Wednesday, March 31, 2010

Surveying EMR Adoption

Adoption of healthcare IT is on a steady incline in the small physician practice as revealed in a March 2010 survey done by NaviNet, a real-time healthcare communications network. NaviNet conducted a survey of IT and EMR adoption trends in small practices with ten or fewer physicians via email and received 269 responses.

In 2009, only 9 percent of respondents from practices with 10 or fewer physicians reported that they planned to implement EMRs within the next six months, yet six months later EMR implementation was higher than expected at 12 percent. Furthermore, the percentage of respondents with no plans to implement an EMR has decreased significantly. In 2009, 31 percent reported that they had no plans to implement EMRs but in 2010, only 21 percent say they have no plans to implement.

The survey showed that 12 percent of provider practices report that they plan to implement EMRs and 17 percent say that their offices will implement a new EMR system by the end of 2011. Of those, 68 percent will do so within the next 12 months. If EMR adoption follows previous growth rates, the industry can expect an even higher percentage of practices implementing EMRs than predicted.

The NaviNet survey indicates that nearly twice as many provider offices making decisions on whether to buy IT are driven by concerns about not being reimbursed versus the potential to earn incentives. In 2010, respondents were asked what external factors were influencing their decision about changes to technology with 53 percent reporting that CMS mandates had an influence. The CMS mandates outline rules for claims submission and what will be required for reimbursement for Medicare and Medicaid.

Administrative concerns continue to be a pressing issue for providers even more so than clinical concerns or potential financial incentives. Nearly the same percentage of respondents in 2009 and 2010 cited the need to manage their practices’ administrative overhead more effectively as a driver behind IT adoption resulting in 44 percent in 2009 and 45 percent in 2010.

However, in 2010, nearly 50 percent of respondents said that cost still remains the biggest barrier to EMR adoption. The survey showed that some provider offices are still unaware of EMR adoption, or simply responded that the practice does not need an EMR, or they do not see how the practice will achieve a return on the investment.

The survey results show that the opportunity to receive incentives from ARRA after meeting the CMS criteria for “Meaningful Use” of technology is becoming more important. However, most practices are unsure or unaware of “Meaningful Use” reporting requirements and nearly half of practices say ARRA will not impact their technology buying decisions.

Only 26 percent of the respondents said that they plan on following CMS guidelines for “Meaningful Use” to qualify for incentive payments provided by ARRA. More than 60 percent said they were unaware or unsure of what the “Meaningful Use” reporting requirements are, and nearly 48 percent said that the “Meaningful Use” requirements will not impact their EMR buying decisions.

“It is encouraging that small physician practices are getting more serious about HIT adoption. Furthermore, it is also encouraging to see Federal incentive programs having more of an impact on IT adoption,” said Brad Waugh, President and CEO of NaviNet. He continued to say “It is clear that opportunities remain for education on how to meet Federal requirements. Providers would benefit from knowing that there are a wide variety of IT solutions in addition to EMRs that could satisfy their office’s business requirements and the clinical criteria for “Meaningful Use”. Many physicians already have these solutions in their offices so additional investment could be minimal or unnecessary”.

For NaviNet survey results, go to or or call (617) 715-6000.

Virtual Dentistry Improving Care

Nearly 28 percent of California’s children have untreated tooth decay, according to a survey done in the state. Families with low incomes and people with complex medical conditions face considerable barriers to obtaining dental care and as a result, have significantly worse oral health than other segments of the population.

Now low income and adults at several California sites will be able to receive free dental care, thanks to a new telehealth project, referred to as the “Virtual Dental Home” created by the University of the Pacific Arthur A. Dugoni School of Dentistry. Significant funding for this pilot project came from CHCF, the Verizon Foundation, Paradise Valley Community Health Fund of the San Diego Foundation, along with additional support from the California Dental Association Foundation.

The four year pilot project will expand and improve access to dental services by giving participating dentists the technological capability to review patients’ dental records remotely. Dental hygienists and dental assistants will be able to perform preventive and temporizing restorative treatments for patients in the community setting. Patients needing further treatment by a dentist will be provided assistance in getting to a dentist’s office or clinic for completion of needed treatment.

The project will eventually operate in nine community locations including schools, nursing homes, and Head Start centers in Los Angeles, the San Francisco Bay Area, the Central Valley, Sacramento, and Northern California.

In other dental activities, virtual dentistry is being used to deliver education in the field. The Columbia Center for New Media Teaching and Learning (CCNMTL) has partnered with Columbia University to create Virtual Techniques in Dentistry” (VirTechs). This interactive web-based dental laboratory manual provides students with access to detailed instructions on procedures and treatments, video demonstrations, supplementary materials for learning, and dental procedures.

Firms known in the field of dentistry have been innovative in adapting virtual imaging to enable dentists to diagnose and provide treatment plans but especially to help dentists plan for accurate tooth implants. Specialized computer software enables implant surgeons to assess all of the critical areas of the maxillary and mandibular bone structures. The precision imaging helps doctors to not only determine the best possible implant sites but also permits the assessment of the need for bone augmentation that will optimize predictability ratios.

So with dentists working in the virtual world and utilizing dental technology, the entire process of assessment, treatment planning and the selection of implant devices and final restoration products is achieved “virtually” before treatment even begins with patients being able to accurately visualize the final outcome possibilities.

Help for Child Abuse Cases

Child abuse a serious problem especially in rural areas can lead to devastating consequences. Rural facilities often lack the resources and generally and have less experienced examiners to properly identify cases and treat victims of child abuse. In California alone, 13 rural California counties have the state’s highest rates of referrals for child abuse and neglect.

While telemedicine is experiencing growing acceptance, its effectiveness for providers in underserved rural emergency departments treating child abuse cases has not always be recognized. As a result, the UC Davis Center for Health and Technology and the Child and Adolescent Abuse Resource and Evaluation (CAARE) Center at the University of California Davis Children’s Hospital, have combined their expertise to evaluate the situation as it relates to child abuse cases.

Telemedicine can prove to be very useful to help healthcare providers from rural underserved emergency departments interact with child abuse experts at the CAARE Center to obtain assistance with taking histories, performing examinations, and interpreting complex findings in child abuse cases.

The initial telemedicine consultation involves two health care providers at the remote site consulting via video conferencing with experts in the field at the UC Davis Medical Center. Once the connection is established, the CAARE experts remotely obtain history from the patient, parent, or guardian, and/or law enforcement. Following the history, tests are done, evidence is collected, and forms are completed by CAARE experts and by the remote providers.

To begin to understand how telemedicine can be beneficial in child abuse cases, a pilot study was undertaken. Positive findings from this pilot project led to expanding the pilots to five additional intervention sites along with five comparison sites. All of the emergency department sites were located in rural underserved areas. This service is now conducted with patients, physicians, and child abuse specialists in six rural hospital emergency departments in underserved regions of northern California.

Three full time physicians and two full time nurse practitioners all experts on sexual abuse participated in the pilots and provided consultations around the clock at the CAARE Center. Equipment in use at each site includes pagers to contact experts at UC Davis 24 hours a day. In addition, videoconferencing units, digital video cameras, and DVD recorders are available. The cost of equipment located at the remote sites range from $15,000 to $25,000 depending on capital needs. Telecommunication costs range from $50 to $200 per month depending on the type of telecommunications used.

The personnel at all of the intervention sites received an overview on how telemedicine consultations operate and how the technology is used in child abuse cases. Personnel from UC Davis conduct the initial equipment training and provide ongoing technical assistance related to the use of the technology.

In addition, the program provides monthly child abuse training to healthcare providers in hospitals who might otherwise not have the time to travel the distance required to attend onsite training. Also, UC Davis hosts monthly training and/or photo review sessions on child abuse related issues that are broadcast over secure internet connections to remote sites.

Today, two of the pilot programs are self sustaining through their respective law enforcement and district attorney’s offices. HRSA”s Maternal and Child Health Research Program is also funding the rest of the pilot sites.

A study of 42 live telemedicine consultations examining sexually abused children at two of the remote sites, suggests that participation in the program has lead to positive changes in child abuse examination and the data collection methods used. In 15 out of the 42 cases, telemedicine consultations resulted in additions or changes to initial histories and data gathering. The program is collecting data to assess diagnostic accuracy and quality of care on an ongoing basis from both intervention and comparison sites.

Moving into the 21st Century

On March 25th, the Navajo Tribal Utility Authority (NTUA) received the largest broadband infrastructure grant of the total $63 million in grants as announced by Commerce Secretary Gary Locke as part of ARRA. In total, ten ARRA investments were made available to help bridge the technological divide, boost economic growth, create jobs, and improve education and healthcare across the country.

NTUA operating in Arizona, New Mexico, and Utah, received $32.2 million for broadband combined with an additional $13.8 million applicant-provided match to bring high speed affordable broadband services to the Navajo Nation. The funding will be used to deploy 550 miles of new aerial fiber-optic cable and 59 new or modified microwave towers covering 15,000 square miles in three states.

Conditions in the Navajo Nation are very primitive since it is estimated that 60 percent of the residents lack basic telephone service which means that emergency telephone service in the area is very limited. In addition, the proposed service area has significant poverty with high unemployment.

The project expects to directly connect 49 Chapter Houses which serve as community centers for the Navajo population at speeds from 10Mbps to 10 Gbps. Last mile wireless services will be offered at speeds between 1 and 3 Mbps through the project’s wireless partner, Commnet Wireless.

In another important move, the “Indian Health Care Improvement Act” was made permanent on March 23rd. The legislation is the cornerstone legal authority for the provision of healthcare to American Indians and Alaska Natives and is now part of the just signed “Patient Protection and Affordable Care Act”.

Some of the many legislative benefits will help with hospice, assisted living, long-term care, both home, and community-based care, help to handle reimbursements from Medicare, Medicaid, and CHIP by Indian health facilities, and enables the IHS to work with the VA and DOD to be able to share medical facilities and services. The Act also directs the IHS to establish comprehensive behavioral health, prevention, and treatment programs for all Indians.

RHIC Secures Funding

The Duke Energy Foundation along with matching state funds makes it possible for the Rural Health Innovation Collaborative (RHIC) to study whether it is feasible to establish a rural healthcare and life science oriented business incubator and accelerator in Indiana. This facility would be used to house and support the development of new ventures.

In addition to the $10,000 Duke Energy grant, half of the cost of the $26,300 study is being funded by the Indian Economic Development Corp. The remaining $3,150 will be shared between Union Hospital, the Terre Haute Economic Development Corp, and the Indiana State University Foundation. Other collaborative partners in the venture are Indiana University School of Medicine (Terre Haute), Ivy Tech Community College, and the City of Terre Haute.

The RHIC working group is looking at programs, services, and amenities that are most needed to support students, educators, and healthcare providers, to be able to ensure that there is a vibrant workforce in the future to meet these needs.

The basic plan is for the collaborative to study and assess workforce needs and at the same time, address revitalization and economic development in neighborhoods and how to increase rural healthcare services along with training and research.

To achieve these goals, the RHIC is trying to appeal to life science organizations, healthcare companies, and start-ups with a particular focus on developing the products and services needed to support the decentralized healthcare system now emerging in rural communities.

RHIC is looking at developing a facility in a selected community in the state, to create a state-of-the-art learning space. The plan is to develop a facility with space for educators , students, and businesses to work on projects that at the same time will spark economic development and perhaps generate future grant funding.

Indiana State University’s Center for Business Support and Economic Innovation will act as lead agent for the study with the Center’s Director Christopher Pfaff as the Coordinator. More information on RHIC is available at

Sunday, March 28, 2010

Interim Final Rule Issued

The Drug Enforcement Administration’s Interim Final Rule on electronic prescribing for controlled substances was issued on March 24th. The Interim Final Rules spells out the rules that healthcare providers will need to follow in order to electronically prescribe controlled substance according to the law.

DEA is in the process of revising its regulations to provide practitioners with the option of writing prescription for controlled substance electronically. The regulations will also permit pharmacies to receive, dispense, and archive electronic prescriptions.

The regulations would enable pharmacies, hospitals, and practitioners to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances dispensing.

The regulations will reduce paperwork for DEA registrants, help both pharmacies and hospitals integrate prescription records into other medical records, reduce the amount of time patients spend waiting to have prescriptions filled, potentially reduce the number of prescription errors, and reduce prescription forgeries.

Once DEA published the first Notice of Proposed Rulemaking for electronic prescribing of controlled substances, ONC, CMS, AHRQ, and other HHS staff have been working closely with DEA to develop the policies for the Interim Final Rule.

Senator Sheldon Whitehouse (D-RI) an active participant concerning the issue, provided a statement supporting the Interim Final Rule. “Allowing for electronic prescribing of controlled substances while maintaining rigorous controls to prevent illegal diversion to protect privacy is the key to unleashing the vast cost saving and quality improvement potential of health IT. This new interim rule from the DEA and DOJ brings us one step closer to that goal.”

The Interim Final Rule is expected to be published in the Federal Register on March 31, 2010 and will include a 60 day comment period.

Diversinet Advancing Secure mHealth

Dr. Wendy Graham, the lead physician along with other members of the Blue Sky Family Health Team in North Bay Ontario is actively conducting the Mihealth pilot project. This pilot powered by Diversinet, is a mobile health solution to give patients secure, 24/7 access to all their vital medical information on their mobile phones.

The Blue Sky Family Health Team is now able to serve more patients at lower costs, help patients more actively manage their health and wellness, help patients enter, retrieve, and update medical records.

The Mihealth Pilot uses Diversinet’s Health Application built on their MobiSecure® Wallet and Vault technology. This specific technology has advanced personalization tools such as over the air branding and new mobile software development kits and enables patients to create and update personal health records (PHR). The records contain summaries of the patient’s healthcare information, data on upcoming and previous appointments, the names of the treating physicians, and laboratory reports.

Both the patients and physicians participating in the Mihealth pilot are seeing benefits. The patients like being able to access personal health information anytime, anywhere and as a result, they become more involved in their healthcare and wellness. Physicians have to spend less time on unnecessary office visits, see increased patient compliance, and see fewer medical errors,

The pilot program illustrates how successfully patients can have 24/7 access to records in a secure manner. More than 100 patients are currently using the application which can run on more than 200 kinds of mobile devices. The pilot of the Mihealth system has been extended because of the positive response to linking patients, physicians, and clinical workers.

Plans are for Diversinet to provide Bluetooth® connectivity to medical diagnostic devices through MobiSecure Wallet and Vault and they expect to release this product in the second half of this year to enable even more additional medical information to be collected

Today, people are being helped enormously via the use of smartphones and mobile phones to improve patient care. The number of mobile phone subscriptions worldwide has reached 4.6 billion. In addition, with the arrival of iPhones and similar products, consumers expect more real-time information at their fingertips. However, at the same time, security issues can be a hurdle and could possibly hinder the adoption of the technology.

To meet this problem, Diversinet has a new product called MobiSecure® SMS to enable healthcare providers to exchange sensitive information instantly with patients via any mobile device in a secure environment. This product is targeted for telemedicine and provider case/disease management. More than $80 million has been invested in MobiSecure technology platform over the last 23 years and this has resulted in a significant patent portfolio.

The key to MobiSecure SMS is the mobile handset that secures communication via any wireless mobile device from the mobile operator or service provider. Encryption and strong authentication provides security for both one and two way messages meeting regulatory and privacy requirements. A remote access wipe capability enables users to erase sensitive data in the event a mobile device is lost or stolen.

“Our mobile expertise puts the company in a position to meet the growing demand for secure application solutions in the healthcare industry, according to Albert Wahbe, Diversinet’s Chairman and CEO. Given government and industry mandates to move to a more efficient and effective electronic system of healthcare information management, we believe this is the ideal time to focus our solutions on healthcare providers, payers, and patients.”

To contact Dr. Wendy Graham for information on the MiHealth Pilot Project, email For information on Diversinet’s products and services, go to

RFI to Help Develop Strategy

The White House Office of Science and Technology Policy and the National Economic Council have released a Request for Information (RFI) seeking ideas from the public on how to promote commercialization of federally funded research. The purpose for gathering the information is to not only find ways encourage commercialization of university research, but also to see whether the establishment of “Proof of Concept Centers” (POCC) can be a way to stimulate the commercialization of early stage technologies.

For example, in the information and communications sector, university-based research has played a key role in the development of technologies such as the internet and especially in the life sciences along with the development of new tools to diagnose, prevent, and treat diseases. Innovative technologies can come from not-for-profit research institutions such as hospitals and foundations as well as from Federal laboratories and the private sector.

The federal government funds much of this early-stage research and also provides incentives so that entrepreneurial businesses can bring new technologies to the marketplace. Despite the resources provided, too many technologies fail to cross what is referred to as the “valley of death” when product development goes between the research laboratory and commercialization by the private sector. Transferring viable research discoveries to the marketplace is posing a challenge to innovators and entrepreneurs.

The National Economic Council and the Office of Science and Technology Policy will use the input from this RFI to shape the Administration’s future policy on the commercialization of federally funded research.

The goal is to find ways that the federal agencies, research institutions, federal researchers, and the private sector can work together to foster more successful POCCs to accelerate the commercialization of research into the marketplace. Answers are also needed to find other funding resources other than in the federal government, such as in state, regional, or local governments.

Responses for this RFI are to be submitted by April 26, 2010. Information obtained from the RFI will be used only for program planning purposes and does not mean that a binding contract or grant will be issued.

For further information, go to the March 25, 2010 Federal Register. Questions on the content of the RFI can be emailed to with the subject line “RFI Questions”.

Informed Consent an Issue

The Policy Committee of the North Carolina Medical Board is continuing to discuss the state’s proposed policy on telemedicine. The Committee approved a draft telemedicine policy statement in January, but the full Board asked the Committee to continue to review the proposed policy to specifically clarify the “informed consent” language. On March 17th, the Policy Committee met and discussed the feedback received from a number of stakeholders on the issue of informed consent.

The informed consent statement in the draft statement reads “The physician using telemedicine should obtain the patient’s informed consent before providing care via telemedicine services. In addition to information relative to treatment, the patient should be informed of the risks and benefits of being treated via telemedicine. This includes how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate as a result of a technological or equipment failure. The patient retains the right to withdraw his or her consent at any time.”

During the Board’s consideration of the statement on informed consent, several radiology groups contacted the Board to voice concern over informed consent. They were concerned that this position statement in the document would require them to obtain an additional informed consent from patients when in the past they had traditionally relied on the informed consent obtained by the hospital or physician requesting the interpretation.

The Board does not intend to create such an additional requirement. In the event that radiologists or other specialists have traditionally relied on the informed consent obtained by another provider, the Board believes that such informed consent should remain sufficient.

The Board does caution that physicians relying on such informed consent and hospitals obtaining such informed consent may want to review such informed consents to ensure that they include the possibility that the patient’s diagnosis or treatment may be obtained by electronic communication, information technology, or by other means.

In March, the Board reviewed all of the comments and it was the consensus that the proposed informed consent statement should stand. However, after further consideration, the Board decided to table the issue until the staff could obtain additional information regarding informed consent.

Go to to download the statement on telemedicine. Topics addressed in the statement other than informed consent include staff training, examinations, physician-patient relationship, medical records, licensure, and fees.

NYSHealth Releases Funding

The New York State Health Foundation (NYSHealth) in working to improve the health of New York State residents at this time, has released an application for the onetime non renewable “2010 Special Projects Fund”. The funding is focused on priority areas to expand health insurance coverage, improve the management and prevention of diabetes, and to encourage the integration of substance use and mental health services.

Projects to be considered will:

• Help low income and elderly consumers understand and navigate the healthcare system
• Improve access to healthcare in service areas that have acute shortages
• Address a statewide health system issue to improve the efficiency or effectiveness of the system
• Improve the quality of care in measurable ways
• Support and strengthen safety net providers of healthcare
• Scale up successful programs or services to reach more people
• Provide culturally appropriate programs for underserved populations

NYSHealth will consider proposals from existing nonprofit and for-profit organizations with a significant presence in New York State. Funding requests can range from $50,000 to $1,000,000 with Special Projects fund grants typically in the $250,000 range.

The deadline for the letter of inquiry is May 6, 2010 and the deadline for the full application is May 20, 2010. Grant applications are considered on a rolling basis with two deadlines. Earlier applicants have a higher probability of receiving funding than those who apply later in the calendar year.

Go to http://nyshealthfoundation.or/section/funding/2010_special_projects_fund or go to for more details. For more information or questions, email

Wednesday, March 24, 2010

SBIR Funding Medical Technologies

NIH issued SBIR Announcement (RFA-EB-10-002) on March 19, 2010 seeking applications from small businesses to develop medical technologies to help reduce disparities in healthcare. The funding is not only for medical technologies but also for imaging and other technologies to help disparity populations.

Appropriate technologies may be new and innovative, or they may be existing technologies that have been redesigned based on the needs of a specific health disparity population. In addition, applications must involve a formal collaboration with a healthcare provider or other healthcare organization.

The estimated amount of funds available to support 7-12 projects is $3.45 million for fiscal year 2011. Future amounts will depend on annual appropriations.

A suggested partial list of appropriate medical technologies includes:

• Telehealth technologies for remote diagnosis and monitoring
• Sensors for point-of-care diagnosis
• Devices for in-home monitoring
• Mobile, portable, diagnostic, and therapeutic systems
• Devices to integrate diagnosis and treatment
• Diagnostics or treatments that do not require special training
• Devices that can operate in low-resource environments
• Non invasive technologies for diagnosis and treatment
• An integrated, automated system to assess or monitor a specific condition

Specific examples can be inexpensive diabetic test strip and/or blood sugar monitoring devices, basic technology to promote self management and patient education, technologies to provide surveillance for chronic diseases, technologies to improve early detection of diseases in areas where there are significant health disparities, and development of low cost portable imaging equipment.

Applications submitted must address one or more of these barriers:

• Physical Barriers—factors such as proximity to healthcare facilities and transportation that may limit access to healthcare
• Knowledge Barriers—health literacy and language barriers that can inhibit health care delivery as well as not provide enough information for the healthcare provider
• Infrastructure Barriers—rural hospitals and community health centers may not have the same resources and expertise as large hospitals and may not be able to afford advanced medical technologies
• Economic Barriers—lack of insurance coverage or financial resources may also contribute to disparities in healthcare access
• Cultural Barriers—religious beliefs and social customs often deter certain populations from seeking healthcare

The technology must provide an improvement over the current quality of care for a health disparity population by overcoming one or more of the barriers. The technology must also be affordable to local hospitals, community health centers, primary care physicians, or to individual patients.

Participating organizations within NIH are NIBIB, NIAMS, NCCAM, NCMHD, and NCRR. Applications are due May 20, 2010 or September 22, 2010. Letters of Intent are due April 20, 2010, or August 22, 2010. Go to for more information.

Stroke Care Produces Results

Crittenden Regional Hospital in West Memphis has partnered with the University of Arkansas for Medical Sciences to provide life-saving emergency care for stroke patients in the region. Using a program called SAVES, the hospital uses a high tech video communications to provide immediate life-saving treatments to stroke patients 24 /7.

The use of real-time video communication enables a stroke neurologist to authorize emergency room physicians to use the blood clot dissolving agent called t-PA. Since the program began, 127 stroke patients have been treated by SAVES neurologists with 23 of those patients receiving the tPA drug with excellent results.

Crittenden is not only partnering with the UAMS Center for Distance Health, but also with the state Department of Human Services, Sparks Regional Health System in Fort Smith and 13 other hospitals in Arkansas. The program is planning to add more hospitals across Arkansas in the coming months, said Curtis Lowery, M.D. Director for the UAMS Center for Distance Health.

In North Carolina, the Comprehensive Stroke Center at Wake Forest University Baptist Medical Center recently expanded their Telestroke Network by adding Ashe Memorial Hospital to the network. The Telestroke system employs a highly specialized telemedicine robot to allow a Wake Forest Baptist stroke expert to evaluate patients and then consult with local emergency room physicians via the internet. Together, they can determine if a patient is a candidate for tPA.

To treat the patient, the stroke physician at Wake Forest Baptist sits at a remote InTouch computer to simultaneously interact with the patient, view medical records, and diagnostic images. Then a connection is made to an InTouch RP-7 robot located at Ashe Memorial which enables them with the help of the robot to move freely around the exam room and interact with patients, family members, and hospital staff.

In another part of the country, the study “Pooled Analysis of the STRoke DOC and STRokE DOC-AZ Telemedicine Stroke Trials” followed two primary hub stroke centers at the Mayo Clinic in Arizona and the University of California, San Diego along with another six rural spoke hospitals.

In the study, 276 patients exhibiting symptoms of stroke at their respective emergency departments were randomly assigned to telephone consultations versus two way telemedicine consultations using a digital observation camera.

Results of the 5 year study showed that the correct emergency stroke treatment decision-making was made 96 percent of the time with the audio/video telemedicine technology as compared with 83 percent for telephone consultations only.

Bart Demaerschalk, M.D., Mayo Clinic neurologist and principal investigator of the Arizona trial, said “This pooled analysis with replication of the hub-and-spoke network infrastructure, supports the fact that telemedicine could be used in broader rural settings and communities in more states in hospitals and with more providers. Results are significant and they confirm the effectiveness of telemedicine to be used as a tool to evaluate acute stroke.”

Test Method & Software Released

The National Institute of Standards and Technology (NIST) working with a broad array of public and private stakeholders released the first of four installments for a new health IT test method and related software. Late last year, HHS identified the required technology standards and requirements needed to help physicians evaluate possible health IT systems against the requirements.

As mandated by ARRA, NIST and HHS are working with health IT system vendors, and with standards organizations such as the American National Standards Institute, Healthcare Information Technology Standards Panel, and with certification bodies and system implementers to develop a suite of software tools to support the HIT testing infrastructure. The tools are intended to help vendors test their health IT products and to ensure basic functionality.

The health IT testing infrastructure does not create any new standards, but only creates the tools necessary to test for compliance with existing standards as announced last year. Testing laboratories will use these tools in the testing component of the certification programs established by ONC. ONC plans to use NIST’s National Voluntary Laboratory Accreditation Program to perform the accreditation for testing laboratories.

A new Health IT Standards and Testing web site has been established at to provide more information on the program and initiatives underway. The site also provides access to test methods used.

Aetna Funding Grants

The Aetna Foundation released their “Call for Proposals” for their 2010 grant cycle. The grant program seeks national and regional partners to find better ways to improve the quality and delivery of health services for everyone. The funding is to address obesity, racial and ethnic healthcare equity, and integrated health care. Regional grant requests may not exceed $150,000 and national grants may not exceed $250,000.

In general, integrated care tries to repair a fractured healthcare system and eliminate gaps in shared information and communication that detract from patient safety and quality in healthcare.

The Aetna foundation believes that while the primary care provider is the key to integrating healthcare, more study is needed on how to achieve integrated care. The Foundation is looking for projects to demonstrate key components, best practices, and benefits that center on strong primary care.

Examples of grants to support projects in this area would:

• Explore the relationship between patient engagement and integrated care
• Enhance communication between patients and care providers as well as among care providers
• Investigate the impact of poor coordination on patient safety, quality, and costs
• Identify best methods for engaging patients as partners in their care particularly for managing chronic conditions
• Identify best practices to align incentives for achieving well-coordinated care

Within three program areas, Aetna will award grants in research and for projects that will test or disseminate new practices designed to improve health and healthcare. Aetna is also interested in projects that have the goal to analyze and promote policies to ensure that programs and practices are replicated and disseminated broadly.

Eligible applicants for the grants are nonprofit organizations but only organizations that are U.S based and only proposals that are national or regional will be considered.

The next date for applications to be accepted is May 15, 2010. For more information, go to or go to

Spectrum Dashboard Launched

The FCC has released the “beta” of their Spectrum Dashboard to enable users to review how spectrum bands are allocated and used but also to identify license holders in specific areas. The initial version released today in plain language provides information on the frequencies between 225 MHz and 3.7 GHz which is the range of spectrum potentially usable for mobile broadband.

The Spectrum Dashboard was released in conjunction with the release of the “National Broadband Plan,” as another resource for stakeholders who want to participate in the deployment of wireless broadband in the nation. The Dashboard is intended to be a one-stop shopping portal for licensing information and combines information that is currently available on a number of separate electronic databases and filing systems.

The Dashboard is able to produce maps of spectrum licenses and show a geographic service area for individual licenses or show the total amount of spectrum licensed within a service area on a county-by-county basis. Users can also access raw licensing data in a format to allow for easy import into spreadsheets and other software is available to do a more detailed analysis.

Plans are to update the Spectrum Dashboard monthly and the FCC is making every effort to keep improving and updating the tool. The agency is seeking comments on what types of information or features to include in the Spectrum Dashboard.

To access the Dashboard, go to On-line support is available from the “eSupport” tool at or from the help lines at (877)-480-3201.

Sunday, March 21, 2010

Grant Applications Available

The USDA’s Rural Utilities Service just announced the Distance Learning and Telemedicine (DLT) grant program application window for FY 2010 is now open. Funding for FY 2010 is $30,255,000 with the maximum grant to be $500,000 and the minimum grant to be $50,000. So far there is no budget authorization for the DLT combination loan/ grant or loan programs. If and when funds are appropriated, the information will be announced in the Federal Register.

RUS administers the DLT program to promote and modernize telecommunication services in rural America. DLT specifically funds projects that deliver critically needed education medical services by providing interactive educational training over distances. These sites link to rural hospitals, medical clinics, medical centers, and experts, by providing clinical interactive video consultations.

To be eligible for a grant your organization must:

• Deliver or propose to deliver distance learning or telemedicine services for the term of the grant. The DLT program is focused on sustainability. Planning studies, research projects, and short-term demonstration projects in place less than the life of the award for three years will not be considered

• Be an incorporated organization or partnership, an Indian tribe or tribal organization, a state or local unit of government, a consortium or a private corporation organized for profit or on a not-for-profit basis

• Operate a rural community facility or deliver distance learning or telemedicine services to residents in rural areas

Applications must be submitted by or on May 18, 2010. For more information, email or call (202) 720-0413. To download the Application Guide including the toolkit go to

VITL Assisting Physicians

The Vermont Information Technology Leaders, Inc. (VITL) with Chittenden Bank has created a loan program to help Vermont physician practices finance electronic health records systems. Various financing options for qualified applicants are available from the bank directly and also through partnerships with local, state, and federal agencies.

Dr. David Cochran, VITL’s President and CEO, said, “Starting next year, the federal government will make available financial incentives to physicians who use EHRs in a meaningful way. However, physicians will first have to invest in the technology and integrate the technology into their practices. The loan program is structured to provide flexibility for physicians that may want to incorporate both the hard and soft costs of transitioning to an electronic platform.”

Vermont physician practices interested in applying for loans can obtain more information and discuss relevant loan terms by calling Jami Rivers at Chittenden Bank at (802) 660-1309.

In addition, VITL has reached out to help physicians obtain and use computerized systems by naming Fletcher Allen Health Care as a VITL “Preferred EHR Partner”. One of the criteria for being named a Preferred EHR Partners is that the software used must be available to exchange data with other EHRs via the Vermont Health Information Exchange operated by VITL.

Fletcher Allen has implemented their Patient Record and Information Systems Management (PRISM) EHR system in the inpatient areas of their hospital and is in the process of rolling it out to the ambulatory care sites.

Through the PRISM Regional Program, Fletcher Allen is also offering the EHR system to physician practices and hospitals statewide. This will enable hundreds of healthcare providers to access a shared database. “While we realize that not all providers in our service area will choose to use PRISM, the system will provide a link between Fletcher Allen and providers using other types of EHR systems,” said Chuck Podesta, Chief Information Officer at Fletcher Allen.

Fletcher Allen is VITL’s second announced Preferred EHR Partner. The first partner was Allscripts, and VITL is now reviewing other applications from EHR vendors and may select additional Preferred EHR Partners in the future.

For more information, contact Steve Larose, Vice President, External Affairs, at

Device to Help Doctors

The University of Utah engineers with National Science Foundation funding have developed a computer-controlled motorized hand and arm support. This arm support enables doctors, and others to precisely control scalpels and other tools over a wider area that is possible now with less fatigue.

“The new device called the “Active Handrest” will help people perform precision tasks with their hands such as in surgery or to do other tasks that require precise control of the fingertips,” says William Provancher, Assistant Professor of Mechanical Engineering.

A person using the handrest puts their wrist on a support that can slide horizontally in any direction with their elbow resting on a support attached to the device. The “Active Handrest” allows a person to maintain a steady hand while it senses the position of a hand-grasped tool or the force exerted by the hand or both. Then the device’s computer software moves the handrest so it constantly re-centers the fingertips in the center of the dexterous workspace.

The prototype of the “Active Handrest” lets a user move their hand precisely within a workspace of about 10 by 10 inches, moving the hand as the arm moves to reach a larger area. Future devices could allow for three-dimensional motion and even larger work areas with the same precision.

Research devices have been developed where a robot and a human user simultaneously hold a tool to increase precision. In these devices, control of the tool is shared between the human and the robot. In contrast, the “Active Handrest” provides ergonomic support and increases precision, but enables the user to maintain complete control of the tool.

A prototype has been built and pilot studies were done to test the handrest. The pilot studies had 12 people perform certain tasks. At this time, a patent on the device is pending and Provancher says he may form a spin-off company to commercialize it, or license it to companies that produce touch-feedback devices, make robotic surgery equipment, produce art, or refurbish electronics.

For more information, email William Provancher, or call (801) 581-4119.

Treating Depression after Surgery

In a program known as “Bypassing the Blues”, nurse care managers are routinely screening patients after cardiac bypass surgery for symptoms of depression in seven Pittsburgh area hospitals. The program centers on giving on-going telephone support over an eight month period.

The problem is that many patients report depressive symptoms after coronary artery bypass graft surgery (CABG) and these symptoms can have a negative effect on the quality of life, lead to an increased risk of chest pain, and possibly result in more hospitalizations and even death.

Hospitals and physicians seldom conduct systematic screening to identify depressed patients after CABG surgery or provide ongoing treatment and support to help manage depression. In addition, available support often does not always align with patient preferences.

While nurse-led collaborative care programs have been effective with depressed patients in primary care settings and in patients with other chronic conditions, they have generally not been used in post-CABG patients suffering from depression.

By using the collaborative care model, these nurses educate patients about depression, help them practice self-management skills, and encourage adherence to recommended treatment options. The nurses met weekly to review the cases with a psychiatrist, psychologist, internist, and routinely communicate with the primary care physician to ensure that coordinated and consistent care is given. If needed, the nurse is able to secure verbal authority from the physician to prescribe medications with a follow-up fax to obtain written authorization. In some states, nurses already have this authority but this is not the case in all states.

Electronic support is provided with each nurse using a tablet personal computer where information is obtained from every patient. The data is formatted with entry questionnaires linked to an electronic data management system or patient registry. This registry helps to provide information on weekly case reviews and can track a patient’s progress over time.

Discharged CABG patients are followed up with in-hospital and other screening to identify eligible patients for the program. This is accomplished by having:

• A series of screening tests performed just prior to discharge for all CABG patients
• The nurse calls those passing the screening two weeks after discharge to administer a second screening
• Patients scoring at or above 10 on the survey that show a moderate level of depressive symptoms qualify for additional telephone-based support but not if they are already actively seeing a mental health specialist.
• Biweekly calls made lasting 15 to 45 minutes to support self management treatment
• Less frequent maintenance calls after recovery is achieved but the calls are continued until the patient has been in the program for eight months
• The final call made at the end of the eight month period. The patients still exhibiting symptoms are encouraged to initiate pharmacotherapy or make a change to existing pharmacotherapy, or see a mental health specialist. Those patients no longer exhibiting symptoms are reminded to continue adherence to the treatment approach

The program ongoing at the Pittsburgh hospitals has been shown to improve mental and physical health in both men and women. It also has been found that men experience a greater degree of benefit, and men are less likely to be readmitted into the hospital if part of this program.

For more information, email Bruce L. Rollman, MD

Minnesota Updating Services

Governor Pawlenty of Minnesota and legislative leaders have agreed to provide continued healthcare for the state’s low income population by creating a new Coordinating Care Organization to replace the General Assistance Medical Care program.

Effective on June 1, 2010, the new hospital-based coordinated care delivery system in partnership with county agencies will be put into place. Coordinating Care Organizations (CCO) will manage healthcare and provide medically necessary services for eligible Minnesota residents.

Capped block grants for CCOs will be funded with $71 million from the state’s General fund in FY 2010-11 and $131 million in FY 2012-13. The Governor and legislators also agreed to establish a method to reimburse CCOs for drug costs associated with medical care. Drug reimbursements would be capped at $45 million with funding from the General fund in FY 2010-11 and $83 million in FY 2012-13.

The agreement also includes a six month uncompensated care pool for Minnesota hospitals that are not designated as CCOs. The temporary UCP will be paid for with $20 million from the healthcare access fund in fiscal year 2010-11.

To address the needs of the mentally ill, the Minnesota Department of Human Services has plans to redesign services so that they will have access to more equitable psychiatric care across the state. The plan has been included in a report resulting from a series of stakeholder meetings held to discuss how to redesign adult mental health services provided by DHS State Operated Services. The report that resulted titled “Chemical and Mental Health Services Transformation” was submitted to the Minnesota Legislature this month with changes to be implemented in phases.

The plan suggests that integrated level 1 psychiatric centers need to be available in each region of the state. These centers need to provide 24/7 psychiatric coverage. At the same time, inpatient psychiatric care centers to that provide a lower level of care along with Psychiatric Extensive Recovery Treatment Services (PERTS) will be developed.

The plan also would provide for a new 24 hour psychiatric access service to provide consultation to emergency departments, primary care clinics, mobile crisis teams, jails, and other mental health providers. Comprehensive assessments, triage services, and referrals to appropriate levels of care will also be provided. The access service will include a new psychiatric emergency transportation system to be developed in consultation with consumers, family, advocates, law enforcement, providers, and other stakeholders.

A partnership process to involve service providers would enable hospitals, mental health centers, primary care centers, and state-operated facilities in regions of Minnesota to collaborate to respond to state requests for proposals for Level 1 and 2 psychiatric care services and PERTS appropriate to the needs of their areas.

Wednesday, March 17, 2010

Plan Submitted to Congress

FCC submitted the Plan titled “Connecting America: The National Broadband Plan” to Congress. Today, nearly 100 million Americans lack broadband in their home and 14 million Americans do not have access to broadband even if they want it. Only 42 percent of people with disabilities use broadband at home while as few as 5 percent of people living on Tribal lands have access.

About half of the Plan’s recommendations are addressed to the FCC, while the rest of the recommendations are for Congress, the Executive Branch, and state and local governments to work with private and nonprofit sections.

The Plan defines e-care as the electronic exchange of information involving data, images, and videos to aid in the practice of medicine and advanced analytics. E-care encompasses technologies to enable video consultations, remote monitoring, and image transmission (store-and-forward) over fixed or mobile networks. Telehealth often used as a synonym for e-care but telehealth includes non-clinical practices that can involve medical education and nursing call centers.

The FCC plan specifically addresses healthcare with the goal to:

• Ensure that all healthcare providers have access to affordable broadband by revamping the Rural Health Care Program, and make better use of the $400 million funded per year

• Upgrade the Indian Health Services broadband network to meet their health IT needs. The plan recommends spending $29 million per year to upgrade their network of providers

• Create economic incentives for broader health IT adoption and innovation. Improving broadband connectivity is necessary but does not close the health IT gap on its own. Providers need reimbursement for health IT plus other economic incentives. The Plan applauds investments that Congress and HHS are making to increase the adoption of EHRs and supports a similar approach for e-care technologies

• Unlock the power of health care data and advanced analytics while protecting privacy. The Plan supports the next generation of interoperability and data access suggesting ongoing actions by the federal government

• Modernize rules to increase access to e-care. The Plan recommends bolstering adoption of e-care technologies by revising licensing, privileging, and credentialing standards

By 2020, the Plan’s call for action over the next decade includes the following goals:

• Connect 100 million household to affordable 100-megabits-per-second service
• Enable schools, hospitals, and military installations to have ultra-high-speed broadband of at least 1 gigabit per second
• Make 500 megahertz of spectrum available for licensed and unlicensed use
• Move the U.S. adoption rates from 65 percent to more than 90 percent
• Transition existing Universal Service Fund support from analog technologies to tomorrow’s digital infrastructure
• Ensure greater transparency, remove barriers to entry, and conduct market-based analysis containing quality data with information on price, speed, and availability
• Provide every first responder with access to a nationwide, wireless interoperable public safety network

To download the Plan, go to

Awards Made to Build HIEs

On March 15th, Dr. David Blumenthal, National Coordinator for HHS, Senator Sheldon Whitehouse, and Congressman Patrick Kennedy visited Rhode Island. This visit was made following last month’s allocation of over $11 million in federal grants to the Rhode Island Quality Institute to help establish regional extension centers. The Rhode Island funding through ARRA will be used to establish regional extension centers and to help establish an integrated information exchange throughout the state.

According to Dr. Blumenthal “Rhode Island is an excellent example of the leadership role that states can play in advancing the development of the exchange capacity of healthcare providers and hospitals within their states and across the nation.”

On the same day, Kathleen Sebelius, Secretary HHS, and Dr. Blumenthal announced a second wave of grants with an additional $162 million in awards to go to 16 states and qualified State Designated Entities (SDE) in Recovery Act Investments.

These 16 awards complete the awarding of cooperative agreements funded by this program and are part of the $2 billion effort to achieve widespread meaningful use of HIT. Just last month, HHS awarded $385 million to 40 states and SDEs.

The new HIE competitive agreements went to:

• The Florida Agency of Health Care Administration ($20,738,582)
• Maryland Department of Health and Mental Hygiene ($9,313,924)
• New Jersey Health Care Facilities Financing Authority ($11,408,594)
• South Carolina Department of Health and Human Services (($9,576,408)
• Iowa Department of Public Health ($8,375,000)
• Idaho Health Data Exchange ($5,940,500)
• State of Alaska ($4,963,063)
• Nebraska Department of Administrative Services (6,837,180)
• South Dakota Department of Health ($6,081,750)
• Connecticut Department of Public Health ($7,297,930)
• State of Mississippi ($10,387,000)
• Indiana Health Information Technology, Inc. ($10,300,000)
• HealthShare Montana ($5,767,926)
• Texas Health and Human Services Commission ($28,810,208)
• Louisiana Health Care Quality Forum ($10,583,000).

PHIX Plan Submitted to ONC

The Pennsylvania Health Information Exchange (PHIX) Strategic Plan was submitted to the HHS Office of the National Coordinator in March 2010. To take advantage of federal resources, the state is required to submit a comprehensive plan for approval to address governance, finances, technical infrastructure, business and technical operations, and legal and policy decisions.

The draft Strategic Plan was completed in November 2009 and was open for public comment. During this time, the plan was presented at more than 25 healthcare provider group meetings, advisory committee meetings, to the Department of Aging, Department of Health, consumer groups, and others for their ideas.

The Strategic Plan presents a detailed review of HIT adoption issues in the state. Some of the fast-facts are that in 2009, 84 percent of Pennsylvania’s acute care hospitals were using some functionalities of an EHR. The high adoption rate in hospitals is in part because 98 of 165 acute care hospitals are part of larger health systems. Even though efforts to move HIT are underway in most hospitals, progress still needs to be made.

According to the information in the Strategic Plan, physician practices are adopting EMR/EHRs slowly and the rate of adoption is still standing at 19.7 percent as in 2007. Of the physicians using EMRs in 2007, 63 percent ordered labs or radiology results electronically, while 84.4 percent viewed lab results electronically, and 80.8 percent viewed radiology results electronically.

It is estimated that up to 5,000 of the state’s physicians work in small and often rural practices. Twenty eight percent of Pennsylvania’s population or approximately 3.4 million people live in 48 rural counties where broadband access may not be presently available.

There are a number of examples of HIE related activities across the state such as:

• Pinnacle Health System—Connects the hospital and community physicians
• Vale-U Health—Connects Monongahela Valley Hospital, 140 medical staff members and several regional ancillary providers
• 6 Bridges—Six health systems in Western Pennsylvania have formed an alliance to create an HIE
• UPMC—Connects 20 academic, community, and specialty hospitals
• Reading Hospital—Discussing a regional HIE
• Harrisburg HIE—In the early stages of formation in Central PA
• Southeast Pennsylvania—Efforts are underway to establish a regional HIE
• KeyHIE—Connects eight hospitals in Northeastern PA
• Commonwealth Medical College—Organizing a health information exchange in Northeastern PA

HIT and HIE adoption are occurring in the state and making some progress. However, according to the plan, it is very important to integrate PHIX with other initiatives within the Commonwealth. In particular, the State Medicaid Health Information Technology Plan and the Department of Health data sharing and registry projects need to be included in PHIX planning. Also, PHIX should be coordinated with the Regional Extension Center.

The ARRA 17.1 million funding with a state match will pay for the backbone of PHIX. Long term funding options for PHIX operations are now under consideration and include various combinations of legislative action and voluntary participation by stakeholders. Potential funding models may include public sector funding, voluntary contributions by insurers, subscription, membership and transaction fees, and value-added services such as offering a scaled down version of an EMR.

A Request for Proposals is being developed with representatives from the Department of Health, the Department of Public Welfare, Office of Aging, the Department of General Services, and the Office for Information Technology. The RFP is expected to be released April 2010.

To download the Strategic Plan, go to

Information for Disability Applicants

The Social Security Administration provides healthcare information to over 3 million disability applicants each year. Michael J. Astrue, Commissioner announced that the agency provides healthcare information through website links to individuals who apply each year for Social Security and Supplemental Security Income (SSI) disability benefits.

The website links take disability applicants to two HHS websites such as where information and tools are provided to help the applicants better understand and cope with their conditions.

This website provides detailed information on specific diseases. For example, if applicants have a problem with breast cancer, rheumatoid arthritis, Alzheimer’s disease, diabetes, or other diseases, they can go to the site to find information on diagnosing the disease, symptoms, treatments, ongoing research, and local resources to help them with the medical issues.

The other website can help applicants pay for prescription drugs. The web site links people to the “Partnership for Prescription Assistance” (PPA) program directing people to information on how to reduce costs, and how to get free prescription drugs offered sometimes by drug companies, from 1,300 national, state and local governments, and other local organizations.

The PPA program offers more than 2,500 brand name and generic medications for adults and also provides a wide range of medications that focus on children. PPA also assists patients with chronic diseases so that they can learn about new types of medications that may be of help.

VCI-Group Newly Formed

The newly formed Visual Communications Industry Group (VCI-Group) is a prominent force within the conferencing and collaboration market. The group formerly aligned with Polycom, Inc., and called the Polycom User Group, was formed to provide a vehicle for peer-to-peer information sharing, education, and to influence industry standards.

VCE-Group has two membership categories. The first is the Principle membership which is open to individuals who are users of conferencing and collaboration products and services. This membership provides all member benefits, including an online resource center, attendance at virtual educational events, discounts for VCI-Group in-person events and offerings from strategic partners, use of the electronic mailing list to discuss issues with other members, and help to gain access to industry leaders.

Alliance memberships are open to vendors, dealers, or consultants who supply collaboration technologies, products and/or services, or complementary products or services. Alliance members have the opportunity to exhibit, sponsor, and present at both in-person and at virtual events. They also have access to electronic newsletters and web postings and a company listing in the buyers guide, and more.

The VCI-Group will hold their 2010 Annual Conference October 3-6 2010 at the Marriott Harbor Beach Resort and Spa in Ft. Lauderdale, Florida. The event will feature exhibits with a variety of industry vendors, cutting-edge educational sessions, and valuable networking opportunities. Attendees will leave with real-life best practices to take back to their companies, beneficial feedback, and new relationships with decision-making users within the industry.

For more information about the VCI-Group, membership or for further details on the 2010 Annual Conference, go to or email Erin Helland at, or call 1-(952)-928-4665.

Sunday, March 14, 2010

Overview of Broadband Awards

Broadband activities resulting from ARRA funding were presented on Capitol Hill to the House Committee on Energy and Commerce, Subcommittee on Communications, Technology, and the Internet. Lawrence E. Strickling, Assistant Secretary for Communications and Information at the Department of Commerce, reported that the $4.7 billion allocated to NTIA to implement the Broadband Technology Opportunities Program (BTOP) and the Broadband Mapping program, has already awarded over one billion for projects.

So far, NTIA has funded Recovery Act grants in 50 states and several territories. This includes 52 broadband mapping grants totaling $100 million with 59 BTOP grants worth more than $960 million. An additional $270 million in matching contributions has been pledged by the applicants themselves.

Some of the BTOP were awarded to:

• Merit Network, Inc., REACH Michigan Middle Mile Collaborative Project—grants totaling $33.2 million with an additional $8.3 million applicant-provided match to build a 955 mile advanced fiber-optic network through underserved counties in Michigan’s Lower Peninsula
• Mid-Atlantic Broadband Cooperative Middle Mile Expansion for Southern Virginia Project—grants totaling $1.6 million with a $4 million applicant provide match to add 465 miles of new fiber to an existing 800 mile fiber network
• MCNC Building a Sustainable Middle Mile Network for Underserved Rural North Carolina Project—grants totaling $28.2 million with an additional $11.8 million applicant provided match to build a 494 mile network serving almost one half of the population of North Carolina in 37 counties

To address the progress at the Department of Agriculture, Jonathan Adelstein, Administrator for the Rural Utilities Service (RUS) emphasized how USDA has worked side-by-side with NTIA and the FCC’s Communications Commission to fulfill the vision for promoting broadband access nationally.

He pointed out that under the first funding notice, RUS and NTIA received over 2,200 proposals from applicants requesting over $28 billion in funding. Of this total 401 applications were BIP-only requesting a total of $4.9 billion. Another 833 applications were joint applications going to BIP and BTOP totaled $12,791 billion. To date, RUS has announced over $895 million in funding for 55 projects in 28 states and one territory and expects to announce additional awards shortly.

On January 15, 2010, RUS and NTIA announced their second NOFAs for the BIP and BTOP programs. RUS has extended the deadline for application submissions from March 15 to March 29, 2010.

For the second NOFA, USDA eliminates the separate funding bucket for remote projects. Instead, USDA offers higher points for projects in most rural areas. USDA also allows applicants to request a grant amount greater than the standard 75 percent grant and this is now up to 100 percent grant. This waiver process allows UDSA to make viable awards to the most rural areas and those areas with density issues, low median income, and high unemployment.

Now with separate NOFAs and no joint applications, USDA and Commerce will concentrate on specific projects. Commerce will focus on Middle Mile projects that connect community anchor institutions and USDA will focus on Last Mile projects and will finance Middle Mile projects for current RUS borrowers and grantees.

Next VLER Phase Announced

The Department of Veterans Affairs and the Department of Defense announced that the Virtual Lifetime Electronic Record (VLER) using the Nationwide Health Information Network is now expanding. DOD and the VA have selected the Virginia/Tidewater area of Southeastern Virginia to partner with since this area has a high concentration of veterans, military retirees, members of the guard and reserve, along with active duty service members and their dependents.

The plans for the Virginia/Tidewater area include having VA and DOD partner with private sector hospitals who have joined a regional health information exchange in the area. The Virginia/Tidewater pilot builds on the success of the first pilot initiated in San Diego with Kaiser Permanente.

Service members and veterans in the area will be invited to participate in this health data exchange program scheduled to launch this year. Individuals who choose to participate will authorize their public and private sector health care providers and doctors to share specific health information electronically, safely, securely, and privately. No exchange of information will occur without the appropriate permissions of the individual patients.

State HIEs Advancing

Trinity Health went live with the first stage of Medicity’s Novo Grid deployment to establish their Health Information Exchange (HIE) with 297 affiliated physician practices and nearly 1000 physicians. Trinity Health the fourth largest Catholic health care system in the country based in Novi Michigan, operates 44 acute care hospitals, 379 outpatient facilities, 33 long-term facilities, numerous home healthcare offices, and hospice programs in eight states.

Trinity Health’s HIE rollout to affiliated physicians began by connecting three Michigan Hospitals that included St. Joseph Mercy Ann Arbor, St. Joseph Mercy Livingston, and St. Joseph Mercy Saline with physician practices previously dependent on faxes to receive transcribed reports. The Grid technology distributes patient information directly to computers at the physician’s practice.

Trinity Health’s use of Novo Grid will enable community physicians’ secure, real-time electronic access to the health system’s clinical data. The Grid deploys intelligent software agents to enable physician offices to receive patient information directly into an EHR, or for paper-based practices, into an electronic “dropbox” accessible via a standard web browser.

According to James K. Lassetter, MD, Medicity’s CEO, “The unique flexibility of the Grid empowers hospital systems to connect to disparate physician practices regardless of their level of technology adoption.”

In another project located in Tennessee, CIGNA has contributed $150,000 grant to the Middle Tennessee eHealth Connect (MTeHC) toward developing a regional health information organization to exchange EMRs.

“MTeHC through the support of the CIGNA grant funding, is going to be a model in Middle Tennessee for clinicians and hospitals to have access to decision-ready health information at the point-of-care,” said Commissioner Dave Goetz, Tennessee Department of Finance and Administration.

Tennessee’s Office of e-Health Initiatives created in 2006 is the state’s coordinating authority for the exchange of electronic health information works with other regional health organizations such as the Mid South e-Health Alliance in Memphis and CareSpark in Kingsport.

The state of Nebraska is moving forward to expand the Nebraska Health Information Initiative (NeHII) to central Nebraska and is connected to the Mary Lanning Memorial Hospital in Hastings, Nebraska. The hospital is now live on NeHII and information concerning laboratory, radiology, and transcription reports is being exchanged with physicians in the state.

NeHII is working collaboratively with healthcare organizations across Nebraska to develop strategies for statewide implementation, and this includes applying for a grant through the Beacon Community Cooperative Agreement Program. The program will fund fifteen awards across the U.S. to qualified non-profit organizations or government entities representing geographic healthcare communities.

NeHII is currently developing a plan to use stimulus funding to enhance the NeHII application to meet the meaningful use criteria. One goal is to create a patient portal to allow patients to see their records stored on the HIE. A disease registry will also be installed and in addition, a reporting hub will be installed to allow practices to extract information to meet meaningful use requirements.

NeHII is also launching a statewide consumer and physician education program. The non-profit organization will also be working with CIMRO of Nebraska on a coordinated physician and consumer awareness campaign to increase HIE use across the state. CIMRO has applied for grant funding to be the Regional Extension Center for Nebraska.

$20,000 Grant Opportunity

Genetic Alliance is offering one grant for $20,000 to be awarded to a single or multi-group organization or consortium to go towards funding entry into the Genetic Alliance BioBank. The BioBank is an advocacy-owned and controlled repository for biological samples and clinical data. The goal is to help a disease-specific organizations further expand their understanding and treatment of diseases using resources available through the BioBank.

According to Sharon Terry, President and CEO of Genetic Alliance and President of the BioBank, the establishment of well characterized cohorts to stand ready for clinical trials is essential for all diseases. We are working with many partners to transform the paradigm for drug development. Disease-specific organizations are critical trust communities and excellent conveners of these cohorts and it is important to give them tools to create registries and biorepositories to provide for treatment development.

All non-profit, disease-specific organizations are eligible to apply for the $20,000 grant. Multiple organizations focused on a single condition, gene, or disease pathway may also apply together. To qualify, applicants must complete an application, demonstrate the ability to financially maintain the registry, attend at least one Genetic Alliance hosted Registry and Repository Boot Camp in person or virtually, create or update a Disease InfoSearch listing, plus upload resources into the Resource Repository.

Eligible organization must submit applications by May 1, 2010 and the grant awardee will be announced at the 2010 Genetic Alliance Annual Conference “Advancing Novel Partnerships to be held July 15-18 at the Bethesda North Marriott Hotel and Conference Center.

For more information, or to fill out a grant application, or to register for the Conference, go to For more details, contact, Liz Horn at 202-966-5557x105 or email

Wednesday, March 10, 2010

Plans to Issue New FOA

The National Heart, Lung, and Blood Institute (NHLBI) and the Canadian Institutes of Health Research (CIHR) expect to issue a new Funding Opportunity Announcement (FOA) June 2010 with the expected receipt date for applications to be October 2010. The future plans are to find new participants to participate in the Pediatric Heart Network (PHN), a cooperative network of pediatric cardiovascular clinical research centers that includes a data coordinating center.

Congenital cardiovascular malformations affect approximately 40,000 infants in the U.S. each year leading the cause of infant deaths. The incidence of congenital heart disease is at least triple that of childhood cancers, and is substantially greater than pediatric AIDS. In the past 25 years, fewer than 40 randomized clinical trials have been carried out in patients with congenital or acquired heart disease.

The major barriers to doing clinical studies in pediatric heart diseases concern the small numbers of individuals with a particular congenital heart defect at any one center, differences in treatment approaches between centers, absence of systematic centralized databases, and a lack of resources to nationally coordinate collaborative efforts. Additional barriers relate to parents that are unaware of studies, or live a distance from a research site, or just lack familiarity with what happens during a study.

The network approach attempts to address these barriers by offering an effective flexible way to study adequate numbers of patients with uncommon diseases. This is accomplished by using a common infrastructure to recruit, monitor, and follow patients whose conditions need to be characterized in a standardized fashion.

For example, Vanderbilt Children’s Hospital a member of the Pediatric Heart Network and participating in a PHN study on the cardiac side effects of the rare disorder known as Marfan Syndrome. Marfan syndrome is an inherited disorder caused by a mutation in the gene that controls certain connective tissues. The malady is characterized by elongated bones and ligaments, and the eyes, lungs, and the wall of the aorta can be affected. A specific study ongoing at Vanderbilt Children’s Hospital is comparing two drugs, Atenolol and Losartan to see which one is better at slowing the speed of aortic enlargement.

PHN has completed a few studies on the Marfan syndrome with several studies still ongoing and more in the pipeline. The Marfan trial is 3 years old and about three quarters completed with 22 sites nationwide participating. Vanderbilt has 13 patients in the study with each patient participating for three years.

Veterans Affairs News

The Department of Veterans Affairs just announced a new aggressive initiative to solicit private-sector input on a proposed “fast track” veteran’s claims process for service-connected presumptive illnesses due to Agent Orange exposure during the Vietnam War.

According to the Secretary of Veterans Affairs, Eric K. Shinseki, “With the latest, fastest, and most reliable technology, the VA hopes to migrate the manual processing of these claims to an automated process to meet the needs of today’s veterans in a more timely manner.”

Over the next two years, about 200,000 veterans are expected to file for disability compensation claims under an historic expansion of three new presumptive illnesses announced last year. They affect veterans who have Parkinson’s disease, ischemic heart disease, and B-cell leukemia.

Along with the publication of the proposed regulations for the three new presumptive illnesses this spring, VA intends to publish a formal request in Federal Business Opportunities seeking private-sector corporations to propose automated solutions for the parts of the claims process that take the longest amount of time.

The contract to provide the new automated solution is expected to be awarded in April with proposed solutions to be submitted to the VA within 90 days. Implementation of the solution is expected within 150 days.

In other news, the Washington D.C. Veterans Medical Center’s (DCVAMC) Eastern VA Cardiac Pacemaker Surveillance Center recently reached a milestone with more than one million plus calls made using the “Electronic House Calls” system.

Two Cardiac Pacemaker Surveillance Centers use the system, one located at DCVAMC and the other located at the San Francisco VA Medical Center. The VA has followed more than 22,000 patients across the country since these facilities maintain a registry of all patients who have had pacemakers implanted at VA facilities.

The Eastern VA Cardiac Pacemaker Surveillance Center monitors 11,600 veterans with regularly scheduled “house calls” made by technicians and nurses. Patients have wristbands and a transmitter that gives EKG readings over telephone lines. The pacemaker rhythm indicates the state of the battery.

The Pacemaker Registry which contains implant histories on devices, can take appropriate actions in the event of a recall or if other pacemaker issues occur. Through the years, a number of innovations have taken place in implanted cardiac therapy, so today devices are all solid state and are able to record multiple events.

The data called tracings are collected and maintained in the patient’s EHR which has all of the records to include vital signs, physician notes, test results, and images on each VA patient. The tracings are downloaded, analyzed, and then a report is sent to the hospital. The VA also has an automated system for recording the tracings called “CardioVoice”.

Funds & Loans Help Companies

The Massachusetts Medical Device Development Center (M2D2) is a lifeline for the state’s smaller medical device companies. The Center offers inventors and executives easy, affordable and coordinated access to world class researchers and resources at the Lowell and Worcester campuses of the University of Massachusetts.

The Center helps smaller firms convince venture capitalists that their companies have marketable ideas and products and helps to develop products from proof-of-concept to commercialization.

In the first eighteen months of operation, M2D2 helped 23 start-up companies and entrepreneurs bridge the gap between invention and the production of new medical devices. Ten start-ups received funding and five of those start-ups received matching funds under M2D2’s fast lane program. Both the fast lane and federal grant assistance programs were supported primarily through competitive awards to M2D2.

Five companies in the program gained federal funding through NIH grants. One NIH STTR fast track grant for $1.2 million went to VasoTech Inc. of Lowell to further develop a biodegradable drug-eluting stent and two other grants were awarded totaling more than $800,000. An additional $200,000 was awarded to two companies through DOD’s STTR program.

Other start-up companies such as Agali Technologies received help from M2D2 to develop technology to help COPD patients. The company has developed a wireless medical activity monitor providing real-time updates for COPD patients. The monitor called “Easy-COPD” is in development and can be of help to the 14 million COPD patients in the U.S.

M2D2 also helped XECAN Inc. a company that now provides a breakthrough RFID plug-and-play technology for the healthcare industry. The technology can be used to track patient care from initial diagnostic procedures through procedural treatment plans by simply tagging and identifying all related items from specimens to medications.

Researchers at the University of Mass at Lowell and the University of Mass Medical School at Worcester, have developed a low cost miniature BP Sensor to use for invasive cardiovascular monitoring. The sensor is a simple method that can be used to determine which patients require an angioplasty or open heart surgery.

Offering other assistance, the Massachusetts Life Science Center announced that they have just launched the 2010 Life Sciences Accelerator Loan Program. This is the second year for the program to provide working capital to help early-stage life sciences companies. The Center started to accept online applications on February 24, 2010 with full proposals due by March 31, 2010.

Target applicants are generally early-stage life sciences companies with a high potential for technology commercialization, rapid growth, and private equity financing. The program has been capitalized with $5.5 million for 2010. This year’s program will offer loans of up to $750,000 per company, an increase from the 2009 maximum loan amount of $500,000. In 2009, 88 companies applied and a $3.4 million investment was made to help life sciences companies.

The program provides support for companies at the critical stages of their development cycle, enabling them to conduct vital research and proof of concept studies, and attract subsequent investment, while improving the odds of bringing cutting edge innovation to the marketplace.

Another grant program supported by the Center for Integration of Medicine and Innovative Technology (CMIT) in Massachusetts provides for early stage collaborative research projects to help improve patient care with an emphasis on devices, procedures, diagnosis, and clinical systems.

For the FY 2011 funding, nearly 200 pre-proposals were received and 106 pre-proposals were selected to advance to the final proposal review with 40 awards of $70,000 are expected to be made.

Of the 106 pre-proposals invited to submit a final proposal:

• One-third of the pre-proposals involved projects in the areas of neurotechnologies, TBI, neurotrauma, PTSD, and pain management
• Twenty percent of the total pre-proposals offered novel technology solutions to solve a clinical problem, approaches to leverage the power of information and /or device integration, and technologies that potentially could be of benefit to the military and other patients in austere environments
• Over one-half of the pre-proposals have direct relevance to improving care on the battlefield, during evacuation, help in other trauma care settings, address rehabilitation needs, and provide newer and better ways to manage chronic conditions.

For information on M2D2, go to, or email For information on the Massachusetts Life Sciences Center 2010 Life Sciences Accelerator Program, email or call (617) 921-7749. For information on the CIMIT grant program, go to

High Speed Network Coming

Pennsylvania’s Bucknell University is going to serve as a hub for a high performance statewide broadband network. The network will make it possible for data intense research and global collaboration to be accomplished by universities and healthcare researchers across the state while connecting underserved communities to high speed internet.

The Keystone Initiative for Network-Based Education and Research (KINBER) a coalition of Pennsylvania colleges and universities, research and healthcare organizations, and economic development entities, have received more than $99 million from NTIA as part of the Recovery Act with an additional $29 million in private investment to construct and manage the Pennsylvania Research and Education Network (PennREN).

When completed, the fiber optic cable network will cover nearly 1,700 miles pass through 39 Pennsylvania counties, including 22 that are currently not served or underserved based on their access to affordable broadband services. At the same time, the network will serve more than 5 million individuals in more than 2 million homes and serve 200,000 businesses and greatly increase service to last mile providers across the Commonwealth. This network will be the largest network funded by NTIA.

Sunday, March 7, 2010

Integrating ODLs into Clinical Care

The Robert Wood Johnson Foundation (RWJF) has just selected five teams for an innovative program to explore how patient-recorded Observations of Daily Living (ODL) can be captured and integrated into clinical care. New technologies such as smart phones and sensors make it possible to gather information on diets, exercise, sleep patterns, medication usage, and pain, and then use the information to study the effects on people’s lives.

RWJF through their “Project HealthDesign: Rethinking the Power and Potential of Personal Health Records” program awarded more than $2.4 million to five grantee teams. For example, these teams are going to look at the stress levels of caregivers for premature infants and how this can be of value to clinicians. They are also going to study how medication-taking routines for seniors at risk of cognitive decline can be collected, interpreted, and acted upon by patients as well as by clinicians in real world clinical settings. Each team will receive a two year $480,000 grant.

“Data from ODLs can drive apps to help people eat better, manage their pain more effectively, and understand how their behaviors, their treatments, and their symptoms are related,” said Stephen Downs, Assistant Vice President for RWJF’s Health Group. “In addition, they can give clinicians a much richer understanding of what goes on with their patients between office visits and so that treatment recommendations will be based on more comprehensive information.”

Grantee teams will work closely with patients with two or more chronic conditions to capture and store several types of ODLs. The teams will analyze and interpret the data to integrate the information into the clinical work flow. The teams will first participate in a refine/design phase to share ideas, establish goals, and refine initial approaches. Over the 12 months, clinicians will care for 30-50 patients while actively monitoring ODLs and assess the value of including the ODLs in their real world care processes.

In addition, the program provides legal and regulatory compliance support to grantees and contributes to the public discourse on the legal and regulatory aspects of capturing ODLs and integrating them into care processes.

The grantee teams include:

• Carnegie Mellon University (Pittsburgh) will develop and evaluate new technologies to monitor the routine of older individuals with arthritis and at risk for cognitive decline to provide the data for long term functional assessment and treatment
• RTI and Virginia Commonwealth University (Richmond Virginia) will design a personal health record application, “BreathEasy” to build on the latest clinical guidelines for treatment and self monitoring for patients with asthma and depression. Clinicians will use a web-based dashboard that will provide them with simple analysis and visualization tools
• San Francisco State University (San Francisco) will examine the potential for collecting ODLs via smart phones for low income teens that are simultaneously managing obesity and depression.
• University of California (Berkeley) in partnership with “The Healthy Communities Foundation” and UCSF will help young adults who suffer from Crohn’s disease create visual narratives of their condition and treatment to provide concrete feedback to providers on how they feel from day to day.
• University of California, Irvine and Charles Drew University (Irvine California) will create a mobile device to collect information from pre-term low birth weight infants and their primary caregivers to allow them to more easily interface with their healthcare providers. This specially designed mobile device “FitBaby” will record ODLs from the babies and provide the nearly real time data to clinicians to help alert them to early signs of health problems

Gateway to Connect WNC to NHIN

The North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) on February 25th announced a Request for Proposal for the NHIN Gateway. The project is being funded through NCHICA’s contract with HHS’s Office of the National Coordinator (ONC) for HIT.

This project is in response to ONC’s strategic plan to support the implementation of the NHIN as a common platform for HIE across diverse entities, within communities and across the country to achieve the goals of the HITECH Act.

NCHICA is involved in incubating healthcare network initiatives for the state, most recently for the North Carolina Immunization Registry and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool.

The gateway will connect the Western North Carolina (WNC) Health Network’s Data Link to the Nationwide Health Information Network (NHIN). The WNC Health Network a mature health information exchange organization (HIO), links 16 hospitals in the region. The purpose of the gateway project is to demonstrate how an established HIO can become a node on the NHIN with implementation planned for this spring.

The WNC Data Link project connects WNC Health Network hospitals by allowing authorized physicians and clinicians to view electronic patient records across all WNC Health Network hospital systems. Upon request, WNC Data Link searches all of the WNC Health Network hospitals information systems for patient records and aggregates these records for display on a web portal. Data Link uses the Med Seek interoperability solution to display the information.

The WNC Health Network hospitals and the Asheville Veterans Administration share many patients since they are in close proximity to each other. In a period of 12 months, there were a total of 1,768 recorded veteran visits to the WNC 16 hospitals with 459 admissions additional ED visits.

The VA provides care to approximately 100,000 veterans from WNC, upstate South Carolina, and Northern Georgia with the majority of those individuals potentially treated in the WNC Health Network hospitals. The VA has recently established initial connectivity with a VA facility in San Diego and NCHICA expects that when community connectivity is available, the Asheville VA will be an early participant in the NHIN. NCHICA also expects to use this project as a learning experience and incubation for expanding NHIN connectivity for North Carolina institutions, both public and private.

Potential second year plans include further connectivity to the NHIN Gateway by public and private North Carolina based entities and incorporation of the NHIN Gateway within the State of North Carolina’s statewide HIE efforts.

The intent to respond to the proposal is due March 8, 2010 with proposals due March 22, 2010. For more information, contact Andrew Weniger at or contact Tara Waechter at or go to

Purchasing Training Equipment

The “Equipment to Enhance Training for Health Professionals” known as the EETHP Equipment Initiative supported by the Recovery Act is comprised of 21 health professional training programs. HRSA released the funding announcement (HRSA-10-194) on February 26th. The closing date for applications is March 26, 2010.

Funding for $50,000,000 will fund approximately 200 grant awards to be used to support multiple programs in purchasing health professionals training equipment. A different funding announcement is being offered for each of the 21 eligible programs comprising the EETHP initiative. This funding opportunity is for entities eligible for the EETHP-Basic/Core Area Health Education Centers (BAHEC) and the Model State Supported Area Health Education Centers (MAHEC).

The Institute of Medicine identified a large gap existing between the rapidly growing minority populations in the U.S. and their representation among health professionals. The Area Health Education Centers program addresses this issue through a range of training activities. Their goal is to increase the number of primary care physicians and other primary care providers in underserved area. The AHECs are trying to increase the number of minority and disadvantaged students seeking health professions as a career option.

For example, in North Carolina additional funding is available that is going to the North Carolina AHEC at the University of North Carolina at Chapel Hill. The funding will be used to hire and train more than 40 new positions in nine regions across the state to provide on-site technical assistance to primary care providers. This will require additional equipment.

Funds may only be used to purchase equipment to support the training for the BAHEC/MAHEC following activities:

• Equipment to use to help increase the number of primary care physicians and other primary care providers working in underserved areas
• Prepare individuals to more effectively provide health services to underserved areas or underserved populations
• To conduct health professions education and training activities for students of health professions schools and medical residents
• To conduct at least 10 percent of medical student required clinical education at remote sites

To receive the funding, the equipment has to be a tangible item with a unit cost of $5,000 or more and a useful life of one or more years.

For more information on this funding opportunity and others within the program, go to or email Norma J. Hatot, CAPT, at or call (301) 443-2681.