Wednesday, October 22, 2008

AHRQ Funding Studies

Chronic diseases such as diabetes and heart disease account for 75% of all healthcare spending but at the same time managing chronic illnesses can be fragmented and ineffective. Patients are increasingly being treated for multiple chronic diseases by many different providers resulting in decreases in the quality of their care and patients are facing more safety concerns.

Treating chronic care patients can be helped through care coordination, active follow-up, good self management, clinician decision support, and the use of information systems. Despite the potential for HIT to help treat chronic care patients, research to date has often failed to show clear benefits.

The Department of Family Medicine and Community Medicine at the University of Missouri-Columbia received funding from AHRQ to study how using several strategies to implement HIT would help patients with chronic diseases. The researchers are devising methods that providers can use to compare and improve their clinical performance against standardized performance targets.

In the study, researchers will provide patients with access to a web-based interactive software system to help with in-home reconciliation of all medications. Also, patients will use in-home smart diagnostic devices to send their data directly to their care team.

A multi-method evaluation of the HIT innovations will be used in the study including qualitative interviews and surveys. The HIT system involving chronic disease care at the University of Missouri will not only be studied but will be implemented differently in various practices and with several associated care systems.

AHRQ is also supporting chronic care research at the Department of Psychiatry, University of Texas Southwest Medical Center in Dallas to specifically help psychiatric settings provide effective care. Depression is the most common mental health cause for disability and treatments therefore the treatment needs to take into account the chronic nature of the disorder.

Despite the development of effective treatments, evidence from practice settings continues to show that inadequate antidepressant medication treatment is used in terms of doses and duration. The goal is to develop a computerized decision support system integrated with an electronic health record to disseminate evidence-based treatment for chronic depression in large systems of care. This project will be implementing Measurement-Based Care (MBC) in an ambulatory care setting using an integrated Clinical Decision Support System (CDSS) and an electronic health record.

The University is collaborating with the Centerstone Community Mental Health Center a behavioral health services provider located in Tennessee. The proposed EHR-CDSS facilitating MBC will be instituted in 24 clinics by 50 clinicians to treat approximately 8000 patients with major depressive disorders.

Neuroprosthetic Research Ongoing

The Worcester Polytechnic Institute’s Bioengineering Institute received a two year $860,000 grant from TATRC to develop the Center for Neuroprosthetics. In addition, WPI will receive a $150,000 grant from the John Adams Innovation Institute within the Massachusetts Technology Collaborative to help with strategic planning and business development for the Center and to stage a national neuroprosthetics conference at WPI in 2009. The TATRC grant will cover prosthetics research to include control signal processing, nervous system integration, and the issue-interface between the device and the body.

Ted Clancy Associate Professor of Electrical and Computer Engineering at WPI will lead the signal processing work. His lab will study the electrical signals that control normal muscle activity, and how that knowledge can be used to control prosthetic limbs. Professor Clancy will measure and analyze signals propagating along the forearm muscles of healthy volunteers, and record the associated movements and forces of the subject’s wrists and fingers. Current prosthetic limbs often rely on remnant muscle control.

Clancy’s work may be able to enhance the control of current prosthetic technology, while also laying the foundation for signal processing for artificial limbs that are connected to the nervous system. This would enable them to be controlled directly by the brain and provide sensory feedback to the brain.

Stephen Lambert, Research Associate Professor with the Bioengineering Institute is directing studies to be able to connect external prosthetic devices with the nervous system. Axons are long thin fibers that extend from neurons and carry electrical impulses across the nervous system with bundles of axons forming nerves. Fully developed axons are covered with a sheath of myelin, a fatty-like substance that insulates the axons and helps them work efficiently. Lambert’s team will try to achieve predictable neuron growth and axon myelination on various surfaces in the laboratory.

The scientists say that whether artificial limbs are controlled by the nervous system or remnant muscle activity, the advanced prosthetics will have a permanent connection to the body. The research goal is for advanced neuroprosthetics to be fully integrated with bone and tissue and under the control of the nervous system.

NIH is actively involved in neuroprosthetics research at the University of Washington. Eberhard E. Fetz, PhD, Professor of Physiology and Biophysics demonstrated for the first time that a direct artificial connection from the brain to muscles can restore voluntary movement in monkeys whose arms have been temporarily anesthetized. Their approach uses brain computer interfaces to record signals from multiple neurons and then converts these signals to control a robotic limb.

Other researchers have delivered artificial stimulation directly to paralyzed arm muscles to drive arm movement—a technique called Functional Electrical Stimulation (FES). This particular study is the first to combine a brain-computer interface with real-time control of FES.

The results of the WPI and NIH research has promising implications for Americans affected by spinal cord injuries, others using artificial limbs, and thousands of others with paralyzing neurological diseases, although clinical applications may be years away.

Cancer Network Launched

The University of California Davis Cancer Center is launching the UC Davis Cancer Care Network to unite five hospital-based cancer centers throughout Northern and Central California. This is the first specialty-care network for UC Davis and the first devoted to cancer care for a public institution that will use telemedicine technology. The centers provide quality patient care in a community setting according to Scott Christensen, a UC Davis Associate Professor of Hematology and Oncology, and now serving as Medical Director for the new organization.

In addition to the UC Davis Cancer Center in Sacramento and satellite clinics in midtown Sacramento, Rocklin, and Elk Grove, network members are Fremont-Rideout Cancer Center in Marysville, Mercy Cancer Center in Merced, Regional Cancer Center at Valley Care in Pleasanton, and Tahoe Forest Cancer Center in Truckee. Discussions with additional cancer centers are ongoing.

The network is establishing “virtual tumor boards” to be funded by the Blue Shield of California Foundation with additional support from participating facilities. The system operates by having all network sites linked through state-of-the-art telemedicine technology, which gives oncologists and others involved in cancer care convenient opportunities to meet via real-time video-conferencing, share medical information, and reach consensus on patient treatment plans.

These virtual sessions will also evaluate appropriate clinical trials opportunities, identify patients who should be referred to UC Davis for specialty care, and provide education sessions on the latest advances in cancer treatment.

“Establishing the Cancer Care Network and expanding our hospital partnerships supports our role as the leading tertiary care provider in the region and we look forward to expanding these partnerships,” said Ann Madden Rice, Chief Executive Officer for UC Davis Medical Center.

Sunday, October 19, 2008

Establishing a Global Hub

The Ohio Telehealth Video Resource Center, an independent, nonprofit self-sustaining organization will provide links between the state’s higher education system and Ohio’s healthcare industries. “The Center will make it possible for Ohio to be the premier global hub for online medical education and videoconferencing,” said Ohio Board of Regents Chancellor Eric D. Fingerhut who recently approved the seed funding for the Center.

The Center’s telehealth resources will be available for clinical care in neonatal care, pediatrics, orthopedics, psychiatry, dermatology, and radiology, plus provide consultations in other medical disciplines. Services will be available for medical education activities, such as grand rounds continuing education programs, and demonstrations of new and emerging clinical practices. The Center will also be used for research projects, such as clinical trials or multi-center interactions, and in the technology arena, the center will provide a forum for the development of standards.

The World Bank one of the partners involved in establishing the Center is currently involved in Ohio-based telehealth projects to provide educational and clinical experiences to physicians in other countries. These collaborations include working with the Ohio Academic Resources Network (OARnet), Johns Hopkins University, and Columbia University.

In addition to the World Bank and the University System of Ohio, another partner the Ohio Supercomputer Center (OSC) has partnered with Ohio universities and industries to provide reliable high performance computing and high performance networking infrastructure for education, academic research, industry, and state government.

OSC recently partnered with Nationwide Children’s Hospital and Adena Regional Medical Center to deliver specialized neonatal expertise via high definition videoconference to hospitals in rural areas. OSC is also testing software that will enable researchers to use broadband networks to remotely access and operate expensive scientific equipment such as electron microscopes.

Charles R. Doarn is leading the collaborative effort to establish the Center and will serve as the Executive Director. He has served as Executive Director for the Center for Surgical Innovation at the University of Cincinnati and is a leader in the industry specializing in space medicine, telemedicine, telehealth, and international health.

Recent Patient Safety Actions

A grant for $100,000 awarded to the HSC Rural and Community Health Institute will help healthcare providers in twenty Texas rural hospitals use their administrative data to measure the quality and safety of patients. The funding will help the rural healthcare providers comply with some of the federal and state regulations that are specific to monitoring and evaluating patient care.

The HSC Rural and Community Health Institute will use the funding to increase involvement in the Texas Rural Health Partnership Program (TRHP) a partnership formed with the Dallas Fort Worth Hospital Council. TRHP uses specially designed software that cleanses and corrects patient administrative data to help hospitals. The Partnership also offers assistance in obtaining data from billing vendors, analyzes data trends and reports, and provides training and staff support. TRHP also assists hospitals with measurement by using AHRQ’s improvement indicators.

Information on becoming a Patient Safety Organization is now available from HHS in the form of an interim guide outlining how to become a Patient Safety Organization. PSOs were set up to provide a secure environment where clinicians and healthcare organizations can voluntarily collect, aggregate and analyze data to reduce the risks associated with patient care. The interim guidance allows AHRQ to receive applications from qualified entities that want to become PSOs. This guidance will remain effective until HHS issues a final rule for PSOs which is expected to be released by the end of 2008.

The interim guide describes how an organization may become a PSO. The first step is obtain a certification form available on AHRQs PSO web site ( that must be submitted. The web site includes more details on the certification process and has instructions for submitting the form either electronically or via mail.

Using Data in the 21st Century

The “Wisconsin Genomics Initiative” was recently formed with four leading institutions to advance personalized healthcare in the state. The collaboration includes Marshfield Clinic, Medical College of Wisconsin (MCW), University of Wisconsin School of Medicine and Public Health (UWSMPH), and the University Wisconsin-Milwaukee UWM).

The public private partnership is the result of a challenge issued by Wisconsin Governor Jim Doyle in 2006 at the groundbreaking for the Marshfield Clinic’s Laird Center for Medical Research. At that time, he challenged the four institutions to combine and leverage resources to create a Wisconsin Medical Research Triangle. The “Wisconsin Genomics Initiative” is the first project resulting from that challenge.

The Initiative is supported by the Federal government, the state, by the partnering institutions and will develop scientific models to:

  • Predict with high accuracy individual susceptibility to disease
  • Precisely target personalized treatments
  • Determine how well each person will respond to specific treatments
  • Prevent disease before it occurs

Marshfield Clinic will greatly contribute to the project as the Clinic is home to the Personalized Medicine Research Project, the largest population-based genetic research project in the country. Approximately 20,000 people have contributed their DNA and given researchers access to their complete electronic health records.

Initial work will involve genotyping each DNA sample in Marshfield Clinic’s bio-bank for one million genetic markers using the Clinic’s electronic medical health record to obtain health history and environmental factors for targeted diseases. The researchers will then build and test a scientific computational model capable of predicting an individual’s disease susceptibility and treatment response.

The other partners such as the Medical College of Wisconsin will effectively genotype individual DNA samples, UW-Milwaukee will be doing research in urban healthcare and health informatics, and UWSMPH will provide the full bio-statistical analysis of the vast data collected.

In addition, UWSMPH with funding of $41 million over five years is going to establish the “Institute for Clinical and Translational Research” (ICTR). The Institute was created in response to the NIH “Roadmap for Medical Research” to aggressively address clinical and translational research in Wisconsin and to use this research information to provide better care in real life.

“Scientists have shown that taking an aspirin a day can reduce a person’s risk of heart attacks, yet only about 60 percent of the people who could benefit use aspirin,” reported ICTR’s Director Marc Drezner, Professor of Medicine and Associate Dean for Clinical and Translational Research at the UW School of Medicine and Public Health. “Many complicated factors contribute to this breakdown in the translation of fundamental knowledge, and we have set up an expansive plan and structure to eliminate the problem.”

When the infrastructure is in place, the ICTR will expand training programs and coordinate and array of resources and services for both new and established investigators. ICTR will build a core group of biostatisticians and medical informatics experts to aid in study design, data analysis, and management. According to UW-Madison Chancellor John D. Wiley, “the opening of our Wisconsin Institutes for Discovery and Interdisciplinary Research Complex in the near future will further enhance our capabilities”.

Thursday, October 16, 2008

Establishing Medical Homes

An “Issue Brief” released at the Brookings Institution and the National Academy of State Health Policy forum on “Strengthening State/National Partnerships to Support Delivery System Reform” stresses the many challenges ahead for the healthcare system. Right now, there are rising costs and large variations in these costs, underuse of evidence-based care, and gaps in coordinating care for chronic diseases.

As mentioned in the brief, one of the solutions to the problems would be to initiate medical homes. States such as Vermont and Rhode Island are now initiating plans for medical homes. Currently, three Vermont communities are implementing the Vermont Blueprint for Health. The Blueprint includes a multi-payer primary care medical home initiative which is currently testing a combination of primary care payment reform, community care coordination teams, and how to provide health IT for patient care.

Vermont legislation authorized the creation of medical homes to enhance provider incentive payments in return for meeting nationally recognized functional standards. Healthcare delivery and public health prevention efforts are closely integrated in the state’s initial pilots. Each participating practice has access to local multidisciplinary care support teams, including prevention specialists that are shared across practices. In addition, practices are provided with a web-based clinical tracking system for tracking patient health information and producing population based reports.

Rhode Island has developed a two year statewide multi-stakeholder chronic care improvement initiative called the “Chronic Care Sustainability Initiative” designed to align quality improvement goals and incentives across the state’s health plans, purchasers, and providers. Beginning in January 2008 and continuing through December 2009, the initiative will provide enhanced payments to primary care providers for the delivery of high quality chronic disease care, including the establishment and promotion of medical homes.

There is news from other states to help develop medical homes, Massachusetts passed legislation (SB 2863) to give the state the authority to establish a medical home demonstration project and create a loan forgiveness program for physicians and nurses who agree to practice primary care in medically underserved areas.

The state of Washington passed legislation to establish patient-centered primary care pilot projects. With the funds available, the Department of Health offers primary care practices an opportunity to participate in a medical home collaborative program. The program will develop common core elements for consistency among medical home providers, provide standard measurements, and promote the adoption and use of the latest techniques to provide efficient patient-centered care. An annual report on the progress and outcomes of the collaborative will be published.

The Collaborative will explore partnering with the Washington Health Information Collaborative and the Health Information Infrastructure Advisory Board as the collaborative advances. The thinking is that if the health care authority makes grants to primary care practices to implement health IT during state fiscal year 2009, these grants should go to primary care providers participating in the medical home collaborative.

The Geisinger Health System serving Central and Northeastern Pennsylvania has nearly 700 physicians across 66 clinical practice sites, three acute-care hospitals, a variety of specialty hospitals and ambulatory surgery campuses, a 215,000 member health plan, and other services and programs. Geisinger’s 2.5 million patients are on the average, poorer, older, and sicker than patients nationally.

As an example of a success story, Geisinger has successfully implemented patient-centered medical homes. This means that round-the-clock access is provided to primary and specialty care services, nurse care coordinators and care management support is available, along with home-based monitoring. Physicians and patients have access to EHRs and are able to view lab results, schedule appointments, receive reminders, and email their providers.

The Geisinger system pays the practice group up-front to take care of patients and gives bonuses for meeting target levels for controlling blood sugar, cholesterol, preventing heart attacks, and cancer screening. Geisinger is providing practice-based monthly payments of $1,800 per physician, and stipends of $5,000 per 1,000 Medicare patients to help finance additional staff.

In other state news, two large health plans in New York are conducting a demonstration to promote medical homes by helping physician practices redesign their offices and revising the way that they are reimbursed for patient services. The project team will evaluate this demonstration to determine if it is feasible to transform practices into medical homes and to assess the impact that such a change can have on the quality of care, patients care experiences, and the total costs of care.

BlueCross Blueshield of North Dakota is developing a state-wide patient-centered medical home initiative called the MediQHome program. The program will launch January 2009 and will make it voluntary for physicians to be in the program that will include 4,241 providers with 1,433 primary care physicians and 2,808 specialists.

The initial program will focus on diabetes, hypertension, heart disease, childhood asthma, and chronic lung disease, immunizations, and ADHD. BCBSND’s MediQHome program will use MDdatacor’s, interoperable CareInformatix ™ technology to automate the collection of clinical data from physician practices from existing electronic medical records, and practice management, lab and registry systems.

The Iowa Department of Public Health has established the Medical Home System Advisory Council. The plan is to develop a plan to implement a statewide patient-centered medical home system. The initial phase will focus on patient centered medical homes for children eligible for Medicaid, the second phase on adults covered by the IowaCare Programs and adults eligible for Medicaid, and the third phase will focus on children covered by the hawk-i program and adults covered by private insurance and self-insured adults. There are also plans to allow state employees to use the patient-centered medical home system.

On the Federal government side, CMS is in the process of developing a Medicare Medical Home Demonstration to include up to 8 states with urban, rural, and medically underserved sites. The sample size will include 400 practices, 2,000 physicians, and 400,000 Medicare beneficiaries. On September 25, 2007, CMS selected Mathematica Policy Research to help design the demonstration which is expected to begin January 2010. At the present time, the demonstration design is not final and is being reviewed by CMS and OMB.

The CMS demonstration for develop of a medical home means there needs to be continuity of care, clinical information systems, delivery system design, decision support, patient/family engagement, coordination of care across providers and settings, and improved access to care.

According to this demonstration, there are two tiers of medical homes. Tier 1 provides basic medical home services and requires discussion with patients on the role of the medical home, written standards, data to identify and track patients, the use of an integrated care plan, the need to provide patient education, and the ability to track tests and referrals.

Tier 2 provides for advanced medical home services and requires the use of an EHR certified by CCHIT, systematic approach in coordinating facility-based and outpatient care, review of post hospitalization medication lists, and three out of nine additional capabilities.

Johns Hopkins University received a $1.7 million grant from the John A. Hartford Foundation to help the medical practices selected in CMS demonstration within the eight states to qualify for and participate in the project. With the funding, the Lipitz Center at the university will offer healthcare providers information, education, and technical support based on a Hopkins developed Care Model geared to help chronically ill older adults.

On Capitol Hill Representative Allyson Schwartz from Pennsylvania on September 27, 2008 introduced the “Preserving Patient Access to Primary Care Act” H.R. 7192. The bill supports medical homes and sets out provisions for Transformation Grants to support patient centered medical homes under Medicaid and SCHIP with $25,000,000 to be funded for fiscal years 2010, 2011, and 2012. The grants will go to states that design programs involving multi-payers test projects to recognize patient-centered medical home practices.

HRSA Grants Expand HIT

HRSA awarded $18.9 million in grants to health center controlled networks and large multi-site health centers to adopt and implement electronic health records and other health information technology innovations. According to HRSA Administrator Elizabeth M. Duke “These funds continue our efforts to help health center grantees access and use the latest technology to improve the care they deliver. Health information technology has the potential to transform care for underserved communities and its expansion is a priority for all Americans.

Twelve grants totaling more than $14.3 million will support the implementation of EHRs. Grants worth almost $3.8 million will help 10 other grantees implement other HIT innovations, including electronic prescribing, health information exchanges, data warehouses, and interoperability with outside partners such as state immunization registries and hospitals. Another six grants totaling over $700,000, will support planning activities to prepare health centers to adopt electronic health records and other health information technology innovations.

HRSA funded health centers treat more than 16 million people each year and support more than 1,000 health centers operating in every state, the District of Columbia, Puerto Rico, U.S. Virgin Islands, and the Pacific Basin. Health centers serve migrant health needs, healthcare for the homeless, and provides primary healthcare for residents of public housing.

The range of services offered at health centers has increased along with the number of patients served. In 2007, almost 2.8 million patients received dental services, and over 600,000 patients came to health centers for mental healthcare and/or substance abuse services.

For the list of grantees, go to .

FDA Approves Device

St. Jude Medical has announced that FDA has cleared their implantable device SJM Confirm ™ implantable cardiac monitor (ICM). The monitor was designed to help physicians detect abnormal heart rhythms in patients with unexplained symptoms. The implantable monitor enables physicians to evaluate heart rhythm signals over a longer period of time using standard monitoring tests. In addition, the monitor was designed to help physicians diagnose and document difficult to detect rhythm disorders in patients who may suffer from unexplained symptoms, including syncope (the sudden and transient loss of consciousness), palpitations, and shortness of breath.

Syncope is responsible for about 3 percent of all emergency room visits and up to 6 percent of all hospitalizations. About 1 million people in the U.S. suffer from syncope, and finding the source of the unexplained syncope according to some physicians can be the most difficult diagnosis to make. Even after a physical examination and electrocardiogram evaluation through a monitor, approximately half of all cases of unexplained syncope go undiagnosed.

The monitor is about the size of a computer thumb drive and is the smallest implantable cardiac monitor available. It is implanted just under the skin which can be done in an outpatient setting under local anesthesia. Patients can remotely send data to their physicians when they are experiencing symptoms. The real time data helps physicians diagnose and treat the arrhythmias.

According to Eric S. Fain, M.D. President of the St. Jude Medical Cardiac Rhythm Management Division, “this implantable monitor enables patients to record data that coincides with their symptoms and then send the data to their physicians remotely for diagnosis to determine the best course of treatment for their arrhythmias.”

Monday, October 13, 2008

Emergency Response Funding

Grants for $63 million were awarded under FEMA’s new Emergency Operations Centers (EOC) and the Interoperable Emergency Communications Grant Programs. To date, the Department of Homeland Security has spent $3.9 billion in grants to improve interoperable communications.

The EOC Grant Program received twenty two grants totaling $14.6 million with two counties in Illinois receiving federal grants totaling more than $1.14 million. The county funds will be used to construct an emergency operations center and to renovate another operations center.

The IECGP awards for $48.5 million will improve interoperable emergency communications to better respond to natural disasters, acts of terrorism and other man-made disasters. IECGP funding will help the states and territories implement their Statewide Communications Interoperability Plans and meet the priorities outlined in the National Emergency Communications Plan.

The state of Missouri received $642,205 from the IECGP program to develop five interoperable communications planning projects. Over $450,000 will be used for interoperable communications planning and training.

Two of the approved projects in Missouri include developing training materials for first responders and telecommunications on the regional communications system and developing a plan for existing VHF user equipment to be reprogrammed to the new Regional Area-Wide Multi-Band Interoperable Communication System.

So far, the Department of Public Safety in Missouri has created the state’s first information analysis center, drafted an interoperability communication plan, implemented a new distribution formula for local governments to receive homeland security grant funding, and put regional homeland security committees across the state in place to encourage input from stakeholders.

The state of California is working to streamline the state’s emergency response capabilities. The Governor recently signed legislation to combine the Governor’s Office of Emergency Services, and the Governor’s Office of Homeland Security into a new cabinet-level California Emergency Management Agency to be called Cal EMA. This reorganization will help to coordinate emergency preparedness, response, recovery, and homeland security activities in the state.

The Federal government is addressing current problems in the 911 system. The limitations on the current 911 system stem from the 1970’s circuit-switched network technology in use. Today there are 255 million wireless telephones in the U.S. About 80 percent of Americans now subscribe to wireless telephone service and 14 percent of American adults live in households with only wireless telephones. Of the estimated 240 million 911 calls made each year, almost one-third originate from wireless telephones.

Unlike landline 911 calls, not all wireless 911 calls are delivered to dispatchers with ANI and Automatic Location Information. Without this information, identifying the telephone number and geographic location of the caller is difficult. Therefore the emergency system needs to have some system modifications and needs a new more capable system based upon a digital Internet-Protocol (IP) based infrastructure.

Upgrading the 911 system to an IP-enabled emergency network will allow E-911 calls to be made from more networked communication devices, enable the transmission of text messages, photographs, data sets and video, and enable geographically independent call access, transfer, and backup.

Recently, the DOT, National Highway Traffic Safety Administration, and the Department of Commerce (NTIA), published a joint notice in the Federal Register proposing regulations for the E-911 Grant Program. The New and Emergency Technologies 911 Improvement Act of 2008 amends the ENHANCE 911 Act of 2004 to permit grant funds to be used for migration to an IP-enabled emergency network.

Computers Helping Design Drugs

The National Institute of General Medical Sciences (NIGMS) is taking computer-aided drug design to the next level. The University of Michigan will lead the effort to expand and enhance the molecular data needed to develop computer programs that can more accurately predict potential drug candidates. In order to do this, researchers want to have access to data housed in a web-based resource that can be accessed for free.

To provide more data and build the web-based resource, NIGMS will provide $5 million over five years. Researchers at the University of Michigan will gather molecular data from existing resources, from published data and databases, and will work with others to generate new data. A major source will be the collection of unpublished data from pharmaceutical company scientists who are willing to share the data during public meetings.

According to the Director of NIGMS Jeremy M. Berg, Ph.D., the ability to screen compounds and accurately predict their binding properties using only computers could greatly impact the drug development process and many other aspects of biomedical research. If we know the structure of a compound bound to a drug target, researchers should be able to tell how tightly the compound binds which is critical to drug development.

Dr. Berg notes that in practice, scientists are not able to do this well enough to contribute significantly to research progress. This web-based resource will make important structural and binding data available so researchers so that they will be able to tackle this problem.

CPAC Releases RFP

The California Program on Access to Care (CPAC) established by the University of California just released their 14th Annual RFP focusing on healthcare access for vulnerable populations. CPAC gives special attention to immigrant workers, their families, and low income households in agricultural and rural areas. CPAC is particularly interested in proposals that include the study of low income populations such as those eligible for and/or enrolled in Medi-Cal and Healthy Families (S-CHIP).

Projects that address health information technology and processes will be considered along with research to assess the use IT or processes to improve access to care. Another research area of interest concerns healthcare workforce issues to support the need for healthcare providers for rural areas and other underserved communities. There is also interest for research on how to strengthen community health safety net programs, including federally funded Community Health Centers, county or hospital supported health clinics, and certain district hospitals.

In addition, CPAC is looking for projects addressing bi-national healthcare collaboration, corporate responsibility, consumer involvement, and local health coverage initiatives. CPAC will also consider proposals in other areas provided they are consistent with the program’s overall mission.

Grants for a minimum of $300,000 in university funds will be available and are normally funded for six to nine months. However, CPAC will consider funding for longer term projects particularly if the PI or CPAC is able to secure outside foundation or state support to augment CPAC funds. The final amount available for individual awards many will not be determined until January 2009. Last year awards ranged from $5,000 to $65,000.

Grants will also be awarded for concept papers in the $5,000 to $10,000 range. Concept papers are needed so that the information can be analyzed from completed research and used to help develop state policies related to healthcare access. Dissertation grants and postdoctoral fellowships will also be funded with awards up to $15,000. The awards are intended to provide support for short term policy research projects.

CPAC encourages applications from health policy and or healthcare researchers affiliated with California academic institutions or non-profit research organizations.

A letter of intent is due Tuesday November 4, 2008. Approved applicants will be invited by November 13th to prepare and submit a full proposal. Full proposals are due by December 11, 2008. An application form for the Letter of Intent can be obtained from the CPAC web site at For further information, contact Gil Ojeda, CPAC Director at (510) 643-3140 or Ann Munoz, Program Manager (510) 642-3729.

Wednesday, October 8, 2008

eHealth Reports Available

A guide has just been published to help clinicians switch from paper to e-prescribing systems. According to eHI Chief Executive Officer Janet Marchibroda, The “Clinician’s Guide to Electronic Prescribing” will remove some of the mystery around e-prescribing and help physicians realize some of the many benefits e-prescribing can provide.

The guide was released at the CMS National e-Prescribing Conference held on October 7, 2008, in Boston to help clinicians make informed decisions on how and when to transition from paper to electronic prescribing systems. A multi-stakeholder Steering Group comprised of clinicians, consumers, employers, health plans, and pharmacies developed and worked in partnership with the eHealth Initiative (eHI), the AMA, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, and the Center for Improving Medication Management.

The guide meets the needs of two target audiences. The first section targets office-based clinicians who are new to the concept of e-prescribing and seek a basic understanding of what e-prescribing is, how it works, benefits, challenges, and the current environment impacting its widespread adoption. The second section targets office-based clinicians who are ready to move forward and bring e-prescribing into their practices. The guide presents fundamental questions and steps to follow in planning, selecting, and implementing the system.

Last June, the Center for Improving Medication Management released a report on e-prescribing and found:

  • More than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over the previous year
  • At the end of 2007, at least 35,000 prescribers were actively e-prescribing. Estimates indicate there will be at least 85,000 active users of e-prescribing by the end of 2008
  • While e-prescribing is growing rapidly, the adoption level at the end of 2007 represents only about six percent of the physicians
  • The biggest challenges to widespread adoption of e-prescribing by providers are financial burdens, workflow changes, the need for improved connectivity and technology, and the need for reconciled medication histories

For more information, on the guide and for other reports, go to

The State Alliance for e-Health in 2006 has published their findings in their inaugural report “Accelerating Progress: Using Health Information Technology and Electronic Health Information Exchange to Improve Care”. The State Alliance created by NGA’s Center for Best Practices with funding support from HHS worked with Governors, state policymakers, and other stakeholders to develop the report.

“We must harness our American ingenuity to bring about a technological revolution in America’s healthcare system,” said Vermont Governor Jim Douglas, co-chair of the State Alliance. “HIT and HIEs are essential tools in states’ efforts to control costs and improve healthcare in the U.S.”

The Alliance reports the challenges are:

  • High investment costs and concerns about revenue loss from lower productivity during the transition phase
  • Consumer concerns about the privacy and security of their data and lack of uniform privacy laws and data disclosure requirements governing electronic information exchange across states and jurisdiction
  • Variations in agreed-upon technical standards for interoperability and state professional licensure requirements
  • For publicly funded health programs to support HIT and electronic HIEs since they are encumbered by fragmented organizational structures, antiquated data systems, limited funds, and workforce constraints

For more information and to view the report, go to

States Expand Communications

Vermont Governor Jim Douglas announced on September 30, 2008, that FairPoint Communications will provide 100 percent broadband coverage to 51 communities spread across all 14 Vermont counties. Today, FairPoint currently offers high speed internet service using DSL over the phone wires that already exist at a customer’s location. The Governor wants Vermont to be the first state to have universal access to quality cellular coverage and high speed broadband technology.

FairPoint will work with the Vermont Telecommunications Authority to deliver high speed internet service using a combination of wired and wireless technology referred to as WiMax. To accomplish this goal, the company is simultaneously building a new IP-based next generation network. This fiber-based core network is capable of integrating various technologies and services over the same secure network infrastructure. The system will not only support high speed internet services but also enhance IP-based products and services across Maine, New Hampshire, and Vermont.

In Alabama, Governor Bob Riley announced that his state just received a $250,000 grant from the Appalachian Regional Commission. The Governor mentioned in his State of the State Address in 2008, that the goal is to make high speed internet available to every community in the state within the next four years. The ARC funding will help to reach that goal.

To help to make high speed internet available to everyone in the state, the Governor created the Alabama Broadband Initiative by Executive Order in May and established a 15 member board to coordinate the initiative’s efforts.

The initial phase of the project will research and map the current broadband infrastructure in the state. The initiative will conduct a comprehensive inventory of existing broadband accessibility and produce a digitized map of the network. The map will serve as a resource for communities to show industrial recruiting prospects existing infrastructure, and will be a guide for the state’s internet service providers interested in filling in the gaps. The second phase of the project will work with communities to develop local technology growth plans.

Hawaii just unveiled a new inter-island communications system to help public safety and civil defense official stay connected during emergencies. The $30 million system includes refurbishing 15 communications towers on five islands that can withstand hurricane force winds up to 155mph and be able to operate with their own generators. The system just went on line and now links Oahu with four towers, Maui, and parts of the Big Island with five towers.

The new system was built with the help of the U.S. Coast Guard which contributed more than $13 million to the effort along with the state and counties. So far, about $23 million has been spent on the system with an additional $7 million in work still to be completed.

Cardinal Health to Fund Grants

Cardinal Health Foundation will award more than $1 million through their “Patient Safety Grant Program” to help hospitals, health systems, and community health clinics improve patient safety and healthcare quality. The Foundation plans to award grants ranging from $5,000 to $50,000 to be used to reduce hospital-acquired infections and to improve medication safety.

Cardinal launched the Patient Safety Grant Program in 2007, and received applications from more than 10% of U.S. hospitals. In the program’s inaugural year, the Foundation awarded grants totaling $1 million to be used for new and innovative programs at 34 hospitals, health systems, and clinics.

For this round of proposals, applicants must be designated 501(c) (3) by the IRS and submit a letter of intent by October 31, 2008. Full proposals for those selected to apply will be due February 20, 2009 and the grants will be announced and awarded in spring 2009.

Applicants are encouraged to involve multiple groups within the applicant’s organization, the community, and other healthcare organizations, develop programs that can be replicated at other organizations, and address at least one of the National Quality Forum’s seven priority areas.

For more information, go to

Sunday, October 5, 2008

NY Funds Millions in Grants

On September 30, 2008, HEAL NY announced $280 million in grants to be used for statewide healthcare projects. According to New York Governor David A. Paterson, these awards will help improve access to health care in New York cities, towns, and villages and bring in smart investments to cut down on wasteful spending by funding the best solutions for healthcare in the state.

Out of the $280 million, the Phase 6 HEAL NY awards will make $100 million available to provide primary and community-based care. The funding will go to non-profit clinics, local health departments, and to hospitals to expand access to primary care services at main sites and satellite clinics.

Golisano Children’s Hospital’s Health-e-Access program received $500,000 and will use the funding to serve residents in Rochester’s poorest neighborhoods by using more telemedicine technologies to diagnose and treat common childhood illnesses. This includes using mobile technology to serve additional school and childcare-based telemedicine sites.

In addition, the grant will allow Health-e-Access to include after hours care through two inner city neighborhood-based sites. When parents call their children’s physicians after hours and reach the existing Rochester Community Pediatric Telephone Triage System, they will have an additional choice to use telemedicine at a conveniently located site in their immediate neighborhood.

Several other Phase 6 awards involving technology include:

  • Samaritan Medical Center in Central New York ($500,000) will link Samaritan Family Health Centers using electronic health records
  • Tri-County Family Medicine Program, Inc. in Central New York ($983,110) will apply HIT to quality primary healthcare
  • Ezras Choilim Health Center, Inc. in the Hudson Valley ($613,993) will upgrade their medical records system
  • The Westchester Institute for Human Development in the Hudson Valley ($363,064) will apply telemedicine to enhance primary care
  • Brownsville Community Development Corporation in New York City ($5,000,000) will develop a 21st century medical home in Central Brooklyn
  • ODA Primary Health Care Center, Inc. in New York City ($500,000) will expand ambulatory care and develop health IT projects

AHRQ Awards Contract

On October 1, 2008, AHRQ awarded a $3 million dollar contract to Johns Hopkins University and the Michigan Health & Hospital Association. The funding will be used to continue work on reducing central line-associated bloodstream infections in hospital ICUs since each year, an estimated 250,000 cases of central line-associated bloodstream infections occur in hospitals in the U.S. An estimated 30,000 to 62,000 patients who get the infections die as a result, according to CDC.

The new program builds on a successful safety checklist and program developed by Peter J. Pronovost, M.D., Ph.D., Johns Hopkins Professor for Anesthesiology and Critical Care Medicine, and Surgery. He is founding Director of the Quality and Safety Research Group and serves as the Medical Director for the Johns Hopkins Center for Innovation in Quality Patient Care.

When implemented in Michigan in partnership with the MHA, participating hospitals reduced catheter-related bloodstream infections by up to 66 percent using a simple checklist of evidence-based precautions. With the funding from AHRQ, the checklist will be implemented by statewide consortia in at least ten more states according to Dr.Pronovost. The consortia will include members of state hospital associations, quality improvement organizations, and public health agencies.

Earlier this month, the John D. and Catherine T. MacArthur Foundation awarded a $500,000 grant to Dr. Pronovost, and last week, the House of Representatives, Committee on Oversight and Government Reform, released a report strongly endorsing the Dr. Pronovost’s work.

FDA Awards $2.5 Billion for IT

On September 26, 2008, FDA awarded ten contractors a total of up to $2.5 billion to provide information technology and data center management services over the next ten years. The funding will be the cornerstone of the FDA’s Information Technology for the 21st Century (ICT21) Bioinformatics initiative.

“This contract (HHS F2232008500131-221) sets the stage for the FDA to have IT to acquire, analyze, and act on data critical for import protection, food protection, and medical product safety plans,” said Andrew C. von Eschenbach, M.D., Commissioner of Food and Drugs. “We are creating a high tech efficient, data management system designed to meet the needs of those who must accomplish our mission.”

The contracts with a minimum value of $25,000 in orders per contractor were awarded to Buccaneer, Warrenton Virginia, Computer Sciences Corporation, Rockville, Maryland, Dynanet, Elkridge, Maryland, Electronic Data Systems, Herndon Virginia, General Dynamics, Fairfax Virginia, Human Touch, McLean Virginia, IDL-Pragmatics, Vienna Virginia, Interactive Technology Solutions, Silver Spring Maryland, Telesis, Rockville Maryland, and Unisys, Reston Virginia.

The ten contractors will compete for the data information technology task orders through this contract. The FDA has awarded three task orders under the ICT 21 contract for the design and migration of all systems application to two new data centers. All FDA software applications and hosting operations will transition to the new data centers over a two year period.

The three task orders were awarded to:

  • IT Solutions (Task Order 1 funded initially at $3,000,000) provides the design and implementation as well as migration of existing FDA applications to the newly configured White Oak Data Center which supports all FDA test and development applications
  • Buccaneer (Task Order 2 funded initially at $3,000.000) provides the operations and maintenance at the White Oak Data Center
  • EDS (Task Order 3 funded initially at $122,000,000) provides the design, implementation, migration and operations, and maintenance of existing FDA applications to a Contractor Owned Contractor Operated hosted data center for FDA production operations

For more information, go to or email

Wednesday, October 1, 2008

AHRQ Plans for HIT

On September 25th, ARHQ released future plans to support HIT. These plans include demonstration projects using health IT to improve quality, studies to support real world health IT implementation, and small research grants to improve healthcare quality. However, funding for the projects is dependent on the availability of funds. As of 2008, AHRQ’s Health Information Technology Portfolio has invested over $260 million in contracts and grants to over 150 communities, hospitals, providers, and healthcare systems in 44 states.

The Funding Opportunity Announcements released on 9/25 include:

  • “Utilizing Health Information Technology to Improve Health Care Quality” (PAR-08-270) to study how health IT can be successfully implemented to improve quality, safety, effectiveness, and efficiency in ambulatory settings and between care settings. So far, the use of health IT has been demonstrated to improve healthcare in various large healthcare delivery systems, but little data has been available on the use of health IT in ambulatory settings. The closing date for applications is May 07, 2011
  • “Exploratory and Developmental Grants to Improve Healthcare Quality through HIT “(PAR-08-269) to do studies on how health IT improves the quality and safety of healthcare. Studies will be done on medication management, patient-centered care, and how health IT can be used to improve healthcare decision making. January 16, 2009 is the earliest date for submission
  • “Small Research Grants to Improve Healthcare Quality through Health IT” (PAR-08-268) to do small pilot and feasibility health IT research projects. Opening date to receive grant proposals is January 16, 2009.

Public and state institutions of higher education, county governments, Native American tribal organizations and governments, eligible Federal government agencies, and Faith-based or community-based organizations are eligible for the grants. For PAR-08-268, individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are encouraged to apply.

For more information, go to Email Angela Lavanderos at or call 301-427-1505.

Texas Posts Grant Notice

The Texas Office of Rural Community Affairs (ORCA) has posted information on the Texas Rural Health Technology Grants for FY 2009. This grant program supports the development of clinical systems and capital equipment for Critical Access Hospitals. ORCA seeks projects that will address at least one of the program goals and at least one of the objectives.

The goals are to expand access to care in rural areas, improve the quality of care and patient safety, provide more efficiency in delivering, coordinating, and integrating healthcare, and improve hospital finances and sustainability.

The program objectives are to implement HIT, EHRs, telemedicine or telepharmacy applications, expand access to health services, reduce health disparities, improve workflow and productivity, enhance hospital viability, and provide for cost efficiencies.

Specifically, the funds are to provide EHRs, physician ordered entry systems, bar-coding systems, data or laboratory information systems, IT/MIS applications, telehealth, telemedicine, telepharmacy, or tele-education. Funds can be used for medical laboratory imaging technologies or services, to improve hospital performance, and produce quality improvement systems or tools.

Only Critical Access Hospitals in Texas that have not been awarded the ORCA Technology Grant in FY 2008 are eligible to apply for the FY 2009 grants. The grants are supported by the Medicare Rural Hospital Flexibility Grant Program and will be awarded by HRSA. A total of $150,000 is available for this program and grants will not exceed $30,000 per grantee. The deadline for the grant applications is December 5, 2008.

For more information, go to, or call 1-800-544-2042, or 1-512-936-6701.

NSF Funds Research Center

The National Science Foundation awarded a five year $18.5 million grant to establish an Engineering Research Center (ERC) at the University of Arizona. The researchers at ERC will work to develop optoelectronic technologies to provide for high bandwidth and low-cost widespread access networks to deliver data more than a thousand times faster. As a result, communications and the healthcare industries will benefit.

The University of Arizona and nine partner universities (UCSD, Caltech, Stanford University, USC, UCLA, UC Berkeley, Columbia University, Norfolk State University, and Tuskegee University) will collaborate and form the Center for Integrated Access Networks (CIAN). The research is timely since there are predictions that the demand for internet access especially in North America will exceed existing internet capacity within the next three to five years. Analysts however, say that failing to invest in new access infrastructure won’t cause the internet to collapse, but it will mean that innovations will slow down.

“CIAN’s goal over the next decade is to devise and adapt chip-scale optoelectronic integration technologies capable of delivering data at 20 gigabits or 10 billion operations per second to single users anywhere, at anytime, and at a lower cost”, according to Shaya Fainman, Professor of Electrical and Computer Engineering at UCSD and CIAN Deputy Director . “The current data transfer rate is about 10 megabits or 10 million operations per second.”

The new Center will work to create truly transformative systems critical to national information infrastructure, “Our vision is to create the PC equivalent of the optical access network.” said CIAN Director Nasser Peyghambarian, Professor at the University of Arizona. In addition, University of Arizona Professor Robert Norwood will head CIAN’s industrial collaboration and technology transfer program so that industry will have a voice in the selection of research projects and play a part in transferring technology.