Wednesday, April 29, 2009

Telemedicine/Telehealth Update

Reimbursement for telemedicine is vital for the technology to move forward at a rapid pace. Policy, costs, standards, infrastructure, and human dimension issues also must be solved before this country can move into a technology enabled healthcare environment, according to Neal Neuberger, Executive Director, Institute for e-Health Policy moderator for the April 22nd Steering Committee on Telehealth and Healthcare Informatics lunch briefing held on Capitol Hill.

This is an amazing time and we are at the center of the storm with everyone ready to see telemedicine and telehealth move forward said Jonathan Linkous, CEO, of the American Telemedicine Association. He continued to say that telemedicine has been growing with 200 networks, at 300 sites, and 100,000 units in homes treating individuals with chronic conditions. Yet we are behind the rest of the world.

Linkous is concerned about CMS rules for telemedicine reimbursement and how their rules can differ from the private sector. CMS will reimburse at times for using interactive video for consults, but this only results in 17% coverage in the U.S. Most of the people in this country are not reimbursed by CMS.

As a notable leader in the telemedicine field, Jay H. Sanders, M.D., President and CEO, the Global Telemedicine Group, discussed how effectively telemedicine can function in the 21st century. In today’s world, telemedicine technologies have brought the exam room, doctors, and specialists to the patient especially patients with chronic diseases. Trauma surgeons, neurologists, ophthalmologists, and many other specialists located at academic centers can now be seen routinely via video at rural hospitals.

As Dr. Sanders pointed out, we are all telemedicine experts since we use cell phones. Using telemedicine in the work place can save a great deal of time and money for employers. Today, cell phones are brought into the worksite making it much easier and more cost effective for employees to be tested where they work. Asthma tests can now be done at work with sensors transmitting the information to cell phones with embedded diagnostics in place. This is just one way for bringing healthcare delivery to the patient.

In addition, EMR systems need to provide intelligent dynamic electronic medical records. For example if the patient has a complaint that is difficult to diagnose, then the EMR intelligent dynamic system would start helping the physician. A dynamic EMR would search records, find essential information, scan the literature, incorporate this new information into the EMR, and then alert the doctor to changes or new therapies.

Both, Stuart Ferguson, Ph.D., Director of Telehealth Alaska Native Tribal Health Consortium, and John Kokesh, M.D., Chairman Department of Otolaryngology, Alaska Native Medical Center in Anchorage Alaska traveled from their state to describe how the Alaska Federal Health Care Access Network (AFHCAN) is improving healthcare. The network supports beneficiaries of IHS and tribal organizations, the Department of Defense, U.S. Coast Guard, and the VA.

As the speakers explained, during the early years, there was overwhelming need to create a store-and-forward telemedicine system. Clinical needs assessments indicated that primary care, otolaryngology and cardiology were the most needed services and amendable to store-and-forward applications.

Today in Alaska, telehealth has had had a huge impact and is used to identify many health issues much earlier. The network handles 12,000 cases per year, has 248 sites with care not only being delivered in Alaska but also delivered to other places such as Greenland, Panamanian prisons, and schools in Ohio.

Both speakers emphasized that much has been accomplished and now telehealth provides care for many health issues including post surgical follow-ups, wound closure examinations, and post cochlear implant assistance. In addition, travel time is greatly saved since 8% of specialty consults are prevented with 20% travel time reduced for primary cases. This has saved AFHCAN $3.5 million in treating 43,800 patients. For every dollar spent by Medicaid on reimbursement, $7.95 is saved on travel costs.

According to both speakers, better healthcare can be provided with multi-providers providing care in multiple regions and with patient participation. But it does require using a system approach when initiating the technology, developing the workflow process efficiently, establishing the relationships needed to maintain the system, and providing for adequate training and support. All of these factors are the key to cost savings since it has been found that telehealth is more cost effective and operates more efficiently when done at higher volumes at many sites.

On the state legislative front, the Alaska State Senate recently passed Senate Bill 233 to create an electronic health network that would enable Alaskans to have their own personal health record and the bill would authorize their healthcare providers to exchange electronic medical records.

Today, 23% of Medicare emergency room visits are due to the elderly and others mismanaging their medications. To help cope with prescription mismanagement problems, a few years back INRange Systems Inc. developed a medication management system called EMMA ®.

Walt Grant, Director of Government Affairs and IT Integration for INRange Systems Inc, discussed how medication management systems can be effective since the system operates as the arm of the caregiver in the patient’s home and greatly helps control medication.

EMMA ® consists of a Medication Delivery Unit (MDU), and wireless two-way web-based communications software that enables a physician, pharmacist, or other licensed practitioners to remotely manage prescriptions stored and released by the patient 24/7.

EMMA ® has proven to be invaluable since it can control narcotics, provide for inventory control, schedule medications or change dosing schedules, provide reminders for other medications, suspend and add medications, provides both visual and audible alarms, and automatic phone notifications.

The Congressional Luncheon Seminar ar Series is a project managed by the Institute for e-Health Policy, a subsidiary of the HIMSS Foundation. For more information, go to

New Products Exhibited at ATA

Many companies successfully exhibited at the ATA meeting held this week in Las Vegas. Many of the new products generated a great deal of excitement in the exhibit hall, at the sessions and panel discussions, and at networking events.

Spotlight on some of the newest products and ideas:

  • Intel exhibited its first home medical device the Intel® Health Guide, a care management tool designed for healthcare professionals who manage patients with chronic conditions. Intel has now entered into a new category of personal health systems that go beyond the simple remote patient monitoring systems now available. The system combines an in-home patient device (Intel® Health Guide PHS6000) as well as an online interface (Intel ® Health Care Management Suite) allowing clinicians to monitor patients in their homes and manage care remotely. Go to
  • GE and Intel have formed an Alliance to market and develop home-based health technologies to help seniors and patients with chronic conditions. The companies intend to invest more than $250 million over the next five years for research and product development of home-based health technologies. The market for telehealth and home health monitoring is predicted to grow from $3 billion in 2009 to an estimated $7.7 billion by 2012. Go to
  • RS TechMedic B.V came from the Netherlands to exhibit their Dyna-Vision© device for the U.S. market. With this device, physicians can monitor vital signs and cardiopulmonary events in ambulant and home-care patients at anytime from anywhere in the world. The device is a small light weight and portable device about the size of a PDA and is worn in a belt pouch. The device automatically transmits cardiac and respiratory events when they occur. The information is transmitted to a central server which can be located anywhere such at a hospital or telemedicine service center. Go to
  • Global Media provides video imaging and visual communications solutions used in telemedicine. The company just unveiled their newest addition to their product line “TransportAV”. Mounted on a stretcher, TransportAV allows for medical consultations from the field to go directly to the clinic or hospital when a patient is being transported. The remote doctor has the ability to control all the aspects of the consult. The system features a military-grade touch screen PC, a 3G Aircard, a controllable camera, echo canceling microphone, a Clear Steth ™ Stethoscope, a TotalExam ™ examination camera, and a Bluetooth wireless keyboard with headset for private conversations. All of this is designed into an adjustable compact unit. Go to or call Jay Culver at +1 (480) 922-044 extension 220
  • Honeywell HomMed just announced LifeStream Connect and Life Stream View as part of their two new offerings in the Honewell LifeStream Telehealth Ecosystem. LifeStream Connect is a suite of interfaces that seamlessly integrated critical EMR and other point-of-care applications in a single platform Clinicians can use a unified application for patient monitoring and no longer have to switch between disparate systems. The system enables clinicians to securely monitor patients from any web-based browser. The system can also securely access and track patient information in real time and identify developing health trends. Life Stream View enables patients, families, and healthcare providers easy, secure access to patient information via the internet. Go to or contact Eric Zalas at or call 262-252-5798
  • LogicMark, LLC introduced their newest product called FreedomAlert with two features that make it stand out. First, the product has the world’s smallest two-way voice communicator and secondly, the device requires no monthly fee since the central monitoring stations used by the competition is bypassed. The product has a two way speakerphone right in a miniature pendant. Go to or email
  • American TeleCare exhibited their new cellular option for establishing telehealth connectivity. The ATI LifeView™ Telehealth Patient Station features compact easy to use patient stations that gather and send information on health status questions by patients as well as provide objective clinical data from integrated medical peripherals. Narrated instructions complement multi-media instructions to guide patients through their telehealth tasks. Individualized patient education and self-care instruction are integrated within the flow of patient tasks. A dashboard display on the system’s Provider Stations color-codes summaries of each patient’s current health risk status. Clinicians can set specific thresholds for each patient to red flag significant changes. The system offers electronic stethoscope options and interactive video. Go to
  • NeuroCall ™ Inc. offers remote neurology services to any facility that needs coverage. Unlike most other telemedicine services, it strictly focuses on neurological services. The team has 26 neurologists and three ARNO’s with services offered in many languages. The company has offices located in Miami, New Hampshire, and Spain. Expertise in all facets of neurology is delivered to any facility with a high speed internet connection. A specialist can appear on the screen in an ER facility within minutes. A video demonstration of the service can be viewed at or for more info, email Joshua Randall at .

Innovative Care Delivery

The Ohio Telehealth Video Resource Center (TVRC) a not-for-profit center recently launched a web site to make the center’s video conferencing services available to physicians and healthcare education professionals worldwide. TVRC serves as an international resource center and video hub of telehealth activities for statewide, national, and international activities. The TVRC site at provides video conference hardware and software requirements that has scheduling tools, telehealth news, instructions, and an e-health forum.

“TVRC supports the use of high quality video for health education and training, research, and associated clinical activities,” explains Charles R. Doarn, the Center’s Executive Director. “Healthcare providers with little technical experience can easily access TVRC resources to communicate via high-quality video conferencing with other health providers.”

TVRC clients have the opportunity to share “grand rounds” where doctors can meet to discuss multiple patients, see demonstrations on new and emerging clinical practices, hold multi-center interactions, and conduct clinical trials and other research projects. The Center also provides a technology forum for the continued development of telehealth processes and standards.

Several years ago, Ohio invested in telehealth by advancing a statewide fiber optic network and then piloted telehealth projects at the Ohio Academic Resources Network (OARnet), the technology infrastructure arm of the University System of Ohio. OARnet established TVRC an international resource partnering with the World Bank, Internet2, and the Ohio supercomputer Center.

Early telehealth projects included a series of video conferences with U.S. trauma specialists sharing insights with healthcare professionals in Latin America, Africa, and South Asia. Another pilot project involved U.S. surgeons demonstrating orthopedic knee surgery for colleagues in China.

TVRC is empowering change and the video resources are benefiting a wide range of applications in both clinical environments and the classroom. For example, the Nationwide Children’s Hospital’s eNICU in Columbus Ohio uses high definition video permitting neonatal experts to examine infants at rural and remote locations.

Another innovative project, the International Virtual e-Hospital Foundation (IVeH) is a non-profit organization supported by the Department of State and based in Anchorage Alaska. IVeH was created to help rebuild the medical system in Kosova and other developing countries by implementing telemedicine, telehealth, and virtual educational programs.

Another group the Medical Missions for Children dedicated to serving the medical needs of catastrophically ill children in underserved international areas is using the Global Telemedicine and Teaching Network to help children in need. The GTTN also broadcasts continuing education programs and supports telemedicine consults among a global network of medical specialists.

Moving NHIN Forward

The Office of the National Coordinator for HIT intends to award a sole source contract to Nitor Group, Ltd., in Chester Maryland. The contract calls for support services to develop a strategy, program governance, technical requirements, and program artifacts, to move the Nationwide Health Information Network (NHIN) forward.

The current Small Business set aside notice posted on April 24th will provide a sole source contract to Nitor so that the organization can prepare documentation for the full and open competition that will take place later in 2009. In the future 2009 competition, contractors will need to:

• Develop a strategy and governance structure for NHIN
• Evaluate, plan, implement, and deploy health IT while emphasizing information networks and interoperability
• Develop a portfolio to manage the assets, resources, and other materials related to NHIN
• Guide and oversee stakeholder and workgroup activities
• Lead a communications campaign which will include effective news messaging, communications, and develop a product web site

Although the government intends to solicit and negotiate with only one source at this time, interested organizations may submit a capability statement. However, the information received will only be considered to determine whether to conduct a competitive procurement or not. The response date for the capability statement is May 08, 2009.

For more information on the notice “Nationwide Health Information Network Production Activities” (ONC-NHIN09), go to, or contact Anita Nearhoof, at or call 301-443-5312.

Wednesday, April 22, 2009

Small Research Grants Available

NIH’s Small Grant Funding Opportunity Announcement (FOA) (PA-09-163) released on April 16, 2009, supports well defined small research projects that can be carried out in two years with limited resources. The grant funding supports:

  • Pilot and feasibility studies
  • Secondary analysis of existing data
  • Small, self contained research projects
  • Development of research methodology
  • Development of new research technology

Small grant applications will be assigned to NIH Institutes and Centers (IC) according to specific program interests, and applicants need to look at the list of participating ICs and their special research interests. For example, the National Institute of Nursing research supports the validation of new technology and novel methods for analysis including meta-analyses or secondary data analyses and NLM is interested in biomedicine and bioinformatics research.

Institutions of higher education, nonprofits, small businesses, for-profit organizations state, county, local governments and a number of other types of organizations are eligible to apply.

Grant applications can be submitted to starting May 16, 2009. Applicants may submit more than one application, providing that each application is scientifically distinct from the others. The total amount to be awarded and the number of awards will depend upon several factors such as the quality, duration, costs for the applications received, and the availability of funds.

For complete information, go to, and for the R03 web site go to For the program announcement PA-09-163, go to For general information inquiries, email Denise Russo at

Software Tracks Changes

The Department of Energy’s Oak Ridge National Laboratory (ORNL) and St. Jude Children’s Research Hospital are collaborating to find ways to predict and prevent diseases. The research team composed of image and computational analysis experts at ORNL are working with experienced neuroscientists at St. Jude to solve some challenging problems in a unique way.

The team is looking at how developing nerve cells may hold a key to finding the answers to diseases such as Cancer, Alzheimer’s, and Parkinson’s. When St. Jude researchers are analyzing images, they look for several specific changes. However, there may be much more relevant information in those images that they don’t have the ability to find or study in great detail.

To deal with this problem, ORNL is working with Michael Dyer of St. Jude’s Department of Developmental Neurobiology to develop computer software that will automate the process of tracking changes in the shape and position of neurons over time.

The next stage for software development will be to focus on automatically detecting when and how neurons branch or grow. Branching patterns and branch orientations can be critical to distinguishing between normally developing neurons and those with the potential to cause disease.

The ultimate goal of the research is to develop computational tools that recognize how neurons change and move in ways that are unexpected or abnormal so that neuroscientists can develop ways to address these changes so as to treat and ultimately prevent neurological diseases.

The work is funded by the Seed Money fund of ORNL’s Laboratory Directed Research and Development program and St. Jude Children’s Research Hospital.

CDC & eHealth Marketing

More Americans own mobile phones than landline phones or even computers so that mobile devices are an ideal medium for health messaging and promotion. CDC is exploring a number of ways to use mobile technology to promote health and safe behaviors.

CDC co-sponsored a Texting4Health Conference in 2008, at the Stanford University Persuasive Technology Lab that focused on using mobile text messaging to promote better health. CDC is now working with numerous public health partners to develop research and best practices for accomplishing this task using mobile phones.

In a collaborative project between HHS, CDC,, and the Kaiser Family Foundation, a mobile text application was developed to locate HIV testing centers by zip code. Users can text their zip code to “KnowIT” (566948) and within seconds, receive a text message identifying an HIV testing site near them. Users who do not have cell phones or prefer to use the web can access the online testing database at to find testing centers.

CDC participated in a project led by the New Media Institute at the University of Georgia to produce a new kind of PSA called a “Personal Public Service announcement” (PPSA). The PPSA was developed to reach target audiences, particularly youth, via their personal media, such as mobile phones and MP3 players. The PPSA is one of CDC’s first attempts to use user-generated content to promote healthy behaviors.

The PPSAs were developed in a single day by teams of student journalists from Temple University, the University of Georgia, and the University of South Carolina to encourage HIV testing for World AIDS Day. The project was funded by Verizon Communications along with support from CDC and other organizations.

CDC has a popular email subscription service that enables users to receive notices when new information is added to To compliment this service, CDC has piloted a mobile text message subscription service to enable users to receive text messages and be notified when the Weekly Influenza Surveillance Report Map is released.

In partnership with Georgia Tech University, CDC is studying how to better use mobile phones to improve the management of diabetes. Patients can now use the phone to record their blood sugar, with the readings made available on a collaborative web site for discussion with their diabetes educator.

FCC Update on Projects

The FCC has approved funding under the Rural Health Care Pilot Program (RHCPP) to build five broadband telehealth networks. The networks will link hundreds of hospitals regionally in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Carolina, South Dakota, Wisconsin, and Wyoming plus funding has been approved for the design of a telehealth project in Alaska.

Collectively, these projects are eligible to receive $46 million in reimbursement for the engineering and construction of their regional telehealth networks. Funding for these projects was issued by the Universal Service Administrative Company which administers the RHCPP for the FCC.

Sixty seven projects are eligible to receive RHCPP funding for telehealth networks serving 6,000 healthcare facilities in 42 state and three U.S. territories using broadband technology to bring state-of-the-art medical practices to isolated rural communities.

At this time, 29 of the projects have developed or posted requests for proposals to select vendors to build out their broadband networks, while the remaining projects are preparing their requests for proposals as part of the competitive bidding process.

Update on specific RHCPP projects:

  • Health Information Exchange of Montana ($13.6 million)—A new fiber network is scheduled to connect healthcare providers in the state to provide distance consultations, electronic record keeping and exchange, disaster readiness, clinical research, and distance education
  • Palmetto State Providers Network ($7.9 million)—This project will connect healthcare providers to a fiber optic backbone to enhance simulation training, remote intensive care unit monitoring, and medical education in South Carolina
  • Iowa Health System ($7.8 million)—This project will use new network connections to link healthcare providers to an existing statewide dedicated, broadband healthcare network, Internet2, and National LambdaRail
  • Heartland Unified Broadband Network ($4.7 million)—This project is expanding and improving an existing network to increase the use and quality of teleradiology and distance education activities throughout Iowa, Minnesota, Nebraska, North Dakota, South Dakota, and Wyoming
  • Rural Wisconsin Health Cooperative ($1.6 million)—This project has augmented an existing shared electronic health records project to provide healthcare providers in Wisconsin with access to redundant connectivity and data centers, as well as higher speeds that will range from 10 to 100Mbps
  • Alaska Native Tribal Health Consortium ($10.4 million)—The consortium’s network will serve primarily rural healthcare practitioners to unify and increase the capacity of disparate healthcare networks throughout Alaska allowing them to connect with urban health centers and access services in the lower 48 states

Saturday, April 18, 2009

eICUs Can Save Millions

Telemedicine can serve the critical care needs of rural communities and already has saved millions of dollars while improving patient survival. Dr. Edward Zawada, Medical Director of Avera eICU® CARE, a service of Avera Health based in Sioux Falls, S.D., authored a study that found that significant financial benefits can be accomplished ranging from improved quality, less stress on rural physicians and nurses, along with higher patient and family satisfaction.

The study presented at the Society of Critical Care Medicine’s annual meeting compared data before eICU implementation, and then did a comparison 30 months after implementation. The findings showed:

  • Rural hospitals had fewer patients requiring transfer, which represented a cost savings of more than $1.2 million
  • There were shorter lengths of stay in intensive care units resulting in a saving of an estimated $8 million
  • Hospital mortality rates were 65-80 percent lower than predicted after implementation of the eICU as compared to 50 percent lower than predicted before implementation
  • Ninety percent of rural hospital clinical leaders reported being more comfortable caring for critically ill patients with eICU
  • Ninety percent of rural hospital leaders agreed that patients and families are comfortable staying in the hospital with the added eICU care
  • One hundred percent of rural physicians agreed that better safer care can be supported by a remote critical care team

While numerous studies documented by the Leapfrog Group show that intensivist staffing reduces the risk of ICU mortality by up to 40 percent, a shortage of intensivists makes such bedside care impossible in most locations. With only about 6,000 of these specialists in practice, less than 15 percent of ICUs have dedicated intensivist care which is especially true in rural areas.

$10 Million Plus X Prize Proposed

The X PRIZE Foundation, WellPoint, and the WellPoint Foundation are developing a $10 million or more competition called the “Healthcare X Prize” designed to generate new ways to address the nation’s serious healthcare system challenges. The competition is focused on reinventing the healthcare system in a bold, measurable, and scientific fashion.

The competition along with a call for public comment was unveiled by leaders in the field on April 14, 2009 at a panel discussion held at the 6th World Health Care Congress in Washington D.C. Dr. Peter H. Diamandis, Chairman, CEO, X PRIZE Foundation, Angela F. Braly, President and CEO WellPoint Inc, Hon. Bill Bradley, former U.S. Senator, and Hon. Newt Gingrich, Founder, Center for Health Transformation, discussed the excitement and the thinking that went into developing the prize. Susan Dentzer, Editor in Chief, Health Affairs moderated the panel discussion.

The panelists were in agreement that the prize will help to create incentives that will reflect on health outcomes in this country, provide greater value for the healthcare dollar, and produce the highest quality healthcare, which in turn, will lead to more active and longer lives.

According to the panelists, the public and other stakeholders are being asked to look at the initial design for the competition and reply with suggestions and ideas as to how the “Healthcare X PRIZE” can improve healthcare for families and communities. Teams will form for the competition and then work for 18 months to develop and submit their plans for the prize. Five finalist plans will be pilot tested on 10,000 individuals with the results to be compared against a control group. WellPoint will then collaborate with employers and providers to test the idea in communities.

The Collaboration will solicit participation from employers, healthcare providers, consumers, government partners and any other interested parties. Transparency will be emphasized from development of the prize to the conclusion of the competition.

Other advisors supporting the competition include Glenn Steele, CEO, Geisinger Health System, Dr. Jim Weinstein, Director, Dartmouth Institute for Health Policy and Clinical Practice, Dr. Carol Diamond, Managing Director, Markle Foundation, Mark Litow, Principal and Consulting Actuary, Milliman, Dr. Dean Ornish, President, Preventive Medicine Research Institute, and Michael E. Porter, Professor, Harvard Business School.

For more information, go to

Behavior Imaging Treats Autism

In a new study funded by NIH, educators overwhelmingly embrace Behavior Imaging technology as a telemedicine tool for more effectively treating children with autism. Dr. Uwe Reischel, M.D., Ph.D, of Boise State University coordinated a study that examined not only the efficacy of “B.I. Capture” (a behavior imaging tool that captures and stores behavioral events via remote control video) in treating students with autism, but also looked at how easy it is for teachers and behavior specialists to use the technology.

“We are finding that autism educators are receptive to using telemedicine and specifically B.I. than we had originally expected,” noted Reischl. “This is especially so for participants who not only want to use it for behavior analysis, but who also see it as a useful tool for assessing student skills, giving or receiving consultation, and for training students and staff.”

Behavior Imaging was initially developed by the Georgia Institute of Technology and is now marketed by Caring Technologies/TalkAutism in Boise, ID. The system is able to capture on video, a child’s behavioral episodes in educational, clinical, and home environments. Behavioral data is captured on video and then the video is used to characterize recognized aspects of behavior to assist in the diagnosis, treatment, and research of autism. The video can be viewed, annotated, and stored online, so that behavioral experts can guide students progress from anywhere in the world.

An earlier phase of the study demonstrated that the technology enabled a 43% reduction in errors when collecting data for the Functional Behavior Assessment program. Now in addition to more effective clinical diagnoses and treatment, behavior imaging can help qualified practitioners save time and money by not always observing autistic behavior in people in person.

“B.I Care” is another platform now used by professionals to diagnose, evaluate, treat, train, and provide remote consultation for autism, TBI, PTSD, and other conditions. The new system B.I. Care will be unveiled and exhibited at the ATA Annual Meeting in Las Vegas and complements B.I Capture.

For more information go to www.bicapture or call Brian C. Cronin at (208) 439-8493. Contact Caring Technologies Inc/TalkAutism for information on both B.I Capture and B.I Care. Call +1.208.629.8778 or cell at +1.609.240.3187.

VMC Looking Ahead

The Vanderbilt Medical Center (VMC) helped establish one of the first health information technology demonstration projects called the MidSouth eHealth Alliance to link several hospitals, emergency departments, and ambulatory clinics in the Memphis area. Mark Frisse, M.D. Director of Regional Informatics Programs in the Vanderbilt Center for Better Health helped develop and oversees the project funded by AHRQ and the state of Tennessee.

A major piece of the stimulus package is the Health Information Technology for Economic and Clinical Health (HITECH) Act. VMC is looking towards HITECH to help continue to make electronic innovations in the healthcare field. Also, Bill Stead, M.D., Director of VMC’s Informatics Center, has been nominated to serve on the Health Information Technology Policy Committee to help make recommendations for implementing the HITECH Act.

Stimulus funding is expected to further help developments in effectiveness research by using electronic health data and other methods to evaluate different medical treatments, including surgery and drug therapy. $1.1 billion will go to HHS for this purpose.

As for effectiveness research at VMC, at least three AHRQ supported projects are currently underway. Marie Griffin, M.D., is a principal investigator in the national “Developing Evidence to Inform Decisions about Effectiveness Research Network” set in motion to conduct accelerated practical studies about the outcomes, comparative clinical effectiveness, safety, and appropriateness of healthcare items and services.

In addition, other centers at VMC are involved in the effectiveness research program. Wayne Ray Ph.D directs the AHRQ Center for Education and Research on Therapeutics, a program to increase the awareness through education and research on the benefits and risks for new, existing, or combined uses of therapeutics emphasizing vulnerable populations.

In another program, Katherine Hartmann, M.D. PhD is leading an AHRQ Evidence-based Practice Center with the purpose to review scientific literature on clinical, behavioral, organization, and financing topics and to produce reports and technology assessments.

Officials at VMC expect to receive an additional share of stimulus funds for research through NIH and other federal agencies. In the last 10 years, VMC has tripled their annual amount of research funding that the school received from all of their sources, and this has amounted to more than $400 million in 2008, even with several years of flat NIH budgets.

Beginning in 2011 and continuing for five years, VMC will receive higher reimbursement rates from Medicare and Medicaid due to its use of health information technology. Also, Vine Hill and other community clinics affiliated with the Vanderbilt School of Nursing are expected to receive a share of the $2 billion from HRSA to spend on health center renovations and technology upgrades.

VMC is expected to provide as much as $290 million in charges in uncompensated care in the current fiscal year, an increase of more than $40 million as compared to fiscal year 2008. Stimulus funding should help ease that burden by providing Tennessee with a temporary increase in the federal match for Medicaid payments, estimated at $1.1 billion through December 2010.

Although Governor Phil Bredesen has recommended cutting the state’s appropriation for TennCare in the next fiscal year (2009-2010), but with stimulus funds, the total TennCare budget proposed for next year could grow by about 3 percent to $7.6 million.

Wednesday, April 15, 2009

Health Data Systems on the Rise

The Arizona Health Query (AZHQ) database integrates and analyzes millions of healthcare records. By analyzing data over time and across health systems, researchers are able to identify specific community health needs and also inform others on public policy.

The system at was created by the Arizona State University’s Center for Health Information and Research (CHiR) and uses SAS software. The information is consolidated from health information available from dozens of healthcare organizations in the state to form the community health data system. Previously, patient data was spread across different healthcare providers which hindered research on community health issues.

“The system makes it possible to track patients over time by location and to identify trends and patterns in healthcare within and across communities,” said Wade Bannister, Creator of the AZHQ Database and Associate Director for CHiR.

According to William Johnson, Founder of AZHQ and the Director for CHiR “SAS predictive analytics presents an opportunity to assess risk factors and to predict costs for patient care years in advance so that steps can be taken to alleviate costs through intervention and more informed budget decisions.”

More than 40 data partners including Medicaid’s Arizona Health Care Cost Containment System took part in the project. So far, AZHQ has consolidated data on 9 million people and 200 million healthcare encounters while pulling data from more than 60 healthcare delivery institutions that includes hospitals, insurers, and employers.

Researchers have used AZHQ to analyze health disparities in Hispanic and non-Hispanic children and were able to study the evolution of Valley fever asthma patterns in Arizona to determine if the hospitals are effectively serving the needy. AZHQ is also studying MRSA a staph infection that is resistant to antibiotics. By tracking the disease’s spread by zip code, researchers are able to determine how and why MRSA spreads.

Other states such as Missouri have available health information on their Missouri Information for Community Assessment (MICA) System. Their system is an interactive internet tool for communities and public health professionals used to access health information and data. The system enables users to access health information, set policies, guide health programs, and educate policymakers and citizens on their community’s health status. By logging into the Missouri Department of Health’s homepage at, an individual can summarize health data, calculate rates, and prepare information in a graphic format for presentations.

North Carolina has developed the Comprehensive Assessment for Tracking Community Health (CATCH) system that provides the public and others with a wide array of demographic and community health data, along with comparisons with peer counties and the state. In addition, the NC-CATCH “Indicator Fact Sheets” supply users with trends in indicators over time, as well as breakdowns by race and ethnicity for many health measures.

North Carolina’s system at is a collaborative effort developed by the faculty at the University of North Carolina at Charlotte under a contract funded by the North Carolina Division of Public Health. Funds for the system were also provided by the Kate B. Reynolds Charitable Trust.

The system is in the first phase however, a feature to enable user defined data queries for approved state and local public health professionals is under development and expected to roll out in 2009.

Navy Seeks to Commercialize Tech

The Navy seeks to commercialize “Haptic Communication Glove” technology. Advancements in sensors and software, technologies have been developed that enable more complex messages to be communicated through haptics which uses the sense of touch.

Haptics can help to overcome communication barriers for blind and deaf people, be used in dangerous, dark, or noisy environments, and can be used where the effective use of auditory or visual communication methods is not possible,

Navy’s Space and Naval Warfare Systems Center Pacific (SSC Pacific) developed the glove where a person is able to send and receive messages simply by moving fingers. Each finger is fitted with a sensor to measure movement and in addition, has a vibration motor to create a sense of touch feedback.

Movements are translated into language and sent wirelessly from one glove to another glove in the form of vibrations that the receiving party feels. For example, if one user holds up the universal peace sign, the other user may feel the Braille writing for the work peace on their fingertips, plus a computer monitor also displays the word peace.

In addition to person to person communication, the glove can be used to interact with computers, the web, and even autonomous robotic vehicles. It is possible that entire books could be communicated electronically to the blind using the glove.

The development of the glove technology took two years and $900,000 in total research and development. One patent (12/325,046) entitled “Wireless Haptic Glove for Language and Information Transference” and another patent (12/323.986) entitled “Static Wireless Glove for Gesture Processing/Recognition and Information Coding/Input” have been filed.

For more information email or call (619) 553-2778.

Biomedical Experiments in Space

“We encourage all biomedical researchers in the U.S. interested in molecular or cellular biology, biomaterials, or telemedicine to give serious thought to possible research projects that could be done on the International Space Station (ISS)”, said Stephen I. Katz, M.D., Ph.D., Director of NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the NIH liaison to NASA.

NIH and NASA are looking to partner with researchers and scientists to design biomedical experiments that astronauts could perform on ISS. NIH is prepared to fund biomedical experiments where the experiments done in a space environment will be able to produce breakthroughs to improve human health on earth.

The ISS provides a special microgravity and radiological environment that earth-based laboratories cannot replicate. Already biomedical experiments conducted in space have addressed how bone and muscle deteriorate, how humans fight infectious disease, and how cancers grow and spread.

The ground feasibility phase (UH2) would enable investigators to focus on ground-based preparatory work that could lead up to the ISS experimental phase. The UH3 phase would prepare the experiments for launch, conduct them on the ISS, and perform the subsequent data analyses on earth.

“The ISS is an extraordinarily capable laboratory in a unique environment that has not previously been available for widespread medical research. NASA supports the NIH leadership in this promising opportunity,” said Mark Uhran, NASA’s Assistant Associate Administrator for the ISS.

A number of NIH institutes and centers are participating in the program and awards for this program are contingent upon the availability of funds. The project was announced in March and operates under a cooperative agreement called “Biomedical Research on the International Space Station” (BioMed-ISS) (UH2/UH3) (PAR-09-120). The opening date to submit an application is August 30, 2009. Letters of Intent must be received by August 31, 2009, 2010, and 2011. The application is due September 30, 2009, 2010, and 2011.

Go to for more information.

Developing a Broadband Plan

The Recovery Act charged the FCC with the job of developing a national broadband plan. The Commission is seeking input from consumers, industry, large and small businesses, non-profits, the disabilities community, governments at the federal, state, local, and tribal levels plus other interested parties. The plan must be delivered to Congress by February 17, 2010.

The FCC seeks comments on:

  • The most effective and efficient ways to ensure broadband access for all Americans
  • Strategies for achieving affordability and maximum utilization of broadband infrastructure and services
  • Evaluation of the status of broadband deployment including the progress of related grant programs
  • How to use broadband to advance consumer welfare, civic participation, public safety and homeland security, community development, healthcare delivery, energy independence and efficiency, education, worker training, private sector investment, entrepreneurial activity, job creation, and economic growth and other national purpose

For more information, email Mark Wigfield at

Monday, April 13, 2009

$60 Million for HIT Available

New York State will fund $60 million in grants for HIT projects to use in patient-centered medical homes. Patient-centered medical homes consist of services provided by physician practices, clinics, hospitals, pharmacies, long term care providers, physical therapists, and other providers with the personal physician coordinating the care using the right tools.

Funding for the grants is provided through the HEAL NY program. While this funding of $60 million is not part of the recently enacted Recovery Act, this funding will help New York providers to better compete for the recovery funding of $19 billion for health information technology when it starts to become available next year.

This new round of grants will build on the progress of the $105.75 million in grants awarded in March 2008 and the $52.9 million awarded in May 2006 to help health IT initiatives in the state. Applicants are expected to propose demonstration projects that will target patients with chronic diseases and will provide their care within a patient-centered medical home. Successful applicants will work with the regional health information organizations already recognized by the State Department of Health.

The grant applications are due on June 15, 2009. A conference to answer questions on the Request for Applications will be held at 10:00 on April 16th with questions due by May 11th. For more information on the RFA, go to

Telemedicine Defies Slowdown

The American Telemedicine Association (ATA) is witnessing its strongest growth in history for their upcoming annual meeting in April despite the nationwide trend toward decreased attendance at meetings. With a record 20 percent increase in attendance and sold-out trade show with 200 exhibiting companies, ATA is experiencing the largest surge in interest since its creation in 1993.

The ATA meeting is viewed by many of the first time attendees and exhibitors as an opportunity to take advantage of the sudden increase in attention to remote healthcare services, considered a hot topic in Washington and elsewhere as part of healthcare reform.

Congressional leaders and the Obama administration have stated their interest in accelerating the adoption of telemedicine services. For example, the nation’s economic stimulus package targets millions of dollars to fund accelerated use of telemedicine networks.

There is still time to register for the ATA annual meeting. All you need to do is go to The meeting will be held on April 26-28 at the Rio Hotel and Convention Center in Las Vegas, Nevada.

RWJF Issues Call for Proposals

The Robert Wood Johnson Foundation (RWJF) has issued a call for proposals through the national program “Project HealthDesign: Rethinking the Power and Potential of Personal Health Records.” The goal is for grant recipients to observe patients in their daily living so that patients and physicians can better manage chronic illnesses. The project will work with clinical partners and patients dealing with two or more chronic conditions.

Up to $2.4 million is available in this second round of funding to go to as many as five grantee teams for 24 month demonstration projects. Grants may total up to $480,000 each. Funded teams will work closely with patients and providers across different care settings.

Led by a national program office based at the University of Wisconsin-Madison, the teams will demonstrate how health data obtained from everyday life such as eating meals, sleeping exercising, having pain episodes, and observing moods need to be interpreted, and integrated into the clinical care process.

Launched in 2006, the Project HealthDesign supported a number of novel applications to work in tandem with personal health records so that patients could better manage their health. Nine multidisciplinary teams, supported through the first round of funding, created a broad range of innovative IT tools to help with specific but complex self management tasks. Patients want to communicate better with healthcare providers by using technologies that are or could seamlessly become part of their daily routines.

According to Stephen Downs, S.M., Assistant Vice President of RWJF’s Health Group, “This information can help clinicians understand their patients better, understand how a treatment is working and then adjust the treatment accordingly. Technology has advanced enough that we can contemplate real breakthroughs in how to work with patients that suffer from chronic diseases.”

“When it comes to patients being active managers of their own health and healthcare, we learned that it is not just important to record observations from the clinical experience, but also to make personal observations of health as we go about our daily lives,” said Director Patricia Flatly Brennan R.N., PH.D., Professor of Nursing and Industrial and Systems Engineering at the University of Wisconsin-Madison. She continued to say “Information about how you feel and what you experience on an ongoing basis needs to be easily integrated into clinical processes because these observations reveal trends that enable care to be vastly improved and tailored to the patients’ realities.”

Applicants for this round of funding may be either public entities, or nonprofit organizations that are tax-exempt and are not private foundations. For more information on the call for proposals, go to

On April 29th and May 7th, optional web conference calls for potential applicants will be held. Deadline for receipt of brief proposals is June 3rd and on July 20th, select applicants will be notified if they are invited to submit a full proposal. The deadline for the full proposal is September 1st.

Premier Demo Helps Health System

Participation in the CMS Premier Hospital Quality Incentive Demonstration (HQID) project has been a catalyst for quality improvement at the North Shore-LIJ Health System in Great Neck, New York. This was reported by Lawrence G. Smith M.D., Chief Medical Officer and Dean of the Hofstra University School of Medicine when he testified on behalf of Premier Healthcare Alliance before the House Ways and Means Committee on April 1.

North Shore-LIJ has been part of the Premier demonstration project where CMS encouraged improvements in hospital quality by testing quality incentives across a broad array of acute care conditions in Medicare patients. The project started in 2003 and was extended through 2009.

The hospitals in the North Shore-LIJ system were charged with developing standardized care for high volume, high-risk, and problem prone conditions emphasizing process and outcome measures. Established benchmarks were created and communicated horizontally and vertically from the bedside caregivers across the organization to the Board of Trustees.

The health system created interdisciplinary task forces to share best practices and lessons learned. In addition, disease-specific toolboxes were created containing various forms, documents, and teaching materials, which were then disseminated to each site. North Shore-LIJ used its corporate university called the “Center for Learning and Innovation” to provide education, knowledge transfer, and team building for employees.

LIJ achieved improvement in patients with heart attacks, heart failure, pneumonia, coronary artery bypass grafts, and with hip and knee replacements. Preliminary findings for year four of the project indicated that eight out of nine North Shore-LIJ hospitals have reached the attainment threshold in all clinical conditions. During the first three years of the project, the hospitals received incentive payments totaling $1,134,120 for the quality achievement for five of the nine providers.

The health system obtained success by having performance measures reported to senior leadership, local leadership, and to all levels of staff. Data is also posted on the health system’s intranet. To search for opportunities for improvement, the health system continuously monitors performance by comparing data among their own facilities and benchmarking it against other healthcare organizations.

Dr. Smith emphasized how important it is for quality reporting to be automated and to be based on medical records data. The current process for reporting quality indicators is a dual process that relies heavily on manually abstracting clinical data, reviewing medical record review information, and then reconciling administrative data. This is both time consuming and costly to the organization. Also, because data is coming from medical records and billing information, this process can lead to errors and inaccuracies. The funding through the Recovery Act will help as more advanced health information technology systems will be implemented within the facilities.

Dr. Smith concluded by saying, “Quality incentives can and do improve patient outcomes across a wide variety of measures and payers. As we learned through HQID, if tested and piloted first to ensure that appropriate incentives are in place with provider interests aligned, we can achieve remarkable advances to improve safety, quality, and affordability of care.”

Wednesday, April 8, 2009

Penn Medicine Reducing CLABSIs

Central Line-associated bloodstream infections (CLABSI) fell by more than 90 percent in the past three years at the Hospital of the University of Pennsylvania. This is due to a multi-pronged approach combining leadership initiatives, electronic infection surveillance, and checklists to guide line insertion and maintenance.

“Central Line-associated bloodstream infections can add up to $40,000 to the cost of a hospitalization and take their toll in human lives. The mortality rate of CLABSI has been reported to be as high as 30 percent, said Neil Fishman, M.D Director of Healthcare Epidemiology and Infection Prevention and Control at the hospital and President Elect of the Society for Healthcare Epidemiology of America.

Previous studies on CLABSI reduction efforts have focused only on intensive care units, but since the majority of cases occur on other hospital floors that care for acutely ill, high-risk patients who require long-term venous access for the delivery of IV medications or nutrition, the Penn researchers wanted to identify ways to eliminate all preventable infections of this kind.

When the campaign began in 2005, more than 30 patients developed CLABSI each month at the hospital. Over time, a series of process, technology, and equipment improvements have cut the number of infections to less than five each month and now only one case was reported in February 2009.

The UPHS has advanced strict adherence to hand hygiene, sterile techniques used during line insertion, and checklists are used. An electronic surveillance program TheraDoc® at a cost of more than one million has been put in place and helps to quash infections. The system enables hospital unit leadership teams to monitor hospital-acquired infection data in real-time, identify problems and trends, and then intervene.

Dr Fishman notes that the hospital system has used this model to attack other hospital-acquired infections such as ventilator-associated pneumonias and catheter-associated urinary tract infections.

In addition, several hospital units have implemented the Toyota Production System which uses processes honed in the auto manufacturing industry to apply to hospitals to reduce variations in practice and to improve hospital care.

Simulation Center Expands

The Wide Area Virtual Environment (WAVE) an 8,000 square foot full-scale immersive virtual reality area enables teams of students to use state-of-the-art technologies to conduct clinical and surgical skills training. Students can take part in mass casualty drills, biochemical attacks, and other medical training scenarios by using simulators.

Current simulation systems do not adequately address team training requirements within lifelike environments. WAVE helps to develop an immersive virtual environment by using three vertical screens displaying the environment. This enables an observer standing in the enclosed space to perceive the illusion of being immersed in a 3D environment. Stereoscopic images are displayed using projectors with polarized filters with users wearing lightweight polarized glasses to view the scene in stereo.

This approach differs from systems using computer monitors and head mounted displays in that all members of the team are in physical proximity, but are still able to interact within a virtual space. A scalable, network-based rendering approach permits highly complex scenes to be rendered in real-time with minimal temporal mismatch between displays.

Costing $4 million to build, WAVE is part of the National Capital Area Medical Simulation Center. The Medical Simulation Center is a 20,000 square foot center and operates as part of the Uniformed Services University of the Health Sciences. The Center hosts 8,000 simulations each academic year and is open to all medical and nursing students, interns, and residents in the National Capital Area. The Center also provides continuing medical education and training to personnel from other federal and DOD agencies.

Case for Improving Communications

A story on AHRQ’s Morbidity & Mortality website makes a strong case for better communication between non-acute care facilities and emergency departments. The case commentary was provided by Christopher Fee, M.D. Assistant Clinical Professor of Emergency Medicine at UCSF Medical Center.

The case highlights the communication failures that can and have occurred between nursing homes and the emergency departments as well as between emergency medical services personnel and emergency departments.

How do failures occur while transporting a patient? In one situation, paramedics delivered a patient to the emergency department and left without speaking with the doctor plus the paramedics did not leave any paperwork or documentation.

The physician managed to find some papers with the patient that identified him as a 68 year old nursing home resident with shortness of breath and some scant notes about his medications but there wasn’t any further information on the patient’s past medical history. Because of the inadequate handoff from the paramedics, the ED physician had no choice but to proceed with the evaluation and treatment of the patient despite only having minimal information.

Although the majority of patients seen in EDs present directly or are brought by ambulance, many are referred from outside facilities such as other EDs, nursing homes, or local clinics. These patients are frequently quite ill and may have received significant medical evaluation or treatment prior to transfer.

Unfortunately, the Emergency Medical Treatment and Active Labor Act (EMTALA) only applies to the transfer of patients to the ED from another ED, hospital, or medical center and does not apply to patients from non-acute facilities.

In a perfect world, the 2008 Joint Commission guidelines would be communicated when bringing the patient into the ED. However, there may be confusion in the emergency department when the patient arrives, the ED physician does not always have the opportunity to ask questions, and in some cases the physician may be overwhelmed with multitasking.

The most important step to take is to use checklists so that the receiving facility and provider can obtain crucial patient information before or on arrival in the ED. These checklists can be on paper but much better if they are part of an electronic record.

Another weak link is the transfer of care between EMS and ED. Many healthcare systems require EMS providers to radio ahead to the ED prior to arriving. However, the information is brief and out of necessity usually the only information given is the patient’s age and gender and very often the radio reception can be faulty when talking to the ED.

In a recent survey of emergency and internal medicine providers from a large academic medical center, 29 percent of the respondents reported that one of their patients had experienced an adverse event or near miss after ED to inpatient transfer.

The case describes a number of pitfalls in communicating information whether from a nursing facility to an ED, EMS to ED, or ED to an admitting team but when lives are at stake, the system has to meet the needs of the patient and provide for safe transfers.

To read the entire case, go to

Communicating to NHIN

Software has been made available to help public and private health information technology systems communicate to the Nationwide Health Information Network (NHIN). The Federal Health Architecture led by the Office of the National Coordinator for HIT is going to makes this free software CONNECT available at

NHIN will eventually tie together health information exchanges, integrated delivery networks, pharmacies, government health facilities and payers, labs, providers, private payers, and other stakeholders into a “network of networks.”

The CONNECT software resulted from a decision made by more than 20 federal agencies to connect their health IT systems to the NHIN. The agencies through the Federal health Architecture created CONNECT so that this shared software solution can be used by each agency.

The Department of Defense, the Department of Veterans Affairs, the Social Security Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the National Cancer Institute have tested and demonstrated CONNECT’s ability to share data among one another and with private sector organizations. In February 2009, the CONNECT software gateway was used for the first time in a limited environment when SSA began receiving live patient data from MedVirginia through the NHIN.

Now both private and public sector organizations can download CONNECT and use it for their connectivity needs. As with other open source solutions, organizations are encouraged to modify and expand the capabilities of the software. Although the download is free, an organization opting to use the solution should be aware that their organization will be responsible for the costs associated with the implementation and maintenance in their own environment.

Sunday, April 5, 2009

DARPA Advancing Programs

Speaking at the recent 9th Battlefield Healthcare Meeting held in Virginia, Colonel, Geoffrey Ling, M.D., PhD, and Program Manager in the Defense Sciences Office for DARPA, said, “DARPA has in excess of three billion dollars to spend on innovative and aggressive projects. The Defense Advanced Research Projects Agency (DARPA) is the central R&D office for the Defense Department.

Colonel Ling reports that DARPA’s Revolutionizing Prosthetics Program in this decade is going to create a fully functional (motor and sensory) upper limb that will respond to direct neural control. This program builds on DARPA’s Defense Science Office effort called the “Human Assisted Neural Devices Program which has decoded the brain’s motor signals will make it possible for the motor movements of a robotic arm to be achieved entirely by direct brain control. Currently, the initial prototypes from their two year and four year efforts are undergoing testing in human clinical trials.

According to Colonel Ling, DARPA’s Trauma Pod Program places surgical teams where and when they are most needed. Basically, the program takes medicine to the patient by not using humans and integrates tele-robotic and robotic medical systems. The initial phase has successfully automated functions typically performed by the scrub nurse and circulating nurse. These functions are now performed by semi-autonomous robots working in coordination with the tele-robotic surgeon.

So far, surgeons have performed complex surgical procedures on a simulation mannequin by operating a robot using the Trauma Pod operations console. Two procedures were performed without the aid of a scrub nurse, and the system correctly changed tools and dispensed supplies with 100 per accuracy.

Phase 2 of the program will develop and create the automatic operating room. Methods for autonomous airway control and intravenous access will be developed so that initial therapy can be administered in addition to diagnosing injuries and placing patients on IVs. Phase 2 has a 24 month time line and includes testing the overall system. In the final effort, the systems will be miniaturized and incorporated into the battlefield or mass casualty environment.

Another thrust area at DARPA includes the “Preventing Violent Explosive Neurologic Trauma (PREVENT) Program” that was put in place to protect warfighters from traumatic brain injury resulting from non-kinetic explosive effects. Specifically, the goal is to address the explosive blast injury at the molecular as well as the macroscopic scales and look at the effects on the central nervous system. The next phase will focus on the prevention of the injury and guide the development of personal protective armor.

For more information on DARPA, go to and for the conference, go to

State Accepting Applications

Illinois Department of Healthcare and Family Services (HFS) Director Barry S. Maram said on April 1, 2009, that grant applications for organizations interested in obtaining financial assistance to implement a state Health Information Exchange (HIE) are now available. On February 4, Governor Quinn signed a law appropriating $3 billion to HFS to establish a planning program for health information exchange.

The measure was sponsored by State Representative Julie Hamos who has been a major proponent of health IT in Illinois. Director Maram said “A state-level HIE will lead to improved quality and efficiency in patient care, and I encourage all eligible nonprofit organizations to log onto the HFS web site at www.hfs.illinois.go/hie.”

The state’s efforts are intended to jump-start HIE in Illinois in anticipation of future funding from the Federal government. The grants will put Illinois in a strong position to leverage these funds in the months ahead.

As part of the planning process, the state was divided into 16 regional Medical Trading Areas, to address local planning and HIE implementation needs. Only one HIE Planning Grant will be awarded to each Medical Trading Area. Organizations interested in applying must work in conjunction with other local healthcare organizations to complete a proposal that will address local HIE planning needs.

Eligible applicants must be nonprofit organizations based in Illinois. Proposals are due on May 15, 2009. For addition information including the listing of Medical Trading Areas, go to the HFS web site.

Plans for IHS Stimulus Funds

A total of $500 million was provided to the Indian Health Service in ARRA to include $85 million for health information technology. The health information technology funds will go for telehealth services and infrastructure requirements. Approximately 20% of the funds will be used for hardware acquisition to use to modernize infrastructure relating to security, networking communications, and health information technology.

The Resource and Patient Management System will be modernized with enhancements for population health applications. These purchases will be completed through new contracts among vendors. Approximately 95% of the health IT activities will be carried out through commercial contracts but may also be carried out under P.L. 93-638 contracts with a Tribe or Tribal organization. Plans are to obligate 75% of the ARRA funds in FY 2009, and 25% in FY 1010.

In addition, a number of new acquisitions are anticipated for software development and related services. These new acquisitions will also be awarded via appropriate contract vehicles, as well as through existing Tribal contracts. The IHS has several existing GSA competitively awarded contract vehicles that will be used to accommodate ARRA funding.

IHS plans to distribute $20 million for equipment. The majority of funds for equipment will be used to acquire medical equipment. In addition, IHS will support ambulances for 84 tribal and IHS emergency medical services programs. GSA and IHS support 175 ambulances nationwide, and the ARRA funds will be used to replace ambulances exceeding the span of 10 years or 100,000 miles.

Another $68 million will be provided for sanitation facilities construction, $227 million for healthcare facilities construction, and $100 million for maintaining and improving safety, and efficiency in existing facilities.

State Bills Introduced

The Massachusetts Medical Society presented testimony to the Massachusetts Joint Committee on Health Care Financing to support state legislation to prevent the sale or transfer of data regarding prescribing practices for commercial purposes. The Society supports Massachusetts House Bills 110,109 that would ban the practice of data mining and supports Senate bills 17 and 19 to protect the confidentiality of patient prescription records. The medical society believes that prescribing data should not be shared with any individual group or corporation whose motive is not solely to improve healthcare delivery.

In general, the proposed bills would protect the privacy of prescriptions for patients since patients could possibly be identified by databases being cross referenced. Also, the Society notes that it is also important to protect physicians from aggressive sales and marketing tactics and thinks that exceptions to complete confidentiality should be limited to the legitimate review of quality care issues and when processing claims for insurance purposes.

Currently, pharmaceutical companies purchase the prescribing records of physicians and other healthcare professionals without the consent of the prescriber or the patient. According to the medical society, this data is then used to target marketing aimed at specific prescribers in order to promote their increased use of particular brand name pharmaceuticals.

Legislation aimed at banning this practice has already been enacted in Maine, New Hampshire, and Vermont with similar legislation under consideration in many other states. The New Hampshire legislation which had been the subject of extensive litigation was recently upheld by the U.S. Court of Appeals (1st Circuit) in the case of IMS Health Inc. v. Ayotte), citing the state’s legitimate interest in containing the cost of prescription drugs.

Legislation Moves to the Senate

The Wakefield Act (H.R. 479) passed by the House and now in the Senate would provide continued improvement in emergency medical services for children. There are 31,000,000 child and adolescent visits to emergency departments every year. Today, significant gaps remain in the emergency medical care delivered to children since only 6 percent of hospitals have the correct pediatric supplies deemed essential by pediatric associations for properly managing pediatric emergencies.

The Emergency Medical Services for Children (EMSC) Program under the Public Health Service Act is the only Federal program that focuses specifically on improving the pediatric components of emergency medical care. The EMSC program promotes the nationwide exchange of pediatric emergency medical care knowledge and collaboration by ensuring that the exchange of knowledge and collaboration takes place.

The Wakefield Act amends the Public Health Service Act to direct the Secretary of HHS to provide grants to states and medical schools to help reduce child morbidity and mortality by improving services.

The legislation would extend the length of time by one year where a grant may be awarded under the EMSC grant program. The grants go to states or schools of medicine that support projects to expand and improve emergency medical services for children who need treatment for trauma or critical care.

According to the Congressional Budget Office (CBO), the legislation would authorize $25 million for 2010 and $138 million over the 2010 to 2014 period. CBO estimates that implementing H.R. 479 would cost $4 million in 2010 and $96 million over the 2010 to 2014 period.

Wednesday, April 1, 2009

Brain Computer Interface Licensed

The New York Department of Health’s Wadsworth Center Laboratories and Washington University in St. Louis jointly invented Brain-Computer Interface (BCI) technology. Washington University in St. Louis has licensed the technology to Neurolutions Inc. BCI technology employs sophisticated computer algorithms to translate brain waves into physical outputs—such as moving a cursor on a computer screen.

Neurolutions is developing and commercializing medical devices to directly harness the brain’s electrical signals for communication and control systems. This technology is very useful for people with severe motor disabilities so that they can learn to operate computers, wheelchairs, and prosthetic limbs.

Neurolutions’s system uses wireless technology placed on the surface of the brain to transmit electrocorticographic (ECoG) signals from the brain areas that control movement. ECoG provides cleaner signals and enables finer control, such as potentially allowing movement of five individual fingers on a prosthetic hand. The device under development also carries less risk than surgically implanting electrodes in the brain and requires less training to use.

Wadsworth Center’s principal collaborator on the project Gerwin Schalk, Ph.D. said “Collaborating with clinicians and others at Washington University has helped move BCI technology another step forward. Within the next decade, I anticipate an array of brain-controlled devices such as hand or even finger prostheses to be made possible.”

Ascension Health Ventures of St. Louis, a strategic healthcare venture fund focused on medical device technology, participated in Neurolutions financing along with BioGenerator also a St. Louis-based venture fund. Neurolutions commercial advancements and royalty revenue will be shared with the Wadsworth Center and Washington University to support continued scientific research.

"WoundMatrix" Used in Hospitals

The public health impact of chronic wounds is staggering. An estimated 1.3 to 3 million people in the U.S. are believed to have pressure ulcers and as many as 10 to 15 percent of the 20 million individuals with diabetes are at risk of developing diabetic ulcers. Many more people have had venous ulcers or wounds resulting from arterial disease. Treating these wounds costs an estimated $5 to $10 billion each year with additional costs to patients in terms of lost productivity.

CMS over the past several years established new ulcer guidelines that will raise the bar for wound care documentation. To address the problem, ACEOS Inc. located in Pennsylvania, has come up with “WoundMatrix” a documentation system that uses a new approach to measure and track wound healing. Wound images, objective measurements, and tracking information are available to any authorized level of a medical or provider organization. This can be done instantaneously allowing clinicians to make accurate evidence-based decisions.

The system uses auto-e-mail notification every time a new wound measurement is performed. Then the username and password is entered to view only the WoundMatrix reporting area that provides access to patients’ wound pictures, digital measurements, notes, and patient data. A digital photography is part of each patient’s report and provides supplementary documentation under the CMS guidelines.

Patients and caregivers no longer need to make subjective judgments that compare the current status of a wound with information from a previous appointment using such descriptors as looks better, worse, drier, wetter, or pinker. Reducing subjectivity involved in measuring and tracking wounds makes it easier to make cost effective decisions and to know what therapies are actually working.

Today, Johns Hopkins University Wound Care Center uses the WoundMatrix web solution for all patient wound encounters. The system automates the process of documenting the healing progression of various wound care therapies and regimens.

According to Gerald S. Lazarus, M.D., Director of the Johns Hopkins Wound Center and Chief of Dermatology at Johns Hopkins Bayview Medical Center, the system uses a quantifiable and replicable wound documentation system to provide accurate objective measurements for the Center. In addition, data collection capabilities record notes over time which allows us to evaluate the effectiveness of our therapeutic and medical interventions.

The system is also being used successfully by the Veterans Administration Medical Center in San Juan, Puerto Rico. Clinicians using the system are now able to link specific wound images and measurements to the VA’s electronic medical record called VistA.

Sean Geary, President of ACEOS, said “his company and the VA Caribbean Health Care System share a vision for improving health information systems by using an integrated approach."

Medical Device Report Available

The Networking and Information Technology Research and Development (NITRD) Program, recently published the report “High-Confidence Medical Devices: Cyber-Physical Systems for 21st Century Health Care”. NITRD is a formal interagency group within the Office of Science Technology Policy.

Prior to the digital age, medical devices were generally built using analog components in relatively simple design with relatively simple user interfaces and limited functionality. The primary method for controlling risk to patients was competent human interventions.

Over the last 20 years, designs for medical devices have evolved from analog to digital systems. Some of the more complex devices can have a million lines or more of code. Device life spans are shrinking due to more rapid innovations in enabling technologies and the demand for more robust systems.

Most devices contain embedded systems that rely on a combination of proprietary commercial-off-the-shelf and custom software or software of unknown pedigree components. These systems are highly proprietary and increasingly depend on software and designs and continue to rely on competent human intervention as the ultimate risk control measure. Embedded systems are becoming critical in medicine because they increasingly control the functions and communicate with the patients themselves.

To address the 21st century needs, NITRD’s High Confidence Software and Systems (HCSS) group held workshops with more than 100 experts to provide a forum for industry, research laboratories, academia, and the Federal government to come together to identify crucial challenges facing the design, manufacture, and the use of high confidence medical devices, software and systems. They identified promising research directions that could revolutionize the way that medical technologies are designed and built so that high confidence could be designed into the devices, software, and systems right from the start.

Key findings indicated:

  • Today’s medical device architectures are typically proprietary, not interoperable, and rely on professionals to provide inputs and assess outputs
  • When patients are connected to multiple devices at one time, clinicians now must monitor all devices independently, synthesize data, and act on their observations, which can be affected by stress, fatigue, or other human factors
  • Ad hoc efforts to aggregate data across devices designed to operate separately can lead to unintended or accidental results
  • Growing interest in home healthcare services, telemedicine, and online clinical lab analysis underscores the central role of advanced networking and distributed communication of medical information in the health systems of the future
  • Devices that will be used in the future will likely include nano/bio devices, bionics, or even pure programmable biological systems

According to the report, there is a need for rationally designed high-confidence medical device cyber-physical architectures, with a strategic focus on R&D in compositional modeling and design. An open research community of academics and medical device manufacturers is needed to create strategies for development of end-to-end, and engineering-based design and development tools. Certifying component devices is necessary but not sufficient.

The HCSS group recommends that R&D focus on high confidence networking and IT for the design, implementation, and certification of open medical technologies. In addition, barriers must fall among the relevant disciplines in order to understand holistic cyber-physical systems. Cooperation is needed between government, industry, and academia to develop standards and networking and information technology frameworks such as testbeds.

For more information or to download a copy of the report, go to , email, or call 703-202-9097.