Wednesday, September 30, 2009

$27.8 Million to Expand Health IT

HHS Secretary Kathleen Sebelius announces awards totaling $27.8 million will go to health center-controlled networks and large multi-site health centers to implement electronic health records and other HIT innovations. The funds are part of the $2 billion allotted to HRSA under the Recovery Act.

“These funds will be used to expand and upgrade electronic health records systems and will make a huge difference for health centers struggling to provide healthcare to the growing number of people in need,” said HRSA Administrator Mary Wakefield, PhD., RN. According to David Blumenthal, MD, the program supports the department’s overall efforts to assist physicians and hospitals in adopting and becoming meaningful users of HIT.

Eighteen grants totaling more than $22.6 million will support EHR implementations. Grants totaling more than $2.6 million will help four grantees implement a variety of HIT innovations, including the creation of health information exchanges among different providers and the incorporation of HIT at dental delivery sites. Another five grants totaling over $2.5 million will help health centers devise plans to use existing EHRs to improve patient health outcomes.

HRSA received $2 billion through the Recovery Act to expand healthcare services to low-income and uninsured individuals through its health center program. To date, more than $1.3 billion has been awarded to community based organizations across the country.

The complete list of grant recipients is available at

Research and Licensing News

Medical software company Analytical Research Systems, Inc. (ASR) and the University of Colorado recently announced that ASR has an exclusive license for the software developed at the university. ASR will use the technology to further develop a new electronic medical record product “asrSynapse ™” to help small to medium-sized independent physician practices.

The web-based point-of-care tool will provide for a longitudinal electronic health record for patients but with a specific focus on primary care, internal, medicine, and chronic disease management. Advanced informatics will provide quality data analysis, along with patient and practice alerts.

To contact ASR, email David M. Spiegel at or call (303) 399-6977.

In a second venture involving the University of Colorado, Illumasonix, LLC, an early stage medical device company has executed an exclusive license with the university. The device developed uses both ultrasound and FDA approved microbubbles to track blood flow, provides real-time assessment of blood flow, and detects blockages.

Illumasonix reports that positive initial results were obtained in early 2009 from the ongoing human feasibility study of the technology and the company anticipates that their first product offering could reach the market as early as 2011.

Illumasonx was formed in 2007, as a partnership between University of Colorado and Allied Minds, an investment corporation specializing in early stage university business ventures. The company received undisclosed initial capitalization and research funding from Allied Minds, as well as $250K in matching funds from the State of Colorado.

To find out more details on this project, email Erick Rabins at or call (206) 336-9707.

The third venture involves the University of Colorado and Biotricity Medical Inc. They have recently executed an option agreement allowing Biotricity Medical to develop technology for implantable biogenerators. These biogenerators can provide a long-term potentially inexhaustible power supply for implanted medical devices such as pacemakers, insulin pumps, cochlear implants, and artificial retinas. The potential for the device is also to improve the quality of life for people enduring chronic pain and Parkinson’s disease.

The company’s first planned product EpiVolt™ is made of living electricity generating cells that use the body’s own natural chemicals and processes to create electrical power. This source of power will be much smaller than the batteries it will replace. The device can be implanted in very small spaces along with the device that it powers without the need for long connecting wires running through the body to a remote battery power source.

To find out more details on EpiVolt™, email Dr. Stephen Rathmill at or call (508) 497-3988.

For more information on all of the tech transfer projects, email Lindsay Polak at the University of Colorado, Office of Technology Transfer or call (303) 735-5518.

CDC Awards Grants

CDC awarded $4.37 million in grants to advance healthcare information management and to improve the detection and response to emerging public health threats. The grants will fund four new Centers of Excellence in Public Health Informatics at Harvard Pilgrim Health Care, Indiana University, the University of Pittsburgh, and the University of Utah. The goal is to find strategies and tools to help health departments, physicians, and other healthcare providers to promote health and prevent diseases, injuries, or disabilities.

Each Center will conduct two new projects to support national priorities in informatics and support real-time biosurveillance for potential health threats. Immediate access will be available at hospitals and health care systems in major metropolitan areas across the U.S.

Researchers at Harvard Pilgrim Health Care, in Boston will integrate EHRs and personal health records to support chronic diseases as it relates to public health. Indiana University in Indianapolis will study how to integrate health information exchange methodology across private and public health domains. The University of Pittsburgh is going to work on detecting and characterizing diseases and outbreaks as quickly as possible. The University of Utah in Salt Lake City building on previous research project with CDC will address decision support needed for disease control.

According to CDC, five previously funded centers have generated over 85 peer reviewed publications, 153 presentations at national meetings, and more than 100 posters and abstracts. The Centers have also contributed to the Informatics Grid and the electronic Medical Record Initiative.

Screening Developmental Disabilities

Between 12 and 16 percent of children in the U.S. have developmental disabilities. The pediatric medical community wants to identify children with developmental delays or disabilities as early as possible by using developmental surveillance and screening. Early intervention programs improve outcomes in children and are also cost effective.

Using computer decision support strategies offers the best hope to achieving this goal in pediatric practices. A program referred to as the “Child Health Improvement through Computer Automation” (CHICA) is available to provide pediatric guidelines, a paper user interface that can be scanned, and a HL7 compliant interface to existing electronic medical record systems.

Preliminary work with CHICA has demonstrated the feasibility of using the system to implement and evaluate clinical guidelines. The AHRQ grant awarded to the Department of Pediatrics, Indiana University, in the School of Medicine proposes to expand CHICA to include a developmental surveillance and screening module.

The researchers are going to evaluate the effect of the CHICA system on the developmental surveillance and screening practices at four pediatric clinics. They also plan to evaluate the effect of the CHICA system on referrals for developmental and medical evaluations as well as study early developmental interventions for children identified as having some problematic developmental screening results problems. The idea is to follow children identified with developmental disabilities over time to see the end results and then look at the effects of developmental screening on these results.

This study will include a randomized trial to compare changes in surveillance, provide for screening, diagnosis, and for the management of developmental disorders before and after implementation of the CHICA system. Data will be collected from medical records with the primary interest in children at 9, 18, and 30 month visits.

The study will also take into account the family’s involvement in treatment decisions and planning, whether treatments were based on an initial assessment, and whether the strategies used are building on the strengths of the child.

For information on the grant Computer Automated Developmental Surveillance and Screening (R01HS017939-01), email Aaron E Carroll, The initial year for the grant is 2009 with the study concluding in 2012.

Sunday, September 27, 2009

Showcase Draws Huge Attendance

An overflow crowd gathered in the newly renamed historic Kennedy Caucus Room on Capitol Hill to attend the Steering Committee on Telehealth and Healthcare Informatics “Health Care Information Technology Showcase and NHIN Presentation”.

Opening the event on September 24th as part of National Health IT Week, Neal Neuberger Executive Director for the Institute for e-Health Policy a subsidiary of the HIMSS Foundation, welcomed everyone. He reports that the Steering Committee has held more than 130 widely attended educational sessions and healthcare technology demonstrations since 1993.

Several Members of Congress were able in these busy times on Capitol Hill to stop by the event to show their support for healthcare technology.

Senator Kent Conrad (D-ND) Chairman of the Senate Budget Committee and a Senior Member of the Senate Finance Committee has been a leader in telehealth. In appreciation, the Senator was presented an award for all of his past and ongoing efforts to improve the quality and efficiency of healthcare.

Senator Conrad told the crowd that he has added an amendment to the Senate Finance Committee’s reform legislation. The amendment encourages innovative care for hospitalized Medicare patients, to include the use of telehealth. The amendment directs Medicare administrators to test projects at local hospitals to allow the electronic monitoring of patients by specialists at high-quality healthcare centers.

Senator Sheldon Whitehouse (D-RI) a member of the Senate Budget Committee stressed that a platform of health information infrastructure equals a fiscally strong country. Our country needs to take a step-by-step approach to develop a robust health information infrastructure. We must reform the underlying mechanisms of our healthcare system and expand access to health insurance to all Americans.

Allyson Y. Schwartz (D-PA) very actively involved in e-prescribing said that it is very important for providers to be able to communicate quickly with the right information at their fingertips. As Representative Schwartz pointed out, although much has been accomplished, more still needs to be done so that at the end of the day Americans will be healthier

Workforce training and development issues are high on the agenda especially in today’s economic times. Representative David Wu (D-OR) Chairman of the Committee on Science and Technology has been very active in providing ideas and effective for leadership for stimulating interest in the workforce. He relates that these issues are particularly relevant today since there are good stable jobs in the healthcare field that go begging and this means that more and more workers in the healthcare field are going to need training.

The need to provide for interoperability, provide for a highly interactive ease of use system for providers, provide for an intelligent data system, and provide a system that is able to integrate medical information is vital according to Representative Tim Murphy (R-PA) Co-Chair of the House 21st Century Health Care Caucus.

Other countries are also playing an important role in HIT. Canada is an early adopter of cutting-edge health technology, hardware, software and services according to Jean-Philippe Linteau, Senior Trade Commissioner and Commercial Counselor of the Canadian Embassy, but he wants to see even more ventures between the two countries.

According to Linteau, Canadian companies have well established track records in providing healthcare systems, leading-edge physician office systems, long term and acute care at a distance using telemedicine, and providing in-home and community care.

To address healthcare in treating people in the population that do not always receive the best healthcare, Garth Graham M.D., DHHS Deputy Assistant Secretary for Minority Health talked about the “Health Information Technology for Underserved Population Initiative”. He explained that it is important to help all populations in this country have the same health expectancy even where there are disparities in the population.

According to Dr. Graham, HIT is an additional tool that can reduce racial and ethnic health disparities, however, any development and use of HIT for patients and providers needs to ensure that racial, ethnic minorities and persons with disabilities are included. To help meet the challenges, everyone has to be educated that a serious situation in the population exists plus public and private partnerships need to work and use HIT to address this issue.

One of the public-private partnerships actively involved in this field is the “National Health IT Collaborative for the Underserved” with Ruth Perot as Managing Director. The Collaborative was formed with Federal agencies and other key private sector and community based stakeholders. The goal is to bring the best HIT ideas and resources to a population that will help to lower overall costs for everyone.

The Nationwide Health Information Network (NHIN) a program under the Office of the National Coordinator for HIT was established to provide a mechanism for exchanging health information nationally. The NHIN Presenters at the event were introduced by Vish Sankaran, Program Director, Federal Health Architecture within the Office of the National Coordinator for HIT to demonstrate how successfully NHIN is able to work across agencies.

The Department of Defense began the NHIN presentation by demonstrating how wounded warriors and veterans health records can be maintained throughout the continuity of care and how effectively information will be exchanged with both civilian and federal partners by using the NHIN infrastructure.

Moving information through the system was well demonstrated by SSA to show how the disability determination process can work to help the disabled individual. SSA and MedVirginia were the first organizations to share live data as NHIN pilot partners. They demonstrated how access to electronic health records dramatically speeds the process for collecting the evidence required to make disability determinations.

CDC, state health organizations and other private entities demonstrated the importance of being able to report and enhance public healthcare data using NHIN-enabled health information exchange. This is especially important today with H1N1 surveillance needed and also for biosurveillance purposes if there are problems in the U.S.

The Cancer Biomedical Informatics Grid (caBIG®) is an initiative overseen by the National Cancer Institute Center for Biomedical Informatics and Information Technology. The need for caBIG® and CONNECT is vital to effectively link cancer research information. Efficient and effective use of biomedical data is essential to understanding the molecular processes that underlie cancer to enable better interventions.

The Technology Showcase featured more than 30 tabletop displays by government, industry, and academia, trade associations, and leading research organizations to demonstrate their latest advances toward an “e-enabled” healthcare system.

Many of the products and services displayed involved work on biosurveillance, battlefield medical information systems, robotic systems, chronic care and disease management tools, electronic health records, handheld devices, imaging patient identification, tracking systems, helping minorities, and providing telemedicine technologies to rural areas.

HIMSS and their Institute for e-Health Policy manage the Capitol Hill HIT briefing series. For more information, contact Neal Neuberger, Executive Director, for the Institute at or go to

Telemedicine to Help PTSD

The Department of Veterans Affairs is sponsoring a clinical trial to study how to improve outcomes for veterans with PTSD being treated in small VA Community Based Outpatient Clinics (CBOC) with patients that have newly emerging or chronic PTSD. Although psychotherapy and pharmacotherapy treatments for PTSD have been proven to help in controlled trials, geographic barriers often prevent veterans from accessing these evidence-based treatments so telemedicine may very well be the answer.

The study is going to evaluate Telemedicine Outreach for PTSD that builds on the evidence base of quality improvement for depression in primary care settings. The study will employ an off-site PTSD care team comprised of a telepsychiatrist and telepsychologist and telenurse care manager. A telepharmacist will also provide medication management by phone.

The dedicated nurse telephone care manager will educate and activate patients to identify treatment preferences, discuss how to overcome treatment barriers, monitor symptoms, provide information on side effects, how to adhere to the program, help patients identify psychiatric co-morbidities, and encourage patient self management.

The telepsychologists will provide Cognitive Processing Therapy via interactive video and telepsychiatrists will supervise the off-site care team as well as conduct consultations and provide medication management via interactive videos.

Approximately 400 veterans 18 years or older with PTSD will be recruited from nine CBOCs in VISN 16 and VISN 22. Veterans screening positive for PTSD or those already in active treatment will be recruited. Patients actively involved in specialty PTSD treatment at the parent VAMC will be excluded. The estimated date for the study completion is December 2012.

For information on the study (NCT00821678) go to or email Michael McCarther at or call (501) 257-1227.

FDA Awards Grants

FDA recently awarded three grants to help to stimulate the development of pediatric medical devices. Development of medical devices for children lags up to a decade behind similar devices intended for use in adults. Children differ in size, growth and body chemistry, and present unique challenges to device designers. In addition, the activity level and ability to manage some implantable or long-term devices may vary greatly among children.

This is a new grant program originating from legislation passed in 2007, and although the program is administered by the Office of Orphan Product Development, this program encompasses devices used in all pediatric diseases, not just rare diseases.

The recipients and grant amounts are:

• James Geiger, M.D., and the Michigan Pediatric Device Consortium for $1 million
• Pedro DelNido, MD., and the Pediatric Cardiovascular Device Consortium, for $500,000
• Michael Harrison, MD., and the University of California at San Francisco Pediatric Device Consortium for $500,000

The grant recipients will use the funding to:

• Encourage innovation and connect qualified individuals with good pediatric device ideas to potential manufacturers
• Mentor and manage pediatric device projects through their development including prototype design and marketing
• Connect innovators and physicians to existing federal and non-federal resources
• Assess the scientific and medical merit of the proposed pediatric projects and provide assistance and advice on business development, training, prototype development, and post-marketing needs

The grant recipients will coordinate their research among the FDA, device companies and the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Wednesday, September 23, 2009

Chairman Speaks at Brookings

FCC Chairman Julius Genachowski speaking at Brookings Institution on September 21st outlined the actions needed to preserve the free and open internet. He talked about the four principles that already guide the FCC’s existing case-by-case enforcement of communications law. Basically, these four principles state that network operators can’t prevent users from accessing lawful internet content, applications, and services of their choice, nor can they prohibit users from attaching non-harmful devices to the network.

Chairman Genachowski announced the addition of two new principles. The first new principle states that broadband providers cannot discriminate against particular internet content or applications. This means they cannot block or degrade lawful traffic over their networks or pick winners by favoring some content or application over others in the connection to the subscriber’s homes. Nor can they disfavor an internet service just because it competes with a similar service offered by that broadband provider.

The Chairman is going to propose that the FCC evaluate alleged violations of the non-discrimination principle as they arise, on a case-by-case basis to allow the Commission to make reasoned and fact-based determinations based on today’s internet—not on the internet of past years.

The second new principle involves transparency and requires that providers of broadband internet access be transparent about their network management practices. Greater transparency will give consumers the confidence of knowing that they are getting the service they have paid for, enable innovators to make their offerings work effectively over the internet, and allow policymakers to ensure that broadband providers are preserving the internet as a level playing field. It will also help facilitate discussion among all the participants in the internet ecosystem, which will help reduce the need for government involvement in network management disagreements.

According to the Chairman, last year, the FCC ruled on the blocking of peer-to-peer transmissions by a cable broadband provider. The blocking was initially implemented with no notice to subscribers or the public. This was only discovered after an engineer and hobbyist living in Oregon realized that his attempt to share public domain recordings of old barbershop quartet songs over a home internet connection was not taking place. It was only when he brought the problem to the attention of the media and internet community that this matter was brought to the attention of the FCC. At that point, the improper network management practice became known and was stopped.

The transparency principle will not require broadband providers to disclose personal information about subscribers or information that might compromise the security of the network and there will be a mechanism in place to protect competitively sensitive data.

The FCC is going to begin the process of codifying the existing four open internet principles along with the two additional principles through a Notice of Proposed Rulemaking (NPRM) in October. At this time, NPRM will ask for feedback on the proposed rules and their applications. The FCC wants to hear comments on topics such as how to determine whether network management practices are reasonable and what information broadband providers should disclose about their network management practices and in what form. Also, under discussion is how the internet openness principles should apply to mobile broadband.

The FCC will also hold a number of public workshops and on September 21st, the Commission launched a new website to kick off the discussion on these principles and issues.

Help for New York Region

The Medical Society of the State of New York (MSSNY) is addressing the lack of coordination of care for patients with chronic conditions. Funding was included in the NY state legislation to use to develop what is being referred to as a “Physician Practice Support Organization (PPSO). The idea is for the PPSO to be guided by a Steering Committee to transform the medical practice business model in the Adirondack Region of New York State.

The Adirondack Region faces many challenges not only because it is rural but also because the economic picture is bleak due to the closing of a number of prevalent industries in the region. The situation is further complicated by the lack of access to primary care due to a primary care physician shortage and as a result, there is a higher occurrence of chronic diseases in the region, especially diabetes.

The MSSNY in coordination with the NY Department of Health has formed a Committee on Health Information Technology that includes over 20 representatives from around the state, including county and specialty medical societies, as well as physicians and group practice managers from diverse practice settings, and representatives from the hospital and payer communities.

Currently, the Committee on Health Information Technology has developed a Request for Proposal (RFP) and is looking for applications from organizations to help MSSNY develop the “Physician Practice Support Organization”. The goal for PPSO is to accomplish enhanced health outcomes for the patient population in the Adirondack region while also improving the reimbursement and methodologies for solo, small group, and rural practices in the area.

According to the RFP, three sub-regional service sites would be selected and new performance reporting requirements would be put in place based on evidence-based care. Also reimbursement models would be put in place to reward the physicians for evidence-based quality of care within their practices.

MSSNY issued RFP (0907131043) on September 11, 2009, with applications due October 23, 2009. For more information email Ron Pucherelli, Project Administrator, Health Information Technology, MSSNY, or call (518)-465-8055.

AHCA Launches New Tool

Florida’s Agency for Health Care Administration now has a new interactive Crosswalk Tool available. The Tool helps to retrieve information on privacy security and laws and regulations related to electronic health records and health information exchange.

The Crosswalk Took is an educational resource for healthcare providers and consumers protecting the use of personal health information when exchanged among providers. The interactive data base by allowing web site visitors to search for federal and state laws related to privacy and security helps to determine which law governs the sharing of specific information.

“People want to know that their health information is protected when they share it with healthcare providers,” Secretary Holly Benson said. “We created this tool to ensure that providers know the laws that protect their patients and their information.”

AHCA developed the Crosswalk Tool through a federally funded grant from the Office of the National Coordinator for Health Information Technology. The federal project created a database titled the “Comparative Analysis Matrix” which is a collection of almost 150 topics typically addressed by state law that involves or impacts health information exchange. Florida is the first state to the Matrix to create an online search tool for healthcare providers and consumers.

“Many healthcare providers are familiar with HIPAA, but the Crosswalk Took shows federal and state requirements side-by-side eliminating many hours of research,” said Karen Koch, Vice President for the Florida Council for Community Mental Health and a member of the Health Information Security and Privacy Collaboration Project Legal Workgroup.

AHCA’s Health Information Privacy and Security Resource Center was created to provide more information on privacy and security of electronic health records and has information on the Florida HISPC project that concluded in July 2009.

The Crosswalk Tool is available at

Device to Help the Blind

Amazingly, a new device has been developed for the blind and visually impaired that uses the brain to see—not the eyes. This device called BrainPort manufactured by Wicab Inc., located in Wisconsin helps to partially restore vision by using the nerves on the tongue to send signals from a camera system to the brain. The tongue appears to be ideal for sensing electrical currents as nerve fibers on the tongue are densely packaged and are close to the surface of the tongue.

The device works by having a small digital video camera located on a pair of sunglasses. Information is collected from the camera with the data going to a handheld device that has settings and a CPU. At this point, the digital signal is translated into gentle electrical stimulation patterns that go on the surface of the tongue to replace the function of the retina. Users describe it as pictures drawn on their tongue which feels like champagne bubbles to the user.

It is not completely understood as to where the information goes. It may go to the brain’s visual cortex or to a somatosensory cortex where perhaps the data from the tongue is interpreted. However, with training, users of the BrainPort may begin to interpret spatial information, perceive shape, size, location, and motion of objects in their environments.

Wicab is working with the researchers at the University of Pittsburgh Eye Center to further test the device. Dr. Amy Nau, Director of Optometry and Low Vision Services at the Eye Center will continue to test the non-invasive device plus the Center is working on other artificial devices to help produce artificial sight. Dr. Nau is currently enrolling patients in evidence-based studies for BrainPort and users are able to take the device home for six weeks to use.

Sunday, September 20, 2009

Workable Health Reform is Key

“The nation stands ready to reform our healthcare system and the governors need to define their roles and work to develop a more coordinated and efficient system”, said Vermont Governor Jim Douglas speaking at the National Press Club on September 17th.

He continued to say “Health reform is imperative because healthcare is such a huge portion of the national economy in terms of its percentage of our gross domestic product. It is also becoming a large percentage of every state’s operating budget. States are going to have to make tough decisions in the coming years to balance the budgets and avoid increasing taxes to a level that will stop growth.”

For example, Medicaid alone is nearly 33 percent of a single state’s budget but in Vermont with its expanded program, the cost is even greater and is expected to only rise in the future. In addition, Vermont is the second oldest state in terms of median age so the elderly population health needs have to be addressed.

Coverage issues are very important but dealing with coverage alone isn’t enough. Coverage without significant improvements to the healthcare delivery system along with substantial efforts to lower health care costs will put the system under further strain according to the Governor.

The Governor reports that Vermont has gained a national reputation for implementing reforms with good results. For example, the “Blueprint for Health” in place for 6 years is a vision, a plan, and a statewide partnership to improve the healthcare system in the state. The program provides information and tools to enable the people with chronic conditions to manage their own health needs.

The program is establishing a new way to practice medicine to help care for the chronically ill. The governor pointed out that there are three communities across the state where a primary care delivery model such as a medical home looks very promising. The concept makes it possible for Vermonters to have a medical home affiliated with a practice, to include not just a physician but a nurse, a behavioral health specialist, a dietician, and whatever else is needed.

Communities all over the state are joining Blueprint to have the right information at the right time and the program has developed a web-based chronic care patient information system that is free to healthcare providers and requires only internet access.

HHS Secretary Sebelius, the Director of the White House Office of Health Reform Nancy-Ann DeParle, along with the Governor just announced a new initiative to enable Medicare to join Medicaid and private insurers in state-based efforts to improve the way healthcare is delivered.

This new initiative will mark the first time that Medicare will be a full partner in these experiments and will build on the medical home model now being tested in Vermont. Under the Vermont model, private insurers will work in cooperation with Medicaid to set uniform stands for medical homes.

States wishing to participate must certify that they have already established similar cooperative agreements between private payers and their Medicaid program, demonstrate a commitment from a majority of their primary care doctors to join, meet a stringent set of qualifications for the doctors who participate, and integrate public health services to emphasize wellness and prevention.

The Governor feels very strongly that state health IT initiatives underway need to be integrated with HIEs. States need to work with the exchanges and state Medicaid programs so that low income individuals can get the appropriate program placement and services and coordinate these services with other services such as food stamps and welfare assistance.

The Governor mentioned that to promote health technology, Vermont has a program called “docsite” where laptops are given to providers, along with information. The information on the program is available at to provide clinicians with tools that are easy to use and affordable. Whether a doctor practices as a sole provider in a multi-disciplinary setting or even manages a network of integrated physicians, the site helps to build and maintain software tools to help in the healthcare setting.

Ohio's Health Tech Actions

Ohio Governor Ted Strickland has designated the non-profit Ohio Health Information Partnership (OHIP) to implement and oversee a statewide health information exchange to improve access to data and patient information. The partnership will also collaborate with industry experts to provide educational, technical, and procurement services to healthcare providers.

OHIP is currently a subsidiary of BioOhio and has its own independent board. The initial board includes not only representation from BioOhio, but also the Ohio Hospital Association, the Ohio State Medical Association, the Ohio Osteopathic Association, and state government. In the future, the partnership will expand its board to include representation from healthcare payers, the business community, the university system behavioral health providers, community health centers, and consumers.

The state is planning to dedicate $10.1 million in General Revenue Fund dollars to develop health IT and to use for other healthcare quality improvement initiatives. The state will use $8 million as matching funds to apply for newly announced federal health IT dollars. An RFP for the design, architecture, and delivery of services should be awarded by the end of 2009.

The Ohio Department of Insurance will work with OHIP to oversee the use of the funding. “Healthcare experts and stakeholders have consistently identified the utilization of health IT as a critical component to lowering costs and improving quality,” said Department of Insurance Director, Mary Jo Hudson. “By utilizing a self-sustaining, non-profit entity with broad-based representation, the state will be able to establish a successful statewide health information exchange and greatly encourage the adoption of EMRs.

To help encourage and support the broad adoption of health IT in the state, several ideas have been considered. Options such as forming purchasing collaboratives could help drive down the costs for small providers, establishing standards for individuals and corporations to help them to provide IT support services, forming a Center of Excellence to act as a trusted source for IT information, and making loans available to help providers purchase EMR tools and services have been discussed.

The state is proud of their recent HIT initiatives that so far have established and their several functioning RHIOs such as HealthBridge, HealthLink, and others. Also, Clinical and Translational Science Collaboratives were set up at Case Western Reserve, Ohio State, and the University of Cincinnati.

In September, a new initiative was announced to connect the nation’s first live, multi-region clinical information exchange. Three Indiana and Ohio organizations are now sending clinical and test results, reports, and other medical information among their health information exchanges. These exchanges include HealthBridge in Cincinnati, Ohio, Indiana Health Information Exchange in Indianapolis, and HealthLINC in Bloomington Indiana.

These organizations have been exchanging health information securely within their regions for years, but what is new is that now they are exchanging information among these regions. These health information organizations connect more than 15,000 physicians, 50 hospitals, and 12 million patient records.

For more information, go to

CDC Issues RFI

CDC issued a Request for Information (RFI) on September 15th to obtain information to use for project planning purposes to develop, operate, and manage a national Transplantation Sentinel Network (TSN). The goal for the network is to improve allograft quality by reducing disease transmission, including infection and malignancy from donors to recipients.

Each year in the U.S., more than 28,000 solid organs and 2 million tissues are transplanted, including heart, lung, liver, kidneys, pancreas, intestine, bone, skin, heart valves, tendons, fascia and corneas. Donor-derived infections have been identified as a source of morbidity and mortality among both solid organ and tissue transplant recipients.

The ability to easily track tissue within a hospital is critical particularly when tissues have been identified for recall. In the past, some healthcare facilities have been unable to locate all recalled tissues due to the lack of effective tracking systems within their institutions.

A national TSN will need to avoid duplication of the Organ Procurement and Transplantation Network and the FDA reporting mechanisms but at the same time, interfacing with these existing systems is critical and needs to be coordinated by CDC in collaboration with other agencies within HHS.

The TSN needs to be able to provide the mechanism for standardizing allograft identifiers, be able to track organ and tissue receipt, notify and respond to potential disease transmissions, and integrate sentinel events into a national biovigilance network. All implanting institutions must be able to rapidly communicate when a possible disease transmission is identified.

CDC is interested in hearing from organ procurement organizations, eye banks, tissue banks, transplant centers, healthcare providers, patients, software developers, IT specialists, consulting firms, trade association, “think tanks”, as well as institutions that may be interested in housing and operating a potential TSN system.

The response date for the RFI 2009-91509 is December 11, 2009. For further information, go to or email Maria Shamburger at

Addressing Safety & Medical Liability

AHRQ plans to support new demonstration grants, contracts, and planning grants that will go to states, localities, and healthcare systems to test models. The idea is to put patient safety first, reduce preventable injuries, foster better communication between doctors and patients, and ensure that patients are fairly and quickly compensated for legitimate medical injuries. The goal is to reduce the incidence of frivolous lawsuits and to reduce escalating liability premiums.

Too many patients experience significant challenges with healthcare quality and patient safety, and are not well served by the current medical liability system. The correlation between lawsuits and negligent care is weak. A substantial proportion of cases associated with negligent care do not result in lawsuits, and at the same time, a substantial proportion of lawsuits are not associated with negligent care.

Many experts believe fear of liability is a substantial barrier to the development of transparent and effective patient safety initiatives in hospitals and other settings. The medical community reports serious problems with the medical liability system. Many physicians have experienced sharp increases in premiums for medical malpractice liability insurance and many believe that medical liability concerns leads to defensive medicine which in turn, contributes to higher healthcare costs.

AHRQ anticipates soliciting applications for the demonstrations starting October 2009 with funding to begin in early 2010. Specifically, the demonstration will evaluate approaches to improving patient safety, how to reduce defensive medicine, provide for fair and timely compensations to patients and families, ways to reduce malpractice premiums and how to provide for enhanced physician accountability.

At this time, AHRQ cannot provide further comments on the future solicitation, but general comments can be directed to Kathie Kendrick, Deputy Director, AHRQ, email

Wednesday, September 16, 2009

Tool Ready to Fight Flu

Researchers are developing new tools to characterize biological pathogens that could give rise to potentially deadly pandemics such as H1N1. The system will be able to automatically determine the genetic sequence of viruses such as influenza hundreds of times faster than any other method now available.

The $1.7 million BioCel Automations System was developed in a joint effort between the Los Alamos National Laboratory, the University of California at Los Angeles School of Public Health, and Agilent Technologies to enable public health officials to rapidly and reliably determine the strain of a virus. The system will also be useful to help monitor animal populations for the emergence of new and potentially deadly pathogens before the pathogens are able to infect humans.

“This system is the next generation tool to rapidly and accurately test and identify biological pathogens in mass quantities of samples. The tool is capable of performing tests 100 times faster than any current method and will provide reliable real-time data to the global health community”, said Nick Roelofs, Vice President and General Manager of Agilent Life Sciences Solutions Unit.

Current genetic identification methods require lots of time and manpower. The new genotyping system features two robots and the ability to fully sequence 10,000 or more influenza viruses per year. This makes it much faster and more reliable than current methods, and reduces the amount of manpower necessary to process a large number of samples.

The system to be deployed at UCLA’s new Global Bio Lab was funded by the Department of Defense and the California Office of Homeland Security and was developed in a partnership between Los Alamos and UCLA.

Wright State Tech Projects

The World Health Organization’s “Global Initiative on Health Technologies” addresses disparities worldwide and is working to expand the role of technology. Katherine Cauley, Ph.D., Associate Professor of Community Health and the Director of the Center for Healthy Communities at Wright State University (WSU) located in Dayton, was appointed to serve on the World Health Organization’s “Expert Advisory Group for Innovative Technologies”.

The goal of the Advisory Group is to bring the benefits of core health technologies to resource-scarce areas of the world. The project is being organized by the WHO’s Department of Essential Technologies and the project is funded and supported by the Bill & Melinda Gates Foundation.

Cauley will join representatives of 23 countries spanning North, Central and South America, as well as Africa, Australia, Europe, Asia, and the Middle East. The members will work to identify health issues in resource-scarce regions that would be most likely to respond to health technologies. The next step is to solicit business and industry proposals to apply these technologies in these regions and to determine which proposals will move forward in partnership with the WHO.

The three year project began at a meeting in Singapore in June to review current health issues and potential technology solutions. In 2010, the committee will meet in Copenhagen to review the proposals submitted from business and industry.

In other news at Wright State University (WSU), the School of Medicine recently received a $2.7 million award to establish a joint venture with the Air Force School of Aerospace Medicine and WSU’s National Center for Medical Readiness (NCMR). The funding will help develop the NCMR Tactical Laboratory, also known as the “Calamityville Tactical Laboratory Project” to develop projects to help others respond to disasters.

The program is expected to bring 30 full time jobs to the area and could generate as much as $75 million for the region. With more than $13 million in state and federal funding, this unique research facility will provide one-of-a-kind training opportunities for the world’s medical, public health, public safety and civilian and military disaster response decision-makers.

The project will also:

• Identify needed civilian and military staffing requirements for community and healthcare facility evacuations
• Develop modeling technologies to enable community health system, public health agencies and emergency management leadership to identify, train and distribute DOD and non-DOD response forces in the event of a large-scale disaster
• Create a common operating structure, communication and procedure for a national medical response
• Cultivate a rapid multi-model in residence training capability for medical staff around the nation

For more information on either project, email Phillip Neal at, call (937) 775-4587 or go to

Eye Movements Detect Autism

Researchers are beginning to look at the way that babies communicate with their eyes in order to understand the development of certain disabilities such as autism. Dr. Noah Sasson, an Assistant Professor and his colleagues at the University of Texas at Dallas in the Center for Children and Families, are currently tracking and measuring the eye movements of infants. Eye tracking technology has been used in previous research to investigate how children and adults perceive social and non-social information.

“By tracking eye movements, we can infer information about an infant based on what he or she views and for how long,” said Sasson. “Although this information alone is not diagnostic, certain patterns of eye movements may signify an abnormality that can reflect potential developmental difficulties.”

Researchers collect the data by having infants sit on their parent’s lap and face a computer monitor. An array of images is projected on the monitor and a standalone unit called the Tobii eye tracker is used to instantly measure eye movements.

Included in the array are social images, such as people and faces and objects that are often of high interest to children with autism. These can include trains, cars, and computers as well as objects that may be less appealing to children with autism.

“We know from experience that early intervention can lessen the effects of autism traits in both childhood and adulthood”, said Sasson. “The goal of our research is to detect a problem as soon as possible so that parents can look into early intervention programs.”

NIST Seeks Info

The National Institute of Standards and Technology’s “Technology Innovation Program” (TIP) is looking for white papers from academia, federal, state, local governments, industry, national laboratories, professional organizations or from any interested party. The idea is to use the white papers to identify areas of critical national need and to find ways to face the technical challenges to be addressed in future TIP competitions.

TIP wants to receive input on problems that are large in magnitude and have the potential to inhibit the growth and well-being of our nation.TIP is interested in information on all areas of critical national need, but also on a number of specific topic areas such as healthcare concerning cost effective advanced tools and techniques for genomics and proteomics research. Other ideas include the need for more information on complex biological systems, biomarker identification, targeted drug and vaccine delivery systems, improved and low cost diagnostic and therapeutic systems, and better methods to integrate and analyze biological data especially when combined with environmental and patient history data.

This solicitation for white papers is neither a Request for Proposals not a Request for Pre-proposals. The suggested dates for submission for the white papers are November 9, 2009, February 15, 2010, May 10, 2010, and July 12, 2010. However, TIP will accept white papers at any time during the Period November 9, 2009 through September 30, 2010.

For further information contact Thomas Wiggins by email at or call (301) 975-5416.

NIST is also interested in working with regional, state, local economic development organizations, technology incubation centers, technology-oriented public-private business development initiatives, and other organizations and partnerships. The goal is to transfer technologies developed at the NIST laboratories through potential licensing and/or collaborative arrangements.

To find information on commercially viable technologies developed at NIST, go to For further information, email Clara Asmail at or call (301) 975-2239.

Sunday, September 13, 2009

MSOs Can Be a Solution

Management Services Organizations (MSO) can provide a cost effective alternative to physician practices that want to implement EHRs. MSOs work by using an application service to host one or more electronic health record systems through the internet and are positioned to leverage buying power plus manage EHRs.

MSOs use critical mass to manage costs and to implement the technology as opposed to standalone EHRs that require the physician practice to implement the necessary software and maintain the hardware. MSOs are a viable alternative to the standalone EHR model and have enormous potential to spur adoption.

Implementing EHRs requires a substantial commitment and willingness of a physician practice to make process changes that impact all levels of a physician practice. State designated MSOs on the other hand, will provide assistance to physician practices with planning and implementation.

According to a report released by the Maryland Health Care Commission in August 2009, the average cost of a client-server EHR system is around $53,000 per physician over three years as compared to the MSO model where the three year average would be around $28,800 per physician or $800 per physician per month.

MSOs are becoming increasingly popular around the country. For example, California and Florida are two states using MSOs to drive the adoption of EHRs, and the result has been to build confidence in physician practices. However, since broadband is required to access an MSO, some locations in states still lack access. For example in Maryland, some areas in Western Maryland, the Eastern Shore, and Southern Maryland have limited access to broadband.

This year, the Maryland legislature tasked the Maryland Health Care Commission (MHCC) with developing requirements for MSOs interested in obtaining a state designation. The criteria for a state designation would require privacy and security rules, make it necessary to comply with ARRA to receive incentive funding, develop provisions to safeguard network operating centers, and develop agreements on how the electronic data is accessed, stored, and maintained. State designated MSOs will also need to integrate hosted EHRs with the statewide HIE as the exchange becomes available.

Existing law requires the MHCC to designate one or more MSOs throughout the state by October 1, 2012. The next step is to convene a stakeholder workgroup to develop the evaluation criteria for MSOs that seek a state designation and there are plans to develop the criteria with the help of stakeholders over the next year.

New Mexico's HIT Efforts

New Mexico’s Health Policy Commission (HPC) an independent state agency collects, stores, organizes, analyzes, and disseminates health information data to use for health research, guidance, and recommendations. Immediate plans are to distribute health information more broadly in state and federal arenas.

HPC-IT collaborative efforts include:

• Collaborating with federal and state agencies to develop data sharing agreements for Hospital Inpatient Discharge Data (HIDD) and to develop the HIDD data dictionary to match the new data elements being collected

• Creating formal agreements so that the Department of Health can share data with AHRQ’s Healthcare Cost and Utilization Project (HCUP). HCUP is a federal-state-industry partnership sponsored by AHRQ that provides hospital inpatient databases from 40 states for research in the areas of healthcare utilization and quality

• Working on other ongoing collaborative efforts with several Department of Health agencies such as the New Mexico Hospital Association, regulatory and licensing departments, Board of Medical Examiners, Texas Department of State Health Services, New Mexico IHS, Veterans Administration, the New Mexico Telehealth Commission, and the New Mexico Telehealth Alliance as well as with several universities in the state

For SFY 2011, HPC-IT will implement the Indicator Based Information System to allow for web-based hospitalization reports. At this time, HIDD will be migrated into a more stable data warehouse environment to provide more reliable and efficient trend reports based on historical data.

New Mexico just received a $1.5 million award as part of ARRA from CDC to help the state continue to track and prevent healthcare-associated infections in the state. A permanent Healthcare-Associated Infections Advisory Committee led by the New Mexico Department of Health has recently completed a pilot project with six hospitals and the Department of Health is going to use the ARRA funding to expand the healthcare-associated projects and help hospitals across the state track and report the data.

On August 31, 2009, the New Mexico Department of Health released a “Request for Information” for an electronic clinical case management system to manage the clinical and non-clinical service and care components and functions of the Department. It is the intent of the Department to follow the RFI with a “Request for Proposal”.

The Department expects to contract with a single vendor for the application software, as well as provide for a hosting arrangement. Partnerships are encouraged among vendors. The deadline for the RFI is October 5, 2009. For more information, email Susan Beltran at or call (505) 476-3765.

Recently, the Robert Wood Johnson Foundation awarded a three year $5 million grant to “Project ECHO”, a New Mexico program that uses evidence-based medicine and interactive technology to bring specialty care to patients living in rural and underserved areas suffering from serious, complex chronic conditions.

ECHO uses a secure, internet-based audio-visual network to connect primary care providers with medical specialists at the University of New Mexico Health Sciences Center. Unlike most telehealth initiatives, that primarily connect patients with doctors, the ECHO project trains doctors, nurses, physician’s assistants and other clinicians in rural and underserved areas to work together to manage patients. The ECHO project network links the UNM medical school with more than 40 partner clinics based in public health departments, prisons, Indian Health Service sites, community health centers, and rural primary care practices around the state.

The Los Alamos National Laboratory scientists are going to co-direct a new National Center for Systems Biology located at the University of New Mexico in Albuquerque. This new spatiotemporal modeling center is funded by a $14.5 Million, five year grant from NIH’s National Institute for General Medical Sciences.

Los Alamos scientists will collaborate with researchers from UNM and Sandia National Laboratory to apply large scale, multidisciplinary approaches to understanding how the immune systems interact. The Center’s primary goal is to develop predictive models of cellular decision-making processes to better study the causes of human disease and explore new treatment options.

Finding the Medical Solution

There are many illnesses that are simple to identify but there are other illnesses that can be complex and extremely difficult to diagnose. NIH estimates that even with the ability to diagnose 20,000 medical conditions, there are still about 7,000 rare conditions that are hard to identify. According to Elise Singer, a physician working on her MBA at UC Berkeley, about half a million people in the U.S. have undiagnosed or misdiagnosed diseases as well as complicated and misleading presentations of more common conditions such as multiple sclerosis, Lyme, and celiac disease.

According to an article appearing in the Center for Information Technology Research in the Interest of Society (CITRIS) August newsletter, the National Organization for Rare Disorders say that when a patient is diagnosed with a rare disease, it takes 36 percent of the patients more than a year to find a diagnosis and another 17 percent more than six years.

Brad Kittredge, A UC Berkeley MBA and Public Health student had to look for his own hard-to-diagnose symptoms for four years and went to nearly 20 doctors before he learned that his condition was not too serious. Last year, he teamed up with Singer and two computer programmers to find a way to connect patients with the doctors who are most likely to successfully diagnose their conditions.

Kittredge and Singer and the other partners are establishing a new company called ComplexDX to turn the traditional hunt for a diagnosis on its head. Rather than going from doctor to doctor, patients pay ComplexDX to post their cases to an online database where participating doctors can examine and solve the cases. The group won a CITRIS Big Ideas Award for $8,000 in 2009 and has since raised additional startup funds with plans to launch the business this fall.

The company will charge each patient $250 to $500 to have their case listed in the database and the doctors will be paid $1,000 for each correct diagnosis. The team is developing software to help patients describe their symptoms and develop narratives to enable the doctors to review the telltale signatures of hard-to-diagnose illnesses.

After identifying interesting cases, the ComplexDX affiliated specialists will then suggest diagnoses and make suggestions about further tests or treatment options. It will however be the patients’ primary care physician who will follow up. “We are limiting ourselves to providing diagnoses at this point and steering clear of the treatment business for now”, says Kittredge. For legal reasons, the patients and the ComplexDX doctors who review their cases will each be represented in the database only by numbers with their identities remaining private.

For more information on CITRIS, go to To read the current newsletter, go to

Tuesday, September 8, 2009

$500,000 in Grants Available

The Center for Technology and Aging located in Oakland California, has application guidelines available for their $500,000 Medication Optimization Diffusion Grants Program. Up to six one year grants will be awarded to organizations successfully proposing programs directly benefiting older adults. Four or five grants will focus on Californians while one or two may benefit older adults in other regions of the U.S.

Medication optimization refers to a wide variety of technologies designed to help older adults dispense and track their medications. Medication optimization technologies are particularly applicable for the elderly and people with chronic illness or complicated medication regimens. Sometimes this can help older adults avoid or delay a move from the home or community-based setting that they prefer.

“Medication-related errors are taking a terrible toll on the health and lives of older adults,” said David Lindeman, PhD, Director, of the Center. He reports that of the three billion medication prescriptions issued each year in the U.S., 12% are never picked up by the patient and 40% are not taken correctly. Additionally, older adults too often receive duplicate prescriptions or prescriptions that have not been safety checked for drug interactions. Yet, effective tools and technologies already exist to greatly reduce these problems.

The grant funding is available for programs to use technologies ready to be used more broadly. Grantees will be expected to have prior experience with medication optimization technologies and need to be able to demonstrate a positive and measureable impact in the near term. The grantees will also need to propose a strategy on how to successfully integrate the technology into state and national healthcare delivery and reimbursement systems.

The deadline for interested organizations to submit Letters of Intent is October 2, 2009. Applicants will be notified of they are selected to submit a full proposal by October 14th. The anticipated start date for the grants is January 1, 2020.

In August, the Center released “Technologies to Help Older Adults Maintain Independence: Advancing Technology Adoption”, a briefing paper that describes seven technology areas with significant potential to improve chronic healthcare while reducing healthcare costs.

To download the grant application information, go to or go to To download the briefing paper, go to For more information, email Daniel Danzig at or call (925) 216-8153.

CBO's Quality Study

The Congressional Budget Office’s (CBO) study “Quality Initiatives Undertaken by the Veterans Health Administration (VHA)” published August 2009, discusses the VHA’s experience with not only quality improvement but also with health information technology.

Many of VHA’s quality improvement programs use data from computerized clinical records to track both process and outcome measures, including risk-adjusted mortality and morbidity. These programs have helped VHA recognize problems in specific healthcare facilities as well as to improve performance throughout the agency.

According to the report, one of the major problems that the VA has in dealing with vast amounts of information is the fact that many veterans receive care outside of the VHA system and as a result, the exchange of information is more difficult to achieve. The VHA has made some progress in exchanging patients’ healthcare information with the military health system, but the exchange of data between VHA and private providers still lags behind because of incompatible data structures and a lack of data-sharing agreements.

In addition, when patients are enrolled in both Medicare and VHA they will choose the program for care depending on the type of medical services that they need at the time. For example, few enrollees rely on VHA for outpatient surgery services but a large fraction of those patients seeking outpatient substance abuse treatment turn to the VHA for that type of care.

The study summarizes the VHA programs in place that are designed to improve the quality of care and this includes:

• VistA plays a key role in the agency’s efforts to measure performance and improve quality. Researchers have used clinical data in VistA’s EHR to study the effects of various quality improvement strategies
• An Internal Clinical Peer Review program is in place at each hospital
• An External Peer Review Program extracts data from patient care records in VHA’s clinical systems and then compares the information with evidence-based performance criteria
• A National Surgical Quality Improvement Program is in place that enables risk-adjusted comparisons of surgical outcomes to be made to identify surgical units with unexpectedly high or low rates of morbidity or mortality
• An Inpatient Evaluation Center is designed to improve outcomes in the acute care hospital setting by examining data from EHRs
• A set of programs in the Quality Enhancement Research Initiative aims to put clinical research findings and evidence-based recommendations into clinical practice
• An Evidence-based Synthesis Program systematically reviews published research on medical issues of particular importance to VHA’s user population

To download the report, go to then click on recent reports.

NIH Awards Grants

Awardees of the “Models of Infectious Disease Agent Study” (MIDAS) grants will receive an estimated $40 million over five years. MIDAS is going to add new research expertise to increase the capacity to simulate disease spread, evaluate different intervention strategies, and use the funding to devise ways to help inform public health officials and policymakers.

Some of the best available tools for studying infectious disease dynamics and interventions are computational models. They incorporate basic information about a disease and the affected communities and then simulate the spread of an infectious agent under any number of conditions.

“Models can’t tell us what will happen but they enable us to explore a range of possibilities for disease containment,” said Jeremy M. Berg, PhD, Director of the National Institute of General Medical Sciences, the NIH component supporting MIDAS. “Since its launch in 2004, the MIDAS research network has been at the forefront of infectious disease modeling efforts, and we hope it continues to serve an important role in preparing for possible outbreaks.”

With a probable resurgence of H1N1, University of Pittsburgh researchers have received $13.4 million from the MIDAS program to establish a “Center of Excellence in Modeling of Infectious Diseases” to be led by Donald Burke, M.D. at the University of Pittsburgh.

The projects at the Center will work to develop statistical tools to define the features of a pathogen and its spread through a population, track the evolution of infectious diseases over time, put a system in place to effectively implement an intervention, and provide new computational tools to local health officials.

Funding will also go to a “Center of Excellence for Communicable Disease Dynamics” to be led by Marc Lipsitch, PhD, from the Harvard School of Public Health. The core research program will focus on modeling drug resistance and studying seasonal infectious diseases. The team will work with health officials to integrate public health knowledge into the models and vice versa.

Other grant funding went to the University of Chicago where Charles Macal, PhD of Argonne National Laboratory in Illinois will create a dynamic model of MRSA to examine factors contributing to its spread. The Yale University School of Public Health and the University of Texas at Austin will develop new models that will integrate individuals’ perceptions and behaviors regarding flu. The University of Washington and the Fred Hutchinson Cancer Research Center in Seattle will develop models to assess the effectiveness and optimal distribution of a variety of control measures.

In addition to these projects MIDAS scientists have published preliminary findings on the origin, infectiousness and likely spread of the 2009 H1N1 virus.

For more information on MIDAS, go to

AHRQ to Publish FOA

AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships announced plans on September 1, 2009 to publish a Funding Opportunity Announcement (FOA). The program is looking for community-based research on using communication and information focused technologies to help provide health related services to older adults.

This initiative to be done over five years has three broad strategic themes:

• Use IT to help extend independence and functioning and also to reduce unnecessary healthcare use by older adults
• Use IT to place the individual and families at the center of expanded and more efficient service delivery networks
• Develop innovative approaches to translate evidence generated in the first two thematic areas into practice

The goal is to develop tools, conduct demonstration projects, provide for educational program development and implementation, and evaluate and disseminate the results. The idea is for the cooperative agreement to support a broad integrated, multidisciplinary, multi-project health services research program and bring together experienced teams and new researchers.

The FOA is expected to be published by the end of calendar year 2009. AHRQ is unable to provide additional specific information on its content until the FOA is published. General inquiries can be emailed to Angela Lavanderos, at the Center for Primary Care, Prevention, and Clinical Partnerships.

DOD Seeks Proposals

The Defense Medical Research and Development Program (DMRDP) called the Applied Research and Advanced Technology Development will offer 100 awards with funding of $97 million in FY 2010. These first time awards are going to support research designed to advance state-of-the-art solutions for medical care emphasizing treatments for PTSD, TBI, prosthetics, restoration of eye sight and advanced eye care, plus other conditions directly related to the injuries service members receive on the battlefield.

Specifically, DMRDP is seeking new products, pharmacologic agents, behavioral and rehabilitation interventions, diagnostic and therapeutic devices, clinical guidance, and medical information and training systems and/or emerging approaches and technologies. The goal is to yield potential health products, approaches or technologies ready for human testing.

For more information, go to to see FOA (W81xWH-09-DMRDP-ARATDA) announced on August 17th. The Pre-Application deadline is September 25, 2009, invitation to submit an application is November 9, 2009, and the closing date for applications is December 18, 2009.

Wednesday, September 2, 2009

Chronic Diseases Worldwide

“Chronic diseases affect everyone, everywhere,” says Dr. Roger I. Glass, Director of NIH’s Fogarty International Center. The Center is partnering with NIH institutes and others to apply knowledge about cancer, cardiovascular disease, lung disease, and diabetes to help in low and middle income countries.

In June, the Fogarty became a founding member of the Global Alliance for Chronic Diseases (GACD) to collaborate with national health agencies in some of the biggest countries in the world. The GACD comprises the six world agencies that supply about 80 percent of all public research funding in the world.

The Alliance is represented by National Heart Lung Blood Institute, Fogarty Center, Australia’s National Health Medical Research Council, Canadian Institutes of Health Research, and China’s Ministry of Health in association with the Chinese Academy of Medical Sciences, the Indian Council of Medical Research, and the United Kingdom’s Medical Research Council. Other funders including philanthropies will be invited to join in the future and the GACD will consider the WHO 2008-2013 action plan for setting priorities to combat chronic diseases.

The Global Alliance’s priorities are to do large-scale international clinical trials of drugs for preventing heart disease, perform public health measures to control obesity, and develop control measures for chronic obstructive airways disease.

Glass explains. “To make real progress it is going to take international collaboration to prevent and treat diseases in developing countries while at the same time, we need to learn how others are addressing the diseases that we have at home.”

The Center is also making initial grants in its “Millennium Promise Awards” program to train researchers in chronic diseases. The funding for the first awards made in the program will study chronic diseases and will train researchers in Asia, Africa, Latin America, and the Middle East.

Seven awards totaling $7.3 million over five years will enable local scientists and institutions to develop long term training programs to deal with the looming crises in the development of chronic diseases. In addition, two planning grants will provide $108.000 for two years.

Each project will be a partnership between U.S universities and with institutions in the countries where training occurs. The U.S. universities include Vanderbilt University, Yale University, University of Texas Health Sciences Center San Antonio, University of Pittsburgh, Mount Sinai School of Medicine New York, University of Michigan, and Emory University.

The National Heart, Lung, and Blood Institute (NHLBI) commissioned an Institute of Medicine report on cardiovascular disease in developing countries. Also, to deal with worldwide chronic diseases, the NHLBI has just awarded contracts worth more than $34 million to set up chronic diseases training networks in nine countries to be led by a research institution and paired with an academic institution in the country.

NHLBI will fund centers in Bangladesh, China, Guatemala, India, and South Africa with three additional centers in Argentina, Kenya, and Peru. United Health Group’s Chronic Disease Initiative supports the centers and two centers at the U.S. Mexico border and in Tunisia. The centers will do research tailored to the local or regional needs to reduce the burden of chronic diseases including heart disease, heart failure, stroke, diabetes, and COPD. Related risk factors such as high blood pressure, high cholesterol, obesity, and environmental exposures that contribute to COPD will also be emphasized.

“By developing infrastructures for research and training, the centers will apply their considerable expertise to enhance local capacity to conduct population-based or clinical research to monitor, prevent, or control chronic cardiovascular and lung diseases,”, said Dr. Cristina Rabadan-Diehl, Director for the NHLBI program.

NJ Seeks HIE Applications

The State of New Jersey has released a Request for Applications seeking innovative health information exchange projects. The State through the NJ Health Information Technology Commission and the Office of e-HIT in the Department of Banking and Insurance is currently assembling a State plan for HIT.

The state is looking for projects in the state that hold the promise for establishing a more effective efficient, sustainable, and interoperable exchange of clinically useful data across healthcare provider organizations, cities, and regions.

HHS has made available $564 million to the states for HIEs with each state receiving between $4 and $40 million based on a formula that has yet to be fully released. The state will receive the funding from the Office of the National Coordinator for HIT with information on the funding to be announced on or about December 15, 2009.

A sizable portion of that funding will go to local and regional health information exchanges to promote the exchanges. Once these exchanges are established, the state is going to integrate them with other sources of healthcare data into a secure, statewide health information exchange.
Sustainability has been a major challenge for regional HIEs nationwide. When submitting an application, a detailed and viable plan for financial and operational sustainability for the grant period and beyond that period of time is required. Revenue sources need to be included for future annual costs for hardware, software, licenses, and staff support. The state understands that not all exchange projects will be fully self-sustaining beyond the life of the grants from ONC.

The Request for Applications must be submitted to the State by September 25th. At that point, the Request for Applications received will possibly be incorporated into the state’s application for funding to be submitted to HHS due on October 16th.

For more information, go to or contact the State of NJ Department of Health and Senior Services at 609-984-7160.

CMS Reports on Demos

The Nursing Home Value-Based Purchasing Demonstration offers financial incentives to nursing homes that meet certain conditions for providing high quality care. The demonstration is open to free-standing and hospital-based facilities with financial rewards going to those facilities that improve or deliver quality care, achieve good outcomes, and avoid unnecessary hospitalizations.

CMS will conduct the demonstration in 79 nursing homes in New York, 62 in Wisconsin and 41 in Arizona. Each of these states assisted in the recruitment process by encouraging facilities to apply to CMS. The demonstration will run from July 2009 through June 2012.

The Physician Hospital Collaboration Demonstration that began July 2009 is evaluating whether gainsharing leads to improvements in quality and efficiency. The demonstration provides an opportunity for hospitals and physicians to join forces to improve quality, efficiency, improve the use of inpatient resources, and to achieve cost reductions.

The demonstration is administered by the New Jersey Hospital Association and has twelve hospitals participating. The program tracks patients beyond a hospital episode to determine the impact of hospital-physician collaborations on preventing short and longer term complications and to determine whether services are duplicated.

The Medical Hospital Gainsharing Demonstration began in October 2008. This demonstration is currently at two sites, Beth Israel Medical Center in New York City, and Charleston Area Medical Center in West Virginia. Under this demonstration, CMS will evaluate whether gainsharing leads to short-term improvements in quality and efficiency during the inpatient stay and immediately following discharge.

According to CMS, the Hospital Quality Incentive Demonstration (HQID) entering its fifth year shows continued quality improvement among participating hospitals. The HQID is sponsored by Medicare in partnership with Premier, Inc., a national hospital quality measurement organization. The demonstration which began in 2003 with hospitals in 38 states was designed to test payment incentives under Medicare to see if they would improve the safety, quality and efficiency of inpatient services by linking incentives to improved quality.

Participants raised overall quality by an average of one percentage point over four years, based on their performance on more than 30 nationally standardized and widely accepted care measures for patients in five clinical areas such as heart attack, coronary bypass graft, heart failure, pneumonia, and hip and knee replacements.

CMS is awarding incentive payments totaling $12 million in year four to 225 hospitals for top performance, top improvements and overall attainment in the five clinical areas. Through the first four years, CMS awarded more than $36.6 million to top performers. After the initial three years of the demonstration, CMS extended the project for three additional years to test new incentive models and ways to improve patient care.

Physician practices participating in the Physician Group Practice (PGP) Demonstration continue to improve quality for patients with chronic illnesses or requiring preventive care. All ten of the physician groups participating in the demonstration achieved benchmark performance on at least 28 of the 32 measures reported in year three of the demonstration. Two groups Geisinger Clinic in Danville PA and Park Nicollet Health Services in St. Louis Park, MN achieved benchmark performance on all 32 performance measures.

Under the PGP demonstration, physician groups earn incentive payments based on the quality of care they provide and the estimated savings they generate in Medicare expenditures for the patient population they serve. As a result of their efforts, five physician groups will receive performance payments totaling $25.3 million as part of their share of $32.3 million of savings generated for the Medicare Trust Funds in year three.

Over the first three years, the physician groups increased their quality scores an average of 10 percentage points on ten diabetes measures, 11 points on ten congestive heart failure measures, 6 points on seven coronary artery disease measures, 10 points on two cancer screening measures, and one percentage point on three hypertension measures.

More than 560 small and solo physician practices participating in the Medicare Care Management Performance (MCMP) Demonstration have been rewarded for providing high quality care in the delivery of preventive care and care for patients with chronic illnesses. The goal of the demonstration is to promote the use of health information technology to help beneficiaries with chronic conditions.

Doctors in small to medium sized practices who meet clinical performance standards on each measure are eligible to receive financial rewards under the MCMP demonstration. The demonstration also provides an additional bonus to practices that report the data using an EHR certified by CCHIT. Twenty three percent of practices were able to submit at least some of the measures from a certified EHR.

In the first year of the MCMP demonstration, almost all of the 610 participating small and solo physician practices were rewarded for performance on 26 quality measures. CMS is awarding $7.5 million in incentive payments to over 560 practices in California, Arkansas, Massachusetts, and Utah. The average payment per practice is $14,000 but some practices earned as much as $62,500. Last year, CMS paid out over $1.5 million for incentives for reporting baseline quality measures.

For additional information, go to