Sunday, September 28, 2008
Forty seven of the grants will provide access to medical services, and 58 grants will be used to improve educational opportunities. In California, the Central Valley Health Network received $74,500 to expand teleconferencing linkages between hub and end user sites in rural areas. These interactive connections will enable healthcare workers to conduct live training sessions on medical issues and establish links to community resources.
In Maine, the Spring Harbor Hospital in Westbrook received $51,850 to establish a telepsychiatry project to expand mental healthcare services in rural areas. The funding will help the hospital purchase televideo equipment so that physicians will be able to consult with patients in rural parts of the state. The plan is to provide mental health consultations to several rural Maine emergency departments and primary care offices.
Grants to be used for healthcare purposes over $300,000 were awarded to Inland Northwest Health Services ($366,884), South Central Foundation (($361,220), Southwest Alabama Mental Health Board Inc. ($409, 078), Ridgecrest Regional Hospital ($474,316), Georgia Partnership for Telehealth Inc., ($496,355), Alegent Health ($383,996), Avera Health (SD) ($485,807), Avera Health, (SD, NE, MN, IA) ($490,537), Community Health Network Inc. ($301,859), and Erlanger Health System ($352,000).
For more information, go to www.rurdev.usda.gov/rd/newsroom/2008/09-18-DLTrl.pdf.
CDC awarded $24 million for 55 projects in 29 states and local public health departments to find innovative ways to respond to a pandemic involving influenza. Many of these projects involve the use of technology to develop electronic laboratory data exchanges, and electronic systems to report deaths. A total of 184 funding applications were submitted.
The projects focus on seven key areas:
- Involve the public in the public health decision-making process
- Develop electronic laboratory data exchanges to monitor influenza pandemics
- Integrate state-based immunization systems to be able to track distribution of influenza pandemic countermeasures
- Develop statewide electronic death reporting systems to be compliant with PHIN requirements
- Have healthcare providers involved in collaborative planning to ensure the delivery of essential services during an influenza pandemic
- Develop methods to promote preparedness for pandemic disease among identified vulnerable populations
- Distribute and dispense of antiviral drugs to self-isolated or self-quarantined persons
The states that received funding to provide for electronic laboratory exchanges include California, Colorado Florida, Hawaii, Iowa, Massachusetts, Maine, Minnesota, Nebraska, New Mexico Oregon, Rhode Island, and Texas. States that received funding to provide for electronic death reporting are Florida Maine, Michigan, and Utah.
Last May, FDA launched the Sentinel Initiative to create and implement the Sentinel System. The purpose and goal for the Sentinel System is to be a national, integrated, electronic system used to monitor medical product safety.
The Sentinel system will enable FDA to query multiple existing data sources, such as electronic health record systems and medical claims databases for information about medical products. The system will also enable FDA to query data sources at remote locations with data sources to continue to be maintained by their owners. FDA will be able to monitor the performance of a product throughout its entire life cycle, and the system could ultimately facilitate data mining and other research related activities.
On September 19, 2008, FDA awarded contracts to further the development of the Sentinel System:
- Pragmatic Data LLC in Indianapolis received $98,000 to identify and evaluate population-based data sources to study the safety of blood and tissue products
- Harvard Pilgrim Health Care, Inc in Wellesley Massachusetts received $98,344 to define and evaluate possible database models
- Booz Allen Hamilton Inc. in Rockville Maryland received $98,532 to evaluate potential data sources and/or data environments
- Outcome Sciences, Inc. in Cambridge Massachusetts received $99,564 to evaluate potential data sources for a National Network of Orthopedic Device Implant Registries
- Group Health Cooperative Center for Health Studies in Seattle Washington received $98,000 to identify, describe, and evaluate existing signal detection methods
- IMS Government Solutions, Inc. in Falls Church Virginia received $92,020 to examine two recent medical product launches each in at least two different types of healthcare databases to assess the timeliness of the products
Dr, Kussman continued to say that the newly formed Joint Clinical Information Board (JCIB) will play a key role in determining the priorities for clinical information that will be shared and how to meet the requirements. JCIB recommends adding family and social history data, expanded types of patient questionnaires, and forms to the required information.
DOD has plans to pilot test the capability to scan paper documents. In addition, DOD intends to implement their inpatient clinical documentation system at additional military treatment facilities in FY 2009 to enable VA providers to view inpatient clinical documentation on a greater number of patients. Additional inpatient documentation such as operative notes, inpatient consultations, transfer summary notes, and inpatient history and physical reports, currently piloted in the Puget Sound area will also be viewable by VA sites.
The VA is also sharing more data with DOD such as digital radiology images. Plans are to expand sharing computable health data beyond the initial seven locations with the VA and DOD adding computable laboratory results in 2009.
In another move to help both CMS and TRICARE, CMS has announced an expansion of the South Carolina Personal Health Record pilot (MyPHRSC) that will now include TRICARE data. An interagency agreement between CMS and DOD enables beneficiaries who have original Medicare and also receive TRICARE benefits to be able to add TRICARE health data to their personal health records. Until this point, this data has only been available to the beneficiary through the DOD Medical Information Technology System. This CMS collaboration with DOD will be the first time additional data from another electronic source other than Medicare will be available in MyPHRSC.
The PHR tool was created by HealthTrio and the Medicare data is provided through Palmetto GBA, a Medicare contractor serving South Carolina. The pilot is being managed by QSSI, a company headquartered in Gaithersburg Maryland.
Wednesday, September 24, 2008
To accomplish this goal, GCI ConnectMD will design, implement, and manage a WAN infrastructure to support the Alaska Community Health Integrated Network (ACHIN), a project of APCA. ACHIN recently deployed Practice Management and Electronic Health Record applications, plus two IT improvements to increase business efficiencies and improve the quality of care. Remote clinics are now going to be connected to one another for the first time and have the necessary technological support needed to provide good quality healthcare.
In addition, GCI ConnectMD and the Inland Northwest Health Services will implement an agreement scheduled to be put in place in October. The partnership will significantly expand the reach and services available to member healthcare facilities and patients. Customers of both GCI ConnectMD and INHS will now have access additional services and resources available through a network cross-connection. This will enable doctors to consult on patients and provide continuing education programs along with staff training.
INHS is providing much needed services in rural communities throughout the Northwest TeleHealth network, said Nancy Vorhees, Chief Operating Officer of INHS which operates Northwest TeleHealth. She said “this collaboration will strengthen the relationship and communication between health providers and in turn improve patient care.”
Researchers at the University of California at Irvine, Carnegie Mellon University, and the University of Maryland are all working on the Army Research Office grant. According to Elmar Schmeisser, ARO Program Manager, it could take 15 to 20 years before the technology gets to the point to support the system since the mathematics behind this research is fierce, a huge amount of brain activity takes place at the same time, and no two people have the same EEG blueprint.
If the scientists are successful, the technology could provide a way for soldiers with brain injuries as well as civilians with neurological problems such as Lou Gehrig’s disease, to be able to communicate without speaking or writing.
Researchers will have test subjects put on special caps to record the EEG signals sent out by their brains. Then scientists will look at the brain information on a computer screen and try to figure out how to translate the information into messages that a computer can type out or speak. If the scientists are successful in decoding the information, then the thoughts will be transmitted via a computer where someone looking at the computer will be able to read the information.
The grant funding came from the Defense Department’s Multidisciplinary University Research Initiative Program to support research involving more than one science and engineering discipline. Schmisser said, “Few other organizations are able to invest in such high-risk ventures, despite the high payoff they could provide. The Army is interested in these breakthrough technologies even though they are high risk and may not pay off, but if and when they do, they pay off big.”
Another long term Army funded program still in its infancy, is exploring how to use genetically modified viruses to produce nanocircuitry. Angela Belcher, Chief Scientist behind this effort won the 2004 John D. and Catherine T. MacArthur Foundation Award for her research.
This research will not only pave the way for low cost production of nanoscale integrated circuits and other electronic components, but this program could lead to a broad range of next generation applications. These applications could include medical implants and tissue growth, energy efficient batteries and lighting, faster and smaller computers, detectors for hazardous agents, and stronger armor for military craft.
AHIC Successor Inc. has announced the appointment of the Board of Directors to make AHIC Successor an independent public-private partnership. The new organization is being established with the HHS as a successor to the federal advisory committee AHIC. The current AHIC is scheduled to complete its work by the end of 2008.
The fifteen members of the AHIC Successor Board of Directors are:
- Laura Adams, President and CEO, Rhode Island Quality Institute
- Simon Cohn, M.D., Associate Executive Director, Health Information Policy, Kaiser Permanente
- Janet Corrigan PhD, President and CEO, National Quality Forum
- Arthur Davidson, M.D., Director, Public Health Preparedness, Denver Public Health Department
- Linda Dillman, Executive Vice President, Benefits and Risk Management, Wal-Mart Stores, Inc.
- Lori Evans, M.P.H., Deputy Commissioner, New York State Department of Health
- Steven Findlay, M.P.H., Health Care Analyst and Editor, “Consumer Reports “Best Buy Drugs,”
- Thomas Fritz M.A. M.P.A, CEO, Inland Northwest Health Services
- C. Martin Harris, M.D., Chief Information Officer and Chairman, Information Technology Division, Cleveland Clinic
- Kevin Hutchinson, President and CEO, Prematics, Inc.
- Charles Kennedy, M.D., Vice President for Health Information Technology, WellPoint, Inc.
- Michael Lardiere, L.C.S.W., Director, Health Information Technology and Senior Advisor, Behavioral Health, National Association of Community Health Centers
- Stephen Ruberg, PhD., Senior Research Fellow, Eli Lilly & Company
- Lisa Simpson, M.P.H. Professor, University of Cincinnati, and Director, Child Policy Research Center, Cincinnati Children’s Hospital
- Paul Tang, M.D., Vice President and Chief Medical Information Officer, Palo Alto Medical Foundation
In addition to the new Board members, HHS Secretary Mike Leavitt and Veterans Affairs Secretary James Peake will serve as federal liaisons to the board. The National Coordinator for Health Information Technology, Robert Kolodner, M.D., will continue to coordinate federal input into the public-private process.
The new North Dakota AHEC will focus on community-based healthcare training through all levels of the workforce pipeline, from elementary students to healthcare providers. Health career awareness programs will be developed for students and new clinical opportunities will be developed for medical and nursing students at the college and graduate level.
Until now, North Dakota was one of only a few U.S. states without a federally funded AHEC to help clinics and hospitals recruit and retain healthcare workers in underserved areas, address workforce shortages, and educate students on career options in healthcare.
With the funding, three regional AHECs will be developed across the East, Central, and Western regions of the state to provide a variety of training experiences. Three of the centers will link the University of North Dakota with local communities, hospitals, and clinics to augment health-related training activities in each region.
“The Dakota AHEC program is a wonderful partnering opportunity for the UND College of Nursing and the School of Medicine and Health Sciences. We will build relationships with institutions throughout North Dakota to support collaboration between academic partners and community-based programs,” said Loretta Heuer, PhD, Professor, UND College of Nursing, and Co-Program Director of the Dakota AHEC.
In addition, UND just received $750,000 from HRSA to establish a Health Workforce Information Center to act as a single point of entry for health workforce information. The Center will help the health workforce including practitioners, nurses, dentists, pharmacy, mental health, allied health, other trained healthcare providers, and the staff that supports them. The new center’s web site and electronic mailing lists will provide information on health workforce programs and funding sources, workforce data, research, and policy, educational opportunities and models, best practices, and provide information on related news and events.
Sunday, September 21, 2008
The research team at Vanderbilt University is actively developing a PHR application for caregivers and children with cystic fibrosis to use both at home and in schools to help manage medications. The emerging system called “My-Medi-Health” features a medication management assistant for younger kids, text messages for older children, reminder mechanisms for schools, plus communications tools that send just-in-time messages to caregivers. The medication management device can be placed in a variety of age appropriate packages to work with the application.
Dr. Kevin Johnson, MD, Vice Chair, Vanderbilt’s Department of Biomedical Informatics reports that the system should have an enormous impact on outcomes and will radically decrease the instances of kids getting the wrong dosage. Also, we will have much better data and we will be better able to understand when and why a child is experiencing side effects.
Laura Esserman, M.D., Director, Carol Franc Buck Breast Care Center at the University of California, San Francisco explained how a diagnosis of breast cancer can be one of the most overwhelming moments in a woman’s life. The UCSF team developed a calendar-based personal health record application to help women gain more control in balancing complex treatment options along with all of the demands in their everyday life. The tool provides women who have breast cancer with a voice and a window into the management of their own care.
The application collects critical data from patients and providers at the point-of-care. The PHR tool using visualization tools, helps schedule treatments, helps plan for care, provides reminders for visits, makes critical information available on prescriptions, and helps the patient move on to the next steps of care.
This tool is also designed to be a potential starting point for creating a patient-based registry open to patients, care providers, and researchers. The UCSF team is planning a nationwide demonstration project to determine if this patient-centered system could be a transformative agent in breast cancer care.
Two of the other grantees T.R.U.E. Research Foundation and the University of Washington are working on projects that focus specifically on people with diabetes with an eye toward assisting in the self management of the disease. The projects collect information on daily behaviors and then provide patients with individualized feedback and recommendations based on that information.
According to Stephanie Fonda, PHD, who heads a Project HealthDesign team at the Joslin Diabetes Center in Boston, “We’re developing a PHR application that takes into account personal data that is needed to manage diabetes with information on medications, emotional state, glucose levels, blood pressure, diet, physical activity, along with the interaction of all of these factors. The application also gives action-oriented advice for self care.”
The University of Washington team is developing a PHR application that uses mobile phones and the internet to shift the focus of healthcare away from the office and into the flow of patients’ daily lives.
The application wirelessly uploads readings over a cell phone to the person’s PHR and their medical provider. Providers can review the information and then provide feedback and advice to the patient through the PHR application. As one patient said “I just don’t need my doctor’s help in the same way I did before, but it’s nice to know that she is able to see how I’m doing”.
Other research teams located at Stanford University/Art Center College of Design are helping adolescents with chronic illness communicate their needs, RTI International is helping sedentary adults become more physically active, University of Massachusetts Medical School is designing a PDA to help patients mange their medications to deal with chronic pain, University of Colorado at Denver and Health Sciences Center, is using a portable touch screen tablet computer to help older patients with complex medication regimens, and the University of Rochester is developing a system to help congestive heart failure patients with their “daily check-up”.
Veterans Affairs Under Secretary for Health, Michael J. Kussman, M.D., appeared at the advisory committee meeting to point out that even though there are only seven people per square mile in highly rural areas that still means there are a lot of veterans to treat in those areas. It is especially important to focus on helping veterans with mental health and substance abuse programs. In many of these areas, there are enormous challenges to meet since many of these areas even today do not have good roads and lack the necessary technology to communicate.
Dr. Kussman commented reports that there are 23 million veterans in the U.S., 8 million enrolled in the system, with over 5 million routine users but not necessarily patients. The VA foresees a decline in the overall number of veterans in the future, but expects that veterans 85 and older seeking care will stay pretty constant over the next 5 years.
Dr. Kussman proposes that changes are going to have to be made to accommodate the VA’s needs in the future. For one thing, the VHA is looking ahead and debating what to do with the 157 VA hospitals with 20% located in rural areas with the average age of 57 years. The problem is that hospitals can only be retrofitted with new technology to a certain point. If new technology is installed then larger rooms and different room arrangements are required. The cost to demolish walls and buildings is enormous and building new hospitals can cost $500 to $600 million to build so this means that in the future, the VA will need to look at alternative ways to provide healthcare.
According to the Under Secretary, the question is do we really need to build more hospitals or do we need to move more and more in the direction of ambulatory care. Right now 90-95% of care for veterans is provided in ambulatory settings.
He suggested several options. For example, in a community in rural Texas, if veterans need to go to a hospital, then they have to drive five hours to the hospital in San Antonio. If the right programs were put in place, then 98% of the time, treatment could be provided locally by using a full care center in an ambulatory environment. If some patients needed to be admitted to the hospital, then contacts could possibly be made with some of the best medical facilities in the rural area or a close by town to accept veterans with serious medical needs.
The goal is to put services close by but not necessarily attached to a hospital. Leasing beds in a fully staffed medical facility will save the VA money since the VA wouldn’t need to build their own bricks and mortar hospital and would be able to provide services closer to home. Patients with complex medical situations could still go to a full center providing complete services.
Kara Hawthorne, MSW, Director, Office of Rural Health mentioned several new initiatives serving rural veterans. Three new Veterans Rural Health Resource Centers are to open on October 1, to help improve healthcare for veterans. These centers will serve as satellite offices for the Office of Rural Health. Each resource center will be staffed with administrative, clinical and research staff who will identify disparities in healthcare for rural veterans and develop practices or programs to improve care delivery.
In addition, ten new outreach clinics are scheduled to be opened by 2009 along with four new mobile health clinics to bring primary care and mental health services closer to serve veterans in 24 predominately rural counties in six states.
He mentioned that thirty years ago telemedicine was largely composed of federally funded demonstration grants and small projects that connected large hospitals with rural clinics. This enabled people to have access to basic medical services and specialty care where it wasn’t previously available.
These first stage initiatives have blossomed into 200 hospital-based networks reaching out to cover 3,000 sites across America. According to Linkous, we now need to ensure the networks use by interconnecting them and to do this, we must have affordable broadband services available to all healthcare centers. Most importantly, physicians need to be fully reimbursed when they use telemedicine to provide care.
He continued to explain, that the second stage of telemedicine now provides healthcare directly into the home through the use of remote monitoring for those with chronic ailments. However, today telemedicine has moved to the third stage and is now beyond hospital and clinic walls and even beyond the home. In many cases, this is a consumer-based initiative, piggybacking on popular PC programs and using cell phones to help the patients communicate.
There are already over 100 health-related applications available for download on the new Apple iPhone. Other applications allow physicians to use their new cell phones to look at diagnostic images such as an MRI or to transmit images of tissue samples to pathologists. Online and video game support groups for patients have exploded and are a part how healthcare delivery is emerging around the world.
To emphasize the important and essential need for broadband in isolated communities, Gene Peltola, President and Chief Executive Officer of the Yukon-Kuskokwim Health Corporation (YKHC), in Bethel, Alaska appeared via video conferencing technology to speak to the Senate Committee to stress the enormous need for broadband in Alaska.
He detailed that YKHC is a consortium established by 58 federally recognized Native American tribes. The consortium provides comprehensive healthcare to 28,000 consisting of the largely Yup’ik Eskimo population living in 50 communities spread across the Yukon-Kuskokwim Delta in a road less region located on the Bering Sea on the western coast of Alaska. In addition to the lack of roads, the villages are only reachable by plane, boat, or snow machine, plus the fact that during the winter, the Bering Sea generates some of the most violent weather in the world. The villages can be isolated for days or weeks at a time.
Fortunately, investments have been made by the Universal Service Fund’s Rural Health Care program and other federal broadband programs. Private industry also has made a $50 million plus investment in a terrestrial microwave network, called DeltaNet. Now the region uses video teleconferencing to offer behavioral health evaluations, treatment, and consultation for veterans and other patients at residential facilities and at clinics. Using the terrestrial broadband network, YKHC can now offer full remote diagnostic imaging services that rely on teleradiology.
Peltola told the Committee, he wants to see Medicaid reimbursement cover telepsychiatry treatment, licensing, see reimbursement issues addressed when providing distance healthcare delivery, have the VA use IHS and IHS contracted medical facilities to provide medical and behavioral healthcare to rural Alaska veterans, and see RHC increase support mechanism percentage for internet access and add advanced services.
Several companies slated to get part of the funding include CardioInsight to develop a device to map the electrical activity of the heart, Cleveland Heart to develop a left ventricular assist system, and VitalStream Health, to develop remote monitoring and care practices for patients with chronic diseases.
The Cleveland Clinic will collaborate with some of Ohio’s leading medical and research institutions such as Case Western Reserve University, Ohio State University, University of Cincinnati, University of Toledo, and University Hospitals of Cleveland along with industry and economic development partners.
As part of the next round of funding to be made available from the Ohio Commercialization Funding Program, GCIC will release an RFP on October 1, 2008 seeking proposals from companies and institutions that wish to commercialize innovative cardiovascular technologies and solutions. The GCIC will provide development assistance and financial support.
Another Ohio program, the Ohio Third Frontier Research Commercialization Program (RCP) was put in place to work with organizations to apply research and develop new products with the goal to commercialize those products.
In June 2008, the Ohio Biomedical Research Commercialization Program (BRCP) within RCP looked for organizations to do research to improve prosthetic limbs, provide better treatments for asthma, cystic fibrosis, and burn and nerve care that would eventually to lead to commercialization. Six organizations have been awarded $128,420,643 through the program.
The BRCP program has released an RFP for FY 2009. The program is looking for proposals from well established research and development programs that have the capability to go on to the next level and focus on commercialization opportunities. Proposals need to provide for collaborations between two or more institutions or organizations.
The biomedical proposals need to specifically address biomedical research in terms of genetics and genomics, structural biology, biomedical engineering, and computational and environmental biology. Proposals solely on information technology are only eligible if they provide a supportive component to biomedical research. Other opportunity areas can address engineering and physical sciences.
The Letter of Intent is due October 1, 2008, with full proposals due November 7, 2008. There will be 4 to 6 grants from $2 to $5 million for BRCP.
Wednesday, September 17, 2008
Dr. William Tierney of Indiana University with a small Fogarty grant, created the first electronic medical record system in Kenya. He was instrumental in developing similar systems based on low cost open source tools now in use in more than a dozen countries on three continents.
After visiting a Fogarty program in Haiti, Dr. Rebecca Dillingham with the University of Virginia Center for Global Health and a former grantee herself, started using cell phones to communicate with HIV infected people in rural parts of Virginia. Under her pilot project, free phones were given to patients to remind them through text messages to take their medications, refill their prescriptions, and the date and time of their next clinic appointment.
In Peru, grantee Dr. Walter Curioso built an interactive computer system using cell phones to help individuals adhere to antiretroviral treatments by collecting adverse events in real-time. Dr. Curioso sees the cell phone as the ideal tool for a mobile team plus the equipment is less likely to be stolen as compared with laptops or PDAs.
Dr. Pamela Johnson of Voxiva, a global health telecom company working with some of the grantees, reports that the fastest growth in cell phone use is in Africa and according to Dr. Johnson by the end of the year, there will be more cell phones used in Africa than in North America. Her company reports there are now 3.5 billion cell phones in the world, and by 2010, 90 percent of the world will have coverage.
Fogarty is taking steps to incorporate technology into its programs to help grantees connect students, clinicians, and patients with both general information and research data. They are using internet 2, Open Course Ware, a device called “Internet in a Box”, and the Virtual Hospital. Fogarty’s focus is to use distance learning to train researchers on building sustainable health infrastructure in countries with the greatest need.
Dr. Thomas Cook, a professor and environmental health grantee at the University of Iowa, has helped to develop an offline method of transferring medical information called the “E-Granary Digital Library”. The system with more than 700 CDs worth of educational resources from 1,000 web sites is shipped to institutions in Africa, India, Bangladesh, Azerbaijan, and Haiti for installation on computers and local networks and used with an internet connection. Dr. Cook also advocates using web conference software such as “Elluminate” to provide cost effective educational information to regions where classrooms are not easily available.
A Tufts University program under grantee Dr. Jeffrey Griffiths is collaborating on developing curriculum with Makerere University and the University of Dar es Salaam to rely heavily on a digital library linking computers in resource poor areas. The program seeks culturally appropriate responses to health problems.
A Harvard program with Fogarty grantee Dr. Richard Mollica, focuses on mental health trauma induced by natural disasters. He initially brought students together for two weeks to study the problem which was then followed by five months of web-based training with close faculty supervision and strong peer learning.
“ICT and distance learning have the potential to transform health systems”, says Dr. Ariel Pablos-Mendez, Managing Director of the Rockefeller Foundation, “but there are still huge disconnects, computer interoperability, and relatively low financial investment in ICT.” Dr. Mendez wants to see public health needs become the highest priority for developing countries and sees this happening within the next 10 years.
For more information, go to www.fic.nih.gov.
Dr. Mullick sees additional challenges in dealing with the increased volume of information because new subspecialties will be developed in the future. This will result since smaller biopsies will be performed, lesions will be detected earlier, new therapies are on the horizon, and new diseases will affect more of the population but especially hit the aging population.
However, according to the Director, there are challenges facing AFIP. The challenges of the Base Realignment and Closure mean that despite the uncertainties of BRAC, AFIP must continue to look forward and be committed to providing world-class research, diagnoses, and education.
Dr. Mullick reports that the 2008 Defense Authorization Act was signed requiring the Joint Pathology Center (JPC) to be established. JPC will function as the reference center in pathology for the Federal government. There are uncertainties in establishing JPC and it is not absolutely certain that JPC will be established in the Defense Department as it could be established in another Federal agency.
A Joint Pathology Center Working Group will determine if JPC can be part of DOD and if so, how it will be structured and where it will be located. Dr. Mullick wants to see JPC established as part of DOD, as this will be a great opportunity for AFIP, and would transform AFIP into the premier pathology center of excellence of the 21st century.
AFIP’s Office of the Armed Forces Medical Examiner (OAFME) is the home of the first forensic CT scanner to be used to aid the autopsy process by providing higher resolution and more data. The scanner is able to do 3D reconstruction of wounds and determine their pathways to efficiently recover projectiles. Using the scanner can bring out injuries that you wouldn’t see with an x-ray or at autopsy.
Navy Captain Craig Mallak, Director, OAFME points out that by sharing knowledge obtained from the analysis of forensic CT scans, this technology will help DOD agencies design new generations of body armor and vehicles. It will be possible to modify current equipment to turn deadly injuries into potentially survivable injuries or almost no injury at all.
According to Captain Mallak, if they can make this scanner technology smaller and less expensive, I think every medical examiner’s office in the country would want the new technology. It would be an efficient and effective triage tool for mass casualty events.
“This research was done to develop a rugged battlefield instrument capable of detecting biological agents such as anthrax, plague, smallpox, and others with the speed, accuracy, sensitivity, and reliability of analytical techniques and instruments found in the state-of-the-art laboratory today”, said Dr. Glickman.
According to Norman Barsalou, Project Co-Investigator, “early front line detection of biological threats using this kind of rugged battlefield system will provide critical information that can save lives as well as support fast well informed command decision making”.
The grant will be carried out as a collaborative project between UTHSC, Fairway Medical Technologies, and the Naval Health Research Center Detachment Directed Energy Bioeffects Laboratory. After completing the R&D part of the project, Fairway will manufacture the devices for the Navy and other DOD customers.
Sunday, September 14, 2008
Moving Health IT forward is key to solving many of the healthcare issues now facing this country. According to Senator Sheldon Whitehouse (D-RI) speaking at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics lunch briefing held on September 11, 2008, there is an urgent need to build the interoperable health information network to drive savings, produce better quality, provide more effective care, and to reduce medical errors.
However, the Senator pointed out that health IT reform presents problems to physicians. It is not only the cost for the installation of the EMR system, the costs involved maintaining the system, but in addition, doctors can risk changing the workflow in their office.
Robert Kolodner, MD, HHS, National Coordinator for Health Information Technology, explained that exchanging medical information electronically just became personal. He recounted the story of how his 93 year old mother living in an independent living community just had surgery.
The immediate problem was that forms had to be filled out many times with the same information. This could be made so much easier if there was a central repository for the data. Since his mother needs to receive care and requires care coordination, this also would be so much easier if all her providers had access to the same records and could exchange information.
However, Dr. Kolodner reports that advances have been made. Telemedicine is helping in rural areas, electronic health records are used more and more, and personal health records are emerging. Even though interoperable health information is available today in only a few communities, advances in health IT are actively appearing on the horizon.
Dr. Kolodner stressed that NHIN will be invaluable in exchanging information but NHIN is just the beginning as more and more technology will evolve over time. Dr Klodner announced that on September 23rd at the AHIC meeting, a demonstration will show how NHIN works.
Dr Kolodner continued to say that the Federal government must continue to make information better and available to all so that providers and patients will be able to make the right choices and be able to use the information in a secure environment any time, and anywhere.
The eHealth Initiative’s survey “Fifth Annual Survey of Health Information Exchanges at the State and Local Levels” just published September 2008 shows some very positive developments.
Janet Marchibroda, CEO, eHealth Initiative summarized some of the findings:
- Operational health information exchange initiatives have increased considerably including18 new health information exchange initiatives
- A majority (69%) of the fully operational exchange efforts report reductions in healthcare costs and report a positive financial return on their investment for their participating stakeholders
- About half of the fully operational exchange efforts report positive impacts on healthcare delivery
- State and local health information exchange efforts continue to view the engagement of multiple stakeholders as a priority
- The most important drivers for operational initiatives are related to quality, patient safety, rising healthcare costs, and inefficiencies experienced by providers
- The most significant challenge for all efforts continues to be the development of a sustainable business model
Rachel Block, Executive Director, New York eHealth Collaborative, and President, eHealth Initiative Foundation, led a panel discussing consumer, physician, and health plan relevant issues. The panelists included Paul Cotton, Senior Legislative Representative AARP, William Handrich, MD, Informatics Officer, CIGNA Healthcare, William Hazel, MD, Practicing Physician, Member, Board of Trustees, AMA, and Liesa Jenkins, Executive Director, CareSpark.
The group consensus was that while developments are encouraging, more consumer involvement and Federal support is much needed and we must be open to approaching the problem in several ways—one approach does not fit all.
Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI), John Thune, R-SD), 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 Steering Committee briefings are now being produced by the HIMSS Foundation’s Institute for e-Health Policy. For more information on future briefings, contact Neal Neuberger, Executive Director for the Institute at firstname.lastname@example.org or go to the web site at www.e-healthpolicy.org. For copies of the eHealth Initiative Survey, go to www.ehealthinitiative.org.
The program provides internet-based healthcare visits to diagnose and treat routine childhood symptoms and has successfully managed 6,500 telemedicine visits since 2001. More than 22,000 pediatric emergency department visits have proved manageable by using telemedicine technology and currently 4701 children are enrolled.
Rochester’s inner city has many children and families that fall below the poverty level and many children for the first two years have a number of health problems. These inner city children have five times greater rates for being hospitalized especially for asthma and this means that their mothers have to take a considerable amount of time off from work.
Dr. McConnochie explained that the Health-e-Access telemedicine program uses video conferencing in the schools between the primary care telemedicine clinician and the school nurse to communicate and look at sick children. Results show that 90% of the time, parents with children seen using telemedicine technology, avoided a primary care or emergency department visit. Many of the parents said they would always choose child care that has telemedicine capabilities.
Dr. McConnochie said “parents aren’t the only ones who stand to benefit from the use of telemedicine for their children, since the technology also serves insurers and the community as well and delivers better quality care at a lower price.” Typically insurers have been wary of embracing the technology fearing it would drive up costs, but a study suggests the exact opposite and points out that insurers would realize cost savings.
In the future, the program hopes to add access for developmentally challenged children and adults, teledentistry, behavioral health, chronic illness prevention, primary care for deaf population, and elder care.
In another telemedicine program operating in New Mexico called Project ECHO. Sanjeev Arora. MD, Professor, and Executive Vice Chairman, Department of Medicine, University of New Mexico directs the program. The program provides care to thousands of cases of hepatitis using telemedicine.
Hepatitis is particularly difficult to treat in the state since the state is very rural with just two million people, has a high poverty rate, only 20% of the doctors practice in rural areas, there are few hepatitis specialists in the entire state, and it is difficult to obtain specialty care because there is inadequate medical insurance for the residents. Dr. Arora, explained that treating hepatitis C is a complicated medical process and it takes many years to develop the expertise.
The ECHO system works by having the patient’s information without the patient present discussed during an ECHO Hepatitis C clinic visit using video conferencing technology. The information is presented on a number of patients one by one and information can be given for any disease. The patient’s medical background is discussed in terms of alcohol usage, weight, smoking and other health issues. At this time, if there aren’t any complicating issues that need to be immediately addressed, the treatment plan can be given to the provider so that the patient’s treatment can be started.
The ECHO program also uses a knowledge network to educate and create a learning loop. By using the network, the program is able to collect data and monitor outcomes centrally, determine costs, and access the effectiveness of the program.
James Marcin, Associate Professor, Director of Pediatrics Telemedicine at UC Davis Children’s Hospital in Sacramento California, reported that the university telemedicine program now has 85 sites up and running in the state. The FCC program and funding will really help to establish more sites and will eventually hook up 350 hospitals with high speed access in the state.
Dr Marcin is very concerned with treating children in emergency rooms since 40% of emergency departments lack 24/7 access to pediatricians. Telemedicine consults in small rural hospitals can have a big impact as these hospitals generally treat few children. To ease the problem, robots with doctors on the screen located in a distant location are now moving around on the floors and are able to confer and help in the hospitals. Plus satellites are also being used to provide remote triage systems.
The realities of the UC telemedicine program is that money has been saved, a financially sustainable model has been developed, family members are connected with sick children in the hospital, and most importantly, a number of hospitals and clinics are now linked to video interpreting services.
Peter V. Lee Executive Director of National Health Policy Pacific Business Group on Health presented ideas on achieving quality and value in health reform. First of all, Lee emphasized that we must understand what works since all too often, we don’t know which drugs, devices, or treatments are the right ones to use. Drugs, devices, and procedures need to be measured to be able to compare their effectiveness.
Lee suggested that comparative performance information be made available to all providers with information on treatments, payments, and incentives. Performance reports need to include patient outcomes, how the patient views the care, and as to whether the right care is being delivered by doctors, medical groups, hospitals, nursing homes, and other providers. The resulting information needs to be considered by public and private plans in benefit design, coverage, payment decisions, and in providing patient decision support.
As many have pointed out, healthcare needs to be reengineered and outdated methods currently used to deliver care need to be eliminated. For example, Lee pointed out recent legislation is now enables Medicare to provide incentives for e-prescribing, Medicare should also reimburse providers for electronic consultations with patients, and allow for physician assistants, nurses, pharmacists, nutritionist, and dietitians to provide more care if they are appropriately trained.
Lee wants to see Medicare develop payment reforms that will support care coordination so that providers will have incentives to redesign care settings to encourage medical providers to work in teams. Changes in payments also need to be made to compensate medical professionals for the time that is spent with patients to help them learn to manage their own health and care.
Wednesday, September 10, 2008
The first fourteen Tribal, IHS, and urban pilot sites of the initial IPC project have been working for over a year with support from national faculty and the partners at the Institute for Healthcare Improvement. The initial pilot sites have already begun to show improvement in screening for cancer, domestic violence, and alcohol misuse, as well as in the care of diabetes and other chronic medical problems. Wait times have been reduced, access to care has improved, and patients now have a care team and provider that they know and who knows them.
The National Chronic Care Team is expanding the IPC innovation collaborative program from fourteen to 40 teams. The original fourteen sites are invited to continue to participate in the expanded project and will have the opportunity to mentor sites that are new to the process. IHS is actively looking for participation from Tribal, IHS, and urban programs to participate. The expanded IPC II program is scheduled to begin in October 2008 and continue through March 2010.
The Chronic Care Model that IHS and their partners use was developed at the MacColl Institute for Healthcare Innovation, adopted by the World Health Organization, with the model tested and implemented widely in the U.S. and aboard. The Chronic Care Model focuses on the relationship between an informed and activated patient, family and community, and their proactive healthcare team.
The IHS has extensive experience with the Chronic Care Model in diabetes care since IHS has provided improved care in clinical prevention and chronic conditions at several facilities. These facilities include the tribally managed South Central Foundation in Anchorage, Community Health Centers, and the Veterans Health Administration.
On September 8, 2008, HRSA posted grant opportunity (HRSA-09-157) to stimulate innovative community-based programs. The funding is to provide access to healthcare for children and their families as part of the “Healthy Tomorrows Partnership for Children Program (HTPC)”. This program encourages the use of innovative health IT to help increase access to healthcare. The HTPC funding will support direct service projects but not research projects.
The grants will support:
- Development of family centered community-based initiatives that use innovative and cost effective means to focus resources on preventive child health in the case of vulnerable children and their families
- Collaborations among community organizations, individuals, agencies, businesses, and families
- Pediatricians and other pediatric health professionals in community-based service programs so that they can become more involved in the delivery of more effective care
- Building community and statewide partnerships among professionals in health, education, social services, government, and business
All public or private entities, community-based organizations are eligible to apply. The estimated amount for this grant is $550,000 with eleven awards anticipated for $50,000 each. Grant recipients must contribute non-federal matching funds in years two through five of the project period equal to two times the amount of the grant.
The application deadline is October 9, 2008. The projected award date is March 1, 2009 with the end date projected to be February 28, 2014.
For more information, email Christopher DeGraw, MD email@example.com or go to www.grants.gov.
The grants were awarded in 10 states that included Arkansas, California, Minnesota, Montana, New Mexico, New York, Oklahoma, Pennsylvania, Tennessee, and Texas. These states were chosen since these states serve primarily low income rural areas with high rates of chronic illnesses.
The grantees found that telehealth can improve patient safety and the quality of care. One project demonstrated that remote pharmacy services provided to rural hospitals during irregular hours can more effectively detect and prevent dangerous medication errors. This is attributed to pharmacists manually reviewing night and weekend orders first thing in the morning before turning to day shift activities.
Other grants have demonstrated that pediatricians can easily remotely treat common childhood illnesses from schools and child care centers. This helps working parents who cannot leave their jobs and also reduces unnecessary visits to the emergency room.
However, the grantees found that implementing telehealth is not always easy. Several problems arose such as some vendor supplied home monitoring devices failed to work on a regular basis, and as a result, one-third of the patients became frustrated with the devices and stopped using them. Also, two projects reported that the video cameras used to transmit video and still images did not provide adequate resolution to yield clear images of small pills and wound areas.
The grantees found that technical support must be available 24/7. While large healthcare organizations have internal IT department to provide support, smaller organizations must rely on vendor technical support. This support can vary and is not always available 24/7.
Telehealth systems should be integrated with EHR systems so that patient data is captured and transmitted to clinicians at the point-of-care. Integrating the systems is particularly valuable when managing medications with home patients and when medications are dispensed by hospitals after hours. Telehealth systems can support team-based care and has created online communities among clinicians, specialists, and community providers.
Although CMS and some third party payers have created telehealth reimbursement guidelines, widespread acceptance of telehealth as a cost category for reimbursement has been slow to develop. One project developed a framework for reimbursement that was generally agreed upon by regional payers. They agreed to measure component healthcare costs and demonstrate to regional payers the cost savings for telehealth over traditional in person care. The project also looked at the impact of early diagnosis when treating patients, and the ability to manage chronic illness via telehealth versus emergency care.
For more information, go to http://healthit.ahrq.gov.
Saturday, September 6, 2008
One of the BSCF grants awarded $1.5 million to the California Health Care Safety Net Institute (SNI), an Oakland-based research and education resource for public hospitals. The funding will be used to develop and implement a model program for e-prescribing in four public hospitals.
The model program is called “Safe and Efficient Electronic Prescribing Practices for the Underserved and Uninsured in California’s Public Hospital Clinics (CAPH)” and will include four CAPH member organizations, their outpatient pharmacies, and two outpatient clinics.
CAPH will help selected public hospitals implement e-prescribing in two or more clinics. The hospitals will receive $50,000 per award for participation and will receive up to $150,000 per hospital to support costs for software and hardware.
For applicants to be part of the pilot program, applications must be received by September 19th, 2008. Eligible applicants need to be public hospitals that are members of the California Association of Public Hospitals. For more information contact Mary Gregory, Senior Program Association at firstname.lastname@example.org.
Another BSCF award for $1 million went to the University of California, Berkeley to do a comprehensive evaluation of one of BSCF’s largest efforts called the “California Healthcare Associated Infection Prevention Initiative”. The Initiative uses new technology in 55 hospitals to monitor the health of hospital patients, studies pharmaceutical and laboratory results, and processes patient data to identify patients who many have infections associated with healthcare.
Another BSCF award for $550,000 went to the Pacific Business Group on Health of San Francisco to improve care for patients with chronic conditions. The funding will provide intensive training and on-site assistance to provider groups in Los Angeles and Orange counties.
In another award related to chronic care, $350,000 in funding will go to Contra Costa Health Services to establish a new chronic disease management system targeting diabetes, pediatric obesity, and mammogram screenings.
Other awards include $1.8 million to go to the University of California, San Francisco to implement the second year of BSCF’s “Clinic Leadership Institute” to provide leadership and management skills. Another award for $324,000 went to the California Women’s Law Center to use in rural school districts.
One of the awards went to Dr. Cynthia Corbett and Dr. Stephen Setter at Washington State University in Spokane to study how homecare nurses can efficiently resolve medication discrepancies between hospitals and home care providers. The research team will conduct a clinical trial to investigate a new nurse-led informatics-based intervention. The team hypothesizes that homecare nurses are in a position to enhance patient outcomes, reduce healthcare costs, and eliminate duplicative services suggested by external consultants or specialty providers.
Other projects will evaluate how nurses contribute to healthcare, study the nurse work environment, and how staffing affects health outcomes and costs. Some of the projects will examine the impact of nurses on the costs and quality of long-term care and ways to improve nursing care in hospitals during off-peak hours.
The other institutions that were funded included Palo Alto Institute for Research and Education, California, Midwestern State University, Wichita Falls, Texas, University of California, San Francisco, University of Maryland, Baltimore, University of Minnesota, Minneapolis, University of North Carolina, Greensboro, University of Texas health Science Center, San Antonio
The Fourth Call for Proposals issued from the INQRI program will be released on October 15, 2008. For more information on the program, go to www.inqri.org.
FDA issued the synopsis/solicitation to locate an independent consultant capable of exploring, identifying, and analyzing the needs of FDA and the medical products industry, and has the capabilities to develop an information exchange network.
The contractor is expected to deliver a work plan with information on existing organizations that are exchanging clinical research data and other healthcare information, while examining their approaches that succeeded or failed.
In addition, the contractor will need to develop a blueprint for workshops and/or outreach activities that will be needed to evaluate existing models of information exchange in the healthcare sector.
The response date for the synopsis/solicitation “Business Model for Partnerships to Develop and Implement an Electronic Data Exchange Program” ((FDA-SOL-08-EPLATFORM) is September 12, 2008. For more information, go to www.fbo.gov or email Terry.Frederick@fda.hhs.gov or call (301) 827-7043.
Tuesday, September 2, 2008
The result is a portable microscope that can send annotated images of blood cells to labs or medical centers for analysis. The final product will weigh less than a pound and probably cost about $50 dollars according to Professor Fletcher.
The project was developed with the Telemedicine program at UC Davis and with industry partners as well as with engineers and clinicians. The research is supported by the Blum Center for Developing Economies which has already begun to use cell phones to collect medical data at sites in Africa. Microsoft Research has also provided financial support.
In the future, patients will prick themselves for a blood sample, insert the sample into the microscope, and push a button to send the microscopic image to the lab. After the lab technicians have done the blood count and other tests, the lab will then send the relevant information back to the patient and to the patient’s doctor.
The device will not only improve the lives of patients in the developed world but also help get information about patients in remote regions or rural areas to specialists at inaccessible medical centers and can help to combat diseases like malaria. Since worldwide anti-malaria projects are being backed by the Bill & Melinda Gates Foundation and other major funders, the device would be able help in their projects.
The microscopes are not be limited to imaging blood cells, and can handle other specimens. Cholera would be diagnosable, along with urinary tract infections and sickle cell anemia, and could also be used so that chemo patients would be able to find out whether or how soon they would need a transfusion.
The researchers are continuing to improve the device and want to add an internal light source so that samples can be illuminated for still clearer images. In addition, the group is developing software that will protect patient confidentiality while allowing users to annotate the micrographs and submit them automatically in a standardized format that will mesh with other record keeping formats.
The research team is now perfecting the prototype and testing the device while developing an economic model for selling it here in the U.S. The group hopes to have the device ready and out in the field within the next year. Once its niche is established, the technology could be shifted to developing nations.
According to a press release from the University of California at San Diego’s Division of Biological Sciences, the Swartz Center for Computational Neuroscience, and the UCSD Division of Calit2, researchers have developed an interactive and synchronized virtual reality and electroencephalography (EEG) prototype to study how to help individuals find their way in buildings. The goal is to gain a better understanding of how humans create “cognitive maps” of architectural spaces even when those architectural spaces are virtual.
Researchers gave the test subjects the task to find their way in a physical location. The locations were then projected in scale onto Calit2’s StarCAVE virtual reality system, a 360 degree 15 panel 3-D immersive environment.
Next the test individuals were instructed to learn and memorize the location of all the rooms and corridors during “free exploration” in StarCAVE. Each individual then completed 96 trials where they navigated through the virtual building from the front lobby or back corridor toward stated goals. These goals were posted on the StarCAVE screen before the trial began.
During the trial, the test subjects were fitted with what looked like red swimming caps covered in strands of spaghetti. The tangle of noodles turned out to be 256 high density EEG electrodes to measure electrical activity in the brain. An amplifier system placed in a backpack worn by the test subjects connected the electrodes via one fiber optic cable to a recording system outside the StarCAVE.
The test subjects then moved around the virtual environment representing a building. Their movements were synchronized with the data from the EEG sensors and the virtual reality data stream online in real-time. The researchers were able to track movements and responses, note visual clues and scenes as the subject moved along, and observe physiological responses as the test subjects encountered specific landmarks.
More studies will be made and the study will be conducted in a real building in the real world. The team plans to publish a paper on the results of this prototype study and then use the findings to write a larger grant proposal. The researchers hope to come to a deeper understanding of how the brain processes the underlying formation of memories which may provide new clues on how building, hospitals, and emergency centers should be designed.
Mechanical engineering graduate students at the University of California at Berkeley have developed a health monitoring wrap which will provide accurate and versatile vitals sensing while also providing thermal and hydration regulation.
The wrap has several advantages. For example, the wrap is able to monitor an infant’s heart-rate, temperature and hydration and will help to mitigate SIDS. The wrap design can provide wireless real-time information to the nursing staff or parents on the condition of the infant by using centralized computers, cell phones, and PDAs. In addition, the wireless system uses MOTE technology developed at Berkeley for multifunctional sensing and detection, which enables the nurses to monitor more children in parallel.
When conditions are not normal, the software can wirelessly send signals to environmental and warning detection control systems to adjust real-time thermal and humidity settings, and at the same time alert the nurses or parents to physically check the infant.
For more information on the “Wireless Vitals Monitoring System for Premature Infant Sensing” case number B08-002, contact the Office of Intellectual Property and Industry Research Alliances at UC Berkeley, Curt A Theisen, at email@example.com or call (510) 643-7201.