Sunday, August 30, 2009

Responding to H1N1

The report “U.S Preparations for 2009-H1N1 Influenza” recently prepared by the President’s Council of Advisors on Science and Technology (PCAST) examined basic strategic issues and how to best minimize the impact of the likely resurgence of the 2009-H1N1 flu.

To further study the impact of the situation, PCAST assembled a Working Group to do an in-depth external review of the possible epidemic and then detail how the nation needs to respond to the problem. The Working Group was chaired by Dr. Harold Varmus, President, Memorial Sloan-Kettering Cancer Center and Dr. Eric Lander, President and Director, Broad Institute of Harvard and MIT. As a result of the group’s review, the “2009 H1N1 Working Group report” was completed.

The report’s chapter “Ensuring Adequate Data for Decision Making: Surveillance Systems” emphasizes the need to respond quickly to a flu epidemic. To do this, data is needed to detail how many people are becoming infected, experiencing illness, seeking medical care, being hospitalized, requiring intensive care, and how many are dying from H1N1. Also, the data needs to show how these numbers are changing over time, who is becoming infected and at the greatest risk for severe outcomes, how is the virus changing, and are medical and public health systems able to respond adequately.

According to the report, CDC works with local and state public health departments to support a large number of systems for surveillance of influenza activity. The output of this accumulated data is summarized publicly and published on

The systems have provided valuable data through the spring and summer and the Working Group is fully aware that CDC is developing plans to expand its surveillance efforts for fall 2009. However, the Working Group sees some shortcomings and thinks that while it is not possible to remedy all of these problems before the fall, there are several short-term steps that could be taken to significantly improve the available data such as:

• CDC needs to combine syndromic surveillance and emergency department data available from existing local and state surveillance systems. The data needs to be incorporated into a geographically representative national network

• Although nationally representative data would be valuable, it may be beneficial for these surveys to oversample in jurisdictions that have relatively robust surveillance plans in place for tracking influenza related primary care visits, hospitalizations, and deaths

• Hospital facilities may also become scarce, so an integrated system needs to be implemented to monitor the healthcare system with an emphasis on reporting the incidence and prevalence of cases occupying hospital beds, ICU beds, and mechanical ventilators

• Timely data on patients hospitalized for respiratory illnesses available to clinicians, public health officials, and the public needs to be make available. This data could be located in a network of participating sites specializing in influenza surveillance, healthcare systems with appropriate electronic record keeping systems, and interested states and localities.

• Adequate surveillance systems are needed for vaccine-associated adverse events with particular attention to adverse events that are likely to occur at high rates in high risk populations. Also, adverse event surveillance and analysis depends to a large degree on the ability to link vaccinations to possible adverse events via medical records

Go to, to download information on the PCAST report “U.S Preparations for 2009 H1N1 Influenza”, and PCAST’s Working Group’s “2009-H1N1 Working Group Report”.

Smartphones in Developing Countries

The University of Texas Health Science Center at Houston has developed new smartphone technology to help improve the quality of healthcare in developing nations where medical services can be scarce.

The technology includes an application with easy-to-follow medical guidelines that can be loaded onto smartphones based on Windows Mobile and used by community health workers in remote areas to diagnose and treat various medical conditions. The GuideView application and contents can be stored on a smartphone so that neither internet access nor the smartphone network is required.

Community health workers provide a large portion of healthcare in developing nations and many use smartphones or have access to them, according to M. Sriram Iyengar, PhD., GuideView inventor, and Assistant Professor at the University of Texas, School of Health Information Sciences at Houston.

In some areas, community health workers have limited medical training and are prone to errors so they can be greatly helped by the information available by using a smartphone. For example, a study done by CDC found that community healthcare workers in developing nations make errors in diagnosis and treatment as much as 62 percent of the time.

GuideView enables the user to get step-by-step instructions on diagnosing and treating medical conditions. Depending on the medical condition, there can be as many as 225 steps to use when treating a particular medical problem or condition. If at any time, the medical condition is deemed serious or life threatening, the application is programmed to dial the closest emergency service and records the steps taken so they can be reviewed at a later time.

Recently GuideView was tested in the Human Patient Simulation Laboratory at the University of Antioquia Medical School in Medellin, Columbia. Fifty health workers used the application to treat medical conditions simulated by sophisticated, life-size mannequins. Ninety five percent said they would use this technology in their daily practice and perceived the technology as useful.

Iyengar came up with the idea for GuideView while helping NASA develop a medical instruction program that astronauts could use on extended missions. Initial funding was through NASA and the Army Telemedicine and Advanced Technology Research Center. Iyengar recently received a grant from Microsoft and the Office of Technology Management at the UT Health Science Center at Houston and also received a UT System Ignition Fund grant to develop the technology for commercialization. The researchers are currently working on versions of GuideView for iPhones, Blackberries, and other types of smartphone technologies.

NIH's CAP Offered to SBIR Awardees

NIH’s Commercialization Assistance Program (CAP) is now available to NIH SBIR Phase II awardees free of charge. The CAP program through a contract with the Larta Institute of Los Angeles is in place to help SBIR II awardees develop their commercial business and to transition their SBIR-developed products into the marketplace. All NIH SBIR awardees with Phase II awards that are active or were active in the past six years are eligible to participate. The 2009-2010 CAP will begin October 2009 and finish July 2010.

The program has the Commercialization Training Track (CTT) and the Accelerated Commercialization Track (ACT) to offer customized assistance. CTT with 60 slots available will help participants in the program enhance their skills and tools needed to create infrastructure, documentation, and business models.

ACT with 20 slots available targets the most critical issues needed to achieve a desired commercialization outcome. This track is for companies that have commercialized other products, have clearly-defined markets and partners, or have raised financing through institutional channels.

The deadline to submit an application is September 14, 2009. For more information, go to For general inquiries, contact Kay Etzler at, or call 301-435-2713. To contact the Larta Institute, contact Judy Hsieh at or call 213-538-1444 Extension 144.

WVU's Research Activities

Combat related injuries have long plagued the military in part because of multidrug-resistant bacteria. Imagine being able to spray a compound fracture with microcapsules to deliver a drug that would bolster the immune system and stop infections before they start. This technology might be just around the corner according to Bingyun Li, PhD., at the West Virginia University Department of Orthopedics and Director of the WVU Biomaterials, Bioengineering and Nanotechnology Laboratory.

Research in these areas is important because of the wars in Iraq and Afghanistan. Li said “the treatment of battlefield casualties is expensive and the infection rate runs from 2 to 15 percent because in some cases the organisms develop resistance, and therefore the antibiotics don’t work.” Millions of people not in the battlefield could also be helped by the technology because infections can sometimes result when biomedical devices are implanted.

Li’s research team is working on several ways to deliver interleukin-12. One way would be to inject microcapsules or to potentially spray a fine mist on stents, pacemakers, pain pumps, artificial limbs, and to virtually any biomedical device before implantation.

According to Li “Interleukin-12 will maximize the body’s natural response to an extent where infections can be prevented without the risk of the bacteria developing resistance to the treatment. With nanocoating, the drug is right where it needs to be at the interface of the implant and the tissue. With the microcapsule, the drug can be injected or sprayed where desired and the nanocoating and microcapsule can prolong the half life of interleukin-12.”

Li’s team has been working for four years to develop the technology. The research has been funded in part by the WVU Research Corporation, the National Science Foundation, and the Osteosynthesis and Trauma Care Foundation.

The university’s Robert C. Byrd, Health Science Center, Department of Orthopedics has several ongoing research programs. The Telemedicine Research program is working with patients with orthopedic problems. Patients are able to go to a nearby medical center where local healthcare providers interact online with surgeons to decide on continuing care for patients with traumatic injuries such as total hip and knee replacements.

The Department also has developed an electronic outcomes data collections system. The system uses HIPAA compliant internet based software to collect and store patient information in a database. Patients are able to complete the condition specific validated surveys from any computer or any location before each outpatient clinic visit with the updated information available to physicians before the visit.

The database is also a valuable resource for researchers who want to answer specific clinical research questions. The database contains de-identified data on surgical spine, surgical shoulder, and total knee and hip replacement patients. The data can also be aggregated and analyzed with data from other institutions that are using the same electronic data collections system.

USDA Funding Rural Facilities

USDA is funding 102 rural community facility projects with $58 million immediately with Federal stimulus funding. Up to now, USDA has made $179.6 million in funding available for community facility projects, and in addition to that amount, USDA Rural Development has provided $58 million plus an additional $41.1 million came from other sources.

The USDA Rural Development Community Facilities Program helps to finance essential community facilities such as child care centers, hospitals, medical clinics, assisted-living facilities, fire and rescue stations, police stations, community centers public buildings and transportation. One recipient of the funding is the City of Mountain View located in Arkansas which used the funding of $50,000 to purchase first responder equipment.

In Whitehall, Montana, the Rural Development Community Facilities Program is providing a $450,000 loan and a $14,000 grant to Liberty Place, Inc., a non-profit corporation that conducts brain injury rehabilitation. The funding will be used to purchase a facility and expand the brain injury care program. Liberty creates structured programs to enable people severely disabled by a brain injury to live in a home-based setting.

The Rural Development program is providing a $9.4 million loan to Guadalupe County Hospital to replace an outdate facility in New Mexico with a new 10 bed acute care hospital and medical clinic. The new facility will serve Guadalupe County, a federally designated health professional shortage area as well as several small villages and surrounding communities. The Guadalupe County Hospital is the only emergency care facility on Interstate 40 between Albuquerque and Amarillo Texas.

Wednesday, August 26, 2009

NIH/CDC SBIR Solicitation Issued

NIH and CDC issued SBIR Solicitation (PHS 2020-1) inviting small business concerns to submit research proposals. The objective of the SBIR program is to stimulate technology innovation in the private sector, strengthen the role of small businesses to meet Federal R&D needs, and to increase private sector innovation commercialization.

Some of the NIH topics listed for research and new technologies include:

• National Cancer Institute—Biopsy instruments and devices, POC analysis for circulating tumor cells, data harmonization and advanced computation of population health data, plus biosensors for early cancer detection

• National Institute on Drug Abuse—Technologies to integrate data from prescription monitoring programs to current clinical practices, innovative techniques and tools to use for clinical trial participants, handheld devices to support recovery, innovative technologies to support research in drug abuse, and web-based cognitive and neuropsychological testing for substance abuse

• National Heart, Lung and Blood Institute—Innovative tools, techniques and software needed for screening, recruitment, and follow-up of participants in pediatric research

Some of the CDC topics include:

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention—A novel technology to identify early infections, a database for storage and data mining, software to perform large scale analyses of infections caused by hepatitis viruses, and decision support tools to use with the Electronic Health Record

• National Center for Immunization and Respiratory Diseases—Technology needed for vaccination delivery and immunization programs

• Coordinating Office for Terrorism Preparedness and Emergency Response—Computer-based models to evaluate strategies and outcomes in pandemic preparedness along with technologies for rapid and efficient communication in emergency response

The due date for proposals is November 9, 2009. For more details, go to, and for general questions, contact Jo Anne Goodnight at

Iowa e-Health Project on Track

Iowa’s Health Information Technology Plan recently published defines the state’s vision for the Iowa e-Health project. The Electronic Health Information Executive Committee and Advisory Council and the Iowa Department of Public Health submitted the report with detailed information on the project.

Although Iowa is not yet currently engaged in a statewide HIE, so far, many health IT milestones have been accomplished. According to the report, Iowa has developed HealthNet connect (HNc) a 3,200 mile fiber optic network. Funds for $7.8 million were made available from the FCC in their Rural Health Care Pilot Program to provide for last mile connections so that nonprofit hospitals can link to HealthNet connect.

Today, the HNc backbone network runs throughout Iowa and spans four states, with direct fiber connections to major metropolitan cities stretching from Denver to Chicago. Additionally, the HNc backbone connects to Internet2 and National Lambda Rail networks.

The Iowa Hospital Association also received grant funding for three years from the FCC in 2008 to link 80 hospital facilities through the state-owned Iowa Communications Network. ICN has provided inter-hospital broadband networking for 23 years and will use the funds to provide the network capacity to extend services to rural hospitals and the communities they serve.

In 2008, seven North Iowa hospitals, integrated an electronic health record system, the first of its kind in a rural healthcare setting. The initiative was supported by two grants from AHRQ, and in addition, the Mercy Health Network-North Iowa, seven rural facilities, local public health agencies, Trinity Health, and the University of Iowa, College of Public Health worked to implement the EHR system.

Iowa has also participated in HISPC, to address privacy and security challenges. The project led by the Iowa foundation for Medical Care and a multi-stakeholder steering committee, studied privacy and security barriers, formed urban and rural consumer focus groups, developed a patient consent framework for treatment scenarios, participated in a continuity of care document exchange pilot, discussed legal and legislative issues, and developed a model for data sharing agreements.

In January 2009 the first meeting of the Electronic Health Information Executive Committee and Advisory Council met. At that time, several workgroups were established to promote the adoption and use of health IT in Iowa. These groups looked at HIEs, privacy and security, provider adoption of EHRs, workforce and education issues, patient identify concerns, and the types of clinical data to be exchanged using the HIE governance.

The Committee discussed the significant start-up and ongoing funding needs. Some of the largest expenses include hardware, software, technical support, legal expertise to safeguard privacy and security, technical project management support for pilot projects, and resources for the overall management and coordination of activities.

Some of the states will receive financial support from their state government for startup costs and ARRA is expected to provide federal financial support. However, this still means that the states will be required to match $1 for each $10 of federal funds in 2011, $1 for each $7 in 2012 and $1 of state match for each $3 for federal funds in 2013 and beyond.

So far, the workgroups and stakeholder organizations have worked together and in the coming year, IDPH and the Electronic Health Information Executive Committee and Advisory Council plan to support additional workgroup meetings to further define and execute project activities, determine cost requirements, and then pursue federal and state grant programs to secure the funding needed for the projects.

To see the full report, go to

NY Funds Workforce Training

Up to $21.1 million is available for New York’s Health Workforce Retraining Initiative to help train or retrain health industry workers who need new jobs and/or new skills due to changes in the healthcare system. The New York State Departments of Health and Labor are jointly soliciting applications from eligible organizations to train workers to meet the new job requirements in the changing healthcare market.

New York’s healthcare industry faces a number of additional pressures including declining statewide and regional occupancy levels at nursing homes and hospitals, persistent shortage of healthcare workers in a variety of occupations, a growing need to integrate emerging technologies into healthcare delivery systems, and the transition of resources from inpatient and tertiary care to primary care.

There are several categories where training is needed. For example, workers need to be trained and retrained to deal with emerging technologies. Training in this category can include training on new coding systems, training to help upgrade to electronic medical records, and training on new hospital information systems. This program will only support equipment directly associated with training and not equipment to be used for on-going operational activities.

Other categories include training laid-off workers, training in shortage occupations, training for changes in job requirements, training to increase diversity in the workforce, and training in occupations where training opportunities are limited by lack of faculty, clinical instructors, or clinical affiliation slots. The expansion of educational capacity can involve nursing such as MSN programs with educational concentrations or for other occupations where opportunities are limited.

Eligible organizations are general hospitals, long term care facilities, other healthcare facilities, health worker unions, labor management committees, healthcare facility trade associations, and educational institutions.

Applications are due October 9, 2009. An applicant conference will be held on August 27, 2009 in Albany New York. For more information, call Barry Gray, Director Workforce Development, Division of Health Facility Planning, New York State Department of Health, at (518) 473-4700. Copies of the RFA (0907311140) are available at, or go to

Military Advancing Wound Care

With operations in Iraq now in the 6th year and Afghanistan operations in their 8th year, doctors at the Walter Reed Army Medical Center (WRAMC) see some of the most severely injured soldiers with multiple wound injuries caused by improvised explosive devices and intense firefights. According to Army Colonel Alexander Stojadinovic, M.D., a Surgeon at WRAMC, there is a need to have an inter-service partnership as well as a private-public partnership to provide not only advanced complex wound care but also complex wound translational research medicine.

Researchers and staff from the Armed Forces Institute of Pathology (AFIP) are working with WRAMC to support research on wound control. This has resulted in a partnership between the Combat Wound Initiative program (CWIP) and the AFIP’s Complex Wound Biospecimen Network Program.

The biorepository for the program will be maintained by AFIP’s Division of Wound Biology and Translational Research. This division has newly renovated laboratories, administrative space, and state-of-the-art equipment and is able to provide wound analysis and molecular diagnostics and therapeutics using cutting edge instrumentation and techniques.

The division is establishing a “Combat Wound Microbial Culture Collection” and a “Combat Wound Genomic Repository.” Researchers will be able to study combat related infections and genetic characterization of microbial agents isolated from the wounds.

Also, extracted metal fragments, foreign bodies, and biospecimens are being submitted to AFIP’s Division of Biophysical Toxicology for biotoxicity studies. Metal fragments, tissues and related wound biospecimens are analyzed and go into the “Depleted Uranium and Embedded Metal Fragments Registries”.

Still Time to Register for ATA

The ATA Mid-Year Meeting will be held at the beautiful Hyatt Grand Champions Resort Villas and Spa in Palm Springs on September 23-25. Come join executives and leaders to discuss telemental health, telemedicine technology, and emerging wireless as well as meet with clinically-based application developers to hear about the latest innovations and developments.

The program will highlight telemedicine’s role in healthcare reform and the stimulus program, social media and telemedicine, the successful use of telemedicine in a private practice, and the state of California’s telemedicine experience.

The meeting will present two great tracks with vital and up-to-the-minute information

• Track One sponsored by the ATA Technology Special Interest Group will feature “Cutting Edge and Off-The-Shelf Technology: Making the Right Decisions”

• Track Two will feature the “4th Annual Pediatric Telehealth Colloquium” jointly sponsored by the UC Davis Health System Office of Continuing Medical Education, UC Davis Children’s Hospital Department of Pediatrics Telehealth, UC Davis Health System Center for Health & Technology, along with the ATA Pediatric Telehealth Special Interest Group

Karen S Rheuban, M.C., President, American Telemedicine Association, Medical Director, Office of Telemedicine, Professor of Pediatrics, Senior Associate Dean for CME and External Affairs at the University of Virginia, will open the Conference along with Jonathan D. Linkous, CEO, ATA, and Gary Capistrant, Senior Director of Public Policy, ATA. The key leaders in the field will discuss telemedicine’s role in healthcare reform and stimulus programs. Hear all about the latest economic stimulus funding actions and the opportunities available.

Richard M. Satava, M.D. Professor, Department of Surgery, University of Washington MedicalCenter, and Senior Science Advisor to the Army Medical Research and Materiel Command, will present highlights on the future of technology in healthcare.

The year 2009 is described as the year for wireless health. Accessing drug interaction information and communicating with doctors along with analyzing cardiac rhythms and MRI scans, are all becoming accepted applications over wireless phones. Robert Jarrin, Director, Government Affairs, Qualcomm, Washington D.C. and Don Jones Vice President Business Development Health, Qualcomm, San Diego will talk about their company’s wireless healthcare projects and how the industry is projected to become a $7 billion industry by 2012.

To meet the needs for social media networking, Craig Stolz Principal, Stoltz Digital Strategies, LLC, will present a keynote address on “Social Media and Telemedicine: Reaching Customers, Patients and the Public on the Social Web.” Come to Palm Springs to learn how your organization can use the power of Twitter, Face book, YouTube, blogs, and other social media to get your message out.

Come early to take part in the Pre-Meeting Symposium to be held on September 23. The symposium organized by the Army Medical Research & Materiel Command, Telemedicine & Advanced Technology Research Center (TATRC) will discuss “Innovative New Technologies to Identify and Treat Traumatic Brain Injuries: Crossover Technologies and Approaches between Military and Civilian Applications”.

This half day forum will provide a unique opportunity for leaders from disparate organizations involved in mental health telemedicine and related disciplines to convene, learn from each other, and explore opportunities to collaborate on new partnership models. The meeting will help TATRC identify opportunities to expand strategic operations and form new alliances.

Other events include a telemedicine 101 tutorial breakfast session to kick off the meeting, the inaugural assembly and organizational meeting, and the ATA Institutional Member Council Reception & Meeting.

To add even more for the attendees, a larger than ever exhibit hall will feature over 25 companies to showcase leading telemedicine products and services.

For more information on the program, on exhibiting, or to register, go to

Sunday, August 23, 2009

$1.2 Billion in Grants Rolled Out

Vice President Joe Biden announced that $1.2 billion in grant funding will be used to help hospitals and healthcare providers implement and use electronic health records (EHRs). The rollout provides two HITECH priority grant programs that will establish Health Information Technology Regional Extension Centers and help States and Qualified State Designated Entities share information within the emerging nationwide system of networks.

“Expanding the use of EHRs is fundamental to reforming our healthcare system,” said HHS Secretary Sebelius. “Electronic records can help reduce medical errors, make healthcare more efficient, and improve the quality of medical care for all Americans.”

“The grant programs will help healthcare providers select and incorporate EHRs into clinical practice and help the states assure that statewide information exchange is developed with an eye toward nationwide connectivity across the healthcare system”, said Dr. David Blumenthal, National Coordinator for Health Information Technology.

The Health Information Technology Regional Extension Centers with $598 million will support 70 or more regional centers across the country. The centers will offer hospitals and clinicians hands-on technical assistance to support “meaningful use” of certified EHR systems, and focus on clinicians that provide primary care services. The Centers will help medical and healthcare professionals select EHR products, implement a certified EHR product, and help with legal, regulatory, professional, and ethical requirements.

As Dr. Blumenthal points out, the new modern health IT centers can be considered as somewhat akin to the agricultural extension centers Congress set up early in the 20th century to help support vast improvements in the efficiency, quality, and productivity in the agricultural sector. We hope that this 21st century health IT extension program will have a similarly profound effect in helping healthcare providers make a major transition in our nation’s health system, ultimately improving the quality, efficiency, reliability, availability and equity of care for every American.

Grants under the Regional Extension Program will be awarded on a rolling basis with 20 grants expected to be awarded in the first quarter of FY 2010. The initial funding will ensure that comprehensive support is available to providers beginning early in FY 2010, with an additional $5 million available for years 3 and 4 of the program. Federal support will continue for four years and at that point, the program is expected to be self sustaining.

A National Health Information Technology Research Center (HITRC) will also be created with an investment of $50 million. The HITRC will help the regional centers collaborate with each other and will serve as a national clearinghouse to identify and share best practices and experiences so that providers can learn from what others have experienced when they put their systems in place.

The State health Information Exchange Grant program with funding of $564 million, will award cooperative agreements to states and qualified state designated entities to advance information sharing across the healthcare system. States may choose to enter into multi-state arrangements but will be required to match grant awards beginning in 2011.

The states are expected to:

• Develop and implement up-to-date privacy and security requirements for HIEs
• Develop directories and technical services to enable interoperability within and across states
• Coordinate with Medicaid and State Public Health Programs to enable information exchange and also to monitor provider participation in HIEs
• Remove barriers that may hinder effective HIEs, particularly those related to interoperability across laboratories, hospitals, clinician offices, health plans, and other HIE partners.
• Ensure that an effective model for HIE governance and accountability is in place
• Convene healthcare stakeholders to support a statewide approach to HIE.

Go to or to for more information on the grants and application requirements.

States Expanding Broadband

The Massachusetts Broadband Institute (MBI), a Division of the Massachusetts Technology Collaborative has submitted two proposals for $105 million to obtain stimulus funding to expand broadband in the western part of the state.

A request for $100 million was sent to the Broadband Technology Opportunities Program seeking funds to build a broadband fiber infrastructure to provide services to 43 unserved and underserved communities in western Massachusetts. Specifically, the MBI proposes to build a fiber “middle mile” network throughout the region and then provide direct connection to regional anchor institutions and critical community facilities.

In addition to the $100 million request, a proposal was submitted for $5 million for statewide broadband mapping to the State Broadband Data and Development Program.

In Illinois, an RFP was posted on August 14th seeking proposals to provide fiber-based facilities to service five regions in the State of Illinois for the Illinois Rural HealthNet (IRHN) project. The regions for service include Northern Illinois, Urbana Central, Southern Illinois, Springfield West and Bloomington Northwest.

In the first phase of work, the IRHN will be managing a $21,063,528 award from the FCC’s Rural Health Care Pilot Program and will use the funding to construct a network to connect 85 rural communities to sources that provide specialized healthcare. High speed networking for rural hospitals, clinics, and mental health facilities will be maintained to allow rural patients access to telemedicine and telehealth services to enable remote diagnostics.

When completed, the IRHN will provide for virtually instantaneous transfer of diagnostic images for treating cardiology, neurology, and oncology patients, virtual consults for trauma patients, psychiatric services, and have the ability to use electronic medical records to improve access to patient information.

Future IRHN efforts will focus on expanding network connections to other Illinois healthcare providers and be able to help researchers collaborate, provide continuing medical education, help in gathering public health data, plus improve capabilities to better handle medical emergencies and disaster recovery.

For more information, go to Click on Funding year 2009 then go to Illinois RFP#02. For email, go to or call 1-800-229-5476.

$300 Million to Support CER

Grant and contract solicitations are going to be published to support new Comparative Effective Research Projects (CER) supported by $300 million from ARRA appropriated funds. AHRQ has announced that the funding will focus initially on 14 priority conditions discussed by the public as well as by federal agencies and will be formally established by the HHS Secretary. AHRQ anticipates that the grant and contract solicitations will be published beginning in fall 2009 with funding to begin in spring 2010.

The Funding Opportunity Announcements soliciting grant applications will provide:

• $148 million for evidence generation which will include $100 million for the Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE)
• $48 million to establish or improve national patient registries
• $29.5 million to support innovative translation and dissemination grants related to CER
• $20 million to support training and career development in CER

Requests for CER contracts will provide:

• $9.5 million to develop the infrastructure to identify new and or emerging issues for comparative effectiveness review investments
• $10 million to establish a Citizen’s forum to engage all stakeholders in the entire effective healthcare enterprise

AHRQ will fund other grants for approximately $80 million to support evidence synthesis, evidence generation, translation and dissemination, and for salary and benefits for ARRA-related full time positions.

For more information, go to the August 19th Federal Register. Until the solicitations are published, AHRQ cannot provide information on their contents. Future CER solicitations will be published in the NIH Guide For more information on the Effective Health Care Program, contact Lia Hotchkiss at 301-427-1502.

DOD SBIR Solicitation Released

The DOD 2009.3 SBIR Solicitation just released is accepting proposals on a number of topics. The Army’s SBIR program is particularly interested in the development of a portable device to diagnose soldiers that are at risk for mTBI and PTSD following their injury and recovery period.

The American Academy of Neurology has established diagnostic criteria for TBI based upon gross behavioral and affective symptoms. These symptoms are difficult to observe in many battlefield situations and may provide only a superficial description of what may be a distinctly complicated injury.

Mild TBI is uniquely difficult to diagnose due to the often delayed and subtle presentation of symptoms. Additionally, many of the symptoms that present for mTBI are also common to other battlefield related neuropsychological conditions such as Acute Stress Disorder and PTSD

Since this is the case, the Army is seeking a non-invasive tool that could provide important information regarding a soldier’s mental health status through the detection and monitoring of biological patterns and/or signals.

For the Army to gather the volume of data needed, a portable inexpensive device is needed to be used near the forward edge of the battle area. The device also needs to be transportable by vehicles to remote sites and have the capacity to provide data comparable to legacy neuro-imaging devices. This new device must use non-invasive techniques to gather the data, provide functional, spatial, and electrophysiological data, collect data from medically relevant areas of the cortex, and allow sufficient freedom-of-movement for the patient to conduct limited physical/cognitive tasks.

Developing the models to diagnose PTSD and mTBI is not the focus for this solicitation. What the Army is looking for is a device that will provide the developmental platform and the data for in-house researchers to derive diagnostic models.

DOD is now accepting proposals for the DOD 2009.3 SBIR Solicitation due on September 23, 2009. For information on all the SBIR solicitation topics and on the need for the portable device, go to The contact information on the portable device topic (A09-157) is Kenneth Pitts, or call 508-233-4539.

Tuesday, August 18, 2009

Bridges to Excellence News

Bridges to Excellence (BTE) has five new programs in place to assess diagnosis improvements, and the treatment and management of chronic conditions such as asthma, congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease and hypertension.

The BTE programs provide incentives to reward physicians and practices so that they are able to adopt better systems of care. The Programs results in physician practice reengineering, the adoption of health IT, and good outcomes for patients. Doctors that demonstrate excellent performance can earn recognition and also qualify for incentives from participating employers and health plans.

The new programs to earn incentives include:

• Asthma Care Link—Physicians must meet benchmarks on lung function testing and monitoring, appropriate asthma medication therapy, smoking cessation, and provide for annual flu vaccinations
• Congestive Heart Failure Care Link—Physicians must meet benchmarks on measuring LV function assessment, appropriate ACE-I/ARB therapy, and on assessing patient activity levels
• COPD Care Link—Physicians must meet benchmarks on measures such as spirometry evaluation and monitoring, appropriate use of inhaled bronchodilators, smoking cessation, and provide for annual flu vaccinations
• Coronary Artery Disease Care Link—Physicians must meet benchmarks on measuring blood pressure and lipid management, aspirin/anti-thrombotic use, and beta blocker use following an MI
• Hypertension Care Link—Physicians must meet the benchmarks on measuring blood pressure and lipid management, aspirin/anti-thrombotic use, diabetes screening, and counseling for diet and physical activity

Blue Cross and Blue Shield of Texas (BCBSTX) are now licensed as a sponsor of a new BTE program that will improve quality management of patients with chronic diseases. Because of the growing prevalence of diabetes in Texas, BTE and BCBSTX will reward physicians who deliver consistent effective care for diabetic patients.

In addition to the BTE diabetes program, BCBSTX is focused on metabolic syndrome. Metabolic syndrome is the presence of a cluster of any three of the five conditions found in one patient such as an unhealthy waist circumference, having diabetes or being pre-diabetes, high blood pressure, high triglycerides, or low HDL. Plans are to raise awareness and engage individuals at risk to eat healthier and be more physically active.

BTE is the operational partner of PROMETHEUS Payment Inc which is in place to provide both administrative and programmatic support. The idea is to provide a new provider payment model that offers a different approach to payment to include all of the providers treating a patient for specified conditions.

This new approach based on Evidence-Informed Case Rates (ECRs), calls for care coordination, and a consumer driven environment. Pilots are ongoing and the program is currently being tested in Illinois, Minnesota, and Pennsylvania. Refinements and adjustments to the model will be made based on the pilot site test results.

For more information on the programs, go to

Great Ideas Can be a Reality

The University of Michigan is proud of their Medical Innovation Center (MIC) and how it helps the medical profession foster creative solutions. To find a way to promote innovation began when Jim Geiger, M.D., a UM Associate Professor of Surgery had trouble using an unwieldy surgical clamp. He often operated on infants with pyloric stenosis—an obstruction in the pyloric muscle that connects the stomach to the small intestine, but there was a problem as he generally had to use surgical instruments that were made for adults.

The more Geiger tried to fit an adult-sized surgical clamp through a tiny incision in a new born baby, the more he thought that there must be a better way to do the procedure. He sketched out some designs for new pyloric clamps to use on his patients. He shopped them around but his ideas went nowhere since it takes time and money to develop new medical devices and the market for instruments used in pediatric surgery is generally too small for companies to justify the investment in new technology.

After a time, Geiger teamed up with Albert Shih, PhD a Professor of Mechanical Engineering who was making a career transition to biomedical engineering. Both men decided that one way to approach finding a solution for the problem was to use the talents of a team of senior engineering students enrolled in the medical school.

Both men worked with the students to perfect the design for the clamp and Geiger came up with the money to cover the cost of making a prototype. The next step was to approach executives at a medical device company and interest them in licensing the device. This was successfully accomplished by The U-M Office of Technology Transfer in 2008.

Geiger and Shih then decided to take another step and make it easier for others to develop new devices and technology and at that time, created the Medical Innovation Center at the university with Geiger as Director and Shih as Associate Director The center was established in 2008 with nearly $2 million in start-up funding contributed by the Medical School and the Department of Surgery, the College of Engineering, School of Dentistry, Office of the Vice President for Research and the Michigan Institute for Clinical and Health Research (MICHR).

According to the University of Michigan’s Department of Surgery newsletter “News and Notes”, MICs goal is to foster innovation and enable new medical technologies by bringing clinicians, scientists, dentists, engineers, and business professionals together through education and research to work on health issues on a global scale. By using a multidisciplinary approach, ideas can be transformed from an idea into a clinical reality so MIC was created to transform promising medical technologies into viable products in the commercial marketplace.

The Center provides a mentoring system to educate leaders in cross-disciplinary research and they now have their own prototype lab to create prototypes of some of the most promising devices. Grant funding from the MICHR has provided advanced rapid prototyping equipment.

In 2008-09, MIC awarded five fellowships to form a team to work with Geiger to look at how surgeries are performed to see if there can be improvements in the way that surgery is being done. The team of fellows came up with a way to develop a better device to secure IV catheters and so the team was able to start a company to develop the device with a $ 5,000 Business Accelerator Award from Ann Arbor SPARK.

Geiger eventually would like to increase the groups of fellow so that there can be more continuity in the program and expand the MICs global reach by using technology to link with similar programs in other countries. He would also like to hear from Department of Surgery alumni as to what types of devices or processes could be improved to make their work easier and safer.

For more information on MIC, go to or email

Exposure Recorded in EMR

Radiology and Imaging Sciences at NIH’s Clinical Center are taking steps to safeguard clinical research patients who are exposed to radiation during certain imaging tests. Computed tomography and positron emission tomography equipment at NIH is now required to routinely record radiation dose exposure to be included in a patient’s hospital-based electronic medical record.

“When a hospital or clinic patient receives a medication or treatment, it is routinely recorded in the patient’s medical record,” said John I. Gallin, M.D., Director of the NIH Clinical Center. According to David a. Bluemke, M.D., Ph.D, Director of Radiology and Imaging Sciences at the Clinical Center, electronic radiology information systems in hospitals today generally do not collect or report radiation exposures since CT and PET/CT scanners do not currently forward data on the radiation dose to our radiology information systems.

“The National Council on Radiation Protection and Measurements reports that Americans received seven times more radiation exposure from medical tests in 2006 then was the case in the 1980s,” said Ronald Neumann, M.D., Chief of Nuclear Medicine and Deputy Associate Director for Imaging Sciences at the Clinical Center. He reports that ultimately, the radiation dosage will become a standard element of a universal electronic medical record and this information could be used to assess radiation risk from life-long medical testing.

Currently, patients can receive their diagnostic imaging studies records on CD-ROM. The NIH Clinical Center’s program is going to work with the vendors who supply the Clinical Center’s imaging equipment to develop software tools to extract the examination type, date, and radiation dose exposure and include this information in the CD-ROM given to the patients. At that point, it will be possible to upload the information to a personal health record.

AMEDD Futures 2039 Project

The Institute for Alternative Futures (IAF) reported in their August newsletter that their Army Medical Department (AMEDD) Futures 2039 Project has been completed. The Futures 2039 Project was designed to help young leaders within AMEDD explore the major trends that will impact AMEDD over the next 30 years. More than 40 military and civilian AMEDD personnel in the U.S. and Europe participated in the project

The 2039 project report forecasts how advanced technologies will provide care in the year 2039. The futurists envision that researchers and doctors will have a comprehensive understanding of health and disease at the genetic and cellular levels which will lead to advanced prevention and therapeutics.

According to the forecasts, by 2039, a plethora of biomonitoring devices are going to be available to use for early detection, diagnosis, therapeutic decisions, follow-up prognosis, home self-management, and environmental monitoring. Imaging technologies will be able to investigate inside individual cells and simple handheld devices will be used to make rapid diagnoses at the point-of-care anywhere. Nanomolecules for imaging the location of cancer will be able to deliver powerful therapies directly into cancer cells and then confirm that the tumor is destroyed.

Powerful knowledge tools such as grid computing, comprehensive databases will convert huge amounts of data into knowledge and disseminate it to researchers, clinicians, patients, policy makers, and consumers. Biomonitoring when combined with personal health records will provide vast amounts of privacy-protected data for real-time research on the health status and effects of medical interventions.

By the year 2039, the “Health Advocate Avata” will exist to mediate interactions between individuals and the vast store of medical knowledge in a personalized and ethical way through voice recognition, haptic devices, and high resolution displays. The Avatar will act as a coach educator, navigator, and health manager to tailor interventions to the needs and preferences of the individual health consumer.

Advanced materials and nanotechnology will be used in drugs, durable artificial organs and for medical nanodevices. For example, implants and sensors, adaptive intelligence and a therapy delivery system will be able to automatically and continuously manage a diabetic patient.

The futurists see neurotechnology, which is the convergence of nano-info-bio-cogno technologies, restore and enhance normal brain function. This will be accomplished through enhanced memory, concentration, and emotional intelligence.

Biosensors will be worn on the body or embedded in the environment to continuously track physiological and psychological health status and behaviors. The data will provide a comprehensive ongoing picture of all aspects of health and allow detection of minute changes in disease.

Smart agents and robotic assistive devices will support care providers, allowing patients to self-manage health at home. The center of home healthcare in the home will use in-home diagnostic tests, virtual visits, and virtual reality. For example, an elderly person might work with a collaborative team in person or in virtual space to include physical and occupational therapists. Device manufacturers will also play a role and produce custom assistive appliances to support living independently at home.

A network of public health leaders will serve a similar role for the entire populations and each day they will conduct ongoing privacy-protected monitoring of the massive data available from all digital health activities. The solutions will involve education, policy changes, new therapies, and then efforts can be made to change behavior for individuals, families, communities, and society.

To read all of the 14 forecasts in the 2039 project, go to

Smartronix Awarded Task Order

Smartronix has won an initial $9.5 million task order award to redesign the web site. The task order includes the procurement, installation, configuration, security, and 24/7 operation and maintenance of the web infrastructure to support millions of users. If all options are exercised, the award is valued at $18 million over the next five years.

The General Services Administration on behalf of the Recovery Accountability and Transparency Board awarded the task order. To help the Recovery Board meet its mid-October 2009 deadline to complete the website revisions, GSA awarded the contract ahead of schedule and expects the task to be completed in 31 days.

This is the first award under GSA’s Alliant contract which is a multiple award, Indefinite-Delivery, Indefinite-Quantity (IDIQ) Governmentwide Acquisition Contract in which 59 companies were eligible to compete for the award.

Smartronix is headquartered in Hollywood Maryland with operating offices in Virginia, North Carolina, Florida, Alabama, Georgia, Ohio, Texas, and Arizona with more than 550 employees in the U.S. and in Germany, Korea, Japan, and the Philippines.

For more information, contact Laurell Aiton, 301-373-6000 or email

Sunday, August 16, 2009

Technology Helping Stroke Patients

Ochsner Health System a non-profit academic multi-specialty healthcare delivery system that includes seven hospitals and more than 35 health centers in Southwest Louisiana is going to use the REACH turn-key telestroke and telehealth service to improve stroke care in urban and rural areas throughout the state. REACH is typically installed in hub-and-spoke networks, where neurologists at a larger hub hospital provide consulting services to smaller spoke hospitals for remote stroke evaluation.

Dr. Kenneth Gaines, Chairman of Ochsner’s Neurology Department, notes that all of Ochsner’s spoke hospitals with the exception of rural St. Anne General Hospital are in urban areas, yet not all of the neurologists are on-call, so now REACHs telestroke service will enable patients to receive an immediate evaluation when every minute counts.

He continued to say “most hospitals are developing “spoke” stroke care for smaller rural hospitals, but we see a huge need for urban hospitals where often there are stroke care needs. REACH provides a way to link hospitals without neurologists on-call to the main campus where multiple stroke neurologists are able to manage the telemedicine system on a rotating basis.

CDC recently awarded a three year grant to the LA Department of Health and Hospitals Heart Disease and Stroke Prevention Program to build a telestroke network in collaboration with Ochsner and the American Heart Association. The grant funding will address the lack of access to stroke neurologists and the availability of stroke treating hospitals in Louisiana by developing a regional TeleStroke Network in Southeastern Louisiana to eventually go statewide.

According to Dr. Gaines, the grant covers half of the up-front installation and maintenance costs for any hospital that wants to be involved in this program. The system in place within Ochsner will rapidly expand to rural areas and eventually cover the entire state.

In Wisconsin, The Watertown Regional Medical Center’s telestroke program is the first in the state to provide patients with 24/7 telemedicine access to nationally recognized stroke experts. The doctors at the hospital are using an interactive camera and web technology to perform comprehensive stroke evaluations and are able to determine if a patient should receive tPA treatment.

In Arkansas, the Mena Regional Hospital was one of the first hospitals to join the state “Stroke Assistance Through Virtual Emergency Support” program. The program links rural hospitals to stroke specialists at the University of Arkansas for Medical Sciences and to the Sparks Health System in Fort Smith. The program linking nine hospitals administered by the UAMS Center for Distance Health was established with a one year $6.1 million DHS Medicaid contract.

In a research effort to help stroke patients, Cedars-Sinai became the first medical center in California to use a new clot-retrieval device for patients with acute stroke. The catheter-delivered Penumbra system has been approved by the FDA. The Penumbra device is effective in retrieving clots from blocked arteries in the brain in approximately 80 percent of patients within eight hours of the onset of their symptoms. This has resulted in giving patients a better chance at recovering and the device can be used alone or in conjunction with IV tPA.

Other university researchers are working on devices and systems using technology to help people with strokes. The University of Pennsylvania team was awarded a $2.8 million five-year Bioengineering Research Partnership from NIH to develop an optical cap to monitor the cerebral blood flow in patients with head injuries such as in the case of strokes. The device is able to continuously monitor brain tissue hemodynamics at the bedside.

The cap contains embedded optical pads placed over major cortical blood vessels in each hemisphere of the brain. The system uses optical tomography, photon-counting detectors, radio frequency electronics, data processors, and a computer monitor to display user friendly images of anatomical information to go to physicians and nurses. The system uses diffusing light to detect physiological changes to be able to inform clinicians about treatments.

Enabling Connected Care

As a family doctor in a small town for 20 years, Mark N. Blatt, M.D. Director, Healthcare Industry Solutions, within Intel’s Digital Health Group, said he knew that connected health could change healthcare. He was a keynote speaker at the “Enabling Point-of-Care Diagnostics” program held at the “Next Generation DX Summit” held on August 10th in Washington D.C.

As Dr. Blatt pointed out, our society is faced with an enormous problem. Today, 91 percent of patients have one or more chronic diseases and that means that 83 percent of healthcare spending now goes to treating those patients. To compound the problem, baby boomers over 65 will have a number of chronic diseases. It is projected that by 2050, there will be 2 billion people over 65 with chronic diseases which will result in severe problems in terms of costs and the care needed.

Dr. Blatt said legislators are looking to improve treatments for chronic diseases in the U.S. In May 2009, the “Independence at Home Act” was introduced in the House and a similar bill was introduced in the Senate. The bills call for establishing a voluntary at home chronic care coordination pilot. This pilot would provide for electronic medical records and electronic health information technology to be used to coordinate the patient’s healthcare. The primary goal would be to provide patients with chronic diseases access to coordinated primary care medical services in lower cost treatment settings.

Dr, Blatt said that Intel is focusing on connected healthcare to provide for effective and less costly chronic disease management. Researchers are working on new technologies that use sensors and remote technologies and are moving to develop personalized, self-managed, timely, and cost effective care.

For example, the “Intel Health Guide” a comprehensive next generation remote patient monitoring solution combines an in-home patient device with an online interface enables clinicians to monitor patients and remotely manage care.

Intel has several other ongoing pilot projects. The Parkinson’s home pilot is collecting objective measures regularly and accurately from patients’ home. The Intel CAMP pilot uses technology to make certain that people take the right pill at the right time. Since this program has been in use, compliance in taking medications is up by 50 percent. Intel’s Gait and Fall Clinical System now prevents hospitalizations by using cameras and sensors to prevent falls.

The future calls for the development of devices that provide two way communication along with 24/7 connection. According to Dr. Blatt, it is very important to use the latest connecting technologies to treat not only chronic diseases in the U.S., but equally important to develop technologies to combat worldwide diseases and epidemics especially as needed in the worldwide emerging market arena.

As Dr. Blatt explained, teleradiology, telepsychology, telepathology, and teleophthalmology have been in use in emerging countries for some time, but in addition, simpler devices are needed to monitor and treat common illnesses. Healthcare workers in emerging countries have mostly an 8th grade education and need to deal with a high volume of cases which they usually treat using mostly low technology solutions. These countries need to have a simple device on hand to collect vital signs and at the same time, be able to send and receive information from other sources in real-time.

Dr. Blatt concluded that if the country wants to transform healthcare, the future absolutely requires using two way point-of-care technologies to reduce healthcare costs, develop devices that are simple for the patient and health worker to use, and make devices available to enable interactive educational possibilities.

The Conference was coordinated and produced by Cambridge Healthtech Institute in Needham MA. For more information, go to or call (781)972-5400 for future programs. For the complete agenda on the “Enabling Point-of-Care Diagnostics” program, go to

AHRQ Posts Grant Notice

On August 13th, AHRQ posted a notice soliciting grant applications to do systematic studies to transform the delivery of primary care. Providers, employers, insurers, and others have suggested the Patient-Centered Medical Home as a model to improve primary care in this country. As a result, numerous healthcare systems and medical groups are currently attempting to transform their primary care practices into PCMHs.

The research will look at whether healthcare quality improves when practices are transformed into a PCMH and examine how the transformation occurred, the impact on costs of care, and how the patients rate the experience. In addition, researchers will look at the organizational and contextual factors within the practices that have influenced the success of these efforts.

The estimated total funding for the program is $3,200,000 with 10 to 12 grant awards to be awarded. The closing date for the applications is November 18, 2009. Eligible applicants can include state, county, local governments, or Native American tribal governments. Public and private institutions of higher education are also eligible to apply.

For more information on “Transforming Primary Care Practice” (R18), go to The funding Opportunity Number is RFA-HS-10-002.

Chronic Care RFP Posted

Louisiana residents with chronic illnesses enrolled in Medicaid will soon have greater help managing their conditions. A new program called the “Chronic Care Management Program” (CCMP) a statewide Medicaid quality improvement initiative is scheduled to begin operating January 2010.

The intent is to award a contract with a qualified healthcare organization to be the CCMP administrator. A Request for Proposals (RFP) was issued August 4, 2009 with the proposal due October 16, 2009.

The program is going to create a more coordinated system of care to help individuals with chronic conditions such as asthma, hypertension, diabetes, congestive heart failure, end stage renal disease, strokes, sickle cell anemia and COPD. The healthcare team approach needs to include but not be limited to care managers, social workers, pharmacists, and lay health workers.
The contractor will need to use predictive modeling to identify individuals for participation in the program, provide outreach and education on chronic illnesses, develop and implement physician-driven plans of care, perform assessments, and provide counseling and monitoring. The contractor will need to provide face-to-face consultations and a free call in line to help participants with disease management.

The contractor must provide real-time electronic health surveillance to interface with advanced health information technology and be able to receive claims data to use to produce reports, surveys, and studies. In addition, the contractor needs to be able to maintain a HIPAA compliant interactive web-based information system and member registry to maintain demographic and clinical information on CCMP participants.

To download the RFP, go to For more information, contact Mary Scorsone at or call 985-413-3166.

Wednesday, August 12, 2009

FDA Funding Projects

FDA has announced plans to fund a heart disease registry for pediatric patients. The registry would help facilitate pediatric cardiovascular device reviews, expedite new device approvals, facilitate post approval studies, and enhance ongoing post-market surveillance.

Currently there is no pediatric cardiology registry that is designed to handle FDA post-market surveillance challenges. Also needed is valid reference data for the development of alternative premarket clinical trial designs, standard definitions, and the ability to link different databases.

FDA wants to provide a registry that will assess the prevalence, demographics, management, and outcomes of patients with congenital heart disease who are undergoing diagnostic catheterization and catheter-based interventions in the U.S.

The collection and analysis of the data will provide performance measurements, benchmarking, and quality improvement initiatives. The registry will also provide for long term data collection and the ability to capture imaging and clinical outcomes when patients return for care for related or unrelated issues.

The FDA pre-solicitation notice for the registry was posted on August 7th has the response date of August 20th. For information on the pre-solicitation notice, go to FDA on or about August 21st plans to issue a full Request for Proposal (RFP) for the registry and the RFP (09-223-SOL-00214) will be posted on For more information, contact Jacqueline Richardson at

FDA has made funding available to support the Office of Critical Path Programs (OCPP). The initiative launched by FDA in 2004, is working with other Federal, academic, scientific, and industry organizations to develop new innovative tools involved in FDA regulated product development. The program is looking for tools to include novel biomarkers, laboratory assays, genetic tests, and state-of-the-art information technologies.

Many of the scientific tools used today to predict and evaluate safety and effectiveness as well as manufacturing products are now decades old, time consuming to use, cumbersome, may be imprecise, and may fail to predict specific safety problems.

Better tools to predict and detect safety problems are needed early in the Critical Path. At that point, products that are likely to fail would be weeded out and then developers would be able to focus on products with a high probability of safety and effectiveness. Also needed are tools to guide the sponsor of a drug in choosing the appropriate dose and regimen or in the case of medical devices, the right size and placement. Manufacturers need tools to better mass produce an approved medical product such as a vaccine and to be able to evaluate the quality of the finished product.

FDA will award a single source Cooperative Agreement for $1.5 million to go to the Critical Path Institute (C-PATH). Competition is limited because of FDA’s ongoing collaboration with the University of Utah and the Critical Path Institute.

The FDA Office of Critical Path programs is also working with the Harvard Clinical Research Institute (HCRI) to fund a Dual Anti-Platelet Therapy (DAPT) clinical trial. Currently, there is uncertainty about the optimal duration of DAPT and it is unclear as to whether the duration of the therapy in patients receiving drug eluting stents should be 3-6 months, 12 months, or even longer. Plans are for a trial to be conducted with four device manufacturers and two drug manufacturers under the direction of HCRI.

Funding for SSA's HIT

On August 7th, the Social Security Administration announced the availability of $24 million in contracts to provide SSA with electronic medical records to improve the efficiency of its disability programs. With health IT, SSA will be able to expand their disability workload of more than 15 million patient-authorized requests for medical information from healthcare providers. Presently, it takes weeks and months to gather the information and by SSA using HIT, the agency will be able to automate both the authorized request and receipt of data in seconds and minutes plus be able to better analyze the data.

In February 2009, SSA partnered with MedVirginia on the first productive use of the Nationwide Health Information Network (NHIN) to make requests and receive electronic health records. The initiative improved the speed of disability decisions made in the pilot offices.

Through a Request for Proposal, SSA is looking for healthcare providers, provider networks, and health information exchanges to participate in its “Medical Evidence Gathering and Analysis through Health Information Technology” program. The contracts will require awardees to send Social Security electronic medical records through NHIN.

The contracts will be awarded under a full and open competitive fixed-price RFP and funded through ARRA. The response date is September 18, 2009. For more details on RFP_10_1001, go to For more information on SSA’s use of health IT, go to

Focus on Psychological Health

The National Center for Telehealth and Technology (T2) a center within the Defense Centers of Excellence (DCoE) program, researches, develops, evaluates, and deploys new and existing technologies. The Center’s studies involve psychological health and traumatic brain injuries, but the center is also involved in coordinating innovative technology applications to use for suicide surveillance and prevention, developing online behavioral health tools, and providing for mental health applications.

The Center is working with virtual reality mental health applications to treat psychological health (PH) and traumatic brain injuries (TBI). The Center’s Innovative Technology Applications program is doing research and has increased the number of providers trained in VR. Future plans include using VR to support pre-deployment psychological resiliency, to conduct TBI assessments through VR, and to expand access to care through virtual worlds.

The Center’s T2 surveillance program monitors suicide events across DOD. The Suicide Risk Management & Surveillance Office helps DOD standardize and track suicide events and their risk and protective factors. The DOD Suicide Event Report (DoDSER) is a web software system that enables to the military to capture detailed information and to brief senior leaders on risk factors across all services. The DoDSE is developing new features such as Common Access Card login and account management features.

The Center’s Automated Behavioral Health Clinic (ABHC) offers a standardized and automated check-in process for mental health clinics that treat service members or veterans. The system is a software system custom tailored to the business practices of military behavioral health clinics.

The ABHC has two web portals of entry with one for patients and one for providers. The ABHC uses standardized measures with established reliability and validity to gather clinical information on PTSD, depression, anxiety, panic, anger, and alcohol and substance abuse. Additionally, information is collected on medical histories, childhood traumas, mental health stigmas, marriage quality, combat exposures, and family and military careers.

Future plans include increasing integration across DOD, sub-specialty clinic customization, DoDSER integration, and AHLTA connectivity. This program collaborates with Fort Lewis, WA, Pacific Regional Medical Command, HI, San Diego Naval Medical Center, CA, and Tri-Service in NCR.

One current research project is evaluating the effectiveness of Virtual Reality Exposure Therapy (VRET) by comparing it to Prolonged Exposure (PE) Therapy in when treating active duty soldiers with PTSD. The rationale for this study is based on the growing evidence that VRET is a high quality effective treatment for PTSD and helps to improve access to caring for soldiers who might otherwise avoid traditional talk therapies due to stigma. Despite its promise as a viable treatment option, there are no published studies comparing VRET to PE in the treatment of combat related PTSD.

The center publishes a quarterly newsletter at that offers information on post deployment conditions. These conditions can include combat stress, conflicts at work, reconnecting with family and friends, depression, anger, sleep problems, substance abuse, stress management, spiritual guidance, living with physical injuries, and health and wellness.

For more information, go to

A Look at Financial Options

In June, Connecticut’s Department of Public Health released their Health Information Technology Plan on implementing health IT and HIE throughout the state. Recently, legislation was passed by the state’s General Assembly naming the Department of Public Health as the lead HIE organization to establish HIT and to establish an advisory committee to examine and identify ways to improve health information exchange in the state.

One of the major considerations is to establish financial models to support infrastructure development. According to the report, there are numerous funding options available to states and regional health information organizations to develop governance capacity as well as technical infrastructure to support HIEs. However, more recently, as health IT/HIE projects have gained momentum and viability on a national level, states are now in the process of developing financing models to support HIT and HIE adoption.

Several funding options are open to drive the development of HIEs. For example HHS is providing several funding sources through the Office of the National Coordinator for HIT, and through AHRQ, CMS, HRSA, and the Office of Rural Health Policy.

The Recovery Act includes funding for promoting EHR adoption and to use to accelerate the construction of the NHIN. Funds will be funneled through the federal agencies but a significant amount will be distributed at the state level.

Private funding of statewide HIT/HIE efforts have been successful in certain markets where economies of scale are dominant. Private health plans have shown interest in funding start-up costs of HIEs and funding the adoption of EHRs across multiple communities.

Private foundations are an additional funding stream for start-up operations or to help develop pilot programs. The report points out that several foundations in the state could be instrumental in supporting the start-up operations or to help in the development of pilot programs. The most likely of these foundations would be the grouping of insurance “conversion” foundations and the Connecticut Health Foundation.

There are several examples of other states with funding provided by private health plans and foundations such as:

• CalRHIO which was initially capitalized by six of the state’s largest health plans with each contributing $1 million. CalRHIO receives funds from federal agencies and California-based private foundations

• Blue Cross/Blue Shield of Arkansas financed the Advanced Health Information Network while piloting low-cost wireless EHRs for small practices.

• Blue Cross/Blue Shield of Massachusetts provided $50 million to fund the Massachusetts of eHealth Collaborative for 3 years

• Blue Cross and Blue shield of Nebraska is the main payer leading the Nebraska Health Information Initiative

• The provisions made through The Stark and Anti-Kickback Exemptions help physicians and other healthcare practitioners or entities receive donations of interoperable EHR technology

There are several possible revenue models that could be used to provide for sustainability in Connecticut as the state RHIO operates through a variety of membership and/or usage fees. It is not necessarily a viable option in the near term, but as the network-based infrastructure matures and service offerings expand, a membership fee structure by organization type may be a practical consideration. These payments could be maintenance fees for hosted services, transaction-based fees, along with service, training, and secondary data use fees.

In order for Connecticut to take full advantage of the opportunities in HITECH and the other sources of funding for health IT within the ARRA, there has to be coordinated activity among a broad range of stakeholders and the formation and the state designation of an entity to take the lead on HIE. In addition, the state has to take an active role to provide leadership and be able to provide the matching funds that may be required to bring the maximum level of funding to the state.

Outside HITECH funding, the state may receive significant amounts of discretionary funding to meet the requirements of the broader stimulus package. However, it is likely that the availability of the designated funding through HITECH will make it more difficult to obtain the highly competitive discretionary dollars.

To download the full report, go to, click on newsroom, go to press releases, click on July 2009 releases, and go the DPH news release published on July 17th.

Sunday, August 9, 2009

Committee to Advise the President

The inaugural meeting of the President’s Council of Advisors on Science and Technology (PCAST) met on August 6-7 to offer insights on policy recommendations in the areas of science, technology, and innovation to President Obama. PCAST is administered by the Office of Science and Technology Policy (OSTP) within the Executive Office of the President.

Dr. John P. Holdren, one of the three Co-Chairs of the Advisory Committee, Assistant to the President for Science and Technology, and Director of the Office of Science and Technology Policy, said “it is a privilege to be working with the Committee to meet the many challenges the country faces.”

The members of the committee include 4 winners of the MacArthur “genius” awards, 3 Nobel laureates, 2 university presidents, as well as 16 members of one or more of the national academies of science, engineering, and medicine. The Committee is in place to make policy recommendations in areas where the understanding of science, technology, and innovation will help to strengthen the economy.

A morning panel discussion on health IT included three experts in the field. David Blumenthal, M.D., the National Coordinator for Health Information Technology, started the discussion on health IT, by saying we need to focus on the use of technology, not just on the technology itself. His office thinks of technology as a means to an end.

He continued to say that there are challenges in accomplishing the task of getting physicians to use the technology since only 20 percent of physicians and 10 percent of hospitals are now using electronic health records. So getting health IT adopted is high on the agenda but to do the job, the right incentives must be in place.

Dr. Blumenthal explained that physicians are faced with uncertainties as to which technologies to adopt and this causes them to feel frustrated. They are also concerned about the platforms needed to support innovation and change, how to develop the right configuration to be able to exchange health data, and how to manage privacy and security issues.

According to Aneesh Chopra, M.D., Associate Director and Chief Technology Officer, OSTP, and appointed as the nation’s first Chief Technology Officer, more Americans have cell phones than dishwashers and this had resulted in decreasing costs for cell phones. As innovation surges, the demand for products increases, costs are reduced, and the public has the opportunity to use more and more digital technologies and applications.

Dr. Chopra said that years ago home networking systems could cost the home owner $100,000 per home. Innovators reengineered the systems, and now the home networking systems are accessible to all Americans and available at prices they can now afford.

He went on to emphasize the need for electronic health systems to help researchers have access to correct and current information. For example, in the U.S, 1.4 million people are diagnosed with cancer and in addition, 40 percent of the population will be faced with cancer challenges. Therefore, it is very important for research and clinical data to be available electronically to better understand future research needs.

John Glaser, PhD, Advisor to the Office of the National Coordinator for Health Information Technology and Vice President and CIO for Partners Health Care says doctors are faced with a tremendous amount of data. The reality is that they don’t always have the time to go through all their notes when they are with a patient. They need to have access to effective electronic technology to determine the exact information that they need at any specific time.

Information not only needs to be available locally in the doctor’s office, but also needs to be available in national databases. Technology needs to be available to mine the large volumes of information on the databases so that the data can be presented at the point-of-care to physicians and/or go to the research community. This is particularly critical in dealing with genetic information and information on clinical trials.

For more information and to see the complete list of the PCAST Advisory Committee Members, go to, then click on About PCAST.

Upgrading Electronic Records

According to the Department of Veterans Affairs publication “Research Currents”, the VA is working on a new research project to harness the power of Natural Language Processing (NLP) to obtain more value from electronic records. The project called the “Consortium for Healthcare Informatics Research” (CHIR) is working to change free text as found in the doctor’s notes in electronic medical records and then translate these notes into structured data. It’s basically a matter of converting information from one form of information into a different format.

Webmasters and database architects typically use checkboxes, pull-down menus, and other tools to structure the information they want to collect. Electronic health records use structured data and templates wherever possible but there is also the need for free text.

It is difficult to ask clinicians to input only structured data when they are evaluating patients as they need to be able to use free text. Merry Ward, PhD, who oversees CHIR for the VA’s Office of Research and Development, says “narrative is very important for healthcare providers. Radio buttons, pull-downs, yes-no, and other forced choices can only go so far in describing the patient’s condition.

According to the researchers, it is also important to be able to convert narrative text into structured data, because it makes it easier to measure quality, track infectious diseases and adverse drug events, and develop new decision support systems.

As part of CHIR, two multi-year studies are underway to develop natural language processing and clinical applications. One study will look at MRSA to be able to capture more relevant MRSA information in the record beyond the standard coded data. A second project on PTSD will examine whether free text can shed light on how the disorder progresses and how symptoms may vary from one patient to the next. Other CHIR projects will look at clinical topics that deal largely in caring for heart disease, cancer, and other diseases.

In another project, the “Veterans Informatics, Information and Computing Infrastructure” (VINCI) will roll out electronic medical records from VA sites nationwide into one secure centralized data repository. Tools to do natural language processing will be installed and available for use within the VINCI environment to enable access to not only free text but also to have access to information on all veterans. Researchers will then be able to conduct large, nationwide studies covering up to two decades of medical care for patients from the information documented in the electronic records.

Helping Children in Texas

The Texas Health and Human Services Commission’s (HHSC) newsletter “In Touch” describes how health information technology is coordinating care for Texans enrolled in Medicaid. A major move was started this year when HHSC rolled out STAR Health to manage healthcare for children in foster care and that included a first-of-its-kind network called Health Passport. The network is able to provide secure web-based electronic health records for the 30,000 children in the Texas foster care system.

The Health Passport is not a complete clinical record of a child’s previous and current healthcare services, but it gives caseworkers, foster parents, and medical providers an easily accessible record with high-level medical and administrative information to help healthcare professionals coordinate care.

Building on the success of the Health Passport and STAR Health, HHSC is expanding the use of electronic health records to provide electronic health records to all enrolled in Medicaid and to the Children’s Health Insurance Program (CHIP).

Currently, the Texas legislature via House Bill 1218, has called on HHSC to establish an EHR Exchange System and to set up a pilot project to test sharing secure electronic health information with hospitals, clinics, and other healthcare providers through local or regional health exchanges.

To develop the project, HHSC is now in the process of soliciting nominations for the Electronic Health Information Exchange System Advisory Committee which will have 12 to 16 members participating. The application deadline to be on the committee is August 14, 2009.

According to the Texas Tech newsletter, “Rural and Community Health Messenger”, $6.7 million in telemedicine grant funding was awarded to Texas Tech University Health Sciences Center to go to the F. Marie Hall Institute for Rural and Community Health.

The funding for over 26 months will be used to expand and study access to pediatric primary and specialty care for Medicaid patients enrolled at 30 patient sites in rural communities throughout West Texas. The project is called “Children’s Healthcare Access for Rural Texas” (CHART). At this time, members from the four Texas Tech University Health Sciences Center Schools of Medicine campuses are assessing the needs of the communities in the region to determine the most effective locations to establish the 30 sites.

Many rural and underserved West Texas communities face significant challenges when seeking pediatric healthcare services. A severe shortage of general pediatricians and pediatric specialists exists in rural and underserved communities and requires lengthy travel to locations where healthcare specialists are available.

In addition, a new TELEDOC ™ design will be launched with the CHART project. Texas Tech’s Department of Telemedicine developed their newly designed TELEDOC and previewed it at the 2009 ATA Conference in Las Vegas in May where it received positive reviews from physicians. They particularly liked the tabletop work space and the easy access to the electronic diagnostics tools.

Funds for Healthcare Training

The Department of Labor’s Employment & Training Administration (ETA) has $220 million in grant funds available through ARRA to use to train and help workers pursue careers in healthcare and other high growth and emerging industry sectors. ETA expects to provide $125 million of the designated funds for healthcare projects and fund 45-65 grants ranging from $2 million to $5 million. DOL also intends to use a portion of the funds to create a virtual tool to help workers learn about and prepare for careers in healthcare.

The transition from paper based medical files to electronic health records will mean more career pathways in health information management and technology. Also, comprehensive reforms in health law and policy will require new and updated skill sets for a range of clinical occupations. HIMSS estimates that there are approximately 108,400 HIT jobs in hospital settings currently and expects workforce needs to require an additional 40,800 HIT occupations by 2012.

Eligible applicants can be public entities or private nonprofit entities and may include local Workforce Investment Boards and their One Stop Systems, Tribal organizations, education and training providers, labor organizations, healthcare providers, and faith-based and community organizations.

Applicants must include at least one strategic partner from the public workforce investment system, or from public and private employers, or from the education and training community. In addition to the required partners, applicants are encouraged to include other partners that can come from nonprofit organizations, labor organizations, organizations implementing projects funded by the Recovery Act, with the goal to create jobs in the healthcare sector or other high growth and emerging industries, national, state, and local foundations, and state and local social service agencies.

Applications are due October 5, 2009. For more information on the funding opportunity (SGA-DFa-PY-09-01) posted on July 22, 2009, go to or the Federal Register published on July 22, 2009.

Tuesday, August 4, 2009

Road to High-Value Healthcare

Mark McClellan, M.D., PhD, Director, Engelberg Center for Health Care Reform, Carolyn Clancy, M.D., Director, AHRQ, speaking at a Capitol Hill briefing, emphasized the need for valid, timely, and consistent information on the quality and cost of healthcare to be made available. The Engelberg Center for Health Care Reform at Brookings, along with support from the Robert Wood Johnson Foundation hosted the July 30th briefing to underline how more complete and collaborative information would help to achieve high value healthcare.

Michael Painter, JD, M.D., Senior Program Officer, Robert Wood Johnson Foundation pointed out that in order to achieve a high value quality healthcare system, forces have to be aligned in the community, key stakeholders have to work together not only statewide, but also regionally and locally, plus the public has to be engaged.

According to Dr. McClellan, effective health IT in terms of electronic records not only plays an important role in improving quality and care coordination between patients and providers, but it is also important for payers because by using the data, they are able to evaluate care and be in a better position to provide support through incentives.

Dr. Clancy noted that the AHRQ’s “2008 National Healthcare Quality Report” sees the immediate need for a virtual infrastructure to measure and report on quality and costs. The infrastructure would collect information systematically, analyze, and then summarize the data for information on safety problems and better evidence on effectiveness.

A paper produced by the Quality Alliance Steering Committee (QASC) describes the road to high-value health care and how to develop the infrastructure needed for meaningful quality measurement and reporting. Formed in 2006, the QASC is a collaborative effort of physicians, nurses, hospitals, health insurers, consumers, employers and other purchasers, government, and sector specific quality alliances.

QASC is involved in a range of activities locally, regionally, and nationally and has statewide pilot projects underway in Florida and Colorado. These pilot projects are collecting data from multiple health plans and will compute the results for 17 NQF-endorsed measures. The data includes composite measures for ambulatory care, preventive care medication management, and measures for diabetes, heart disease, lower back pain, arthritis, and depression.

The pilot projects are working with health plans in the two states, with CMS, and with America’s Health Insurance Plans Foundation. Other pilot efforts are going to collect and combine clinical data to include lab results and registry information from specialty societies and other entities including claims data. Also, as part of the “High-Value Health Care Project”, multiple efforts are currently underway to address the best practices for collecting data on race, ethnicity, and language that needs to be standardized and supported by patients and consumers.

In addition, there are other efforts underway in several parts of the country to measure and improve performance to determine the most effective way to promote consistent and comparable quality measures across regions. At this time, QASC is creating a network of regional measurement sites to identify effective, efficient, and widely applicable measurement practices that will be replicated and implemented across the nation.

QASC’s goal for 2010 is to launch 7-10 pilots to produce additional performance measurement results that will rely on selected clinical data elements. These new pilots will address how to measure healthcare disparities and how to efficiently collect information on care experience and resource use.

As for 2011, the goals are to launch 7-10 new pilots to produce further performance measurement results from not only clinical data but also from HIT systems. For 2012, new projects as needed will be launched to produce clinically sophisticated performance measurement results.

Several panelists at the briefing contributed their thoughts on the topic. Panelist John Tooker, Executive Vice President and Chief Executive Officer, American College of Physicians discussed how complex it is to effectively manage chronic diseases. He pointed out that a great deal of information is needed for each patient and this means that each physician is required to interact with many physicians to treat the patients needing chronic care management. Physicians are required to deal with not only complicated but also with enormous amounts of information. As a result, how the data is presented and used can greatly affect quality and the cost of healthcare.

Steve Findlay, MPH, Health Care Analyst and Managing Editor of “Consumer Reports Best Buy Drugs,” looking at the problem from the consumer’s viewpoint, can see how overwhelmed consumers are with choices and information. As he sees it, in order to obtain good quality care, not only providers but also consumers are greatly in need of outcomes and measurement information.

Jim Chase MHA, President of Minnesota Community Measurement a non-profit collaborative, supports greater transparency. The group includes medical groups, clinics, physicians, hospitals, health plans, employers, consumer representatives and quality improvement organizations. According to Chase, one of the most promising results is that in the five years that the organization has been measuring which medical groups are providing optimal care for their patients with diabetes, the number of people receiving the best possible care has almost tripled.

Funds Available to Survey ASCs

Earlier this year, a GAO report underscored that Ambulatory Surgical Centers (ASC) do not make standardized data pertaining to the prevalence of Healthcare Associated Infections (HAI) available. According to the GAO report, there are at least five disparate sources of data on HAIs in ambulatory surgical centers and recommended that HHS implement a plan to do recurring periodic surveys at randomly selected ambulatory surgical centers.

On July 31st, HHS Secretary Kathleen Sebelius announced that ARRA funding to be administered by CMS, will go to 12 states to survey more than 125 ambulatory surgical centers before September 30, 2009 at an estimated cost of up to $1 million. The goal is to ensure that the facilities are following Medicare’s health and safety standards. As part of the new initiative, state surveyors will use a new CMS survey process that uses a tool developed with CDC.

New Jersey was one of the 12 states awarded funding of $125,000. Presently, the state has 100 licensed surgery centers that are inspected every two years under extensive state licensing rules. Other ambulatory surgical centers in the state are operated by physicians who are regulated by the state Board of Medical Examiners. The New Jersey Department of Health and Senior Services conducts additional federal inspections which currently are only required every seven years.

New Jersey plus the following states to receive funding include Arkansas ($14,000), Florida ($16,000), Indiana ($62,000), Kansas ($53,500), Maine ($13,500), Maryland ($73,000), Michigan ($53,000), North Carolina ($34,000), Oregon ($53,500), Utah ($62,500), and Wyoming ($11,500).

In addition to the funds made to the twelve states, an additional $9 million will be made available in October 2009 so that all of the states will be able to make additional inspections of ASCs with the new survey tool. Also, CDC will also make $40 million available to state public health departments to create or expand state-based HAI prevention and surveillance efforts and to strengthen the public health workforce to help prevent HAIs.