Wednesday, April 28, 2010

Roundtable Held on the Hill

Representatives Tim Murphy (R-PA) and Patrick Kennedy (D-RI) Co-chairs of the House 21st Century Healthcare Caucus, hosted a roundtable discussion. The event supported by the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics discussed issues of importance to the healthcare technology and medical community.

Neal Neuberger, Executive Director for the Institute for e-Health Policy, said “It is important to listen to the leaders in the field present their thoughts and ideas as to what is now needed to implement HIT in this quickly changing healthcare environment.”

Representative Murphy in his opening statement explained that today only six percent of hospitals and two percent of physicians rely on electronic health records. Although this will improve with the economic stimulus legislation incentives, there still are legitimate concerns that the guidelines for HIT “meaningful use” produced by CMS are too ambitious and impractical.

He reports that he has heard from physicians and hospitals in his district that say that the initial requirements for incentive payments are too complex and simply unattainable and unrealistic. They feel that small physician practices not able to benefit from the incentives will still need to invest in HIT. This can cost as much as $30,000 and the small practices feel that they will have to spend the money for the system to avoid non-compliance penalties that are to begin in 2015.

Representative Murphy thanked Representative Kennedy for recently introducing the “HITECH Extension for Behavioral Health Service Act” to enable mental health providers to be eligible for federal incentive payments. Representative Murphy is looking forward to helping Kennedy secure passage of H.R. 5040.

Both Representatives realize how important it is to help mental health professionals diagnose and treat patients with complete up-to-date medical histories at their fingertips. For instance, when depression is not treated, the costs of caring for a person with a chronic illness like heart disease can double.

Representative Kennedy in his opening statement praised the health IT landmark funding and the grand design of health reform. Kennedy wants to see the effort made to get not only the dollars out to the communities but also to move forward and enable all of the health reforms help medical and healthcare professionals do their work more efficiently. For the past 16 years, Kennedy has worked hard to transform healthcare so that the system will be able to deliver consistently high quality care more efficiently to the population.

Andrew Urbach, M.D. Medical Director, Clinical Excellence and Service at Children’s Hospital of Pittsburgh has only praise for the hospital’s innovative single integrated electronic medical record initiated and built in 2002.

Dr. Urbach pointed out there are many advantages to the hospital resulting from the use of the EMR system. For example, the system has made it possible for the hospital’s medication error rate to be among the lowest in the county with the error rate dropping over 60 percent from the hospital’s starting point.

He praised the hospital in other ways. The hospital’s medication administration system is complete with order sets, computerized order entry, dose range checks, and bar coding. In addition, the hospital has the capacity to mine data to use for decision making. For example, during the H1N1 outbreak, the epidemic’s ebb and flow minute-to-minute actions were tracked and this data helped to deploy resources wisely.

Today, the hospital campus uses 4,000 computers connected to the system which has resulted in no more searching for charts, no more waiting in line to use a chart, no handwritten errors, and clinical decisions being made without paper data.

After searching for the right system for two years, the Thundermist Health Center located in Rhode Island, switched from a paper medical record to an EMR system. According to CEO Maria Montanaro, the system complete with structured data provides comprehensive high quality primary care. This has resulted in a seamless interface for the integration of comprehensive medical, behavioral health, dental, and pharmaceutical information.

The EMR system also used as a quality management tool helps the Center support evidence-based, population focused outcomes, primary and preventive healthcare, along with effective chronic disease management. As Montanaro explained, “Right now, many EMR systems only support what primary care doctors do now in terms of episodic care not what is needed in the future. This needs to change.”

“Today, the Geisinger Health System an integrated health services organization is improving efficiently and quality by using their EHR system to help over 142,000 people”, reports James Walker, M.D. Chief Health Information Officer at Geisinger.

By using the EHR system, Geisinger has the ability to focus on total processes that are needed to help patients by enabling the team approach to be used when treating patients. To develop the team approach, the data from the EHR system helps the staff coordinate their ideas and information, and this in turn, helps the staff put their ideas to work. As Dr, Walker said, “Getting doctors and teams on the grid and the ability to work with great speed is what improves care.”

Very importantly, the EHR system enables the medical home program at Geisingers to work and the program provides improved care coordination and quality while reducing costs. Since the program was initiated, hospital admissions have fallen by 20 percent and total medical costs have fallen by 7 percent.

The new meaningful use best-practices library referred to as the “Premier Healthcare Alliance HIT Collaborative” was formed to share knowledge and best practices around EHR system according to Blair Childs, Vice President Public Affairs at Premier, Inc. He explained that the HIT Collaborative was set up to help hospitals implement EHRs and to support meaningful use.

The Collaborative was formed with diverse health care organizations participating and today 160 not-for-profit hospitals have joined. The key lessons learned from the hospitals participating in the Premier Healthcare Alliance HIT Collaborative was highlighted in the April 2010 issue of the publication “Health Affairs”

He also discussed the need for “Accountable Care Organizations (ACO)” to exist. The goal for the ACOs is to pay providers in a way that encourages them to work together and to create organizations that are rewarded for providing high quality care. In the case of the ACOs, accountability rests with the providers and they are evaluated on the quality and efficiency of care that they provide.

Professor Latanya Sweeney, Director of the Data Privacy Lab at Carnegie Mellon University, and a member of the HIT Policy Committee, feels that HIPAA alone is not sufficient to protect patients from harm. The Data Privacy Lab at Carnegie Mellon was put in place to create technologies and related polices that are needed while protecting privacy, and at the same time, to allow society to collect and share private information for many purposes.

According to the Professor, with massive data sharing and improved patient care, tension often exists between privacy and utility. However, the reaction to this tension can sometimes harbor a false belief that one must be traded against the other.

Dr. Sweeney thinks that the current approach to NHIN design is making it unlikely Americans will have either privacy or utility. The problem is that there is a lack of architectural direction in the NHIN design and this will allow simultaneous efforts to proceed in different even opposing directions.

As a result, patient information is exposed to various risks and limits benefits. In addition, states and regional organizations are making independent isolated decisions, various competing industry efforts are underway, and national efforts recognized by ONC are inconsistent and problematical.

Eva Powell, Director, Health IT Program for the National Partnership for Women and Children stressed the need for healthcare to be a patient centered system with patient engagement that can guarantee quality and safety. Powell is very concerned about the present payment system. She wants to see payment reform and this means that reimbursement needs to be based on outcomes and quality not volume. A new payment model must be established to improve the coordination of care by using health IT.

Martin Harris, M.D. Chief Information Officer at the Cleveland Clinic pointed out that the Cleveland Clinic uses EMR technology tools in all their hospitals making it possible to concentrate on health and wellness. President Obama recently paid a visit to the Cleveland Clinic to see how the EMR system is used in all of their facilities.

However, as Dr. Harris mentioned there are challenges to face such as the need to align reimbursement so diseases can be managed better, identify the medical devices that need to be used to provide care, and at the same time, guarantee privacy to patients.

Tony Trenkle, Director, of the CMS Office of e-Health Standards and Service reiterated that we need to develop a balanced approach when advising the policy and standards committees. Also, care coordination is supported by data but in order for it to work, we have to address privacy challenges and other issues in a balanced way.

Communities need to come together to recognize the value of HIT, the value of the incentive programs, and the system needs to move towards outcomes. As he said, “This is just the beginning of the road to success and we need to look at the challenges ahead with optimism.”

Farzad Mostashari, M.D. Deputy Director of the Office of National Coordinator HIT, reports that the ONC has been working to get programs such as the Beacon Community Cooperative Agreement Program underway. The plan is to provide funding to communities to help strength their health IT programs. Awards are scheduled to be made soon to 15 qualified non-profit organizations.

ONC is working diligently to get the country involved in the definition of “meaningful use” that will be used to drive payments and establish the infrastructure needed to get physicians to adopt technology. ONC is working on cyber security issues, helping the states develop HIEs, and providing funding and assistance to help establish Regional Extension Centers. The goal is to help 95 percent of the doctors implement an EMR system in their offices.

The next program to be presented by the Institute for E-Health Policy for the Capitol Hill Steering Committee for Telehealth and Healthcare Informatics, will discuss “Policy, Technology, and Research Development in Mobile Health” from 11:30 to 1:30 on May 5th in Room 428 in the Senate Dirksen Building. For more information, email

OMH Linking Physicians

The New York State Office of Mental Health (OMH) is funding a collaborative effort with NY state and county governments to link pediatricians and primary care physicians with child mental health experts across the state. OMH realizes that pediatricians and primary care physicians play a critical role in the early identification of mental and emotional problems in children and can effectively direct parents to available treatments.

The project called “Training and Education for the Advancement of Children’s Health” (TEACH) will provide specialized training, consultations, and links to mental care providers in the mental health field. OMH is collaborating with the Department of Health, Conference of Local Mental Hygiene Directors, American Academy of Pediatrics, and the New York State Academy of Family Physicians.

Under Project TEACH, consultative support primarily related to diagnostic and psychopharmacologic concerns will occur mainly by telephone, but in some cases via telemedicine and in-person. When more than an initial intervention is needed, referrals will be made and links will be provided to assist families and primary care providers. Access will be provided to clinic treatments, case management, and/or provide family support.

TEACH services will be available statewide and will be provided by the University Psychiatric Practice (UPP) and the Four Winds Foundation. The UPP under the University of Buffalo is an innovative partnership of academic medical centers in the state that came together to support the initiative.

Educational-based training will be available to physicians who provide primary care to children on topics related to children’s social and emotional development. The psychiatry departments from the University of Buffalo, University of Rochester, Columbia University, SUNY Upstate Medical University in Syracuse, and the LIJ/North Shore University Health System are working in conjunction with the Resource of Advancing Children’s Health (REACH) Institute to support the training component.

Project TEACH will begin work with their partners in April 2010. For more information, contact Joseph Rosczak, OMH Telepsychiatry Coordinator at (518) 402-4774.

New Curriculum for HIT

Community colleges will soon have the capacity and ability to educate health information technology workers. A new six to 12 month informatics curriculum developed at the Johns Hopkins University School of Nursing (JHUSON) is going to be deployed to local colleges so that students will have access to high quality HIT educational programs.

The curriculum was developed at the new JHUSON Curriculum Development Center in collaboration with the JHU Schools of Nursing, Medicine, Public Health, and Business as well as with four community college partners in Maryland. An advisory board includes academic HIT experts and representatives from HIT employer groups.

The Center is funded through a $1.8 million grant from the stimulus package. A second $3.75 million will enable a team to collaborate on the JHU Health IT Workforce Training Program that will create post-baccalaureate HIT programs. Also, the School of Nursing plans to have an eight month certificate program established in Applied Health Informatics where students will be able to earn 13.5 academic credit hours to apply towards their master’s degree.

The Health Services Management and Leadership Department in the School of Public Health and Health Services at George Washington University has been awarded a $4.6 million grant from the HHS Office of the National Coordinator to develop curriculum that will emphasize IT related critical thinking and healthcare analytical skills.

The plan is to link the GW School of Public Health and Health Services, Department of Health Services Management and Leadership; (School of Business), Department of Information Systems and Technology Management; (School of Engineering and Applied Science), Department of Computer Science; (School of Medicine and Health Service), Department of Nursing Education; and GW Medical Faculty Associates to work on the curriculum together.

The program will provide a cross disciplinary perspective for the student composed of clinician and public health leaders, health information management and exchange specialists, health information privacy and security specialists, programmers, and software engineers.

GW will offer four eighteen credit hour certificate programs to be completed within six months. The courses in the program can be rolled into one of three nationally and/or regionally accredited masters degrees. The courses are currently in existence at GW in a traditional classroom format, but will be converted into an online or week long, onsite format. The program will begin by fall 2010.

Sana Group Recognized

The Vodafone Americas Foundation and the mHealth Alliance awarded Sana (formerly called Moca) the mHealth Alliance Award valued at $50,000 and Sana finished third in the Wireless Innovation Prize valued at $100,000 at the Global Philanthropy Forum. These awards recognized Sana’s new application for wireless technology and their potential to address health challenges in low resource settings.

Sana, a multidisciplinary group of MIT and Harvard students and a spinoff from the MIT Nextlab program has been working very hard to revolutionize healthcare delivery in rural and underserved areas, both nationally and internationally.

The group developed an innovative open source platform that allows mobile phones to capture and send data to an electronic medical record (OpenMRS) that links community health workers with physicians for real-time decision support.

Sana intends to use the seed funding and management support of the Santa Clara University’s Center for Science Technology, and the Global Social Benefit Incubator Program (GSBI). Placement in the GSBI secured via the mHealth Alliance Award will help provide access to Silicon Valley and help support the goal to achieve maximum sustainability and impact.

Sana is developing the “mHealth Lab,” a course to be taught at MIT and disseminated by distance learning to partner institutions worldwide. The aim is to build a template on how to develop and deploy mHealth projects based on best practices. The plan is to help identify health needs, create solutions, and overcome any contextual factors that can limit the impact of health information technology.

Sana is also involved in other activities. Their work will be featured in a Smithsonian exhibit called “Why Design Now?” to open in May at the Cooper-Hewitt National Design Museum in New York City which will examine design thinking to use as an essential tool for solving some of today’s most urgent problems.

In addition, Sana will receive the Massachusetts Medical Society Information Technology award in May for developing information tools that help physicians practice medicine, teach medicine, or pursue clinical research.

For more information, go to

Sunday, April 25, 2010

Telehealth Vital in Home Care

Speakers at the Senate Special Committee on Aging hearing on April 22nd emphasized the need to use telehealth technologies to improve patient care especially in the aging population. Speakers from the FCC, several universities, Office of the National Coordinator at HHS, and Intel, appeared to discuss aging in place by bringing healthcare technology into the home, as well as addressing the regulatory issues involved.

As Senator Herb Kohl (D-WI) Chairman of the Committee stated “there are still stumbling blocks that stand in the way of the widespread adoption of telehealth technology in the home.” The speakers agreed that connectivity gaps, misaligned economic incentives, and outdated regulations are preventing the increased usage of technologies in the home.

Richard Kuebler Department Head for Telehealth at the University of Tennessee Health Science Center (UTHSC) in Memphis explained how UTHSC research outcomes show how home-based telehealth helps at-risk populations with congestive heart failure decrease hospital admissions by 80 percent. He said, “The national implications of using telehealth in this single specialty could reduce healthcare costs by $3.8 billion. The telehealth program at the university shows that telehealth saves lives, increases the quality of life, and has successfully treated chronic diseases across the state and the entire region.”

He noted that by using telehealth technologies, the aging population prevents unnecessary hospital stays and nursing home enrollments. The significant cost of healthcare for our aging population is undeniable and UTHSC has demonstrated that in using telehealth cost savings exist with limitless potential to deliver quality medical care.

The American Telemedicine Association (ATA) presented a statement to the Committee on the changes needed by Medicare and Medicaid to bring telehealth into the home along with information on other issues affecting the use of medical technology in the home.

ATA is quick to point out that an important restriction in Medicare’s coverage of telehealth is the lack of coverage for video conferencing which is the most common telehealth method used for beneficiaries in metropolitan areas.

This means that 79 percent of Medicare’s beneficiaries are blocked from accessing these cost effective vital health services. Also in this fast evolving technology environment, it should be noted that soon mobile phone devices will be able to conduct video conferencing.

Medicare law essentially states that a beneficiary must be served at the site located in a county that is not included in a Metropolitan Statistical Area. This essentially bars reimbursement in all but the most rural parts of America.

A second restriction is that Medicare essentially does not cover remote patient monitoring, which has proven to be critical for managing chronic conditions and helps beneficiaries get care and at the same time, does not require treating patients in expensive hospitals and nursing homes.

A third restriction is that the major therapist categories such as physical and occupational therapy, speech-language pathologists, and audiologists are not covered for telehealth to the extent they are covered for other Medicare services.

As for telehealth use in the states under Medicaid, home telehealth may only be provided under waiver, but only seven states so far have established such waivers however, two more states have demonstration programs.

Home telehealth and remote monitoring both benefit both the aging and younger patients with disabilities. Although the primary focus of the Committee is on aging, the inclusion of all Medicaid recipients with disabilities to be able to obtain telehealth services yields economies of scale, efficiencies, and continuity of care.

Specifically, ATA wants to see several changes:

• Home telehealth needs to be used to monitor chronic conditions by home health agencies and physicians, but it is also important to accommodate other clinical applications as well, notably telemental health for depression and telerehabilitation for stroke care

• Since the Medicare home health benefit is very short-term focused, other service providers such as Federally-qualified Health Centers and the Indian Health Service and tribal entities should be eligible to participate

• There are health provider shortages in both rural and urban areas. Federal designations of health professional shortage areas, medically underserved areas, and medically underserved populations highlight these concerns

• Transportation problems are multiple and diverse. While federal and other public funds for special transportation services address this issue, they fall short. On an individual level, there are several reasons why travel may be difficult for many seniors, notably those with disabilities and other limitations on mobility, medical conditions and the inability to drive, or the need to reduce their driving time. Telemedicine can be an important part of this solution to their transportation problems

Mohit Kaushal M.D. Digital Health Care Director for the FCC brought up an important point as it relates to the regulatory uncertainty that exists regarding the convergence of telecommunications and medical devices.

The problem is that smart phones, video conferencing equipment, and wireless routers are regulated solely by the FCC. However, medical devices including life critical wireless devices such as remotely controlled drug release mechanisms are regulated by the FDA. To deal with this regulatory issue, the FCC and FDA are going to hold a workshop with industry at the end of the summer to propose specific solutions on how to remedy the problem.

Safety & Home Medical Devices

Bringing medical technology into the home involves safety issues and following the correct procedures in using or operating medical devices. Today, healthcare is requiring a number of medical devices, including dialysis equipment to treat kidney failure, infusion pumps, intravenous therapy devices, ventilators, wound therapy care therapies along with telemedicine technologies and wireless monitoring devices to be used in the home.

In April 2010, FDA’s Center for Devices and Radiological Health published a document to launch their “Medical Device Home Use Initiative”. Currently, the FDA does not have a clear regulatory pathway for devices intended for home use that describes the unique factors that manufacturers need to take into consideration when designing, testing, and labeling such products.

The use of medical devices includes all permanently and temporarily implanted devices and any type of equipment that a person may need to recover. The term “home use” extends beyond the home to encompass all environments in which a person plans to use their medical device in day-to-day life.

The use of medical devices presents some challenges. Many devices are still too complex for a layperson to use safely and effectively without training. In many cases, home care recipients may be using devices designed for use by trained healthcare professionals in an acute care facility and not by lay caregivers in a non-clinical setting.

Sometimes individuals who receive or provide care in the home use older medical devices which often come with minimal or no labeling or instructions for use. In such cases, the home healthcare provider must develop their own basic instructions for use.

Another concern is that home care recipients may not be able to choose the devices that are provided to them and therefore may not receive devices that are optimal to meet their individual needs.

In addition, although the internet offers care recipients more control over their equipment purchases, it also means that the quality of devices and associated materials and services provided by internet-based device distributors can vary.

Lastly, unlike the clinical setting, the home is an uncontrolled environment with space limitations, there may be children and/or pets in the home, electromagnetic interference, sanitation issues, clutter in the home, high levels of noise, while poor air quality, temperature, and humidity may also affect device performance.

The new FDA home use guidance document that FDA intends to develop will:

• Establish the guidelines for manufacturers of home use devices. FDA will develop a guidance document recommending actions that manufacturers should take to receive FDA approval or clearance on devices intended to be used in the home

• Create an online labeling repository for medical devices that have been approved or cleared for home use and are available to the public. FDA is launching a ten month pilot program beginning in summer 2010 where manufacturers of devices labeled for home use may voluntarily submit their labeling electronically to FDA

• Partner with home health accrediting bodies to support the safe use of devices. To do this, the agency is partnering with two major accrediting bodies to include the Community Health Accreditation Program and the Joint Commission with the goal to strengthen home health agency accreditation criteria relating to medical device safe use practices

• Enhance post market oversight and continue to strengthen the HomeNet arm of the Medical Product Surveillance Network (MedSun). This network is an adverse reporting program that includes more than 350 healthcare facilities nationwide

• Work to increase public awareness and education. To help do this, FDA is launching an new Home Use Devices web site featuring information on using medical devices in the home and the strategies needed to reduce the risks associate with home use

On May 24th, FDA will be holding a public workshop entitled “Medical Device Use in the Home Environment: Implications for the Safe and Effective Use of Medical Device Technology Migrating Into the Home.” The purpose for the workshop is to solicit information from healthcare providers, academics, human factors experts, medical device manufacturers, distributors, professional societies, patient advocacy groups, patients, caregivers to talk about the challenges surrounding the use of devices in the home. The workshop will be held at the Hilton Hotel in Silver Spring Maryland.

For more information, email Mary Brady, Center for Devices and Radiological Health at

Funding for Emergency Care

The Texas Department of State Health Services (DSHS), Office of Emergency Medical Services Trauma System Coordination announces that State Fiscal Year 2011 funds are now available to provide Local Project Grants (LPG). Historically, $1 million has been available for funding the awards each year to support and improve the development of the Texas Emergency Health Care System and to increase the availability and quality of emergency pre-hospital health care.

The types of projects funded through LPGs include EMS personnel certification training, specialty training related to pre hospital healthcare management, communication and patient care equipment, non-disposable supplies, injury prevention projects, and continuing education programs.

Eligible organizations include department licensed EMS providers, first responder organizations, regional EMS Trauma Advisory Councils, EMS education organizations, and pre-hospital injury prevention organizations.

The LPG applications period is open once per year for at least a six week period. This RFP application period is currently open and will close May 13, 2010.

In addition, funding available from the Governor’s Extraordinary Emergency Fund has been set aside each fiscal year to support the emergent unexpected needs of EMS providers of DSHS approved organizations. Proposals are evaluated based on impact to the regional or statewide EMS/trauma system. The funding is available to licensed EMS providers, registered first responder organizations, and licensed hospitals.

Go to for information or go to, or email Tuanh Perez at For information on the Governor’s Extraordinary Emergency Fund, email Roxanne Cuellar at

New Sensors Being Developed

Real-time monitoring of the physiological state of pilots flying high performance tactical aircraft would help to prevent aviation mishaps due to gravity induced loss of consciousness. The military is looking for compact, reliable, and rugged sensor technologies to monitor the neurophysiological response of the brain of pilots working in stressful operational environments.

Srico, Inc., a Columbus-based photonics company has developed innovative optical sensors called Photrodes ™ to use for electrocardiogram and electroencephalogram monitoring. The key operational component of the sensor device is a miniature specially designed optical chip. While electronic chips use electrical current (electrons), optical chips use light (photons) for measurement and transmission of signals.

To help develop the monitoring device for pilots in the cockpit, Srico was awarded a Phase 1 SBIR contract from the Navy’s Office of Naval Research to specifically develop a neurophysiological optical sensor suite to use for Gravity-Induced Loss of Consciousness (GLOC) monitoring intervention.

The sensing system would be suitable for integration with tactical aircraft cockpit and control systems to provide a reliable means to rapidly detect the onset of GLOC, provide alert alarm functions, and activate an autopilot recovery mechanism.

Current electroencephalogram monitoring is accomplished through electrode-based instrumentation systems requiring adhesives or conductive gel. Srico’s patented optical Photrode ™ technology offers a new approach for monitoring the physiological conditions of military pilots and other combat personnel in a reliable convenient and non intrusive way. Srico’s optical sensing system will be able to monitor the pilots while they are flying without using adhesives or conductive gels.

The Photrodes eliminate the need for troublesome electrode attachments. For example, a set of simple dry-scalp-contact Photrodes could be placed in the helmet of an aviator and could potentially be used to routinely monitor EEG in military scenarios.

Srico’s product under development will have significant commercial potential outside the military for anesthesia awareness monitoring, critical care monitoring, alertness monitoring in the transportation industry, sleep medicine, and perhaps for other neuro-monitoring applications.

The use of Photrodes also has the potential to open the door to new brain and heart research, neurodiagnostics, and cardiodiagnostics. In addition, the sensors could be used at a mass trauma scene to measure heart rate (EKG) where a small sensor could be placed over the person’s clothing to enable emergency medical personnel to make a quick patient assessment.

For more information, go to or email or call (614) 799-0664.

Wednesday, April 21, 2010

UTMB Responds to Disasters

Alexander H. Vo, PhD, Executive Director of the Center for Telehealth Research and Policy at the University of Texas Medical Branch (UTMB) described how telehealth technologies and mobile communications have helped the university face significant healthcare delivery challenges. He was speaking at a panel discussion held at Bookings Institution on April 19th held to discuss modern emergency preparedness activities.

Dr. Vo one of the authors of the White Paper “UTMB Telemedicine Disaster Response and Recovery: Lessons Learned from Hurricane Ike” discussed how UTMB was able to manage and use telemedicine technology when Hurricane Ike hit Galveston Texas on September 12, 2009. That hurricane turned out to be the most destructive hurricane ever to hit the continental U.S.

UTMB immediately activated its Incident Command System and Emergency Plan that released nonessential personnel and prepared for patient evacuations several days before Ike’s arrival. Due to the evacuation of Galveston Island and a significant portion of Houston, many residents were without access to local medical care and few primary clinics were available to use for non-emergency medical care.

UTMB’s county telemedicine patients were part of this displaced group and did not have access to non-emergency care. By using cell phones, the UTMB telemedicine team moved their patient scheduling system to cell phones used by UTMB team members.

Within the first post Ike recovery week, UTMB used the cell phones to establish physician primary care consultations for the displaced telemedicine patients residing in and around the Houston area. In addition a statewide primary care telephonic physician consult service was put in place and enabled patients to call and speak with a primary care physician for non-emergency care issues within the first two weeks of the recovery period.

The impact of the hurricane was also mitigated because years ago UTMB decided to build a fault-tolerant system capable of continuing operations despite marked interruptions or disruptions in parts of the system. The concept uses wide grid networks like the kind that exist in the electrical, natural gas, telecommunications, and banking industries. While there may be disruptions to certain components of the grid, the disruptions are localized and do not always hurt the remaining system. As a result of this forward thinking, UTMB’s distributed network of physicians was able to conduct telemedicine clinical sessions with minimal interruptions.

Some of the important lessons learned from Ike:

• Providing the locally-based network with a geographically dispersed group of physicians linked by modern telecommunications can really help reduce disruptions in healthcare

• Developing the protocols needed for mobile communications devices in advance of disasters can really help to ensure the rapid deployment of telemedicine. It is necessary to use mobile communications devices to provide routine care, triage, shelter-in-place medical care, and other services to the affected communities

• It is vital to locate data backup remotely and it needs to be far away from the disaster area. UTMB’s data backup facilities were located in Huntsville Texas, about 108 miles from the parent site in Galveston. Although storm damage in Huntsville was relatively modest compared to Galveston, the geographic separation was inadequate for the size and path of Ike’s destructive path. Also, equipment for critical systems should be housed at main data centers to allow for easy access and deployment

• Network design that reduces the reliance on individual failure points such as network hubs can limit service disruptions. The network at UTMB is now being reconfigured so that an outage at a hub would only affect one satellite site

• Written plans that identify critical systems and ways to protect, conserve, continue, recover, and restore the systems are all crucial elements needed to incorporate into disaster preparedness plans.

Dr. Vo emphasized that there are many telemedicine programs actively involved in providing care. In the 90’s UTMB worked with grant programs 90 percent of the time but now they only work on grant programs about 5 percent of the time which means it is very important to develop mechanisms to sustain projects many years beyond the grant period. As he noted, sustainability, interoperability, and productive reimbursement policies are essential today for telemedicine and telehealth projects to succeed and operate effectively.

For more information on the UTMB program, email Dr. Alexander Vo at

State Expands Mental Healthcare

Front line care providers in rural Alaska can now access remote mental healthcare from the Alaska Psychiatric Institute (API) on an as-needed basis without entering into a long term formal agreement. API is part of the Alaska Department of Health and Social Services, Division of Behavioral Health, and provides a telebehavioral health clinic primarily serving the larger healthcare centers in the state.

Alaskans need for mental health services in remote communities is very clear. The suicide rate for rural Alaska teens is nine times the national average. The Alaska Native adult death rate from suicide is four times greater than the national average and from alcohol the rate is nine times greater.

The Substance Abuse and Mental Health Services Administration within HHS awarded API a $221,000 grant to open a “walk-in” type open access clinic, where services are accessible using video conferencing. Primary care providers in remote communities can now request a same day video conferencing appointment for their patients. Also, providers are able to consult on patient cases with behavioral health professionals who treat both mental health and substance use issues.

This funding will deliver this service to more than 200 small healthcare sites in Alaska. These sites have the equipment to connect to API, but not enough patient demand to justify the cost of a long term contract such as those that API maintains with regional hub communities.

“Nurse practitioners, physician’s assistants, and other frontline primary healthcare providers are the first contact for people who need behavioral health treatment,” said API CEO, Ron Adler. “By providing behavioral healthcare before patients needs become so dire that they must come to urban centers, we are providing better care more quickly without the trauma and cost of leaving home for treatment.”

For more information, go to

Call for Proposals Issued

The Robert Wood Johnson Foundation is interested in new ideas from the field to address healthcare quality and value problems. A call for proposals has been issued looking for ideas in specific areas to better understand how to achieve better value-based purchasing, data collection and aggregation for performance measurement, quality improvement support, and public reporting of provider performance.

Projects may include short term evaluations of local, state, or federal policy changes or private sector innovations by employers, health plans, or others. The proposals may also include research and policy analysis that demonstrate the likely effect of the projects. Preference will be given to shorter projects.

RWJF is also interested in supporting public opinion research that provides quantitative and qualitative insights into what Americans think about these concepts as well as other potential changes in the way healthcare is paid for in America.

Applicant organizations must be based in the U.S. or its territories. Preference will be given to those applicants who may be either public entities or nonprofit organizations.

Grants of up to $300,000 will be awarded for up to three years and up to $3 million will be awarded. Deadline for brief proposals is May 19, 2010 and July 14, 2010 is the deadline for the full proposal. For more information, contact Cathy Goldsmith at

AT&T to Advance Telehealth

A telehealth consortium led by the University of California, Office of the President and the UC Davis Health System was formed to create a statewide broadband system. AT&T was selected to build a secure medical-grade telecommunications system as part of the California Telehealth Network (CTN). AT&T with a three year $27 million contract will provide the Network Services to support the telehealth initiative.

Led by the University of California System, CTN is a partnership of organizations throughout the state established in 2007 with a $22 million pilot project from the FCC. The long range goal for CTN is to establish a statewide telehealth system linking a majority of state healthcare facilities including those in urban areas. The network team plans to train and support participants in the use of the telemedicine equipment and help them establish a working relationship with medical specialists and other health providers.

AT&T tasks for the project will establish new or upgrading existing telemedicine connections, especially in rural communities in the state. The project will increase bandwidth capacity for telecommunications so that clinics, hospitals, and other provider sites will have direct, peer-to-peer connectivity to all network members, plus provide connections to a wide range of external networks and services.

According to Dr. Cathryn L. Nation, University of California Associate Vice President for Health Sciences and Services, the new network is also designed to address healthcare disparities in the state since millions of Californians live in rural and other medically underserved areas in the state where disparities in care exist. CTN will improve their access to quality healthcare services.

Plans call for the network to be a peer-to-peer system enabling each member to have reliable, high quality connections with public and nonprofit healthcare providers located in both rural and urban locations. The network will also provide opportunities for continuing education and distance learning for health professionals, along with access to clinical research, and the possibility of access to commercially hosted EHR systems.

The contract award announcement will be finalized following formal approval by the Universal Service Administrative Company on behalf of the FCC.

Gearing up for ATA 2010

To zero in on the latest telemedicine, telehealth, ehealth, mobile applications, and advanced remote medical technology, sign up now for the 15th American Telemedicine Association Annual International Meeting and Exposition to take place at the Henry B. Gonzalez Convention Center in San Antonio, Texas, on May 16-18 2010.

In recent months, the industry has seen huge changes in both national and state telehealth policies, National Health Reform, billions spent on broadband and health IT, new FCC broadband activities, and states mandating telemedicine coverage. The next year will be equally critical for the industry.

To address the many changes and issues involved, Aneesh Chopra, Federal Chief Technology Officer of the U.S. and John P. Howe, III, MD, President and CEO, Project Hope will be the featured speakers at the opening plenary session on Tuesday May 18th.

If you use telecommunications solutions for healthcare, the ATA Annual Meeting is the single most important event of the year to keep you up-to-date on the latest developments in your field. ATA 2010 will provide insightful keynote speakers, peer-reviewed presentations, executive roundtables, professional networking events, daily breakout sessions, and pre-meeting certificate courses.

Educational concurrent sessions will feature 72 peer-reviewed sessions and discussions on clinical services, telemental health, pediatric telehealth, remote monitoring, consumer and mobile health, emergency and disaster response, operations, business and finance, regulatory issues, and reimbursement issues.

Partner meetings to be held on May 15th and open to all registrants will provide opportunities to meet many new colleagues. You will hear from a wide range of organizations including the Association of the U.S. Army Tradeshow, Universal Service Administrative Company Rural Health Care Training Program, Indian Health Service, Four Corners Telehealth Consortium, Appalachian Regional Commission, and also hear how the programs for Alaska Native and American Indians are addressing telemedicine and other health issues.

For a preliminary program and further details, go to

Sunday, April 18, 2010

Quaid Discusses Safety Issues

Dennis Quaid the actor and prominent advocate for patient safety spoke at the National Press Club on April 12th on the serious medical problem that resulted when his newborn twin infants were given a massive overdose of the blood thinner heparin. After the near fatal incident, he launched the Quaid Foundation with his wife Kimberly to focus on preventing these types of potentially deadly medical errors in the future.

He recounted that two years ago his twin boys just ten days old were admitted to the hospital with infections requiring intravenous antibiotics. While he and his wife were in the hospital room, the nurse unintentionally gave the twins a thousand times the dosage of heparin that turned their blood into the consistency of water.

The next day, the twins bled all day profusely and were severely bruised from internal bleeding and screaming in pain. They were given an antidote for heparin but they keep bleeding and their lab tests remained off the chart. Finally after 41 hours, their coagulation levels dropped back into the normal range and the twins thankfully survived apparently with no damage.

When asked how this happened, Quaid said that after interviewing the doctors and nurses, they discovered that the bottles of the high dose and low dose medication looked very similar and since it was difficult to distinguish between the high and low dose, this is what led to the overdose of the twins. Unfortunately, the same error happened in Indianapolis the year before and caused three tragic deaths and injuries to a number of children.

As Quaid explained he did not come to speak on the topic of medical errors to denigrate doctors, nurses, pharmacists, caregivers, or the hospital. He pointed out that medical professionals are dedicated to their profession, overworked, underappreciated, but they are also human and all humans make mistakes.

The hospital is to be applauded for taking action. After the incident, the hospital put a great deal of time and money into electronic recordkeeping, bedside bar coding, checklists, installed more new technology, and conducted additional training, so that today, the hospital is a premier hospital on the cutting edge.

The actor has taken several steps to educate others on patient safety issues. On April 20th, he will be speaking at the Global Patient Safety Summit to be held in Nice, France where the documentary “Chasing Zero: Winning the War on Healthcare Harm” will be presented. It is slated to be released in the U.S. on April 24th on the Discovery Channel. The documentary will be given to every hospital board of directors in the country and will become a continuing education program for caregivers.

Also, Quaid was happy to announce that the National Quality Forum’s updated manual “Safe Practices for Better Healthcare” has just been released. According to Quaid, the 34 Safe Practices updated and outlined in the manual feature the tools needed to prevent healthcare errors and how to deal with common safety issues. He made it clear that this is a time for action and he is encouraging policymakers to tie the NQF safe practices to healthcare reform.

At this time in his battle for patient safety, Quaid feels the time is right for the Quaid Foundation to merge into the Texas Medical Institute of Technology. TMIT has been actively involved in a long-term collaboration with the Institute for Health Care Improvement and their projects. Quaid feels that he is not well suited as others to run a foundation and wants to see experts such as Dr. Charles Denham Chairman, of TMIT plus other experts in the field forge ahead to provide the safe practices needed to ensure safe and high performance medical care.

Addressing HIT & Mental Health

On April 14th, both Congressman Patrick J. Kennedy (D-RI) and Congressman Tim Murphy (R-PA) introduced the “Health Information Technology Extension for Behavioral Health Services Act of 2010”. The bill would extend the incentives for the “meaningful use” of electronic health records established by ARRA to ensure that behavioral and mental health professionals, psychiatric hospitals, along with behavioral and mental health treatment and substance abuse treatment facilities are eligible to participate.

“As co-chairs of the 21st Century Health Care Caucus, Congressman Murphy and I have long advocated for the adoption of EHRs as an efficient means to lower healthcare costs and reduce medical errors,” said Congressman Kennedy. The legislation would further extend the incentives included in the HITECH Act to the mental and behavioral health community.”

“Delivering health IT to mental and behavioral providers bridges the care for those with mental and physical illnesses. To best diagnose and treat patients, mental health professionals need complete, up-to-date medical histories. For instance when depression is not treated, the costs of caring for a person with chronic illness like heart disease can double. Electronic medical records ensure that physicians and mental health professionals are working together to deliver the best possible treatments”, explained Congressman Murphy.

“As a long time supporter of access to mental health services, I’m glad to see this legislation as a corrective action to a previous oversight. The vague language in the HITECH was insufficient to allow the equal access of mental health facilities to health IT grants”, said Congressman Gene Green (D-TX)

The grant program included in the bill would help mental health services:

• Purchase health IT
• Cover costs associated with upgrading HIT in order to meet the criteria required to become a certified EHR technology
• Train personnel in the use of health IT
• Improve the secure electronic exchange of health information in the mental health field
• Improve the adaption for health IT to community-based behavioral health settings
• Assist with the implementation of telemedicine, to include facilitating distance clinical consultations in rural and underserved areas
• Collaborate and integrate with health IT regional extension centers

To carry out the grant program, $15,000,000 for fiscal year 2011 would be appropriated. The bill (H.R. 5025) has been referred to the House Committee on Energy and Commerce and to the Committee on Ways and Means.

Hearing Held on DCoE

On April 13th, the House Armed Services Committee, Subcommittee on Military Personnel held a hearing to discuss present and future plans for the Defense Centers of Excellence (DCoE) established in partnership with the VA, academia, and others. The DCoE are leading efforts to improve the prevention, diagnosis, training, outreach, and direct care for those with TBI and psychological health conditions.

The DCoE have six component centers to provide care, support training, and to advance science to include:
• The Defense and Veterans Brain Injury Center (DVBIC)
• The National Intrepid Center of Excellence (NICoE)—Scheduled to open 2010
• The Center for the Study of Traumatic Stress (CSTS)
• The Deployment Health Clinical Center (DHCC)
• The Center for Deployment Psychology (CDP)
• The National Center for Telehealth and Technology (T2)

Charles L. Rice, M.D., President, University of the Health Sciences plus the Assistant Secretary of Defense for Health Affairs, and Acting Director for the TRICARE Management Activity, appeared at the hearing to discuss the current DCoE and to discuss the need for centers to also be available to help service members with vision, hearing, and traumatic extremity injuries and amputations.

As Dr. Rice pointed out the Centers are to:

• Identify and proliferate best practices and help the Defense Department work with clinical centers across the services, VA, and the civilian sector and to be able to identify and communicate best clinical practices throughout the medical community. For example, TATRC’s Community-Based Warrior Transition Units have explored mobile care protocols for personal telerehabilitation by using cell phones to help with TBI

• Prioritize the Defense medical research agenda and lead efforts to identify gaps in scientific knowledge on wounds, injuries, and diseases, as well as prioritize and coordinate research efforts to fill the gaps. Nearly $50 million in funding is directed to further research to study PTSD brain tissue, the impact of blast physics on brain tissue, and to study advance technologies such as virtual reality, avatars, videogames, telehealth and in other areas

• Enhance patient-centered care and integrate services across the continuum of care by establishing disease registry functions based upon the clinical data repository. So far, call centers and web sites have been established. A registry used by both DOD and the VA is in place to facilitate case management, support longitudinal care, and assess outcomes

Through The National Center for Telehealth and Technology (T2), efforts are being made to standardize DOD telehealth services for psychological health and TBI by establishing a Federal Partners Exploratory Committee on telemental health. DCoE has recently begun serving as a coordinating and resource center for the emerging telehealth network of systems across DOD.

T2 efforts are establishing a collaborative network to help rural and underserved locations by connecting various rural patients with treatment facilities via telehealth technologies that includes web-based applications.

The DCoE coordinated and developed TRICARE’s web-based assistance program (TRIAP) launched in 2009. TRIAP offers counseling assistance by video, and is available 24/7 to active duty and family members as well as to TRICARE reserve select enrollees.

According to Dr. Rice although the Vision Center of Excellence, the Hearing, and the Traumatic Extremity Injuries and Amputations Centers of Excellence were directed by Congress to be established, the initial activities have not developed as expected. However, significant progress on these centers has been made during the past several months.

Dr. Rice is monitoring three significant milestones for 2010. For example, in the coming weeks decisions will be made on how to integrate DCoE operations and share resources with the VA will be put in place. He is going to approve the CONOPS for the three newest Centers in 2010, and the NICoE will open this year with a state-of-the-art facility.

Technology Tracking Drugs

Ohio Governor Ted Strickland signed an Executive Order to provide a more comprehensive and coordinated approach to combating prescription drug abuse across the state. The Governor is calling on all doctors and pharmacists to use the Ohio Automated Rx Reporting System. Once registered, the system enables healthcare professionals and law enforcement to be able to request Rx History reports. All public documents distributed by the system are available.

Today, although all pharmacists report into this system, only one in five use the system when filling prescriptions. The system is able to track prescriptions every time pain medications are prescribed. The state has set aside $250,000 in Justice Assistance Grants for local law enforcement to use to expand or improve their efforts to control the dispensing of pain medications.

Prescription drug abuse has been identified as a rising public health problem on the national level and has reached epidemic rates in Ohio. Ohio’s death rate due to unintentional drug poisoning has increased more than 300 percent from 1999 to 2007 and is now the leading cause of injury death in the state.

The Executive Order establishes the Ohio Prescription Drug Abuse Task Force to help unite the ongoing efforts at the federal, state, and local levels. The Task Force is charged with researching the issue and identifying public health, law enforcement, updating legislation, and using other strategies to reduce the danger of prescription drug abuse. Findings and recommendations will be reported to the Governor and the Ohio General Assembly.

Links are available at the Ohio Department of Health at www.odh.ohiolgov/drugoverdose to other state prescription monitoring programs such as Indiana INSPECT, Kentucky’s All Schedule Prescription Electronic Reporting, and Michigan’s Automated Prescription System.

The Governor of Alabama has signed into law a bill that will help the state fight the use of meth. The new law creates an electronic database so law enforcement can quickly track excessive purchases of pseudoephedrine, the chief ingredient used in the manufacture of meth.

The electronic database replaces paper records and now it is possible for the state to restrict excessive purchases of pseudoephedrine and help law enforcement do instant tracing. Every pharmacy or retailer selling ephedrine or pseudoephedrine products under the new law are required to enter the purchaser’s identifying information into the database prior to any sale. The database then notifies the seller if the purchaser has exceeded their daily or monthly limit for such purchases.

DOL Announces Grant Funding

The Department of Labor (DOL) is going to award $13.2 million to prepare workers for careers in the healthcare sector. The goal is to create an online platform using standardized data and programming interfaces with the infrastructure in place to support new applications. The Employment and Training Administration (ETA at DOL is particularly interested in supporting the development of a platform that will emphasize opportunities within health technology and healthcare support occupations.

There are two grant categories in this funding program. Category 1 provides funding for one grant up to $6.6 million to create and manage the Healthcare Virtual Career Platform (HVCP). Eligible applicants for this category include private nonprofit organizations with a nationally focused mission.

Some of the key deliverables for Category 1 are to identify what virtual tools and services are currently available, develop a gap analysis, have the ability to build and operate the HVCP, and be able to develop an assessment tool.

Category 2 grant funding includes $6.6 million for two to four grants to deliver virtual career exploration services that will include healthcare careers. This category requires the ability to conduct training on using the HVCP and provide training for the staff from local One-Stop Career Centers.

Applicants for Category 2 can include private national nonprofit organizations that deliver services through networks of local affiliates, coalition members, or other established partners including nonprofit operators of One-Stop Career Centers.

Some of the key deliverables for Category 2 are to deliver computer workstations, increase broadband capacity or internet access, obtain software to include computer literacy assessments, and develop training modules to help customers learn about using online services.

The applications for the funding are due on May 7, 2010 and the grants are schedule to be awarded by June. 30. For more information, go to the April 7, 2010 Federal Register or go to

Wednesday, April 14, 2010

States Initiating Actions

The Governor of Maine has signed an Executive Order establishing the Office of the State Coordinator for Health Information Technology. The Executive Order also establishes a Health Information Steering Committee with subcommittees to advise the Coordinator on specific areas of HIT implementation.

The Office of the State Coordinator for HIT will:

• Serve as a clearinghouse for all state HIT policy
• Align HIT planning efforts with the State Health Plan
• Coordinate ARRA HIT/HIE planning and implementation and provide for financial and regulatory oversight of HIT and HIE efforts
• Disseminate public information about HIT and HIE through partnerships with stakeholders
• Work collaboratively with HealthInfoNet, the state’s designated health information exchange that has just been awarded $4.7 million in Recovery Act funds.

In the state of Washington, Governor Chris Gregoire is taking steps to get the state ready to implement healthcare reform as components of the law are beginning to take effect. The Governor signed an Executive Order creating a Health Care Cabinet to implement healthcare reform in the state.

The Executive Order directs the Health Care Cabinet to integrate existing prevention and wellness strategies into all reform efforts. The law increases federal investment in public health programs for prevention, wellness, and monitoring and tracking of disease outbreaks.

The Health Care Cabinet will work to attract and retain enough nurses and healthcare staff to meet the growing under the new legislation. The plan is to invest more in training programs, more scholarships for healthcare workers, and improve the diversity of the workforce.

To jumpstart the Health Care Cabinet, Doug Porter has been appointed as the new Administrator for the Health Care Authority. Currently he is Medicaid Director and Assistant Secretary of the Department of Social and Health Services’ Health and Recovery Services Administration.

In his role as the new administrator for the Health Care Authority, he will assume primary responsibility for building and operating a unified purchasing system for publicly funded health services for the state. By combining the purchasing power of Medicaid and the Health Care Authority, greater control will be yielded over costs and the result will streamline the state’s ability to implement healthcare reform.

Maryland Governor Martin O’Malley signed an Executive Order to create the Maryland Health Care Reform Coordinating Council. The Council will advise the administration on policies and procedures needed to implement the recent and future federal healthcare reform legislation. A preliminary report on the Council’s activities and findings are due July 2010 with a more complete report due in 2011.

PHRs Motivating Consumers

Americans with access to their health information through Personal Health Records (PHR) report that they know more about their health, ask more questions, and take better care of themselves than when their health information was less accessible to them in paper records, according to a just released study by the California HealthCare Foundation (CHCF).

The survey conducted with 1,849 people was done between December 18, 2009 and January 15, 2010 by Lake Research Partners. In general this new national survey finds PHRs motivate consumers to improve their health, but the tools that help people to manage their health are still not widely used.

The survey indicates that one in 14 Americans have used a PHR which is double the number of users from a year earlier. Users say that secure, password-protected PHRs give them the confidence they need to access their personal information online, and when they do, they pay more attention to their health.

One in three PHR users say they took a specific action to improve their health—sparking hope that these technologies could be the long awaited tools that help engage patients in taking better care of themselves. Surprisingly, the benefits of PHR use is most valued among populations that have been difficult for healthcare providers to engage—those with multiple chronic conditions, less education, and lower incomes.

“We know that most healthcare is self-care, since most people only see their physicians periodically,” said CHCF President and CEO Mark D. Smith, M.D. “The survey shows that when individuals have easy access to their health information, they pay greater attention to their health. For the first time, the survey documents that PHRs empower some people—including some of the heaviest users of the health system to take better care of themselves.”

Despite the growing availability of PHRs through health plans and online services, the survey found most Americans have yet to take advantage or PHRs or related applications. While usage of these tools is relatively low, it has increased considerably from earlier surveys. In fact 7 percent of Americans now say they have used a PHR—more than double the rate since 2008, when the Markle Foundation released a survey finding only 2.7 percent of people had used a PHR.

About half of all survey respondents say they want to use PHRs provided by their physicians (58%) or from insurers (50%). Just one in four (25%) reports wanting to use PHRs developed and marketed by private technology companies.

Healthcare privacy still remains a concern. In 2010, 68% expressed the same levels of concern on the issue. However, two thirds of those surveyed said privacy concerns should not stand in the way of learning how technology can help improve healthcare.

Other findings indicate that PHR users are predominantly young, highly educated, higher income, white men but traditionally vulnerable populations have the most to gain from PHR use. Also, if the users have doctors who use EMRs then they are more likely to want to use a PHR.

To view the full survey findings, go to

iPhone-like HIT Research

Researchers at Children’s Hospital in Boston and Harvard Medical School are leading a $15 million grant effort to advance health IT with funding available from the HHS Office of the National Coordinator for HIT through the Strategic Health IT Advanced Research Projects (SHARP) program.

The four year project led by Isaac Kohane, MD, PhD, and Kenneth Mandl, MD, MPH, of the Children’s Hospital Informatics Program and Harvard Medical School will research, evaluate and prototype approaches to achieving an “iPhone-like” health IT platform model. This was first described by the researchers in a March 2009 Perspectives article in “The New England Journal of Medicine.”

The platform architecture, described as “Substitutable Medical Applications Reusable Technologies” (SMArt) architecture will provide core services and support extensively networked data from across the health system. This will enable the equivalent of the iTunes App Store for health and stand in stark contrast to the way health information systems have been designed and implemented to date. The grant funding will enable organizations across the health ecosystem to partner with the research team on efforts to translate their solutions into real-world practice.

HRSA to Help in the Pacific

Spread across 107 inhabited islands covering an expanse of ocean larger than the continental U.S., the affiliated Pacific Basin jurisdictions with a diverse population needs assistance to address healthcare needs. However, it is difficult to get community involvement along with technical assistance in this enormous region to apply successfully for HHS funding opportunities.

To help the Pacific region, the Health Resources and Services Administration (HRSA) on April 1st, announced the release of FY 2010 grant funding to address the problem. The funding will be used to form and support a regional health policy body to be called the “Regional Collaborative for the Pacific Basin” (RCPB). Specifically, the grant funding will help set up the Regional Collaborative to help improve healthcare for residents in American Samoa, Guam, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau.

The Regional Collaborative will be organized to serve as a formal mechanism to discuss common health interests, problems and concerns, to promote and enhance a regional approach for the cost-effective sharing of resources, provide data and health information, and provide for expert advice to advance healthcare in the Pacific Basin and the Pacific Basin jurisdictions.

Specifically, the Regional Collaborative will develop and advance a strategic plan, promote and plan partnerships across different regions to help seek funding sources, provide grant writing assistance, obtain community engagement, and create a regional Primary Care Office (PCO) for the six U.S Affiliated Pacific Basin jurisdictions.

HHS funding opportunities are available to strengthen primary care and public health delivery systems, to support rural health outreach and network activities, to enhance telehealth and distance education capacities, support health workforce development, do community-based participatory research, do health disparities research, and find funding for a variety of chronic, infectious, and behavioral conditions. Many of these funding opportunities could be of great value to healthcare in the Pacific region.

Eligible applicants must be public or private non-profit entities that are part of an established network representing the six U.S Affiliated Pacific Basin jurisdictions. Awards will provide funding for Fiscal years 2010-2014 but funding beyond the first year is dependent on funds. HRSA is anticipating that between $429,500 and $679,500 will be available annually to fund one cooperative agreement.

The letter of intent is due on April 30, 2010 and the final application due date is May 21, 2010. For more information, go to or contact Lynnette S. Araki, at (301) 443-6204.

SSA Looks to the Future

The 7th Meeting of the Social Security Administration’s Future Systems Technology Advisory Panel Meeting will take place on May 4th in Philadelphia at the Hotel Palomer. The Advisory Panel was established in 2008 to provide independent advice and recommendations on the future of systems technology and electronic services at SSA looking five to ten years into the future.

The panel’s recommendations will provide SSA with a roadmap of future systems technologies that will be needed in the areas of internet applications, customer service, privacy, and any other area of importance to SSA.

The panel is composed of 14 members from academia and private industry with experts in future computer systems technology and other related areas. Issues under discussion include strategies for service delivery, plans for data center replacement, privacy and fraud detection, conversion of legacy systems, and systems development,

John D. Halamaka, M.D., Chairman for the Healthcare Information Technology Standards Panel serves on the panel along with Phil Becker, Associate Commissioner, Office of Telecommunications and Systems Operations at SSA.

The Health Information Technology and Backlog Management subcommittee is going to tackle issues such as health IT management related to storing, using, and processing medical information along with the immediate need for technology to reduce disability backlogs. The subcommittee would like to see a long term HIT vision as part of an ultimate disability service model.

The meeting agenda will be available one week before the meeting. For more information, go to the April 12th Federal Register or email or call (410) 965-0201.

New York Releases RFP

The New York State Department of Health on April 7th released RFP “Communicable Disease and Infection Control Surveillance and Investigation”. All suspected or confirmed communicable disease cases, outbreaks, or unusual diseases are required to be reported to the New York State Department of Health (NYSDOH).

Hospitals and nursing homes are also required to report facility-acquired communicable disease outbreaks or increases in diseases. In addition, any unusual disease that could possibly be caused by a transmissible infectious agent or microbial toxin is required to be reported.

Since NYSDOH is responsible for identifying and responding to disease outbreaks, the department needs the expertise to detect unusual events, investigate the events, contain possible threats, assure that appropriate medical care follow-up is done, and provide for appropriate laboratory ton an ongoing basis.

In addition, the NYSDOH provides advice on communicable diseases to Local Health Departments (LHD), hospitals, long term care facilities, physicians, schools, state agencies, and the public along with providing communicable disease education and training to LHDs and other healthcare staff.

NYSDOH in releasing the RFP seeks two qualified contractors who have the ability to assist in conducting enhanced communicable disease surveillance and also do disease investigations in the healthcare and community setting.

Specifically, the contracts will be awarded to:

• Investigate and file required reports available from healthcare settings
• Ensure that surveillance and disease reporting activities are consistent and comply with state rules and regulations
• Provide NYSDOH regional offices and LHDs with technical assistance in investigations
• Analyze disease trends by monitoring and evaluating the data
• Develop action plans to address and contain disease outbreaks

The NYSDOH will accept proposals from healthcare review organizations, health care organizations, business groups and councils, or any other potential private review organization
Eligible bidders must have a minimum of 3 years of experience in surveillance and communicable, epidemiological and/or infectious disease reviews, or investigation experience in healthcare and community settings. Must be licensed to do business in New York State and must demonstrate an understanding of New York State Communicable Disease laws, rules, and regulations.

Proposals are due May 21, 2010. Contracts will be awarded for a maximum of five years with an anticipated contract period from August 1, 2010 to July 31, 2015 subject to the NYSDPH’s need for services, the availability of funds approval by the Office of the State Comptroller, and acceptable performance by the contractor.

For more information, go to or email Cindi Dubner at

Sunday, April 11, 2010

HHS Secretary Speaks at NPC

“The future of healthcare is in practice at Cincinnati Children’s Hospital” reports HHS Secretary Kathleen Sebelius after a recent tour of the medical center. The Secretary saw firsthand how patient-centered care and the use of information technology can translate into high quality healthcare. Sebelius a Cincinnati native, visiting the hospital on April 5th at the invitation of the President and CEO Michael Fisher, said she was impressed how technology in the hospital enables patients and families to address their care needs.

The Secretary speaking the next day at a luncheon at the National Press Club in Washington D.C. reported that the Cincinnati hospital deals with some of the sickest children not only in the Ohio region, but also with children from all over the country and from international sources because they are renowned for doing some very complicated surgeries.

At one stop on the hospital tour, she saw a baby not quite two months old who was born prematurely and still staying in the newborn intensive care unit. She saw how the nurses used bar codes on the baby and on themselves to check on the infant and also to make sure that the right doses of medications were given at the right time.

The hospital reports that since the hospital put their EHR system in place they have gone over 1,000 days without a serious incident in their Neonatal Intensive Care Unit. This has been accomplished by using an automated checklist appearing at every incubator, at every crib, to remind providers of the various steps that need to be taken to keep the hospital setting as safe and secure as possible.

During her stop at the outpatient clinic, the Secretary discussed how effectively online access to medical records is working. A mother in the clinic said that instead of bothering doctors and nurses with questions, she can use the internet access to the hospital’s databases to learn how to take care of her daughter. She said that if the has questions, she can send emails and hear back the same day with an answer. Secretary Sebelius said she was glad to hear that ownership of the medical records resided with the patient and not with the hospital.

The hospital is very concerned with making surgery safer and to greatly reduce the number of medical errors. The hospital’s pediatric cardiac surgery team not only uses checklists but also videotapes every surgery. They are looking not just for errors or near misses but for any unexpected events, no matter how small.

At the luncheon, the Secretary announced that the last round of the health information technology grants for $267 million funded by the Recovery Act was awarded to 28 additional non-profit organizations to establish HIT Regional Extension Centers (REC). This round of awards brings the total number of RECs to 60 and will provide nationwide outreach and technical support services to at least 100,000 primary care providers and hospitals within two years.

She explained that if a small provider group or a doctor’s office wants to switch to electronic records, they will now have a health extension center close at hand and boots on the ground to help them implement new strategies, be able to get expert advice, and technical assistance if needed.

The Secretary also announced that this is the first time HHS has released Medicare data in what the agency is calling their “Medicare Dashboard”. This online tool now makes it much easier for Americans to search and sort aggregate Medicare data with full protections of patient privacy. The agency also has launched Medicare’s inpatient hospital data where the user is able to sort data by state, by condition, and by hospital which makes it possible for the first time to make price comparisons

Cloud Computing Advancing

“Cloud computing can lower costs and change the way computer services are delivered but it won’t happen overnight”, according to Vivek Kundra, Administrator and Federal Chief Information Officer for the Executive Office of the President. As the keynote speaker at the Brookings Institution Policy Forum on “The Economic Gains of Cloud Computing”, he stressed that the federal government needs to promote and develop cloud computing.

He sees cloud computing lowering government operation costs, driving innovation, and changing how we deliver IT services. Cloud computing is still in the early days and future progress won’t happen easily overnight and may take a decade or longer to mature.

Kundra looked back in history to explain the concept of cloud computing. He said ‘Consider how homes used to have a well to generate or get water, but as time went on, people were able to turn on a tap to get water. What this means is that we not only have the convenience of tap water, but we also can control how much water we consume and we are billed only for what water we use.” Cloud computing is similar since users can access computing power from a pool of shared resources and in the future this is how our computing resources will be delivered.

Many highly respected people in the field think that the federal agencies should migrate to the cloud. According to Kundra, cloud computing will offer big financial gains and save the government billions of dollars.

As Kundra explained, the U.S spends over $76 billion annually on more than 10,000 systems and provides technology support for millions of people but yet we do this with a fragmented and inefficient technology infrastructure. To prove the point, over the past decade, in the federal government, the number of federal data centers grew from 432 to more than 1,100 data centers. The result is that we have redundant infrastructure investments that are costly, inefficient, unsustainable, and also greatly impact energy consumption.

Cloud computing is taking place in the private sector and so far has produced some good results and savings. For example, NASDAQ now has the ability to give customers and regulators information on past trading actions and a snapshot of market conditions at the time of the trade. Starbucks is using cloud-based tools to launch an online community in order to hear from customers on how to make improvements.

As Kundra explained, the Department of Commerce’s National Institute of Standards and Technology (NIST) heavily involved in the cloud issue is leading efforts to develop standards for data portability, cloud interoperability, and security. The President’s budget proposed $70 million in standard development at NIST to not only use for cloud computing, but cloud computing will be the major focus.

To start the process, NIST is hosting a “Cloud Summit” on May 20th along with other government agencies and the private sector. The plan is to define Federal Government requirements for cloud computing, determine the technical research that is needed, and develop standards. The goal is to work closely with industry and meet their concerns for security, portability and interoperability.

Some of the agencies across government have already begun shifting to the cloud. For example, HHS recently awarded a contract to support the implementation of EHR systems. If new easier models of delivery and technology are developed then it will be easier for providers to use EHR systems and reduced costs will help doctors adopt EMRs. With this project in place, analysts will able to quickly identify the best practices for EHR implementation as they emerge.

HHS also uses cloud computing through their Information and Systems Management Service (ISMS). ISMS, is able to consolidate technological resources and information to provide an extensive array of information and technology services to HHS.

For example, the Medical Affairs Branch within ISMS offers many services and an enormous amount of information from just one single source to make it easier to administer healthcare with ease. Because of the efficiency of the operation, 99 percent of customer requests for information are responded to within two business day after the request is made.

Kundra summed up and said the individual federal agencies are now committed to rethinking their strategy for cloud computing and are creating their own plans for development and not just duplicating solutions across the federal government. The information from the agencies will be compiled and could play a big part in planning for cloud computing in the FY 2012 budget.

IT and the Medical Home

The April 2010 issue of Health Affairs devotes the entire issue to the impact and use of health IT on care quality and costs. One of the articles “The Future of Health Information Technology in the Patient-Centered Medical Home” looks at what is needed in terms of electronic records to further enable medical homes to really improve efficiency, quality, and safety.

In order to achieve the goals for medical homes, the authors David W. Bates, Chief of the Division of General Internal Medicine at Brigham and Women’s Hospital in Boston and Asaf Bitton a Fellow in General Internal Medicine at Brigham and Women’s Hospital and in the Department of Health Care Policy at Harvard Medical School, think that developing electronic health records is critical in seven major areas.

The seven major areas include telehealth, measurement of quality and efficiency, care transitions, personal health records, registries to use for team care, along with clinical decision support for chronic diseases. The authors also suggest that in order to encourage development, policy leaders need to look at the issues related to medical homes in the emerging electronic health record regulations.

Using telehealth technologies can help practitioners check on patients but it also can be used to monitor patients remotely. According to the authors, medical homes could use this technology to collect vital signs and report on symptoms for patients with chronic illnesses and do this not only in urban areas but in rural areas as well.

The authors concluded that EHRs are important in establishing medical homes but in order for this to happen, EHRs and other systems will have to evolve substantially. The key areas needing development include registry functions, clinical decision support, and development of the tools needed to deliver care. Also, an external payment reform is absolutely essential for medical homes to take hold and become financially sustainable.

The medical home concept is not only being developed in the civilian sector but the concept is under development in the military setting. However, there are differences between the civilian and military sector in the ability to develop and test the concept. However, both the civilian and military medical home concepts require and are dependent on the use of technology.

The military has more financial and personnel resources and is able to reassign staff to what is needed, has an easier job selecting systems, has the resources to invest in team building, and is able to operate on a larger scale. It is easier for the military to set up and operate a medical home at one facility and then test and develop the concept at many other facilities doing this all at the same time.

In 2007, Navy doctors and researchers at the Naval Medical Center’s Department of Internal Medicine serving 35,000 patients on an outpatient basis began investigating how to restructure their primary care delivery system so that they would be able to use a patient-centered approach emphasizing primary and preventive care.

The Navy researched and borrowed from medical home models developed by the Patient Centered Primary Care Collaborative (PCPCC). The Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, physicians, and others working to develop the patient-centered medical home.

The Naval Medical Center then created integrated medical home teams within the internal medicine outpatient clinics. The goal was to provide personalized, proactive, coordinated care, and care management services to patients.

The system put in place provides scheduling for same day appointments for acute care, allows emails to go to providers, and enables patients to submit requests for prescription refills. Patients are also encouraged to schedule visits virtually rather than schedule face-to-face visits with providers when it is appropriate.

Web-based personal health records and systems support this form of care management. The medical team, working with IT specialists created the portal and personal health record system. At the same time, they designed a medical home management system for clinicians that includes population management functions and in-depth data search capabilities.

The Navy’s pilot program with 1,200 patients then presented training sessions to tell the patients how the new medical home model would work. Also, patients registered at the web site, provided information and answered questions about their health. Patients were encouraged to enter clinical information such as recent blood glucose or blood pressure readings that may be helpful to providers. Eventually, the team members hope the online concept grows and they will be able to enroll about 70 percent of the patients in the system.

The providers benefit by being able to obtain data on patients especially patients with chronic conditions. The providers find it especially valuable to detect when patients are not being seen or screened as recommended. The system uses benchmarks, such as blood glucose and mammography screening rates to measure quality of care for each provider. In addition, disease management tools are provided to help provide better care for patients with chronic illnesses. The technology is in place to alert the medical team when a patient has been treated in the emergency department or enters the hospital in the past 24 hours.

At present six teams are working and there are plans underway to create additional medical home clinics to serve children, adolescents, wounded soldiers, and geriatric patients. Periodically, it is necessary to re-examine the model’s strengths and weaknesses, making changes as needed.

The Navy hopes to create a comprehensive information management system to enable teams to access disparate medical and patient health records through the portal. The ultimate goal is to provide evidence-based resources at the point-of-care, a patient-centered education portal, and assistance with check in procedures for patients.

DOD Program Announcement

Appropriations for $50 million for FY 10 are funding the Peer Reviewed Medical Research Program (PRMRP) to support military health-related research. The program issued a funding opportunity notice (W81XWH-10-PRMRP-TTDA) to make Technology/Therapeutic Development Awards. The program is looking for original ideas to foster new directions to improve therapeutic or diagnostic tools, to improve clinical policies/guidelines, or develop clinical trials that address an immediate clinical need.

The Office of the Congressionally Directed Medical Research Program (CDMRP) expects to fund $5.1 million of the $50 million for the FY 10 PRMRP appropriation and anticipates funding approximately two technology/therapeutic development award applications.

The PRMRP seeks applications in laboratory, clinical, behavioral, and epidemiologic research as well as in public health and policy, environmental sciences, nursing, occupational health, alternative therapies, ethics, economics, and strategic research.

All applications for the funding must address at least one of the topic areas directed by Congress and the application needs to have direct relevance to the healthcare needs of the Armed Forces, their families, and/or the Veteran population.

Some of the research topic areas include chronic migraine and post-traumatic headaches, drug abuse, epilepsy, fragile X syndrome, inflammatory bowel disease, interstitial cystitis, vaccines for infectious disease, lupus, mesothelioma, neuroblastina, osteoporosis and related bone disease, Paget’s disease, pheochromocytoma, polycystic kidney disease, osteoarthritis, scleroderma, and tinnitus.

Some of the examples of research that might be supported but not limited to include:

• Collection and analysis of data for developing and validating clinical guidance
• Testing new therapeutic modalities
• Developing prototype devices for diagnosis/ treatment for initiation of clinical trials
• Optimizing diagnostic or treatment devices for field deployment

Eligible organizations for the funding include for-profit, nonprofit, public and private organizations such as universities, colleges, hospitals, laboratories, and companies. PIs at the level or above the level of Assistant Professor or equivalent are eligible to submit applications.

Pre-application submission deadline is April 22, 2010, with May 13, 2010 as the application submission deadline. For more information, go to then go to Technology/Therapeutic Development Award or email or call (301) 619-7079.

State Expands Telemedicine

Virginia’s Governor Bob McDonnell visited Virginia Commonwealth University’s Minimally Invasive Surgery Center to sign into law legislation expanding telemedicine coverage for the people in the state. The legislation (SB 675) makes certain that health insurers will cover and reimburse for healthcare services provided in the state through the use of telemedicine technologies.

SB 675 defined telemedicine services to mean the use of interactive audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Utilization review may be undertaken to determine the appropriateness of telemedicine services.

Speaking about the expansion of the access to telemedicine to the state, the Governor remarked: “Telemedicine can save both dollars and lives. This growing medical field utilizes modern technology to ensure that all Virginians are properly diagnosed and treated no matter where they live and that they are treated in a cost efficient manner.

Dr. Karen Rheuban, Medical Director University of Virginia Office of Telemedicine, a Board Member of the Center for Telemedicine Law, and President of the American Telemedicine Association, said “Information is the greatest medicine. A proper diagnosis provided in a timely manner can all too often be the difference in a positive or negative outcome. Unfortunately, doctors can’t be everywhere, and for a long time, geography proved to be one of the greatest impediments to proper care.”

Tuesday, April 6, 2010

HHS Awards $144 Million

HHS just announced two sets of awards totaling $144 million. The first set for $84 million went to 16 universities and junior colleges to support training and development for more than 50,000 new Health IT professionals. In addition, the second set for $60 million is going to support research and innovation at four advanced research institutions. Both award programs are being funded by the Recovery Act.

Of the $84 million, $36 million will go towards supporting the “Community College Consortia Program” to help five regional recipients establish a multi-institutional consortium within each region. The five regional consortia will include 70 community colleges and will create non-degree training programs that can be completed in six months or less by individuals with appropriate prior education and /or experience.

The grant awards will go to Bellevue College in Washington, Cuyahoga Community College District in Ohio, Los Rios Community College District in California, Pitt Community College in North Carolina, and Tidewater Community College in Virginia.

The “Curriculum Development Centers” program received $10 million to develop educational materials for key health IT topics to be used by the members of the “Community College Consortia” program. The materials will also be available to other institutions of higher education across the country.

The funding will go to the University of Alabama at Birmingham, Columbia University in New York, Duke University, Johns Hopkins University, and the Oregon Health & Science University.

In addition, $32 million is going to the “Assistance for University-Based Training” program to help produce professionals for highly specialized health IT roles. Most trainees in the program will complete intensive courses of study in 12 months or less and receive a university-issued certificate of advanced training.

The institutions to be part of the training program include Columbia University, University of Colorado Denver College of Nursing, Duke University, George Washington University, Indiana University, Johns Hopkins University, University of Minnesota, Oregon Health & Science University, and Texas State University.

One individual award of $6 million is going to Northern Virginia Community College in Annandale, Virginia to support the development and initial administration of a set of health IT competency examinations. The program will create an objective measure to use to assess basic competency for individuals trained in short-term, non degree health IT programs and help the workforce demonstrate their competency in certain health IT roles.

The second part of the HHS funding announcement allows the Office of the National Coordinator for Health Information Technology through the Strategic Health IT Advanced Research Projects (SHARP) program, to award $60 million to promote research and innovations. Fifteen million each was awarded to four recipients

The awards went to:

• Mayo Clinic of Medicine—To develop and use strategies for the secondary use of EHR data to improve the overall quality of healthcare while maintaining privacy and security
• Harvard University—To develop new and improved architectures to leverage the benefits of today’s architecture, focus the needs for the future, and address significant increases in data
• University of Texas Health Science Center at Houston—To harness the power of health IT so that it integrates, enhances, and supports clinicians reason and decision-making
• University of Illinois at Urbana-Champaign—Develop security and risk mitigation policies and the technologies necessary to build and preserve the public trust as health IT systems gain widespread use

These projects will be conducted by multidisciplinary teams led by recognized public and private sector leaders in health, including researchers, the technology industry, and healthcare providers. The results of these diverse teams work will be translated into practice to produce innovative health IT solutions that can be deployed nationwide. The goal is to quickly infuse the dynamic health IT sector with new thinking, ideas, and solutions.

Information on the awards made available through the workforce development program is available at and at