts to increase efficiency and accountability. For example On October 1, 2008, CMS will no longer pay for treatment needed to correct adverse drug events that could have been prevented during hospital stays. CMS estimates that it will save $20 million in direct outlays to hospitals.

The CMS Medical Home Demonstration coming in 2009 will provide family centered care to high-need Medicare beneficiaries. Care will be provided using evidence-based medicine, clinical decision support, and health IT will provide patients with enhance access to services.

CMS has an ongoing EHR Demonstration Project where Medicare will provide incentive payments in 12 communities nationwide to physicians who use EHRs. Financial incentives will be provided to as many as 1,200 small and medium size primary care physician practices over a 5 year period.

On Capitol Hill, the Senate Finance Committee held a hearing on July 17th to discuss the potential and limitations for HIT. Peter Orszag, Director, CBO, appearing before the Committee, said “the bottom line is that research indicates that in certain settings, health IT appears to facilitate reductions in health spending if other steps in the broader health care system are also taken to alter incentives to promote savings. By itself, however, the adoption of more health IT is generally not sufficient to produce significant cost savings.”

Richard Hillestad, Principle Researcher, Professor, RAND Graduate School told the Committee that HIT efficiency savings could reach approximately $80 billion per year at the 90% adoption level for hospitals and physicians. RAND estimates the costs to achieving these savings in 15 years would average about $8 billion per year or $120 billion total. During the 15 year adoption period, the cumulative net savings would be about $510 billion or approximately $34 billion per year.

Also appearing before the Committee, George C. Halvorson, Chairman and CEO Kaiser Foundation Health Plan Inc., and Kaiser Foundation Hospitals, pointed out that one of the solutions is to have special computer systems or care registries analyze data from electronic medical records. The registry would provide doctors and other clinicians with reminders and prompts, and provide recommendations on the best scientific evidence and expert opinions for individual cases. However, only a few places in this country will be able to achieve the full electronic medical record supported by an up-to-date care registry in the immediate future.

OHSU's Innovative Research

Researchers at Oregon Health & Science University (OHSU) are developing a device to improve monitoring and use resuscitative treatment strategies with patients that develop septic shock. Septic shock alone afflicts 750,000 people a year resulting in 215,000 deaths annually in the U.S. Today over 25% of the entire healthcare budget is spent on patients who develop shock and mortality from shock persists at an unacceptably high rate.

Researchers think that this unacceptably high death rate is due at least in part, to complications from persistent or recurrent periods of end-organ under-perfusion that goes unrecognized and therefore the patients are under treated. Right now, current monitoring techniques and resuscitative treatment strategies are not as effective as they need to be.

Researchers are now working on a device that promises to greatly improve monitoring techniques. They have been working on a “data acquisition device” capable of recording and analyzing high resolution data at the bed side. The hidden information contained in high frequency recordings of physiological data can reveal information on the health status of the patient by highlighting the breakdown of compensatory mechanisms as they occur prior to catastrophic events and during the resuscitative period. The researchers think that development of this device will improve diagnostic abilities to predict and will be able to impact treatment decisions in patients with shock.

Plans are to incorporate the “data acquisition device” into what will be called a “Portable Resuscitation Assist Device in Shock” (PRADS). The smart device will serve as a patient monitor, a sophisticated data analysis system, and will employ artificial intelligence to provide treatment recommendations to care providers based on the information available at the bedside.

The researchers will approach the market place once they have finished developing the device and plan on incorporating the device into existing bedside and portable hemodynamic monitoring systems. They think that this device has applications in the military, in remote locations, and in both rural and urban hospitals worldwide.

So far, a team of expert researchers consisting of intensivists, system scientists, computer programmers, and hemodynamic specialists, involved in this project have worked closely on several projects at OHSU plus they have formed a strategic partnership with the Biomedical Signal Processing Lab at PSU.

For more information, contact Chris Andon at 503-494-4185.

Tuesday, July 15, 2008

Congress Overrides the President's Veto

President Bush on July 15th vetoed the Medicare bill but Congress overrode the veto and the legislation became law. The passage of the Medicare bill was of great concern due to the scheduled cuts in physician fees that would have taken place. The telemedicine community had a stake in the bill as well since the bill called for skilled nursing facilities, hospital-based dialysis centers, and community mental health centers to be telehealth/telemedicine originating sites and be reimbursed by Medicare. The legislation also has an important and timely provision for health IT interests because the Medicare legislation includes requirements for e-prescribing.

On June 24, the bill originally passed the House by a vote of 355 to 39 and then passed the Senate on July 9 by a vote of 69-30. However, on July 15, President Bush vetoed the bill, but then Congress was able to override the veto making the bill law. The House vote was 383 to 41 and the Senate vote was 70-26. The vote in both the Senate and the House exceeded the two-thirds required to override a presidential veto, meaning that the bill will become law despite the administration’s objections.

ATA has been actively involved in getting the legislation passed. According to Jonathan Linkous, Executive Director for the ATA, the law goes into effect January 1, 2009, but CMS needs to issue regulations detailing how it will be implemented. ATA will work very hard with CMS as they develop these regulations.

Many thanks go to all of the Senators and Representatives that contributed their support, to the telemedicine, telehealth, and the health IT community, to the tremendous support at ATA, to all the many people who made calls and visits to Capitol Hill, and to Bob Waters and the Center for Telehealth and e-Health Law. The Medicare legislation became a reality because of their enormous efforts.

Louisiana Passes Key Legislation

The Louisiana Mental Health Care Reform Legislative package includes two bills on telemedicine passed in the state legislative session. HB 653 will help all mental health professionals’ complete actual exams to assess patient’s needs. The law allows for the use of telemedicine through video and audio technology to enable psychiatrists in different locations to issue emergency certificates that may be needed to commit individuals in crisis.

The second bill concerning telemedicine is HB 193. The legislation ensures that physicians and other mental healthcare professionals who are providing telemedicine services on a voluntary basis for the Department of Health and Hospitals (DHHS) will now have medical malpractice liability coverage. The bill eliminates a major barrier in current law that would discourage physicians from volunteering to provide telemedicine services to patients throughout the state.

Senate bill 287, the “Louisiana Consumers Right to Know Act” requires DHHS to create a web site to be launched before April 30, 2009 so that healthcare consumers will have access to reliable information on costs and quality issues. DHHS will publish key performance data on healthcare providers and health plans to include complication rates for procedures, average costs for procedures, and the number of procedures a provider has performed. This information will enable consumers to compare providers across a range of performance categories.

The Act also calls on DHHS to form a Health Data Panel with healthcare stakeholders and technology experts from the state to advise the agency on best practices needed to collect provider data, adjust the data for accuracy, and to make the data on the web site clear and easy to understand.

The Governor’s budget also supports the second year of the Louisiana Rural Health Information Exchange, a partnership between the Rural Hospital Coalition and LSU Health Sciences Center. The HIE uses telemedicine and electronic health records to connect rural hospitals with the resources at the LSU Health Sciences Center to host the network. This accounts for $13.5 million of the $18 million in funding.


On July 11th, HRSA’s Office of Rural Health Policy issued a Request for Proposal (RFP 08-N250-6025) to find ways to improve the recruitment and retention of physicians and other health professionals in rural underserved areas. Various methods have been used such as payment incentives, training programs, scholarships and loan repayment programs, and recruiting of students from rural areas, but none have met the demand for health professionals. The demand is particularly important for dentists and professionals in mental and behavioral health and nursing.

The goal is to improve the skills of the state entities that are doing the recruiting. The contractor will be expected to perform to:

  • Identify the focal point within each State that is doing rural recruitment and invite them to become a member of the National Network
  • Participate in workshops, presentations, webinars and conferences designed to improve successful recruitment and retention efforts.
  • Make presentations at meetings of the State Offices of Rural Health, State Rural Health
  • Develop articles for publication addressing the shortage of providers in rural areas
  • Maintain a library of rural medical workforce and recruitment and retention materials
  • Establish toll free phone line to respond to inquiries
  • Develop a strategic plan with goals, objectives, activities, and work plan
  • Work with HRSA programs and the AHEC program to promote well coordinated and effective recruitment
  • Conduct an annual workshop on workforce needs for the State members
  • Do an annual project evaluation to identify the status, progress, and effectiveness of the project as identified in the annual strategic plan

The RFP is due on August 11, 2008. For more information contact David Trejo at or call 301-443-2730 or 301-443-2750.

Sunday, July 13, 2008

Digital Hearing Devices Improving

Audigence a computer engineering firm has software to assess digital hearing devices, such as cochlear implants or digital hearing aids without needing to modify the existing hardware. Audigence began when the founder of Audigence Lee Krause received a cochlear implant and decided that there had to be a better way to tune the device. So he and several co-inventors formed a strategic alliance with the University of Florida to develop a software product to solve the problem and from there Krause developed his new company Audigence.

Using cochlear implants or digital hearing aids can require multiple trips to an audiologist where patients are tested in a sound chamber using antiquated technology. The testing process is time consuming and somewhat inexact and can put severe limits on an audiologist’s throughput and as a result, the patient will endure suboptimal performance.

Audigence’s software product fully automates the assessment process and has the capability to deliver service remotely over the web. Patients can be tested in any environment that is equipped with internet access, a personal computer, and a microphone. The technology can also be applied to cellular telephone handsets so that these devices can be self-tuned to an individual’s unique hearing capabilities.

Audigence estimates that 40,000 implants are installed per year with a 20% annual growth rate and there are estimates that 140,000 existing users could benefit from device optimization. $600 million is spent annually on implant devices and an additional $150 million is spent at audiologists to tune these devices. In addition the target market for digital hearing aids represents a $7 billion device market.

Right now, the technology is being clinically tested at the University of Florida and is nearing approval from the FDA. According to Krause, the technology could be in reach of the general public within the next year or two.

Audigence’s strategy is to work with device manufacturers on the cochlear implant market since these suppliers control 95% of the market. Audigence plans to sell or license its software directly to one or more device manufacturers in each targeted market who will then embed the software in their product to be marketed through audiologists and ENTs.

For more information on Audigence, contact Paul Suchoski at (321) 243-9360 or go to

Technology Key During Pandemics

The new report “Home Health Care during an Influenza Pandemic: Issues and Resources” highlights the critical need for home healthcare in providing care during a pandemic influenza event. The report funded by the HHS Assistant Secretary for Preparedness and Response and CDC, and developed by AHRQ, describes the resources and the technology needed by home healthcare providers and community planners to prepare for such an event.

“Community planners, state and local public health departments and healthcare systems must look critically at leveraging the existing resources of home healthcare agencies to meet the possible surge demands of an influenza pandemic,” said the Assistant Secretary for Preparedness and Response W. Craig Vanderwagen, M.D, RADM.

The report further stresses the need for telehealth technologies to deliver patient care and e to do advanced planning and coordination at the local level. Using technologies would allow remote monitoring of patients and the ability to prompt patients on taking medications.

The equipment needed includes:

  • Remote vital sign monitoring units using standard phone lines. This technology is already being adopted in New York, Pennsylvania, and several other states
  • Interactive voice response systems to enable callers to use their touchtone phones to receive information automatically.

More information can be found at The report can be downloaded at

Computers Helping VA Patients

The VISN 1 Mental Illness, Research, Education, and Clinical Center, (MIRECC) has found that using a computer to deliver coping skills training programs boosts treatment success when added to a traditional outpatient treatment program. Seventy seven patients with drug abuse issues entering treatment were given either standard care alone or standard care with the addition of a multimedia computer program based on the principles of cognitive behavioral therapy (CBT).

CBT uses the learning process to train individuals to change addictive behaviors. When used for drug abuse treatment, CBT helps patients recognize situations in which they are most likely to use drugs, how to avoid these situations when appropriate, and how to cope more effectively with a range of drug-related problems.

In the eight week treatment study, patients who used the computer-based program had fewer drug positive urine specimens and had longer periods of abstinence during treatment when compared to patients who only met with a counselor. This is the first time that a computer-based treatment has been shown to work with drug abusers in treatment programs. This research represents a breakthrough because it delivers a proven behavioral therapy in a user-friendly online format that can be administered anytime and anywhere using a computer.

In another VA development to help veterans with mental health issues, 44 new community based outpatient clinics are coming on board at the VA to provide healthcare closer to home for veterans in 21 states. These clinics in addition to on-site primary care staff, very often have state-of-the-art telehealth systems that permit veterans to regularly contact their doctors in specialties from cardiac care to mental health at the VA’s regional hospitals via video consultations.

Wednesday, July 9, 2008

Senate Passes Medicare Legislation

On Wednesday July 9th, the Senate passed the comprehensive Medicare legislation. This legislation with a number of important issues of importance to the Medicare community will also expand the list of telehealth originating sites to include hospital-based renal dialysis centers, skilled nursing facilities, and community mental health centers. The vote was the second attempt at passing this legislation after a vote for cloture failed in June.

The Medicare legislation was important enough for Senator Edward Kennedy to make an unexpected trip to Washington to vote for the bill. When Senator Kennedy appeared on the Senate floor as the roll was being called, the entire Senate gave him a resounding and sustained standing ovation.

According to Reed Franklin, Senior Director of Public Policy ATA, the measure was called up after a 2 week intensive advocacy effort on the part of medical groups and senior citizens. The tally was 69-30, which is a sufficient margin to override the veto that President Bush has threatened.

The legislation now goes to the President for either his signature or veto. The administration has previously threatened to veto the Senate passed bill. It is still unclear as to whether the President will veto the bill given that both the House and the Senate passed the measure with sufficient margins to override a veto. It is likely that if there is a veto that it will be overridden.

Many thanks go out to all of the Senators and Representatives that championed for the legislation, to the many people in the telemedicine community who worked hard to see the legislation passed, to all the support and guidance at ATA, and to Bob Waters and the Center for Telehealth and e-Health Law.

Healthcare Improving in India

Health Affairs held a briefing at the National Press Club on July 8th, to let the attendees know that although healthcare in India and China has improved, these countries are still facing fundamental challenges, but at the same time stand on the brink of major health reforms. These countries face other health concerns such as HIV/AIDS, aging populations, and as their populations grow wealthier, many will face the same chronic diseases that affect the U.S.

There are however a number of success stories in India and one in particular is the specialty eye care network in India called Aravind which won the Gates Award for Global health in May 2008. Aman Bhandari, a researcher at CMS, discussed the network in the article “Specialty Care Systems: A Pioneering Vision for Global Health”. The article co-authored by Bhandaria, Sandra Dratler, Kristiana Raube, and R.D. Thulasiraj, was just published in the July/August Health Affairs Journal.

Aravind began in the 1970’s when Govindappa Venkataswamy also known as Dr. V, noted that the Indian government could not meet their current need for cataract surgery especially in impoverished populations and in low resource settings. Dr. V then came to the U.S and was very impressed with how the McDonald chain was able to provide affordable and consistent quality using a highly efficient system at each restaurant. Taking this information back to his country, Dr. V went to work to provide better cataract care by developing a system using standardized management to efficiently provide better care.

As a result, Dr. V created the Aravind Eye Care System that was first used in an eleven bed hospital. The program has grown so much that by 2008, Aravind now has 4,000 beds at five hospitals and examines more than two million patients annually. Revenue generated by paying patients is used to support the services provided at low or no cost to poor patients.

In another move initially done to provide efficiency and to lower the cost for intraocular lenses that are needed to perform widespread cataract surgery, Aravind and two key partner organizations started and now operate their own manufacturing plant. By producing the lenses themselves, they reduced the cost of the lenses from $200 to less than $10. Now Aurolab intraocular lenses are used in more than 100 countries and exported through various NGO partners and distribution channels which make up 10% of the global market for intraocular lenses.

As Aravind matured, they located services in urban areas or settings where people are willing to travel to eye camps, vision centers, or kiosks. There are however, patients in very rural villages, the Himalayas, and Nepal, and these residents are still able to receive quality eye care provided through “Wi-Fi” wireless networks.

For example, the networks allow eye specialists at Aravind Eye Hospital in Southern India to interview and examine patients in remote clinics using high quality video conferencing. Patients see the nurse, than spend a few minutes on a web camera consulting with an Aravind doctor. If the doctor determines that a closer examination is needed, the patient is given a hospital appointment.

In addition to effective treatments for cataracts, the Indian healthcare industry in general is emerging as one of the major growth service sectors in India. The Indian pathology industry has been growing along with the outsourcing of laboratory tests. Since many Americans are now interested in doing business with India especially in the medical technology field, the U.S. Department of Commerce has established a new India Business Center to help find business opportunities for American businesses.

The India Business Center provides a web portal with up-to-date information, telephone counseling, information on the complexities of the market, and conducts outreach activities to provide information on business opportunities in India.

In addition, the U.S. Commercial Service Health Care Team housed within the Department of Commerce, has created the Health Care e-Market Express at . This service was requested by U.S. healthcare companies to notify them at least monthly of new healthcare market research and trade leads received from the U.S. Embassies and Consulates overseas.

Nasa Developing Smart Medicine

NASA’s Space Medicine Program is studying how to optimize oxygen utilization so that multiple individuals can be monitored during transport. Right now oxygen use during transport is not being measured. Scientists at the University of Cincinnati are working on research in this area that is supported by not only by NASA and the National Space Biomedical Research Institute, but also by the Office of Naval Research, Wyle Laboratories, and Impact Instrumentation Inc.

The funding is being used to develop an autonomous module that can change settings breath-to-breath based on the individual’s needs and at the same time help maintain an adequate oxygen supply to the body as well as conserve oxygen. The smart technology under development will not only help transport astronauts in space, but the technology may also change the way medicine is practiced for all types of patient transport and in disaster scenarios where patients outnumber medical caregivers.

Also, NASA’s Johnson Space Center has developed technology that incorporates an oxygen partial pressure sensor into an aircraft oxygen mask to alert a pilot or crewmember when the partial pressure of oxygen (PPO) decreases below a predefined safety level. If the oxygen level decreases below the level equivalent to a cabin altitude of 10,000 feet, an auditory or warning device is activated and alerts the pilot and crew so that hypoxia may be avoided.

The technology has numerous applications that not only include commercial and military aviation, but can be used with military field troops, firefighters, and for industrial workers who work in hazardous breathing environments.

RFP to Help Children

As part of the Illinois Children Healthcare Foundation’s (ILCHF) mission to address the overall health needs of children in the state, the Foundation announced an RFP seeking collaborations between primary care and mental health providers. Grants for $2 million are expected to be awarded.

The RFP process is open to any non-profit organization that serves children in the state and wishes to form a collaboration between primary care and mental health, or build upon existing partnerships, or develop a plan for integrating mental health services in a primary care setting.

All proposals will need to demonstrate expertise in using formal mental health assessment tools, using a patient registry to track patients, and using psychiatric consultations to support primary care providers.

Eligible organizations can include federally-qualified health centers (FQHC), FQHC look-alikes, school-based health centers, free clinics, public health department clinics, hospital clinics, and other community health centers.

Organizations that would like to develop a plan for a collaborative program may be awarded up to $50,000 to underwrite the planning phase. Applicants that wish to establish completely new services may be awarded up to half a million dollars over the course of two years. Finally organizations wishing to expand existing mental or behavioral health service may be awarded up to $220,000 over 15 months.

The RFP will close August 15, 2008 and all interested applicants should visit to see the complete RFP.

Sunday, July 6, 2008

Vermont Seeks Proposals

On July 2, 2008, the Vermont Department of Information and Innovation released a Request for Quotation (RFQ) (1107-VHITF/JM) seeking competitive, fixed price proposals to conduct an independent study of the new Vermont Health Information Technology Fund. An award ranging between $15,000 and $25,000 per year for a two year period will begin September 1, 2008. The closing date for the proposals is 8/8/2008.

The study will evaluate the effectiveness of programs and initiatives funded through the Technology Fund and will include data on the return on investment. The study findings will be presented to the Secretary of Administration and the Commissioner of DII no later than September 1, 2009. The State intends to use the results of the study to make future policy decisions on the allocation of health IT funds and the need for continuation of the fund in future years.

The Fund was established during the 2008 legislative session and must be used to promote and improve healthcare IT in the state. Starting in October 1, 2008, each health insurer operating in the state will pay a quarterly fee into the Health IT Fund. This Health Care Information Technology Reinvestment Fee is expected to raise a total of $32 million over the next seven years.

State government entities and Vermont Information Technology Leaders Inc. (VITL) a non-profit public private partnership will be able to draw money from the Health IT Fund. The money is to be used to help, independent primary care practitioners purchase and implement EHRs and practice management systems, provide financial support to build and operate the HIE, implement the Vermont Blueprint for health IT initiatives, implement the advanced medical home project, and help to provide consulting services.

For more information on the RFQ, contact John McIntyre (802) 828-2210 or email For additional information, go to

A Plan & Funds for Global Care

The Fogarty International Center, the international component of NIH, has just published a new Strategic Plan to direct the Center’s activities until 2012. The plan calls for the expansion of research training opportunities for U.S. and foreign scientists, providing a sustainable research environment, and forming new strategic alliances and partnerships globally.

“Fogarty’s new strategic plan provides the pathway toward developing sustainable global health research and training programs where they are needed the most”, according to Center Director, Dr. Roger I Glass.

The strategic plan’s first goal is to mobilize the scientific community to address the growing epidemic of chronic non-communicable diseases while continuing to address the unfinished infectious diseases agenda. The plan emphasizes the urgent need to deal with chronic diseases in low and middle income countries and to promote implementation science.

In line with the strategic plan concerning chronic diseases, FIC plans to issue seven full awards and two planning grants annually. The $1.5 million per year grant program is designed to build research capacity in areas such as stroke, lung disease, cancer, environmental factors, obesity, lifestyle, and the relationship of genetics to chronic diseases.

Full awards would receive $220,000 per year for up to five years with planning grants being allocated up to $27,000 each year for up to two years. Letters of intent are due August 31 and full applications must be submitted by September 29, 2008. The program seeks proposals from those working across disciplines, such as nutrition, business, behavioral health, health law, economics, environmental health, and urban planning.

The strategic plan emphasizes the urgent need not only to provide training but also to share information. To do this, the plan calls for developing more information and communication technologies (ICT). Fogarty also encourages using complex systems analysis and predictive modeling as research tools. Fogarty is holding a series of consultations with IT experts to guide these efforts.

ICT usage can range from accessing scientific literature to using sophisticated systems for long distance learning and for data management and analysis. Linkages will need to be established where resources and knowledge can be shared across sites in other languages and in real-time.

Fogarty is also going to sponsor developing alumni networks to link the newest generations with established leaders in global health science. The alumni networks can promote the exchange of information, and publicize research opportunities.

For more information, go to

HRSA's Grant Program

On July 2, 2008, HRSA published the announcement for the Rural Health Network Development Planning Grant Program (HRSA-09-004). The grant program helps rural entities plan, organize, and develop a healthcare network. The support from the program helps health care networks become operational and be able to develop the right strategies for becoming sustainable.

Successful applicants can use the one year planning grants to conduct planning activities, identify critical needs, identify factors and develop a plan to leading to sustainability, develop a strategic plan identify potential collaborating network partners, and begin to carry out network activities.
Grantees of this program will be eligible to apply for the Rural Health Care Services Outreach Grant Program for FY 09 funding and for the Rural Health Network Development Grant Program that will have a new start funding cycle in FY 2011.

Eligible applicants must be rural, non-profit or public entities that represent a consortium of three or more health related entities. Applications from profit making organizations will not be accepted. For profit organizations may participate in the network and must include three or more healthcare providers. Faith based, community based organizations, tribal governments and tribal organizations are also eligible to apply.

The Network Planning Grant funding cycle is from March 1, 2009 through February 28, 2010 and will be funded from the FY 2009 appropriations, pending availability of funds. The amount of funding is anticipated at $1,150,000 with 20 awards. Individual awards are limited to $25,000 and $85,000.

For more information, go to

Wednesday, July 2, 2008

Doctors Using Virtual Approach

Rush University Medical Center's new study reports that elderly patients suffering from chronic illnesses receiving virtual care from a team of medical experts linked together via phone, fax, and e-mail make fewer emergency room visits. The authors of the study examined the Rush University pilot project called, “Virtual Integrated Practice (VIP)” that links physician practices to teams of pharmacists, social workers, and dieticians. The VIP approach is designed to develop effective team building and ongoing collaboration with healthcare providers who do not work together in the same practice, in the same location, or in the same organization.

The researchers followed the higher risk diabetic patients over the course of two years and found that not only did patients in the VIP program made fewer trips to the ER but patients receiving VIP care also reported having a better understanding of how to use their medications. In addition, physicians who were part of the virtual teams reported that they were better informed on how their patients were doing between visits. The VIP study shows the feasibility of interdisciplinary virtual teams as a practical solution to many of the challenges in primary care geriatric care practices.

Coordinated team care is a key element for the “Medical Home” patient-centered care approach. While older adults with multiple chronic illnesses can benefit from coordinated care provided by physicians as well as nurses, pharmacists, and other healthcare providers, 60% of primary care physician practices in the U.S. are small and unlikely to have the resources to create and maintain interdisciplinary care teams. However, it has been proven that using the VIP model can easily be adopted by solo and small group practices that care for frail elders.

The goals of the VIP program are to:

  • Implement the program over an 18 month period in four practice sites focusing on patients with diabetes type II, chronic obstructive pulmonary disease, and urinary incontinence
  • Evaluate the costs involved and examine patient and provider perception
  • Promote practitioner usage of VIP locally and nationally and distribute the findings of the VIP intervention through a variety of collaborative activities

For more information on VIP, go to or email Stan Lapidos, Project Manager at

Researching Wound Care

The Military Infectious Diseases Research Program (MIDRP) is a DOD joint multi-service effort to develop and evaluate devices, technologies, and treatments to prevent and treat wound infections in combat casualty injuries.

While work in these areas is already ongoing, MIDRP will officially begin in FY 2010. Potential areas of investigation will include bacterial pathogenesis and colonization of wounds, and investigation of topical antimicrobial agents and antimicrobial synergy.

The program was created in response to new types of wound infections found in injured combat troops returning from Iraq and Afghanistan, Many of these infections are very difficult to treat and are resistant to current antibiotics and other traditional treatments.

Commander Kyle Petersen, a Navy undersea medical officer assigned to the NMRC Combat Casualty Care Directorate was just selected as the research coordinator for the program. Along with Commander Petersen’s selection, eleven MIDRP research coordinators were selected to lead the joint efforts of approximately 300 Army, Navy, Air Force, DOD civilian and contract scientists located in eight infectious diseases research laboratories.

The eight MIDRP major infectious diseases research laboratories are located at NMRC, Walter Reed Army Institute of Research, and the Army Medical Research Institute of Infectious Diseases. In addition, there are laboratories in Peru, Egypt, Kenya, Thailand, and Indonesia with smaller detachments in Nepal, Uganda, Tanzania, Nigeria, Cameroon, and Ghana.

Commander Petersen explained that Navy Military Treatment Facilities will be involved in some of the clinical research and will benefit from the basic science research as it transitions to the clinical setting. Other Navy involvement will come from NMRC laboratories involved in the basic science research effort.

Remote Pharamcists in Nebraska

The Nebraska Medical Center’s new “Remote Pharmaceutical Care Program” connects rural hospitals with experienced pharmacists who are either leaving the workforce, want to stay home with their children, or want to work additional hours. The Medical Center now provides remote pharmacists with secure computers to use at home. During their shift, remote pharmacists stay near the computers that will sound an audible alarm when the pharmacist’s attention is required.

This system is a convenience for both rural hospitals and the remote pharmacists, since the remote pharmacists are able to review orders before medication is administered and this can greatly reduce errors, according to Lori Murante, Pharmacy Relations and Clinical Support Administrator at the Nebraska Medical Center.

The remote pharmacists use computers equipped with video conferencing systems so that medical staff at the hospitals are able to communicate visually with the pharmacist. The computers also allow the pharmacists to have access from home to all of the resources available to pharmacists at the Medical Center.

This new program developed through an initiative between the Medical Center and Prairie Health Ventures, LLC, is going to help as 64 of the 93 counties in the state face a shortage or near shortage of hospital pharmacists. Litzenberg Memorial County Hospital in Central City, Nebraska serves 2,800 people who live in the city, and nearly 8,000 who live in surrounding Merrick County. This hospital was the first hospital to begin working with the program in June 2008.

The shortage of pharmacists is not unique to the Midwest. According to the Pharmacy Manpower Project, 45 states have a moderate or high demand for pharmacists. The Director of the Litzenberg hospital Reg Hain, believes that this program can have a positive effect on the shortage of pharmacists in rural areas.

The pharmacists in the program are well trained with extensive hospital backgrounds. For example, Sharon Foust was Assistant Professor of Pharmacy Practice at Drake University and Clinical Pharmacist at the Veterans Administration hospital in Des Moines before she started working at home as a remote pharmacist.

Pharmacists participating in the remote pharmacy program need to obtain licenses to practice in Nebraska, Iowa, and Missouri. Since Litzenberg and Howard County Community Hospital in St. Paul, Nebraska are the first hospitals to participate in the program, hospitals in all three states are expected to eventually take part. The program is available to all community hospitals and critical access centers in the region.