Sunday, May 31, 2009

ATA Provides Input to Senate

The American Telemedicine Association (ATA) provided specific comments and recommendations on May 15th to Chairman Max Baucus, Ranking Member Chuck Grassley, and other members of the Senate Finance Committee concerning the Committee’s Policy Options paper of April 29th. The paper is titled “Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce health Care Costs.”

ATA is very interested in addressing Medicare coverage for telemedicine. According to the data, Medicare payments for interactive telehealth services were only $6 million in 2007. One of Medicare’s worst restrictions is that it essentially excludes beneficiaries in metropolitan areas and as a result, 83 percent of the U.S. population is left out.

Surprisingly, this affects even some of the most rural states in the country. For example, 47 percent of North Dakota’s population resides in a metropolitan area and the figure for Montana residents is 35 percent. New Jersey and Rhode Island beneficiaries essentially do not have telehealth coverage because all of their counties are within a metropolitan area. Also Medicare’s restrictions block telehealth services in HHS identified health professional shortage areas, medically underserved areas, or medically underserved populations within metropolitan areas.

ATA estimates that extending covered telehealth services for all Medicare beneficiaries would result in less than $40 million in total expenditures per year, even without factoring in any resulting cost savings for remote services.

According to ATA, home telehealth and patient monitoring services have proven to yield substantial cost savings and improve care in homebound and chronic disease patient groups. Telehealth has been singled out as a valued service by patients but Medicare pays for almost no remote health monitoring.

Telemedicine is set to have a widespread and significant impact on the delivery of healthcare. Physicians and other providers have been learning and adapting. For example, the application of advanced life-saving therapies for people suffering a stroke requires access to specialized stroke and brain imaging expertise. The American Heart Association and the American Stroke Association recommends the use of telemedicine to overcome significant disparities in access to care in the U.S.

Telemedicine encompasses a wide variety of applications from remote reads of medical images, to live video consultations, to distant monitoring of vital signs. Key technologies such as wireless, video resolution, sensors, and mobile devices have been rapidly advancing and allowing telemedicine to be better, faster, and cheaper.

ATA strongly urges the Senate Committee to include Medicare reimbursement for telehealth services throughout the country. It makes no sense to invest billions of taxpayer dollars to purchase health information technology, deploy broadband telecommunications, but not allow providers to use the technology and for patients not to receive the benefits.

Some of ATA’s recommendations and clarifications sent to the Senate Committee want telemedicine and telehealth technologies included in coverage to Medicare beneficiaries regardless of their location, Medicare facilities to be originating sites for interactive video, store-and-forward applications use needs to be expanded, advanced software systems need to be used in hospital intensive care units, and remote monitoring should be used when treating chronic conditions in the home.

For more information, contact Gary Capistrant at

New Legislation Introduced

Representative Harry Teague from New Mexico introduced legislation on May 19th to direct the VA to establish three pilot projects that would use telehealth platforms to help treat veterans living in rural areas who suffer from PTSD or TBI. The goals for the “Reaching Rural Veterans through Telehealth Act (HR 2505)” would provide education to help primary care providers diagnose and better manage their clients on a 24/7 basis. The bill has been referred to the House Committee on Veterans Affairs.

Participants could include medical clinicians, trainers, educators, researchers, community members and others. Grants provided in the bill would be awarded based on geographical diversity, ability to reach the most veterans that are not currently receiving treatment, and would create programs for rural Veterans Integrated Service Networks. Funds may be used for training, research, to purchase equipment, and for partnering and contracting with local community groups already providing services in a rural area.

On May 20th, Representative Peter Welch from Vermont introduced the “Blueprint for Health Act of 2009 (HR 2535)” to establish a blueprint to help create a comprehensive system of care. The plan would integrate coordinated chronic care management to include medical practices acting as medical homes with community care teams to provide the care and coordination needed.

Chronic care management programs would identify and enroll chronically ill patients and also encourage primary care physicians, specialists, hospitals, and others to participate in the program. In addition, the legislation calls for methods to increase communication among healthcare professionals and patients.

Financial incentives included in the legislation would include increased payments to medical practices based on a per member per month fee, payment for care support services to include community care teams, and the support of community-based savings sharing and reinvestment models referred to as an accountable care organizations. The plan could include grant opportunities and Federal tax credits for localities to use to conduct community assessments, interventions, and to develop activation plans.

Maryland Issues RFA

The Maryland Health Care Commission (MHCC) and the Health Services Cost Review Commission (HSCRC) issued a Request for Application due on June 12, 2009 to build a statewide health information exchange. The HSCRC will provide the initial funding of up to $10 million through hospital reimbursement rate adjustments.

Applications need to provide sound solutions on issues such as governance, privacy and security, and the strategies to use to help consumers have appropriate control over their health information. The system must also serve public health, provide for post marketing drug surveillance, and for health services research.

The requirements for a statewide HIE will take into account the ideas submitted by several multi-stakeholders groups. These groups included the Chesapeake Regional Information System for our Patients (CRISP) and the Montgomery County Health Information Exchange Collaborative (MCHIE). These teams focused on not only governance, privacy and security and standards but also on the architecture of the exchange, on hardware and software solutions, and cost for implementation. Go to for the final report.

The financial model must provide a feasible strategy on how to provide long term funding and sustainability. Responders must detail the revenue sources for both the start-up and ongoing operations of the HIE. In discussing fees, the responder must define who the fee is for, the amount, how the fee is calculated, service offerings, and funding available from other sources. The responder must also outline a strategy to secure additional funding, the amount of proposed funding, and the anticipated time frame for the funding.

For more information, on the RFA “A Consumer-Centric Health Information Exchange for Maryland”, email Kathy Francis, Chief of the Center for Health Information Technology, at or call (410) 764-5590.

Draft Published on Centers

HHS published their draft description of the proposed regional extension centers program in the “Federal Register “on May 28th. The notice seeks feedback and comments on setting up the centers so that clinicians and hospitals will have an easier time in adopting health IT as required by the HITECH Act.

The notice is not a solicitation for proposals but only seeks comments on the draft description. However, after the comments are reviewed, a solicitation will be published to provide further details on the requirements and the application process that applicants need to go through to receive an award.

HHS anticipates that the average award will be approximately $1 million to $2 million per center with the maximum award for any one regional center to be $10 million. HHS proposes to make initial awards for the regional centers as early as the first quarter of FY 2010 and to continue making awards through the fourth quarter of FY 2010.

HHS anticipates not requiring matching funds for awards made in FY 2010 due to the current economic situation, however, using matching funds will be encouraged but not required.

All comments on the draft plan are due on June 11, 2009. For information, send an email to, or call (202) -690-7151.

Tuesday, May 26, 2009

EMRs & PHRs Discussed

Leading experts came to the May 21st Steering Committee on Telehealth and Healthcare Informatics lunch briefing held on Capitol Hill to discuss how EMRs, PHRs, and hybrid systems are going to operate and change in the coming years.

Congressman Patrick Kennedy (D-RI) lending his support to the Steering Committee’s work, was introduced by Neal Neuberger, Executive Director of the Institute for e-Health Policy. Congressman Kennedy told the attendees that we are so fortunate that $19 billion is out there to support health IT, but he emphasized that legislation needs to be crafted to fit and work with those dollars so that the money will be spent wisely.

Jeff Margolis Chairman and CEO, TriZetto, defined Integrated Healthcare Management as the system application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The reality is that our healthcare system is in crisis which is going to require that any technology used in healthcare will need to be integrated. Every time that you combine good information with technology, the healthcare system can only win.

He explained that the core elements for an integrated healthcare management system depend on value-based benefits, value-based reimbursement designs, systematic health management, and the active engagement of all constituents in a culture of health. All of these elements need to be based upon a growing body of evidence-based medicine.

Additionally, breaking down information silos by taking the best of benefits information and adding this information to the best of care information helps the consumer at the right time and provides effective information management.

Alfred Spector, PhD., Vice President, Research and Special Initiatives, Google Health, stressed that it is important for PHRs to put order to disorganized information so that the information can be shared. Google’s PHR system is able to store large amounts of data, manage the data, and then make the information accessible.

Google’s vision is to provide a non-tethered PHR where the user controls and owns the data, and where Google is able to add on services and tools personalized to suit the users’ needs. The business model enables the product to be offered free, no advertising is permitted on the site, and the data is not sold. The only time the data is shared is if the user gives permission.

As Dr. Spector told the group, there are still challenges to using the technology since there are still interoperability issues, problems at times getting accurate and complete data, incorporating the PHR data into the physicians’ electronic medical record, and finding ways to increase the consumer’s use of the site.

Deven McGraw, Esq., Director of the Health Privacy Project, Center for Democracy and Technology, pointed out that it is not yet clear how regulators and courts will interpret ARRA’s health privacy provisions. ARRA charges the FTC to work with HHS to report to Congress on privacy and security recommendation for PHR vendors. PHRs are covered by HIPAA if offered by a covered entity or business associates but is not covered by HIPAA if offered by an independent vendor.

McGraw explained that HIPAA permits broad information sharing for treatment payment and healthcare operations. This is the right approach for the health system but the wrong approach for a tool intended to be used by consumers. Today and in the future, health privacy needs to build on HIPAA, establish new protections to address concerns, and develop specific rules to make electronic medical records and PHRs sustainable over the long term.

John Hummel, CTO, Perot Healthcare Services, said the company provides innovative technology to improve the safety and quality of care. Services are provided to over 1000 hospitals, to over 65 million health plan members, and to more than 70 health insurers.

In his own experience he has seen his wife receive duplicate tests and duplicate drugs simply because the hospital couldn’t communicate the information to the right place at the right time. Obviously, our healthcare system has to be able to provide data that is accurate, timely, secure and private.

Hummel joined Perot Systems coming from the California Prison Healthcare Receivership. The receivership was a federal court takeover of California’s failing prison healthcare system which was declared unconstitutional due to the deaths of inmates. In California, there is a death every five days since prisoners receive below third-world country care levels of medical quality and safety. Hummel worked to ensure that the most clinically, technically, and cost-effective tools were designed and deployed to help repair the problem.

HIMSS launched the Washington-based Institute for e-Health Policy last year and manages the Capitol Hill HIT briefing series. For more information, go to

$215 Million to Help Rural Vets

The Department of Veterans Affairs has provided $215 million to improve access and quality of healthcare for veterans in rural areas. The funding will be used to support the latest technologies, to recruit and retain a well educated and trained healthcare workforce, and to collaborate with non-VA rural health community partners.

According to Secretary of Veterans Affairs Eric Shinseki, the funds will enable the VA to establish new outpatient clinics, expand collaborations with federal and community partners, accelerate the use of telemedicine deployment, explore innovative uses of technology, and fund pilot programs.

The VISNs, VA regional healthcare networks, and VHA program offices were allowed to submit up to eight proposed projects each for funding. The proposals were prioritized and then sent to the Office of Rural Health where they were evaluated based on methodology, feasibility, and the intended impact on rural veterans. ORH then selected 74 programs where many of the programs were either national in scope or affected multiple states.

To address the issues facing rural veterans, the VA created the Office of Rural Health in 2007. In the past two years, the VA formed a 16 member national committee to advise on issues affecting rural veterans, opened three Veterans Rural Health Resource Centers to study rural veteran issues, rolled out four new mobile health clinics to serve 24 predominately rural counties, and announced that 10 new rural outreach clinics are scheduled to be opened in 2009.

Telehealth Funding Opportunity

HRSA posted the notice (HRSA-09-239) on May 22nd for $500,000.00 in grant funding to be used to demonstrate how existing telehealth programs, networks, and sites can improve access to quality healthcare services. The project is specifically geared to children and youth with epilepsy and their families dealing with the issues living in medically underserved areas and rural areas.

The grant funding will support telehealth networks that provide services in different settings such as long term care facilities, community health centers or clinics, medical homes, hospitals, and schools. The goal is to demonstrate how telehealth networks can be used to expand access to care, coordinate, and improve the quality of healthcare services, improve the training of healthcare providers, and also improve the quality of health information.

The grantees will need to:

  • Increase the dialogue and collaboration between families and their healthcare providers
  • Improve community-wide interventions and models to improve access and also reduce the wait time associated when referrals are made to specialists
  • Improve the integration with community support services including partnerships with media and other community-based resources
  • Deliver the medical home model of care for children and families that is culturally and linguistically competent, family centered, comprehensive, and coordinated
  • Improve communications by developing tools such as individualized written care plans, home medication lists, individualized school support plans, and written plans to support the youth transition to adult care

HRSA is looking for projects that will integrate administrative and clinical information systems with the proposed telehealth system and then integrate the proposed system into the normal provider practice. Projects will also need to address the privacy of patients and clinicians using the system. In addition, each grant applicant is required to submit a sustainability plan that outlines how the services will be sustained after the federal funding has ended.

Any public or private entity including an Indian tribe or tribal organization, faith based, and community-based organizations are eligible to apply for the funding. The application deadline is June 29, 2009 and a letter of intent is not required. The estimate average size of the awards will be up to $250,000 with two awards estimated.

For more information, go to or contact Deanna McPherson at

Dr. Blumenthal Speaks at Brookings

HHS’s Office of the National Coordinator for Health Information Technology has come out of the shadows and is now in the spotlight, according to David Blumenthal, M.D., HHS National Coordinator. He explained that the funding for the health technology program went from $60 million to $2 billion and this means that the office is going to be implementing the agenda instead of just advising HHS.

Dr. Blumenthal discussed his thoughts at the May 20th Forum held at the Engelberg Center for Health Care Reform at Brookings Institution. He explained that since arriving at HHS, there have been efforts to define “meaningful use” since the ARRA legislation refers to the “meaningful use” of health IT. He said his idea of “meaningful use” would focus on outcomes rather than adoption.

Dr Blumenthal continued to say that the most important question to ask is how health IT relates to health reform. Health reform is essential in order for health IT to play an essential role in healthcare. The need is strong to make healthcare efficient and at the same time reduce the rate of growth for costs. HIT will play a critical role in health reform by managing the information so that the technology can assist healthcare providers to make important and life saving decisions.

According to Mark McClellan, M.D. PhD, Director for the Engelberg Center, also commenting on the subject “meaningful use”, noted that is very important for the term “meaningful use” to refer to the maximum impact on patient care. There is little reason to support health IT if the results don’t show an increase in the efficiency and quality of healthcare delivery. Also, performance measures need to be integral in order to validate “meaningful use”. It is essential to know whether or not payments for health IT use are actually facilitating improvements in health.

He also commented on the importance of how health IT payments fit into the broader reform environment. According to a recent Brookings White Paper, health IT bonus payments are only one of several new payment incentives to improve quality that will face providers in the coming years. It is also thought that Medicare will expand its-pay-for-reporting initiatives in the years ahead. Further payment reforms that may be applied on a broader scale in the coming years may include payments to medical homes, bundled payments, and accountability-based payments.

Medical homes are set up to effectively coordinate care for patients especially with chronic illnesses. These payments could be disbursed in addition for fee-for-services reimbursement. Also, the bundled payment system approach would pay providers a single fee to cover the entire duration of care for a patient’s particular health problem. Under the accountability-based payment model, physicians and hospitals participating in an Accountable Care Organizations would work toward cost savings benchmarks based on local historical cost trends and care improvement targets.

Several Forum panel discussions were moderated by Carol Diamond, Managing Director, the Markle Foundation, and John Tooker, CEO American College of Physicians. Panelists from the public and private sectors offered their ideas on the lessons learned from ongoing initiatives.

Panelist Neil Calman, President and CEO of the Institute for Family Health, discussed how the Institute’s community network covering 150 miles helps to provide the right data and how the information indicates general trends at the centers, determines if equality is being achieved in the outcomes achieved at the centers, and enables patients to communicate with their providers. The Institute is now able to link up and report to the public health system with the essential information going directly to the providers at the point-of-care.

Another panelist, John Toussaint, President and Founder, ThedaCare Center for Healthcare Value, and Chair, of the Wisconsin Health Information Organization, reported that the organization is reporting data to help provide the highest value at the lowest cost. Health IT can play an important role in retrieving the data so that providers and patients can make better decisions.

8th CCS Coming in June

Top level executives, legislators, physicians, regulators, and technologists will come together at the 8th Collaborative Communications Summit “Transforming Healthcare Through Health Information Technology” to be held June 16-17, 2009 at the Hilton Fort Lauderdale Marina in Florida. The Summit will discuss the many positive changes happening in the health information technology environment, policy changes, and changing business models.

The CCS Summit provides a high level forum to open up avenues of communication among executives and stakeholders in healthcare. There will be many opportunities to meet with colleagues to gain insight into the most pressing issues that today’s organizations face. Attendees and thought leaders will be able to engage one another and discuss what they have learned throughout the years.

A featured presentation will discuss the future and reality of health IT’s impact on the healthcare system. This session will identify the challenges and opportunities that lie ahead and provide strategic insights on how organizations and individuals can flourish in the years to come. Presenters will include Laura Kolkman, President of Mosaica Partners, and Chair of the HIMSS Health Information Exchange Steering Committee, Laura Adams, President & CEO, Rhode Island Quality Institute, Mike Dunn, M.D., Clinical Professor of Medicine and Biomedical Informatics at the University of Pittsburgh, School of Medicine, and Rick Schooler, Vice President and Chief Information Officer at Orlando Health.

Other presentations will touch on:

  • Revenue cycle management and provider care
  • Connecting the healthcare enterprise for improved outcomes and coordination of care
  • Consumer tools, health IT, and the impact on point-of-care
  • Transforming care delivery in a digital environment
  • The Federal government’s role in promoting the Nationwide Health Information Network
  • Using innovative public-private partnerships to drive health IT

Other key presenters at the many sessions include:

  • Arthur Young, CEO, Interbit Data
  • Mac McMillan, Chair, HIMSS Information Systems Security Working Group
  • Vish Sankaran, Director of the Federal Health Architecture for the Office of the National Coordinator, HHS
  • Evon Hollady, Vice President Business Intelligence, Catholic Health Initiatives
  • Holly Benson, Secretary, of the Florida Agency for Health Care Administration
  • Amy Ting, Senior Marketing Director of Health Care, Netmotion Wireless
  • William Gillespie Vice President, Chief Technology Officer, and CIO, Emeritus Wellspan Health
  • Roland Garcia, Senior Vice President and Chief Information Officer, Baptist Health

To maximize networking, Summit attendees will have a number of opportunities to meet in groups. The groups will meet starting early in the day so that attendees will have the chance to make new contacts and enhance their conference experience.

For more information and to register, go to .

Wednesday, May 20, 2009

Systems Help 1st Responders

EFR MedCom is an emergency first responder command and communications platform enabling faster and more accurate analysis and response to complex emergencies. Launched by Med Red, LLC and developed with support from the Army’s Telemedicine Advanced Technology Research Center, the software application allows emergency responders at local, state, and federal levels to communicate and collaborate more effectively in emergency situations such as catastrophic accidents, natural disasters, and terror attacks.

The technology gives first responders the ability to:

  • Communicate using hand-held computers that permit near instantaneous voice and text communications between Emergency First Responders and Command and Control Centers.
  • Communicate critical medical data through an electronic medical record embedded in an interactive hand-held computer
  • Download relevant health information from the National Health Information Network (NHIN) and Google Health, and then communicate this data to key personnel, health centers, and agencies nationwide using handhelds

EFR MedCom rapidly transmits detailed clinical information to the secure server where it is accessible to medical facilities and command centers through the web-based Command and Control Portal. This enables Command and Control to monitor illness patterns, reports of exposure, and the location of casualties. This can be useful information to identify patterns that might signal an act of terrorism or other medical emergency.

“Real-time communication and accurate information are critical to saving lives during an emergency,” said Dr. William K. Smith, Founder of MedRed. “First responders on the ground need to be able to collect health information quickly and share the data broadly with others in order to formulate the best plan of action.”

The system will be available for piloting or purchase by national, state, and local first responder organizations on June 1, 2009. The company is also looking to create a pilot project for the system in Washington and one or two other major urban areas.

Another approach that is helping first responders, involves using a new web-based software program called PolARES to address crisis-based decision-making. The program was developed by AlphaTRAC, an emergency management consulting firm based in Colorado to make it possible for responders to receive more timely input during emergencies. PolARES was funded internally at AlphaTRAC and through the Defense Advanced Research Projects Agency (DARPA).

PolARES contains a database of decisions made by first responders during various situations and the actions taken. The system is designed to help a decision maker decide on a course of action based on the experiences mined from a knowledge base built by the response community.

The database is maintained at a central location for each response community and accessible through the internet. Users can run the application located on the central server or the application can be downloaded to their computers. The database is continuously changing and downloads daily to their machine with the latest version.

The system is based on the Recognition Primed Decision Method (RpDM) that focuses on identifying changes in an event and using these changes to proactively make decisions as opposed to the conventional reactive approach that involves analyzing a situations and responding.

The program uses six steps to size up the situation. These steps include selecting questions or cues to identify a case from a community knowledge base, comparing cases, modifying the case and decisions suggested by PolARES, playing out the decision either alone or with other team members, and the last important step is put the decisions made into action.

FDA Posts Presolicitation

The goal for the FDA Sentinel project is to take queries from numerous data sources and provide information quickly and securely for relevant product safety information. The data will be managed by the owner and only the data from organizations who agree to participate in the system will be included. FDA posted the Sentinel presolicitation on May 15th with the intent to issue a Request for Quotations in June.

The scope of work and tasks are to:

  • Provide technical expertise in pharmacoepidemiology and biostatistics to identify, develop, validate, and implement advance analytical and statistical methods related to signal detection, strengthening and validation
  • Provide access and utilize data from disparate automated healthcare data systems including but not limited to electronic health record systems, administrative claims databases, and registries
  • Develop data identification and access plans along with surveillance plans and study designs
  • Test data model options and the effects on signal detection, strengthening and validation
  • Implement standardized data elements in disparate automated healthcare data systems
  • Develop and propose a secure communication strategy to support the data access needs

This announcement is not a RFQ. For more information, go to If interested in the solicitation when released, email Tara R. Hobson, Contract Specialist or call 301-827-9691. The solicitation is scheduled to be available on or about June 1, 2009.

New Mexico Creates Team

Governor Bill Richardson has signed an Executive Order to create the “Competitive Grant Advisory Team” to assist local communities in New Mexico compete for funds under the American Reinvestment and Recovery Act (ARRA).

“Most of the formula recovery funds are designated for specific existing programs with very little local discretion. The competitive grant process is the best way for many New Mexico communities, especially rural areas, to access funding for qualified projects that will create jobs and boost the economy,” said Governor Richardson.

The advisory team will meet with the local communities to let them know about the competitive grant opportunities under ARRA and then help the communities navigate the grant process. The group will also look for local partners in state applications for broadband and health information technology funding.

Also, the Executive Order establishes the New Mexico Office of Recovery and Reinvestment to be headed by former New Mexico Governor Toney Anaya to ensure that stimulus funds spur economic activity, create and retain jobs, and promote long-term economic prosperity.

MIT Develops BP Sensor

Visits to the doctor’s office can provoke anxiety that distorts blood pressure readings and only provides one time snapshots of the patient’s condition but now MIT engineers have built a wearable blood pressure sensor to provide continuous 24/7 monitoring.

The monitor loops around the wrist and the index finger and has been found to be just as accurate as traditional cuff devices but much less cumbersome, allowing the user to wear the device for hours or days at a time.

“The human body is so complex, but if you get signals all of the time, you can see the trends and capture the physical condition quite well according to Harry Asada, Ford Professor of Engineering and Director of MIT’s d’Arbeloff Laboratory for Information Systems and Technology. He is the MIT mechanical engineer who led the development of the new monitor.

The company CardioSign is working on commercializing the device and hopes to start clinical trials soon. Asada believes that a commercial version of the device could be available within five years, once it becomes easier to use, more reliable, and cheaper to manufacture.

The latest prototype developed jointly by Sharp Corporation and Dr. Andrew Reisner with Massachusetts General Hospital, has taken the lead in clinical applications and human subject tests.

Sunday, May 17, 2009

Help for Small Practices

The California HealthCare Foundation is funding a two year $1.5 million initiative called “Small Practice eDesign” to develop a prototype community infrastructure and tools. The funding will support the adoption, integration, and meaningful use of EHRs for small practices.

The project will develop, refine, and test a model to support EHR implementation in up to 20 primary care practices in Tulare County a federally designated primary care shortage area. This county has the highest prevalence of diabetes in California (9.9% of the population) and is one of the poorest counties in the nation.

Up to 20 primary care practices in the county will implement EHRs in two phases beginning with 5 to 8 sites (Wave 1) and followed by 12 to 15 sites (Wave 2) and will combine web-hosted software, centralized implementation, and technical support. The program will work through a local trusted intermediary organization, the Foundation for Medical Care of Tulare and Kings Counties with the Massachusetts eHealth Collaborative providing much of the health information technology implementation support.

Small primary care practices participating in the initial pilot will receive funding to purchase selected software and test the curriculum developed to support workflow redesign and data driven quality improvement processes. The selected software combines practice billing, and revenue management with an electronic health record along with a patient portal.

Two information technology vendors were selected for the program. One vendor Athenahealth will support revenue cycle management and the other vendor e-ClinicalWorks (eCW) will support EHR functionality. The medical practices will directly contract with the vendors to purchase any needed hardware and participate in a learning community designed to complement workflow redesign and technology implementation activities.

In addition to demonstrating successful adoption of EHRs by small practices in Tulare County, the initiative will then work with other communities to replicate these approaches and develop a sustainable delivery network and along with business models.

Applicants that intend to submit a proposal must submit an “Intent to Apply” by May 29th. The submission of an “Intent to Apply” is optional and if not submitted does not disqualify applicants from submitting a full proposal in June. A Bidders Teleconference will be held on May 26th at 2 pm Pacific Time. The call number for the teleconference is 1-866-270-7427 (access code *5873134*)

Proposals must be received by June 17, 2009. For more information on proposal submissions, contact Faith Wu at

Monitoring System Almost Here

The National Space Biomedical Research Institute (NSBRI) is funding the development of a sensor and portable monitor for astronauts to use in space. The futuristic system dubbed the “Venus” prototype was developed by Dr. Babs Soller and her colleagues at NSBRI. The prototype is a noninvasive monitoring system to help NASA astronauts know how much oxygen they are using up in space.

The Venus prototype is a needle-free system that uses light to measure tissue oxygen and pH. Consisting of a sensor that can be worn on the thigh and a wearable monitor, the medical technology will soon be a real-time alternative to the painful use of needles to draw blood and the need to use cumbersome equipment to determine metabolic rate. The prototype has the capability to measure blood and tissue chemistry, metabolic rate, and other parameters.

The device is placed directly on the skin where the four-inch by two-inch sensor uses near infrared light to take the measurements. Blood in tiny blood vessels absorbs some of the light, but the rest is reflected back to the sensor. The monitor is able to analyze the reflected light to determine metabolic rate, along with tissue oxygen, and pH.

“Tissue and bold chemistry measurements can be used in medical care to assess patients with traumatic injuries and those at risk for cardiovascular collapse”, said Dr. Soller, who leads the NSBRI Smart Medical Systems and Technology team.

The futuristic technology can also be used in emergency ambulances and on the battlefield. Eventually, the researchers on the project expect first-responders to use these devices to determine the severity of a person’s injury and the system will enable doctors to more efficiently monitor pediatric and intensive care patients. Athletes and physical therapy patients will also gain from the technology’s ability to help determine the level of activity or exercise that is needed for their training or physical therapy programs.

Most of the system’s development has occurred at the University of Massachusetts Medical School where Dr. Soller is a professor of anesthesiology. She has also worked closely with researchers at NASA’s Johnson Space Center in Houston to develop applications for the Venus system. Currently, Dr. Soller and her collaborators are working to prepare the system for integration into spacesuits by reducing the size of the system, increasing the accuracy in measuring metabolic rate, and making it possible for Venus to run on batteries.

NSBRI works with NASA to find solutions to help health related problems and the physical and psychological challenges astronauts face on long duration missions. While solving space health issues, the Institute is transferring these solutions to patients suffering from osteoporosis, muscle wasting, shift-related sleep disorders, balance disorders, and cardiovascular system problems.

For more information, go to or call (713) 798-7412.

NY Announces Grants

New York Governor David A. Paterson announced two grant programs under the Health Care Efficiency and Affordability Law of New York State (HEAL NY). The first grant program has $175 million available to support projects to help the state’s older adults and individuals with disabilities have increased access to person-centered high quality community-based services.

In the “Request for Grant Applications” (RGA), the New York Department of Health is seeking grant applications to better organize and develop alternatives for care. The idea is to coordinate a variety of licensed residential long term care programs, develop other residential options, and reduce certified inpatient bed capacity in residential healthcare facilities all with financial concerns in mind.

State Senator Thomas K. Duane said, “Our stated goal in this year’s budget is to shift resources into home and community-based services and to move healthcare in the state toward a more primary and preventive care framework.”

Grant applications are due on July 14, 2009. A conference for potential HEAL NY Phase 12 applicants will be held on May 22nd.The RGA can be viewed at .

The second New York state grant announcement will provide $175 million in funding to further restructure the New York healthcare system. This funding will help hospitals transition to a new model of care by consolidating excess hospital beds, eliminate duplicative services, support more outpatient care, and provide better support for ambulatory and outpatient care.

The eleven grants to be awarded will fund projects to help hospitals enter into mergers, shared governance agreements, and other collaborative arrangements. The goal is to identify healthcare needs in local communities and by providing good access to primary care, avoid hospitalizations for conditions generally considered preventable.

N.Y. State Department of Health Commissioner Richard F. Daines, M.D., said “Together with the Medicaid reforms enacted in this year’s budget, this round of HEAL NY grants will assist in reducing costly inpatient care in favor of more appropriate outpatient care.”

Grant applications for Phase 11 of HEAL NY are due on July 1, 2009 and the RGA can be viewed on .

Wednesday, May 13, 2009

VA's Information Tech Focus

The VA is requesting $3,307 billion for FY 2010 excluding the Recovery Act stimulus funding for $50.1 million. This is an increase of $559 million or 20 percent above 2009 to support Information and Technology.

In April, President Obama along with Department of Veterans Affairs Secretary Shinseki and Defense Secretary Gates, took the first step to create a Joint Virtual Lifetime Electronic Record. The two Departments will leverage information sharing programs and infrastructure, expand existing initiatives, and implement health benefits and personnel communities as technology advances. DOD and VA are committed to achieving clinical interoperable EHR systems by September 30, 2009.

The Departments recognize that the information does not always need to be computable to be of value. In many cases, just making information viewable by users may be the most cost effective way to meet the need. For example, unstructured text or scanned documents may be the best current form for some information.

With the release of the VA FY 2010 budget request, the goal is to build modern IT systems that will move the agency into the 21st century. The VA know that this can only be done with a modern IT infrastructure, a high performing IT workforce, and a state-of-the-art information system in healthcare.

Planning and architectural design efforts to implement an interoperable electronic health and benefits record systems will take place in conjunction with the Office of the National Coordinator’s National Health Information Network initiative.

The VA’s Next Generation HealtheVet System and the VistA Legacy System, differs as to how information will be stored and available. The next generation HealtheVet will provide clinical decision support tools so that clinicians can access and compute healthcare information regardless of where the veteran receives care. VistA Legacy is structured according to the location where the veteran received care, and this means that the clinician must view the information on a location by location basis.

The next generation HealtheVet program improvement activities include pharmacy reengineering (to improve pharmacy operations, customer service, and patient safety), scheduling replacement (to improve staff and medical resource management to reduce clinic wait times and to do a better job of coordinating care), and VistA Laboratory Information System reengineering (to enrich service to veterans by enhancing pathology and laboratory medicine service business processes.

The modernization of VistA into the HealtheVet environment is being structured into blocks, with completion targeted for 2018. Block One spans FY 2008 through 2011, when further development will be done on enrollment application system scheduling, expand barcode usage, deal with laboratory and pharmacy issues, work on standardization, provide for workflow engineering compensation and pension records interchange, improve clinical decision support, provide improved services for emergency rooms, provide for VA/DOD seamless care, improve surveillance on healthcare acquired infection and influenza, implant a joint inpatient electronic health record, and provide for even better mental healthcare for veterans.

The stakeholders working on the development of next generation HealtheVet will continue to meet and work intensively throughout FY 2010 to refine and finalize requirements for upcoming development blocks as well as work on the HealtheVet Integrated Program Plan.

NIH Posts Announcements

NIH’s National Center for Research Resources (NCRR) posted a presolicitation on May 8th seeking organizations to provide IT to support helpdesk services. The helpdesk effort will include installing, configuring, testing, maintaining information technology hardware, video, webcasting, develop software, train users, document standard operating procedures, and troubleshoot and respond to technical problems.

This presolicitation notice is designated as 8(a) competition with the maximum allowable annual receipts size standard to be $25 million dollars. The contract will be a cost-plus-fixed-fee type. The award will be for one base year and for four option years.

This presolicitation notice (NHLBI-RR-PB-2009-84-LMB1) is not an RFP. The RFP will be available on or about May 26, 2009 on The primary contact is Lawrence M. Butler at

Within NIH, the National Institute of Dental and Craniofacial Research (NIDCR) on May 4th, posted the Funding Opportunity Announcement (FOA) “Small Research Grants for Data Analysis-(PAR-09-182)”. The NIDCR supports a portfolio of clinical trials and large scale epidemiologic research projects where a number of data collection activities are done for each project. Since the data generated by these studies can provide valuable data, the grant recipient will gather data and develop statistical methods for analyzing oral health data using these existing database resources.

Any individual with the skills, knowledge, and resources needed to carry out the proposed research is eligible to work with their organization to develop an application.

Because the nature and scope of the proposed research will vary from application to application, the award size will also vary. For more information, go to The earliest date to submit application is May 16th with grant application submissions to go to

Telemedicine Bill Introduced

Legislation was recently introduced to increase the use of telemedicine in this country. The Medicare Telehealth Enhancement Act (H.R 2068) was introduced by Congressmen Mike Thompson (D-CA), Bart Stupak (D-MI), Lee Terry (R-NE), and Sam Johnson (R-TX) to bring telemedicine into new settings and increase the pool of Medicare providers eligible to participate in telehealth programs.

The legislation would provide $30 million in grant funding to be available through HRSA’s Office for the Advancement of Telehealth. Basically, the funding would help health facilities pay for telehealth equipment and to improve telecommunications facilities.

The grant funding would provide for:

  • Instruction in the use of the telehealth equipment and acquisition of instructional programming
  • Demonstration projects to teach or train medical students residents and other health profession students in rural or medically underserved training sites
  • Telenursing services to provide for care coordination and to promote patient self-management skills
  • Services to promote patient understanding for common chronic diseases
  • Projects that use telehealth to facilitate collaboration between healthcare providers
  • Electronic archival of patient records
  • Collection and analysis of usage statistics and data to show the cost-effectiveness of the telehealth services

The legislation would also increase originating sites and provide for the reimbursement of telehealth services when provided by a home health agency to individuals in the home. The legislation would expand home health remote patient management services coverage to additional chronic health conditions.

Studies have shown that remote patient management services have failed to expand because of the relative lack of payment mechanisms in fee for services. The legislation calls for remote technologies payments to be made on a separate basis and not be combined with payments for other services. The payment codes used for reporting and billing for payments for these services should be revised or adjusted to encourage the application of these services for other medical conditions.

Sunday, May 10, 2009

2010 HHS Budget Request

President’s Obama’s FY 2010 HHS budget request for $879 billion was highlighted at an agency media briefing held on May 7th. “This budget sends a clear message that we can’t afford to wait any longer if we want to get healthcare costs under control and improve our fiscal outlook,” said HHS Secretary Kathleen Sebelius. The 2010 budget establishes a healthcare reserve fund of $635 billion over 10 years to finance health reform to bring down costs and improve and ensure access to quality care.

The country has been very concerned about the H1N1 flu but it now seems that we are dealing with a much milder version of the flu reports the Secretary. The Secretary said she visited CDC and saw firsthand that CDC has the resources to handle flu epidemics. On April 30, 2009, the President requested a FY 2009 supplemental of $1.5 billion to provide immediate support to address the 2009 HINI influenza outbreak. These funds, in addition to the FY 2010 budget request of $584 million and the remaining balances of pandemic flu preparedness funds, will enable HHS to handle the public health surveillance and response efforts needed to handle the situation effectively.

The CDC budget request for Health Information and Services includes $292 million for Health Statistics, Health Marketing, and Public Health Informatics capabilities. Specifically, the Public Health Informatics budget request includes $71 million to determine the need for public health information systems and to develop standards for the systems to work together.

The budget request for the Office of the National Coordinator for Health Information Technology is $61 million, $0.1 million above FY 2009. This proposed funding is in conjunction with the $2 billion appropriated to ONC under the Recovery Act. The funding will enable HHS to implement the HITECH Act.

In addition, the budget request also includes funding for health IT in other divisions within HHS:

  • AHRQ’s budget requests $45 million for health IT to enhance patient safety
  • The CMS request includes resources to conduct the second year of a demonstration to encourage small physician practices to adopt electronic health records. The Recovery Act also includes $45 billion to accelerate the adoption of electronic health records through incentives to Medicare and Medicaid providers starting in 2011
  • The Substance Abuse and Mental Health Services Administration request includes $2 million to support State-administered controlled substance monitoring programs to enable the early identification of patients at risk for addition
  • The Indian Health Services budget request is for $5 billion an increase of $454 million over FY 2009 and includes $16 million to support the IHS health IT program. Specifically, the Resource and Patient Management System and the IHS electronic health record will receive funds to be used in conjunction with the $85 million for Health IT provided in the Recovery Act
  • In FY 2009 and 2010, the Office for Civil Rights will develop the regulations and guidance required under the HITECH Act to strengthen the privacy protections of HIPAA

ONC funding will address standards development, privacy, security issues, and expand health information exchange network capabilities across additional markets and communities.ONC will update the Federal Health IT Strategic Plan in FY 2009 and will fund surveys on the adoption rates for electronic health records among physicians and hospitals.

Also included in the request is $50 million in funding for comparative effectiveness research through AHRQ’s Effective Health Care Program. Comparative effectiveness research provides patients and physicians with state-of-the-science information to determine the best medical treatments that will work best for a given clinical condition.

NIH’s budget request includes $31 billion with an increase of $443 million over the FY 2009 level. The budget request will build on the $10.4 billion provided by the Recovery Act has $8.2 billion for to use for biomedical research, $1.3 billion for infrastructure, $0.5 billion for NIH owned facility construction and repairs, and $0.4 billion for comparative effectiveness research.

The budget requests more than $6 billion to be used to support cancer research across NIH. As part of the $211 million HHS wide initiative, $1 billion would be invested over the next eight years for autism-related activities, $3.1 billion for HIV/AIDS research, and $467 million to fund the Clinical and Translational Science Award program and the General Clinical Research Centers.

HRSA has put improving the quality of rural healthcare high on the agenda. The budget includes $73 million for a new “Improve Rural Health Care” initiative. This will mean that there will be increased funding of $55 million for Rural Health Care Services Outreach, Network, and Quality Improvement grants and $9 million to go to the State Offices of Rural Health.

The request would fund Telehealth grants with $8 million to expand the use of telecommunications technologies within rural areas. Funding is also requested for HRSA to improve chronic disease management options for patients in rural areas who suffer with cardiovascular diseases and diabetes.

The budget request includes over $1 billion for the healthcare workforce. The funding would be used to expand loan repayment and scholarship programs for physicians, nurses, and dentists who will practice in medically underserved areas.

The budget request for CMS is $758.9 billion, a net increase of $56.3 billion over the FY 2009 level. The Medicare budget would provide incentives to improve quality by paying hospitals incentive payments based on the quality of care provided, reduce hospital readmissions, enable physicians to form voluntary groups to coordinate care for Medicare beneficiaries.

Other incentives to promote efficiency and accountability include competitive bidding for Medicare Advantage Plans, bundle payments for inpatient hospital services and post-acute care within 20 days of discharge beginning in 2013, and improve payment accuracy by helping contractors with resources to update their claims processing systems to better screen for payment errors.

Secretary Sebelius estimates that for every $1 spent to stop fraud in the system, $1.55 would be saved. The President’s budget lays out funding for anti-fraud efforts over five years that could save $2.7 billion by improving overall oversight of fraud and abuse in the Medicare Advantage and Medicare prescription drug programs.

Some of the other funding areas included in the budget request would provide FDA $3.2 billion with an additional $511 million over FY 2009. $259 million of the increase is to use to devote to food safety issues.

The HHS budget request calls for $354 million to combat health disparities and improve the health of racial and ethnic minorities and low income and disadvantaged populations. $116 million would be allotted for the Health Professions and Nursing Training Diversity Programs, the Office of Minority Health, and $40 million for the CDC Reach program.

The budget calls for $10 million to be used for a new Emergency Care System program to improve the quality of emergency rooms at regional hospitals and to set national standards. The funding would support a demonstration program to support the quality of operations and outcomes at regional emergency medical systems.

Fighting Hospital Infections

Healthcare Associated Infections (HAIs) are among the top ten leading causes of death in the U.S. and drive up the cost of healthcare by $20 billion per year. To help contain the problem, HHS Secretary Kathleen Sebelius announced that $50 million in grants will be funded by the American Recovery Act to help states fight Healthcare Associated Infections (HAIs).

HHS plans to make $40 million available through competitive grants to eligible states to create or expand state-based HAI prevention and surveillance efforts and to strengthen the public health workforce trained to prevent HAIs. HHS is also allocating $10 billion in grants to states to improve the process and increase the frequency of inspections for ambulatory surgical centers.

In a speech before the United Nurses of America’s 12th National Nurses Congress, the Secretary discussed two new HHS reports on the quality of healthcare in America and challenged hospitals to work to reduce HAIs.

The reports “2008 National Healthcare Quality Report” and the “2008 National healthcare Disparities Report” published by AHRQ, indicate that patient safety measures have worsened and that a substantial number of Americans do not receive recommended care.

Secretary Sebelius specifically calls upon hospitals to reduce Central Line Associated Blood Stream Infections (CLABSI) in Intensive Care Units by 75 percent over the next three years. Research indicates that these infections strike hundreds of thousands of surgical patients and the percentage of patients acquiring these infections has steadily increased over the past six years.

AHRQ has announced that organizations in ten states are now undertaking a project to test methods to reduce CLABSI’s in hospital ICUs. AHRQ has awarded a three year, $3 million contract to the Health Research & Educational Trust (HRET) to coordinate the project and provide tools to help healthcare professionals identify opportunities to reduce HAIs and also to implement policies for safer care.

The project enables HRET and their partners at Johns Hopkins University Quality and Safety Research Group and the Michigan Health & Hospital Association’s Keystone Center for Patient Safety & Quality to collaborate.

The organizations involved in the project include three patient safety groups, the California Hospital Patient Safety Organization, the North Carolina Center for Hospital Quality and Patient Safety, and the Ohio Patient Safety Institute. Hospital associations in those states as well as the hospital associations in Colorado, Florida, Massachusetts, Nebraska, Pennsylvania, Texas, and Washington are also involved in the project.

To see the reports issued by AHRQ, go to .

e-Prescribing for Controlled Substances

A bipartisan group of Senators have asked Secretary of HHS, Kathleen Sebelius and Attorney General Eric Holder to quickly put federal regulations in place to allow electronic prescribing for controlled substances.

Senators Sheldon Whitehouse(D-RI), Tim Johnson (D-SD), Tom Coburn (R-OK), Jay Rockefeller (D-WV), Edward Kennedy (D-MA), Debbie Stabenow (D-MI), Sherrod Brown (D-OH), Lindsey Graham (R-SC), John Kerry (D-MA), John Thune (R-SD), and Richard Burr (R-NC) believe the time is right to make progress on this issue since broader healthcare reform is looming on the horizon.

Studies show that e-prescribing is used today in about 18 percent of the doctors’ practices and could possibly save $20 billion annually as patients would experience fewer adverse drug events. However, current federal rules require that doctors write paper prescription for controlled pharmaceuticals, such as pain medications, antidepressants, and some drugs used to treat asthma in children. As a result, most doctors resort to writing all of their prescriptions by hand rather than maintain a paper system for controlled substances and an electronic system for non-controlled substances.

After four years of inaction, a hearing was held December 2007. At the hearing, Senators Whitehouse and Coburn pressed a DEA official on the agency’s timeframe to revise the existing rules. This resulted in DEA issuing a new draft rule to lift the prohibition against e-prescribing for controlled substances.

However, the rule is not yet finalized. The Senators want to see a final rule that advances both healthcare quality and efficiency and reduces illegal prescription drug diversion, but passing the rule will require the cooperation, compromise, and knowledge of experts at both the Department of Justice and HHS.

Wednesday, May 6, 2009

Software Predicts Flu Impact

Experts at Johns Hopkins experts are offering a free web-based software tool able to calculate and predict the impact on individual hospitals during a flu epidemic, bioterrorist attack, or other emergencies. The tool is able to account for the number of victims, germ-carrying wide patterns, available medical resources, and bacterial incubation periods.

“Biological, chemical, radiological or explosive attacks, can bring hospitals and local health agencies to their knees quickly overwhelming their ability to care for mass casualties,” said Gabor Kelen, M.D., Head of Emergency Medicine at Johns Hopkins and Director of Hopkins Office of Critical Event Preparedness and Response (CEPAR). “Our software lets users put their own information into the modeling software, customize it to their needs, and predict what they will need to handle a surge in casualties.”

The software referred to as “Electronic Mass Casualty Assessment & Planning Scenarios” (EMCAPS), is able to predict the anticipated outcomes for disaster planning scenarios that have been developed by the Department of Homeland Security (DHS). The scenarios include patient estimates by injury type, estimated level of care required, and the need for decontamination facilities.

“While the planning scenarios developed by DHS form a good basis for constructing disaster exercises, EMCAPS adds value by giving hospitals a platform for providing a needed level of detail and accounting for local conditions that can influence healthcare demand and response in their regions,” according to Meridith Thanner, PhD, a CEPAR Research Associate and Program Manager with the National Center for the Study of Preparedness and Catastrophic Event Response.

The software developed by CEPAR and programmed by the Johns Hopkins Applied Physics Laboratory, is available for download free of cost from Johns Hopkins CEPAR web site at .

Ohio Invests in Stimulation Tech

JumpStart Inc., the Northeast Ohio’s venture development organization and Case Technology Ventures, a pre-seed stage venture capital and technology validation fund at Case Western Reserve University, recently invested $375,000 in Neuros Medical Inc a company commercializing neurostimulation technology.

The technology was developed by Kevin Kilgore and Niloy Bhadra doctors and researchers at Case Western Reserve University’s Department of Biomedical Engineering and MetroHealth Medical Center. The technology designed in partnership with the Cleveland Functional Electrical Stimulation Center and referred to as “Nerve Block” delivers high-frequency stimulation to sensory nerves in the peripheral nervous system to block chronic pain.

The system consists of an electrode that is placed around a peripheral nerve and powered by a pace-maker size generator implanted in the body. The generator operates at a much higher frequency range than conventional neurostimulation devices.

The Neuros technology is able to stop nerve activity to block pain completely as opposed to simply masking the pain signal. The company’s initial target market is patients with chronic pain, specifically residual limb pain, a common occurrence after undergoing limb amputation due to vascular disease, circulatory issues, diabetes, cancer, or trauma-related events. Case has secured a patent for this unique high-frequency application with two additional patents pending.

Neuros CEO Jon Snyder said “This investment recognizes the positive results of our research, validates the potential in the technology, and will support continued clinical trial plans and future commercialization efforts.”

CDC's Systems in Place

Preparing people for emerging health threats is one of CDC’s goals. The agency has several programs to address national, state, and local efforts in dealing with public health disasters and to prepare people for emerging and ongoing health threats.

CDC’s Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) helps to prepare the nation for public health emergencies that include natural, biological, chemical, radiological, and nuclear incidents. Among other activities, COTPER staffs an Emergency Operations Center 24/7 to monitor worldwide health threats and to coordinate emergency response activities.

COPTER released their inaugural report in January 2009 describing CDC’s activities in public health emergency preparedness. The report, “Public Health Preparedness: Strengthening CDC’s Emergency Response” is available at .

Some of the programs and systems across CDC working to improve emergency preparedness and response are:

  • National Center for Health Marketing—Strengthens health communication networks across federal, state, and local levels with programs such as Epi-X, and the Emergency Communication System that manages the CDC Emergency Preparedness and Response web site
  • National Center for Immunization and Respiratory Diseases—Conducts vaccine research to protect people from anthrax and other diseases
  • National Center for Public Health Informatics—Identifies public health informatics solutions for outbreak investigation, event detection, and monitoring. Supports the BioSense System with 800 registered users connecting with more than 600 hospitals. BioSense receives data from DOD and VA hospitals, laboratories, and other healthcare facilities
  • National Center for the Preparedness, Detection, and Control of Infectious Diseases—manages the Laboratory Response Network (LRN). The LRN maintains an integrated network of state and local public health, federal, military, and international laboratories to respond to bioterrorism, chemical terrorism, and other public health emergencies
  • National Institute for Occupational Safety and Health—provides technical expertise, and facilitates on-site support during emergencies, advances research and collaborates on response efforts
  • National Electronic Disease Surveillance System—designed to detect outbreaks rapidly and electronically and then transfer the information from clinical information systems to public health departments
  • Early Aberration Reporting System—city, county, and state public health officials in the U.S. use the system to obtain syndromic data from emergency departments, 911 calls, physician offices, schools, businesses, and from pharmacies for information on over-the-counter drug sales
  • Early Warning Infectious Disease Surveillance Program—is a collaboration of state, federal, and international partners to provide rapid and effective laboratory confirmation for urgent infectious disease case reports in the border regions of the U.S., Canada, and Mexico
  • Enhanced Surveillance Project—works with state and local health departments and information system contractors to develop real-time special event syndromic surveillance and analytical methods. During events, ESP monitors sentinel hospital emergency department visit data and reports the information to state and local health departments for confirmations and appropriate follow-up
  • National Notifiable Disease Surveillance System—is a state-based public health surveillance system for conditions designated by the Council of State and Territorial Epidemiologists as nationally notifiable. Weekly provisional NNDSS data is shared with CDC programs

To address the issue for exchanging information electronically, CDC’s Public Health Information Network (PHIN) promotes the use of standards by defining functional and technical requirements, supports the exchange of health information between all levels of public health and healthcare, monitors the capability of state and local health departments to exchange information, and provides technical assistance to state and local health departments.

CDC is also very interested in reaching the public with immediate information. For example is available on Twitter and provides updates on new emergencies. In addition, CDC provides information via email updates, pod casts, emergency text messages, and by RSS feeds.

The newest way to receive information is from the CDC’s Data and Statistics Widget. Widgets are online applications built by one web site that can be displayed onto another web site. Therefore, the widget application is able to display featured content directly to your web page. Information can be embedded in personalized home pages, blogs, on other sites and also via mobile devices.

USDA Grants for Broadband

USDA is now accepting applications for grants to bring broadband services to rural areas. State and local governments, corporations, and Indian tribes are eligible to apply for the grants from $50,000 to $1 million through USDA’s Community Connect Grant Program with $13.4 million available. The grants are needed to bring state-of-the-art broadband services to isolated and economically challenged communities currently without broadband.

Grant funding is to be used to:

  • Construct, acquire, or lease broadband transmission services
  • Improve, expand, or lease community centers that provide ten free computer access to broadband for at least two years before, during, and after normal work hours, and on Saturdays and Sundays.
  • Purchase computer equipment
  • Provide broadband to all critical community facilities such as first responders, police, and others within the proposed service area

Applications are due by June 19, 2009. Go to for more information, or call Kenneth Kuchno, Director, Broadband Division, RUS, or call 202-690-4673.

Healthcare Conference Coming

The 6th Healthcare Unbound Conference will build on the strength of the past five highly successful Conferences. Be sure to mark the date of June 22-23, 2009 to attend this great networking event to take place in at the Seattle Airport Marriot that will attract high level executives and clinicians from across the U.S. and abroad.

Innovative technologies are driving opportunities to service health consumers in new ways and in new settings. Forrester Research coined the term “Healthcare Unbound” to encompass the trends toward self-care, mobile care, home care, and using technology in, on, and around the body so that care can be free from formal institutions. This rapidly evolving technology field includes sensor technology, wearable computing, home-based health monitoring, and wellness and lifestyle support solutions.

It is highly important for healthcare companies involved in telemedicine and remote monitoring to attend this meeting. Sessions are geared to help healthcare providers, consumer technology companies, health IT companies, pharmaceutical and medical device companies, health plans and health insurance companies, hospitals, homecare agencies, chronic care management companies, long-term care facilities and retirement communities, wireless companies, the financial and consulting community, and government officials.

The program will focus primarily on the use of innovative remote monitoring, home telehealth, ehealth, and pervasive computing technology to use for chronic care management and wellness promotion. Over 75 speakers will participate in panel discussions, case studies, and keynote addresses. Sessions will include in-depth coverage of technology-enabled chronic care management and wellness promotion, impact of the economic stimulus bill on the marketplace, legal/regulatory and reimbursement issues, payer perspectives, wireless technologies, the medical home model, social media, and much more. This year’s program will again feature an Aging Services educational track developed in conjunction with AAHSA and the Center for Aging Services Technology.

Keynoter David R. Hunt M.D. FACS, Chief Medical Officer and Acting Director for the HHS Office for Health Information Technology Adoption within the Office of the National Coordinator for Health IT, will discuss how the ONC for HIT can provide a clear path for promising technological solutions to compete in the marketplace and how this can improve the value of healthcare services.

Some of the other Keynote speakers include:

  • Vince Kuraitis, JD, MBA, Principal Better Health Technologies to discuss how the stimulus funding for HIT and health reform will present dramatic opportunities for new disruptive technology and business models
  • Charles (Chuck) Parker Executive Director, Continua Health Alliance will discuss the release of the V1 Guides and certification process and the process ongoing for Version 2
  • William L. (Larry) Minnix Jr. President and CEO AAHSA will illustrate his vision for unbound long term services and how they should be financed
  • Michael J. Barrett, Managing Partner, Critical Mass Consulting, will look at how best to architect and deliver technology to connect the dots while driving significant health and economic outcomes
  • David C, Kibbe, M.D., Principal, The Kibbe Group and Senior Advisor for the American Academy of Family Physicians will address how to stay healthy and make treating illnesses more affordable, convenient, and personalized

Additional keynoters with innovative ideas include, Grant Harrison, Vice President, Consumer Innovation Center, for Humana Inc., Robert L Heyl, Head of Digital Engagement Strategy and Innovation, for Aetna, Claire Trescott, M.D., Director of the Primary Care, for the Group Health Cooperative, Anand K. Iyer, PhD, President and Chief Operating Officer, for WellDoc, Inc., and Joseph Gifford, M.D., Senior Medical Director, for the Regence Group a BCBS affiliate.

Three optional post-conference workshops will be held. One workshop “Innovations in Technology-enabled Patient Self Management” will cover integrating remote monitoring with the health record, web portals, computer-based programs, health 2.0 applications, portable devices for self management and behavior change, and for games for health.

This workshop will be chaired by Steven Locke, MD, Associate Professor of Psychiatry, Harvard Medical School, Associate Professor of Health Sciences and Technology, MIT & Principal, Veritas Health Solutions LLC.

The second post conference workshop will explore the Patient Centered Medical Home and Healthcare Unbound and chaired by Jaan Sidorov, M.D., MHSA, Medical Director, Medical Informatics, EDS.
Topics will include implications of medical technology to support medical homes, ways that technology can tie the medical home to the rest of value-based care. The question is does technology shape the medical home or does the medical home shape technology.

The third post conference workshop “When Consumer Electronics Deliver Healthcare Unbound Services—a National Case Study chaired by Rob Scheschareg, President, MedConcierge LLC., will present real-world solutions available and in-use today that can overcome infrastructure and compliance hurdles to deliver a comprehensive set of healthcare unbound services.

For information on sponsorship, exhibiting, or to register, email the Managing Director of TCBI, Satish Kavirajan at , call 310-265-2570, or go to The Center for Business Innovation (TCBI) organizes conferences and exhibitions for the U.S. and international markets. For additional information, go to

Sunday, May 3, 2009

Timely Report Published

Healthcare leaders at a forum hosted by the Markle Foundation on April 30th discussed the just released 2009 report “Achieving the Health Objectives under ARRA: A Framework for Meaningful Use and Certified or Qualified EHR”. The document examines how the meaningful use of EHRs can be accomplished when qualifying for CMS incentives under ARRA.

A diverse group of consumer, business, and health organizations under the auspices of Markle Connecting for Health worked together to provide the input to the document. The goal was to set a strategic course for the health IT provisions included in the American Recovery and Reinvestment Act (ARRA).

The document basically stresses the importance for measuring progress when trying to accomplish specific goals. This is essential to improve healthcare quality, reduce the growth in costs, stimulate innovation, and protect privacy.

Opening the forum, Zoe Baird, President of the Markle Foundation said “there is an enormous potential to keep improving our healthcare system through using modern information tools. To do that, we need to set clear goals, define meaningful use as the use of information to improve health, and adopt an approach to technology and standards that fosters market innovation.”

David Blumenthal M.D., M.P.P, the newly appointed HHS National Coordinator for Health IT, told the attendees that he enthusiastically relates to electronic records, since he has used electronic records for the past ten years. He found that using technology has not only saved him from making mistakes in prescribing medications but also from ordering unnecessary tests.

As he pointed out, the HIT field was not advancing when only the private sector was involved, but now with the Federal government on board, this partnership will help the healthcare community move forward with health IT.

Dr. Blumenthal realizes that there is an enormous amount of work to do to accomplish the goals included in the ARRA legislation and to make those concepts concrete. To start, he plans to meet immediately with the advisory committees on standards and policy.

Mark McClellan, Former CMS and FDA Director, and now Senior Fellow and Director, Engelberg Center for Healthcare Reform at Brookings Institution, emphasized that the technology issues involving health IT have to fit into the big healthcare picture and be interrelated. The primary goal should be to study the impact of technology on healthcare and determine if those investments are making a difference.

To download the report, go to

Pediatric Device Grants

The FDA Office of Orphan Products Development (OOPD) posted grant notice (RFA-FD-09-007) on April 30th to solicit grant applications from nonprofit organizations to develop, produce, and distribute pediatric medical devices. Although administered by OOPD, this grant program encompasses devices that could be used in all pediatric conditions and diseases—not just rare diseases. The pediatric population includes patients who are 21 years of age or younger at the time of diagnosis or treatment.

The development of pediatric medical devices currently lags five to ten years behind the development of devices for adults. Children differ from adults in terms of size, growth, and body chemistry, and this adds to the challenge in developing pediatric devices.

To help remedy this problem, the Pediatric Medical Device Safety and Improvement Act of 2007, established the Pediatric Device Consortia Grant Program (P50) to support non-profit work on stimulating projects. This will help promote pediatric device development since interdisciplinary researchers would be able to focus on common problems. The P50 grant mechanism supports a wide spectrum of activities.

The goal is to encourage development, production, and distribution of medical devices by:

  • Encouraging innovation and work to connect individuals with potential manufacturers
  • Mentoring and managing device projects through the development process
  • Connecting innovators and physicians to existing Federal and non-Federal resources
  • Addressing the scientific and medical merit of proposed pediatric device projects
  • Providing help with business development, personnel training, prototype development, post-market needs, and other activities

OOPD is coordinating the grant program with NIH. The funding is expected to be for $2 million, to be distributed on a competitive basis, and result in one to four awards. The grant application is due on June 15, 2009.

Go to for further information. For more information from FDA’s OOPD, email or call 301-827-3666.

New Legislation Introduced

Senator John D. (Jay) Rockefeller, Chairman of the Senate Finance Subcommittee on Health Care, has introduced legislation to help the nation adopt EHRs particularly among small rural providers. The “Health Information Technology Public Utility Act of 2009” will build upon open source EHRs by the VA as well as the open source exchange model recently expanded in the Federal agencies through the Nationwide Health Information Network-Connect Initiative.

Open source software is a computer program with unrestricted source code that does not limit the use or distribution by any organization or user. “Open source software is a cost-effective, proven way to advance health IT particularly among small rural providers. This legislation does not replace commercial software, instead, it complements the private industry in this field by making health information technology a realistic option for all providers,” said Senator Rockefeller.

The legislation would specifically:

  • Create a new Federal Public Utility Board within the Office of the National Coordinator for Health IT to direct and oversee the formation and implementation of the HIT Public Utility Model
  • Implement and administer a new 21st Century Health IT Grant Program for safety-net providers to cover the full cost of open source software implementation and maintenance for up to five years with the possibility of renewal for up to five years if required benchmarks are met
  • Facilitate ongoing communication with open source user groups to incorporate improvements and innovations into the core programs
  • Ensure interoperability between these programs, including mechanisms to integrate open source software with Medicaid and CHIP billing
  • Create a child-specific EHR to be used in Medicaid, CHIP, and other Federal children’s health programs
  • Develop and integrate quality and performance measurement into open source software modules

Another bill recently introduced in the House would increase the use of telemedicine and telehealth technologies in the U.S. The legislation would pave the way for Medicare reimbursement to be provided in additional areas and provide for more remote patient monitoring. The bill “Medicare Telehealth Enhancement Act of 2009 (H.R 2068) was introduced by Congressmen Mike Thompson (D-CA), Bart Stupak (D-MI), Lee Terry (R-NE), and Sam Johnson (R-TX).

The legislation would:

  • Expand telehealth to all areas and use more store and forward technology
  • Increase originating sites to include renal dialysis facilities
  • Extend telehealth services by enabling home health agencies to utilize telecommunications systems to provide care in homes especially for patients with chronic health conditions
  • Establish a Telehealth Advisory Committee to advise CMS

Neonatal Program Launched

Preterm births along with the number of premature infants who survive are on the rise in the U.S. The NeoRISK Project was initiated to address the current national shortage of highly skilled neonatal nurse practitioners and also to prepare graduates to provide vital support to the highest risk infants as they leave the carefully controlled environment of the hospital. The University of California San Francisco (UCSF) has launched a first-of-its kind neonatal nursing program in collaboration with the University of Hawaii.

Today, there is a growing population of preterm infants who survive, which means there is a whole set of unique health challenges present during the transition from the hospital to the community,” said NeoRISK Project Director Christine Kennedy, UCSF’s Jack and Elaine Koehn Chair in Pediatric Nursing and a Professor of Family Healthcare Nursing.

These challenges include limited access to quality medical care among families in rural areas, as well as health disparities linked to race, ethnicity, and socioeconomic status. The complex geographic, demographic, and cultural characteristics of California and Hawaii make these states ideal incubators for a program like NeoRISK, Kennedy said.

“Also, both California and Hawaii have a very diverse premature infant population. We’ve had great advance in medical technology, but not much has been done to really change what happens when babies go home.”

NeoRISK started in September with five students based at UCSF’s School of Nursing and four at the University of Hawaii at the Manoa School of Nursing & Dental Hygiene. The program is being funded by a three year grant from HRSA.

NeoRISK is the first NNP training program to focus on infants at risk for experiencing health disparities, particularly during the transition from hospital to home, said Project Coordinator Mary Lynch, Clinical Professor and Coordinator for the Neonatal and Pediatric Specialty Programs at the School of Nursing.

Throughout the two year course, the faculty will make use of the latest technologies, such as streaming online videos. The Hawaii based students will complete most of their clinical applications at neonatal intensive care units and various other sites in Hawaii. They will also complete a portion of their clinical training hours at UCSF affiliated facilities.