Wednesday, May 26, 2010

ATA's Special Announcement

CMS proposed new regulations in the May 26th Federal Register to address the credentialing and privileging of physicians and practitioners that provide telemedicine services. Almost ten years ago, ATA worked with the Joint Commission to develop a process and standards whereby one accredited hospital could accept the credentialing and privileging of physicians providing telemedicine services from another accredited hospital—a process referred to as “by proxy”.

However, CMS had been insisting that as of July 15th, all hospitals would have to comply with the outmoded Medicare requirement that requires each hospital fully and independently credential and privilege each telemedicine practitioner in order to qualify under the CMS “Conditions of Participation” for the facility. This would have forced many telemedicine networks to close or shrink.

According to ATA, the newly proposed rule appears to ensure that Medicare-participating hospitals will be able to credential and grant privileges to telemedicine physicians in a manner similar to the Joint Commission process.

The new flexibility under the proposed rule would reduce the burden and duplicative nature of the traditional credentialing and privileging process for Medicare-participating hospitals and Critical Access Hospitals engaged in telemedicine agreements while still assuring accountability to the process. This is a big win for telemedicine and bodes well for future dealings with Medicare over using technology and telecommunications to deliver healthcare.

ATA is presenting a video cast to discuss all the details and answer questions concerning the new CMS proposal. The video cast free for ATA members and $25 for non-members, is going to be held on May 27th at 11:30am EST. For more information, go to or call (202) 223-3333.

Expanding Health Technology

Patients with chronic illnesses often require close monitoring, although access to a doctor is not always available. Royal Philips Electronics have announced an agreement with Project HOPE, an international health education and humanitarian assistance organization to place telemonitoring devices in select homes in rural areas in New Mexico. This will help patients with chronic diseases such as diabetes, cardiovascular disease, and respiratory ailments receive the proper treatment for their medical problems.

“Some residents in the state face a significant challenge in access to care due to a lack of healthcare professionals to meet the needs of the population,” said John P. Howe III, M.D., President and CEO of Project HOPE. He talked about the unique program in New Mexico during his keynote address at the American Telemedicine Association Conference held recently in San Antonio.

The Philips-HOPE partnership will provide training to local health workers who will assist in the installation of monitoring devices and teach patients how to use the technology. Training of local health workers will be provided through a traveling health unit operated by Project HOPE. When the HOPE mobile unit is in the patient’s community, the telemonitoring data will be used to help clinicians assess the patient’s condition and manage their care.

Some of the other telehealth programs in the state are due to expand. According to the New Mexico Human Services Department’s Strategic Plan for FY 2011, Goal 6.3 in the plan would expand healthcare access in rural and underserved areas through telehealth services. The plan is to assist the Telehealth Commission evaluate and integrate individual agency telehealth efforts, continue to participate in state-wide efforts such as “Envision New Mexico” that links pediatric sub specialists at the University of New Mexico with rural primary care providers, and to continue telehealth initiatives through the Human Services Department’s e-Prescribing pilot program.

State efforts are to continue to provide tele-behavioral health services throughout the state. Most of the telehealth based programs provide direct clinical services in child, adolescent, adult and addiction psychiatry. Also, there are other programs that provide training and consultations to primary care and behavioral health providers working in rural and isolated communities.

To help move forward with health IT, the state received $13 million from Recovery Act funding to expand the use of health IT in the state. The $7 million grant funding for that purpose will enable the HIE called the New Mexico Health Information Collaborative (NMHIC) to serve 2 million patients throughout the state. MedPlus and their Centergy Data Exchange Services will manage the exchange.

Funding for $6 million will be used to promote a health IT Regional Extension Center. The New Mexico HIT Regional Extension Center will be operated by LCF Research in cooperation with the NM Primary Care Association and the NM Medical Review Association.

In addition, the state’s Human Services Department recently announced that the state’s Medicaid incentive program will benefit hundreds of New Mexico’s healthcare providers and enable them to adopt and or utilize health IT. The Medicaid incentive payment program is 100 percent federally funded and is scheduled to be up and running by October 2010. The Human Services Department will provide an opportunity for healthcare providers to submit their input when the department submits its program plan to CMS for approval this summer.

NIH Funds Unique Study

NIH’s National Institute of General Medical Sciences funded research at Stanford University to examine how the environment can contribute to the development of Type 2 diabetes. This “enviromics” approach to research mirrors genome-wide association studies and harnesses high-speed computers and publicly accessible databases.

As a result of the research, the scientists recently authored a study called “Environment-wide Association Study” (EWAS) published in the May 20th online journal PLoS O.

Like many complex diseases, diabetes results from the interplay of genetic and environmental factors. To examine genetic risk factors, scientists pore over the human genome sequence. Environmental factors have been trickier since there is no way to evaluate them comprehensively.

Research in this area is nothing new. Researchers for years have been identified the relationships between a person’s environment and cancer and the environment on other diseases. Up to now, scientists have been limited in their ability to assess the hundreds or even thousands of variables that are involved in our everyday lives.

In this study, the Stanford scientists treated environmental variables as genes. This conceptual shift allowed them to use some of the same techniques initially developed to identify the many sections of DNA throughout the genome that may contribute to disease development.

Bioinformatics expert and senior author for the published information on the research study, Atul Butte, MD, PhD, Assistant Professor of Pediatric Cancer Biology at Stanford, compares the data generated by the new approach to the amount and types of information gleaned from a DNA microarray.

Dr. Butte imagines that one day people will wear chips on their clothing and will be able to assess their exposure to hundreds or thousands of environmental toxins. The patient would then be able to bring that information to their annual physical and at that point, the patient and doctor would be able to incorporate this information into discussions about disease risk and prevention.

For the study, the researchers examined 226 separate environmental factors like nutrition and exposure to bacteria, viruses, allergens, and toxins. They found that a certain factor notably a pesticide derivative and the environmental contaminant PCB were strongly associated with the development of diabetes. Other factors showed that the nutrient beta-carotene serves as a protective role.

The researchers report that their work demonstrates that computational approaches can reveal as much about environmental contributions to disease as genetic factors can. They contend that the techniques that they used in their research could be applied to other complex diseases like cancer, obesity, hypertension, and cardiovascular disorders.

The NIGMS research was also funded by the National Library of Medicine, the National Institute on Aging, Lucile Packard Foundation for Children’s Health, and the Howard Hughes Medical Institute.

Tech to Help Disabled

Minnesota’s Department of Human Services in their Disability Service Division is looking for ways to help people with disabilities of all ages use technology in order to stay in their own homes 24/7. The state plans to minimize costs while using technology to provide people with the right amount of service in the most independent setting possible.

The Request for Proposals published May 17th seeks qualified grantees to provide consultation, evaluation, and information so that lead agencies will be up-to-date on the use of technology that can help people with disabilities of all ages continue to live in their own homes. Regional and/or statewide organizations are needed to advise the lead agencies.

Some of the examples of what is needed include:

• Automatic reminders to use to perform daily living tasks
• Environmental controls such as door and appliance controls and sensors
• Cost effective monitory systems such as emergency alert systems, sensors, cameras, and medical monitoring
• A database of knowledge on technologies that can be used to support the project

Proposals are due June 9, 2010 with $975,000 to be awarded in fiscal years 2010 and 2011.
Go to to download the RFP. For more information, email Kelsey Neumann, Disability Services Division, at

Awards for Nursing Innovation

With emerging mobile technologies, tens of thousands of clinical applications have been downloaded onto iPhones, the BlackBerry, other smart phones, and tablets. Whether incorporated into an organization’s information system or work independently, these applications provide valuable tools for clinicians worldwide.

Nursing applications with mobile devices cover the fields of patient education and communications. The devices help clinicians collaborate, provide for telehealth and mentoring, mApps are used for clinical applications in hospitals, plus mobile devices are valuable to use for long-term care.

Clinical tool applications include drug databases, medical calculators, reference programs, decision support tools, tracking vitals, patient history access, management and documentation, and payer tools. “The use of clinical apps on mobile communication and computing devices is a quiet revolution”, says C. Peter Waegemann, Vice President of mHealth Initiative. “We want to bring attention to this paradigm shift in health informatics with the support of Brandman University and their nursing program.”

mHealth Initiative in conjunction with Brandman University’s School of Nursing and Health Professions, have announced that the 2010 Awards for “Nursing Innovation using Mobile Technology in Clinical Practice” are now open to receive applications. Applicants are encouraged to complete a simple online submission form to be announced at the 2nd mHealth Conference to be held in San Diego September 8-9, 2010.

“We particularly want to recognize the adoption of mobile apps in nursing as this important component of healthcare is often overlooked,” noted Claudia Tessier, President of mHealth Inititative.

For more information, email either Claudia Tessier at or C. Peter Waegemann, at or call (617) 642-0010.

Sunday, May 23, 2010

Colorado to Roll Out HIE

The Colorado Regional Health Information Organization (CORHIO) has selected Medicity to build the statewide information network. “The selection of Medicity is a first step towards building a statewide information network, which is vital to improving today’s healthcare system,” said Joan Henneberry, Executive Director for Colorado’s Department of Health Care Policy and Financing and CORHIO Board Chair.

CORHIO will use the company’s technology platform to implement HIEs across the state, starting with the San Luis Valley region. With letters of intent from healthcare organizations in Boulder, Colorado Springs, Northern Colorado, and Denver, CORHIO plans to introduce HIE in a second region this summer as part of CORHIO’s strategy to implement HIE community-by-community. In five years, CORHIO plans to connect over 85 percent of healthcare providers and hospitals in the state to the statewide HIE.

CORHIO is collaborating with Quality Health Network (QHN), a regional HIE operating out of Grand Junction that currently provides services to healthcare providers in western Colorado. The vast majority of physicians and pharmacies as well as two hospitals in the Grand Junction area are connected to the network which includes data on more than 400,000 patients.

“Now that CORHIO has picked a vendor, we can continue our progress towards deploying health information exchange throughout the state”, said Dick Thompson, CEO of QHN and CORHIO Board member.

CORHIO, a not-for-profit organization is collaborating with diverse groups including healthcare organizations and providers. CORHIO’s board of directors and partners include members from large, urban hospitals, rural hospitals and clinics, safety net and behavioral health providers, state health agencies, health plans, and healthcare associations representing 90 hospitals, more than 7,500 physicians and millions of patients in the state.

Companies Seeking Partners

Nine New Zealand companies are in the U.S. in search of investors and partners to help commercialize innovative health technology. Hailing from the same country that developed the technological wizardry of Avatar and The Lord of the Rings, The Kiwi companies are showcasing everything from 3D virtual reality medical simulators to tissue regeneration patches for use in reconstructive surgeries.

New Zealand has a small dispersed population of 4 million people and as a result, the country has been an early adopter of healthcare technology. For example, 97 percent of the country’s general practitioners use EMR systems and 100 percent of the laboratories communicate via secure health data networks.

A “Focus on Health” business competition was developed by the New Zealand Trade and Enterprise—the government’s economic development agency. The competition was held to identify products and services with strong potential for the U.S. healthcare market.

Nine New Zealand finalists were chosen from 104 entries by an international panel of judges:

• Airway Skills: This bronchoscopy simulator is a 3-D virtual-reality training device that allows doctors and anesthesiologists to develop expert skills without practicing on a patient. The device is portable, affordable and runs off of a regular laptop. Go to

• B2P: This portable device is used for testing food and water for E Coli and other dangerous bacteria and could help prevent more than 76 million cases of food poisoning each year in the U.S. alone. Go to

• Comprehensive Health Services: A new software Giving Asthma Support to Patients (GASP) helps patients and doctors manage asthma through the internet, thereby reducing costs, hospital admissions, and emergency room visits.

• Emendo: A new CapPlan capacity planning software to help hospitals forecast demand. This helps manage doctor/nursing staffing and workflow in emergency rooms, operating rooms, and inpatient and outpatient centers.

• INROnline: This web-based program allows people on blood thinners to monitor and manage their condition through the web. Users use a standard finger prick test, enter their results online to get immediate treatment advice that includes dose management.

• Matakina Technologies: The Company’s Volpara software helps clinicians analyze mammograms with greater accuracy, improving early detection, reducing false positives, and allowing for personalized screening plans.

• Mesynthes: Endoform Infection Control is an easy-to-apply tissue regeneration patch that can be used inside or outside the body to promote faster healing and prevents infections.

• Pictor: The Company’s PictArray test kits deliver diagnostic results for Rheumatoid Arthritis and Hepatitis B and C in just two minutes using only one drop of blood. The kits reduce the cost, time, equipment, and training needed to test blood so it is ideal for small, remote clinics as well as large sophisticated labs.

• Simtics: This web-based training program teaches medical students and doctors surgical and clinical procedures without practicing on patients. It uses 3D anatomy and virtual reality simulation to teach and update skills anytime anywhere with a standard PC connected to the internet.

For more information, email Jordan Robinson Agnor at Development Counselors International at, call (212) 725-0707 or cell at 254-631-5517.

State Releases Draft Plan

Last August, ONC created the State HIE Cooperative Agreement Program but in order to receive funding, each state was required to develop both Strategic and Operational Plans. The state of Tennessee just updated their Strategic Plan and on May 17th, the state released the Draft “Tennessee Health Information Exchange Operational Plan for Public Comment.”

The draft Operational Plan details how the Strategic Plan will be executed to establish a statewide HIE. The plan outlines specific actions and the role of the various stakeholders needed to implement the HIE, and defines an approach for continuous improvement and evaluation. The plan addresses governance, finance, technical infrastructure, business and technical operations, plus legal and policy issues.

Tennessee has two well developed and operational regional initiatives. The MidSouth eHealth Alliance originated in Memphis emergency departments and the system is now used in safety net clinics, among hospitalists, and is currently extending access to ambulatory providers.

The second regional initiative CareSpark serves 34 counties spanning Northeast Tennessee and Southwest Virginia. In 2008, CareSpark launched its community health record and is now actively exchanging demographic data and clinical data. In addition, CareSpark currently is able to exchange both the Tennessee and Virginia immunization registries and is in discussion with several other states to exchange this data.

Many regions of the state that lie between the areas served by CareSpark and MidSouth eHealth Alliance are not served by HIEs. Steps are being taken to build HIE capacity in a number of areas to include groups such as Middle Tennessee eHealth Connect, Innovation Valley Health Information Network, Middle Tennessee Rural Health Information Network, and West Tennessee Healthcare.

Public health reporting and surveillance is actively taking place in Tennessee and includes collecting data on reportable and notifiable diseases, obtaining birth and death data from healthcare providers, along with ambulance emergency run records from licensed EMS providers in Tennessee. The Tennessee Department of Health (TDOH) manages multiple registries for immunization, cancer, traumatic brain injuries, and controlled substances.

Laboratory reports are received from state laboratories, commercial laboratories, and healthcare providers. About 200,000 lab reports are received electronically in the state per year. The State Lab will be sending electronic laboratory results reports to the TDOH surveillance system in the immediate future with the estimate that 100,000 additional reports will be sent.

The State government has contracted with Shared Health, a for-profit venture of BCBS to make Medicaid data available statewide. The Shared Health platform provides a clinical viewer for data, ePrescribing, a clinical decision application offering problem lists, care opportunities, along with a clinical analytics application.

Tennessee’s Office of eHealth Initiatives has approved 1,961 healthcare providers and more than 420 treatment sites, has trained more than 350 grant recipients statewide on the process of ePrescribing and on understanding the pharmacy workflow process, best practice models, workflow adoption, and what to know when choosing a vendor.

Coordination is also ongoing with other states on HIE activities. The State wants to see data exchanges flow across state borders, find opportunities to share HIE infrastructure design and development, provide for cross border Medicaid determinations, and work on new approaches to encourage providers to adopt EHRs.

Tennessee’s eHealth efforts will continue to be coordinated with federal programs. Federal matching funds of $2.7 million were awarded to the state so that Tennessee’s Medicaid program could perform state planning activities to implement the EHR. The state also received $11.7 million in Recovery Act Awards to help healthcare providers increase the adoption and meaningful use of electronic health information technology in the state.

In addition, efforts are being made to continue efforts to extend connectivity between Veteran Administration facilities and local providers plus the VA has been involved with a number of Tennessee’s regional HIOs.

Also, CareSpark has been working with the Social Security Administration and in 2010 received a $1.3 million contract from SSA to develop, test, and implement a capability to gather and relay medical records as authorized by patients applying for disability benefits.

To download the draft Tennessee Health Information Exchange Operational Plan for Public Comment, go to

Help for Veterans

In an effort to reduce the financial burden on veterans living in rural areas, Senator Mark Begich representing Alaska introduced legislation on May 6th with Senator Chuck Grassley from Iowa to waive copayments for telehealth and telemedicine visits for veterans. The bill amends title 38 of the U.S. Code related to Veterans Benefits to give the Secretary of Veterans Affairs authority to waive the fee.

There are more than 200 veterans in Alaska with 100 of the veterans living in rural Alaska that are enrolled in the VHA’s Telemedicine Program. The veterans are paying up to $50 per visit for a copayment on a telehealth appointment.

“Telemedicine has become an increasingly integral part for addressing the needs of veterans living in rural and remote communities and is a critical piece to ensure that they have proper access to healthcare,” Begich said. He continued to say “For rural veterans in Alaska, who sometimes have to travel by float planes or boats or even snow machines to get to a clinic to monitor diabetes, high blood pressure, or other chronic conditions, using more telehealth can only result in lower costs and better health.”

Begich said he believes waiving the fees may encourage more veterans to take advantage of VHA’s telehealth programs, which saves taxpayer money by eliminating or reducing the need for travel for some of the health services.

The Senate Committee on Veterans Affairs held a hearing on May 19th to discuss pending bills affecting veterans before the Committee. Dr. Robert Jesse, Acting Principal Deputy Under Secretary for Policy and Program Management for the Veterans Benefits Administration appeared before the Committee to discuss S.3035 a bill dealing with TBI.

The bill, the “Veterans Traumatic Brain Injury Care Improvement Act of 2010” (S.3035) would require the establishment of a Polytrama Rehabilitation Center or Polytrauma Network site for the VA in the northern Rockies or the Dakotas.

According to Dr. Jesse, the VA has determined that an enhanced Polytrauma Support Clinic Team with a strong telehealth component operating at the Ft. Harrison, Montana, VA facility would meet the needs and the workload volume of Veterans with mild to moderate TBI residing in the catchment area of the Montana Healthcare System. The estimated cost of staffing the Polytrauma Support Clinic Team at Ft. Harrison would be $1 million in the first year, $6.1 million for five years, and approximately $13 million over 10 years. It would also make it possible for other Veterans from the northern Rockies and the Dakotas to have access to TBI rehabilitation care via telehealth technologies.

Dr. Jesse emphasized that with the VA using a Polytrauma Support Clinic Team using telehealth, it is not feasible or advisable for the VA to establish a Polytrauma Rehabilitation Center or Network site focusing on moderate to severe TBI. Because of the action already taken by the VA, Dr. Jesse told that Committee that this bill is not necessary and therefore the VA won’t support S 3035.

In another action to specifically to help veterans, the VA at their Technology Acquisition Center in Eatontown NJ is going to develop the “Patient Assessment System” (PAS) to use to administer web-based patient self-assessments for veterans with mental health issues. The PAS will provide data to the VistA-based system that will generate chart notes for mental health clinicians to use. This would make it possible for veterans to do mental health assessments nationally in kiosks using Internet Explorer.

The solicitation (VA 118-10-RQ-0156) posted on May 14th on is looking for a contractor to develop software for the system. The response date for the solicitation is June 4, 2010. This is a set aside for a Service-Disabled Veteran-Owned Small Business.

Advancing Stroke Care

InTouch Health has developed 25 stroke and multispecialty care networks enabling patients to have access to clinical stroke experts at over 300 locations. Today, only two to three percent of stroke patients coming to hospital emergency rooms receive proper care. However, at the Michigan Stroke Network the patients are receiving appropriate treatment at five to six times the national average while using InTouch Health’s Remote Presence.

The real problem according to Jack Weiner, CEO, at St. Joseph Mercy, Oakland is due to the gross misdistribution of specialists. Today, few hospitals have 24/7 access to stroke neurologists for emergency stroke care and even fewer are able to staff one of the 500 neurointerventional specialists qualified to deliver advanced stroke interventions.

InTouch’s Remote Presence enables highly trained stroke specialists to immediately assess patients located at any network hospital which means that 70 percent of the patients within the Michigan Stroke Network are able to stay in their community hospital.

Communication technologies are vital to helping stroke patients but ongoing robotic assisted research is also helping stroke patients. For example, MIT robots are able to deliver high intensity interactive physical therapy to stroke patients according to a study published in the April 16th online issue of “The New England Journal of Medicine” that examined the effectiveness of a class or robotic devices develop at MIT.

They found that in chronic stroke survivors, robot-assisted therapy led to modest improvements in upper-body motor function and improved the quality of life six months after active therapy was completed.

In addition, a three year randomized control trial conducted by the Department of Veterans Affairs with 127 veterans enrolled at four Veterans Affairs hospitals, found that patients who used the MIT robotic device for 12 weeks experienced a small but significant gain in arm function. A group of patients after receiving high intensity therapy from a therapist and matching the number and intensity of the robot movements also showed similar improvements.

In a new stroke research effort, Insera Therapeutics of Sacramento, California received $150,000 through an SBIR grant from the National Science Foundation to develop a revolutionary stroke treatment platform. The device is able to remove blood clots in the brain and is called “Stroke Help using an Endo-Luminal Transcatheter Embolus Retrieval” or referred to as (SHELTER) ™. The device is the industry’s first clot-specific catheter-based platform to treat ischemic strokes. Insera hopes that this platform will help make catheter-based procedures safer and help to prevent the cause of secondary strokes.

Wednesday, May 19, 2010

Enhancing HIT Use

Health information linked to patients and tracked over time can provide insight into the relationship between interventions and the outcomes of care, according to Mark McClellan M.D., PhD, Director, of the Engelberg Center for Health Care Reform at the Brookings Institution. As moderator for a panel discussion on “Making Enhanced Use of Health Information” held on May 14th at Brookings, he stressed that today the major momentum is to use electronically collected data not only for clinical activities but also to use the data to help consumers and the general population.

Dr. McClellan summarized information from the Engelberg Center for Health Care Reform’s issue brief released May 2010, by discussing in detail how the enhanced use of health technology and learning from patient care data will influence quality, performance measurements, provide for better medical product safety surveillance, enable comparative effectiveness research, and provide for better public health surveillance.

However, as the issue brief points out, the Center for Medicare and Medicaid Innovation (CMI) due to be established by January 2011, along with the establishment of a shared savings program built around Accountable Care Organizations (ACO) by January 2012, will greatly need health information provided across multiple data sources. As stated in the brief, without having the health information needed for the project, it is difficult to see how CMI will be able to rapidly test promising payment and delivery models and be able to evaluate the results in time for ACOs to be established.

To further discuss some of the issues, panelists gathered to present information on current models that are currently making good use of health information or will find new ways to enhance the data in the near future. These examples show how information can be successfully gathered and how valuable the information can be for further use in the healthcare field.

For example, James Walker, MD., Chief Health Information Officer at the Geisinger Health System explained how his organization has developed a fully integrated inpatient and outpatient EHR. They also operate a networked PHR used by 146,000 patients, plus operate a health information exchange serving 2.5 million patients in 31 Pennsylvania counties.

According to Dr Walker, in order to improve the care process in our now fragmented health system, the healthcare community needs to work together, needs to understand the power and limitations of human intelligence, and focus specifically on task specific information to send to the care team and then on to patients.

Robert Steffel, President and Chief Executive Officer of HealthBridge, described HealthBridge as a not-for-profit multi-stakeholder community directed health information exchange. The exchange serves a population of 2.2 million in Southwestern Ohio, Northern Kentucky, and Southeastern Indiana to deliver information to hospitals, laboratories, and physicians. While the delivery of clinical data is essential, another important asset is to be able to use a systematic approach to deliver the most valued electronic information needed by public health officials at the community level.

David Patterson PhD, Chief of the Health and Demographics Section of the South Carolina Budget and Control Board’s Office of Research and Statistics, oversees the South Carolina Health Information Exchange (SCHIEx). He explained how the exchange provides clinical data including information on medications, diagnoses, procedures, and common problems. Much of the clinical data is obtained from paid South Carolina Medicaid claims as well as information available from participating providers EMR systems and continues to provide valuable ongoing data.

The Wisconsin Health Exchange supported by Microsoft is meeting the needs of 40 hospitals and 120 plus clinics, according to Michael Raymer, General Manager for Microsoft’s Health Solutions Group. The Exchange was able to provide the data needed and help researchers study the effects of the floods in 1993, and researchers were again able to look at the data available on the floods in 2008.

In the 1993 floods, 400,000 residents became ill because of contaminated water. However, after gathering information from data available from the floods in 2008, it was determined that this was no longer a problem during floods because after studying the information available electronically from the 2008 event, it was determined that today even during flooding, the water system can now handle the event and not become contaminated.

He explained how the exchange is the statewide repository of data available from hospitals, from ten years of paid state Medicaid claims, as well as from Health Plans to give providers clinical data on medications, diagnoses, procedures, and common problems. They have found that one of the biggest challenges to make usage of the exchange lies with rural doctors since there is still a lack of understanding by rural doctors to use the information.

John Steiner, MD, Senior Director of the Institute for Health Research at Kaiser Permanente in Colorado explained how Kaiser an integrated delivery system serving one-half million individuals has access to the data obtained from all of Kaiser’s research departments. This data provides valuable information to help determine how to improve care not only in Colorado but throughout the U.S.

To download the Issue Brief, go to

mHealth on the Rise

The Army’s use of mCare a bi-directional messaging system provides valuable information to the soldier’s personal cell phone. Appointment reminders, unit announcements, health and wellness tips, questionnaires, and resource messages are available. Because of the scalability of “mCare”, messages can go to all users and/or to specific regions, units, or individuals.

The system is operational when the care team enters the web site and schedules a message, the message is then sent to the soldier’s phone, where the solider can respond to the message by selecting a button or single character. The replies are then returned securely to the online mCare portal awaiting a response.

The Army is working to expand the cell phone concept especially to help TBI patients. Research is ongoing to upgrade the personal cell phones with unique software to allow targeted reminders and messages to be sent to individuals regarding their specialized treatment plans.

The plan is to target the Community-based Warrior Transition Units (CBWTU) that currently provide outpatient care to Army National Guard and Reserve members affected with TBI once they leave inpatient medical facilities.

Through the program, every eligible soldier that comes into one of the designated CBWTUs will have their personal cell phone upgraded with the mCare application. Once upgraded, the phones will receive SMS text messages announcing new treatments and program information when available, and provide appointment reminders when applicable.

Even with the special software, cell users must open the secure application by entering a password before being able to access the appointment reminders as well as important health and medical information related specifically to their treatment plan.

The project is set to roll out in four phases. The first phase dealing with performance improvement began in February to implement the application on the cell phones of soldiers at three CBWTUs. The goal is to measure appointment no-show rates and then evaluate if appoint notifications sent to cell phones increases the likelihood that service members will keep their appointments.

Phase II is due to start and will expand the full spectrum of messaging to two additional CBWTUs in Florida and Arkansas. Researchers will look at whether the system affects the Army’s information network. Expanding on the success of Phases I and II, Phases III and IV will expand the program to the remaining three CBWTUs as well as to additional treatment facilities at the Department of Veterans Affairs.

For TBI patients, who frequently experience treatment disruption because of cognitive and functional impairment, this may be the solution to a serious problem. People with TBI experience memory loss and suffer from a wide variety of functional limitations, such as headaches, sensitivity to light, ringing in the ear, nausea, blurred vision, trouble reading, balance problems, trouble with sleep, nightmares, depression, and mood swings.

As a result, their ability to manage their care can be impaired. By sending reminders and updates via cell phones, patients will be less likely to forget critical steps in their treatment and more likely to stay on track with their treatment.

Lighter TransportAV Exhibited

GlobalMedia Group LLC exhibited their new slimmer lighter TransportAV to over 3000 attendees at the 15th American Telemedicine Association International Meeting and Exposition in San Antonio Texas held this week. The new TransportAV provides telemedical ambulatory and emergency care enabling remote physician participation. Updates to the new system include a slimmer, more dynamic design, a 25 percent cut in weight, and increased battery power.

Mounted on a stretcher, TransportAV allows for medical consultations to go from the field directly to the clinic or hospital where a patient is being transported. With the TransportAV, the remote doctor has the ability to control all aspects of the consult. The system features a military-grand touch-screen PC, a 3G/4G Aircard, a controllable camera, echo canceling microphone, a ClearSteth™ Stethoscope, a TotalExam™ examination camera, and a Bluetooth wireless keyboard with headset for private conversations.

All of this is designed into an adjustable, compact unit that can be mounted on a stretcher complete with a built-in pneumatic lift to allow the unit to be high enough above to be operational. The unit is able to easily enter the transport vehicle while in a compact position. The unit can also detach from the stretcher and be mounted on a mobile cart at the scene or in the trauma center allowing the EMTs to answer their next call.

“The updates to the TransportAV system make it even more ergonomic for use in the field especially for fast-paced scenarios when life hangs in the balance,” said Joel E. Barthelemy, GlobalMedia’s Managing Director.

GlobalMedia’s telemedicine equipment has been especially helpful in transporting children to the emergency room at Cincinnati Children’s Hospital. Dr. Hamilton Schwartz a Board Certified Emergency Room Pediatric Practitioner at the hospital finds that since TransportAV mobile telemedicine has been used, the hospital’s critical care transport teams are able to provide top quality care from the moment of pick up until the patient is physically in the same room with the doctor.

“With mobile telemedicine, we can now interact with the ambulance crews to customize critical care for each individual patient from the minute the patient is transferred into their care. We can immediately diagnose and begin critical care treatment, and we can monitor the patient’s condition and reactions to treatment throughout the transport”, said Dr. Schwartz.

For more information, go to or call +1.480.922.0044.

Partnering in Rural Areas

Collaborative efforts can be a positive factor enabling rural communities to have access to high quality healthcare services as reported in April’s HRSA report. The report “Effective Collaboration between Critical Access Hospitals (CAH) and Federally Qualified Health Centers” (FQHC) was published by the Office of Rural Health Policy and pointed out many reasons as to why CAH’s and FQHC’s need to develop collaborative efforts in rural communities.

One major benefit would be to improve health information technology systems to avoid the need for duplicating equipment between ambulatory and inpatient care, produce savings on information technology staff, plus laboratory and radiology needs could be met by one hospital operated laboratory and radiology department. However, according to the report studies have shown that documented successful collaboration in rural communities appears to be the exception rather than the rule.

To meet the need for collaborative efforts to serve rural communities, several successful new collaborative programs involving health technologies were announced at the American Telemedicine Association International Meeting and Exhibition held in San Antonio this week.

Royal Philips Electronics is expanding access to critical care support in rural communities with their eICU program available from Philips VISICU. Several hospitals are partnering with eICU service providers to increase their patient’s access to critical care specialists in their local communities.

The hospitals and their partnering efforts include Grinnell Regional Medical Center in Grinnell Iowa collaborating with the Mercy Health Network in Des Moines, Providence Kodiak Island Medical Center in Kodiak Alaska working with Providence Alaska Medical Center in Alaska, and Union Hospital in Clinton Indiana working as partners with Advanced ICU Care in St. Louis.

Another partnership consisting of three academic centers working together to establish a pilot program enables the residents of rural Florida communities experiencing hypertension to use IDEAL LIFE’s wireless remote health monitoring system. This system requires no training or installation and transmits educational and motivational messages directly to the user so that they are able to effectively manage their high blood pressure. This program is operating under the direction of the Center for Research and Education on Aging and Technology Enhancement (CREATE) and was funded by NIH’s National Institute on Aging.

“IDEAL LIFE was selected for this program because it is the most flexible, affordable, and user friendly remote monitoring system available,” according to Sara Czaha, PH.D, Co-director of the University of Miami’s Center on Aging, one of the three academic centers participating in the CREATE Program.

Go to to download HRSA’s report. For more information on the collaborative effort at Philips go to and for information on the IDEAL LIFE project go to

P4P Demo Shows Savings

CMS is sharing savings with 166 Home Health Agencies (HHA) based on their performance during the first year of the Medicare Home Health Pay for Performance (HHP4P) demonstration.

The two year demonstration which began in 2008, and ended December 2009, showed the impact of financial incentives on the quality of care provided to home health patients in traditional fee-for-service Medicare and their overall Medicare costs. Savings are being shared with agencies that either maintained high levels of quality or made significant improvements in quality of care.

All Medicare-certified home health agencies in seven states representing four census regions were invited to participate in the demo. The Northeast region includes HHAs in Connecticut and Massachusetts, the South included HHAs in Alabama, Georgia, and Tennessee, and the Midwest and West regions included HHAs in Illinois and California.

HHAs that volunteered were randomly assigned to either an intervention or control group. Performance was measured using seven home health quality measures computed from the Outcome-Based Quality Improvement data set and listed on the Home Health Compare Web site.

Each measure evaluated the performance of the HHA’s for the quality and efficiency of care provided to traditional Medicare patients. Each HHA in the intervention group was compared only to other intervention agencies within the same state.

For each measure, HHAs ranked by performance in the top 20 percent in their state, as well as those demonstrating the greatest degree of quality improvement were eligible to share in Medicare savings generated in their region.

Medicare savings for the demo were determined by comparing total Medicare costs for beneficiaries receiving care from the intervention group’s HHAs with the costs for beneficiaries served by the control groups HHAs in the same region. These costs include Medicare payments for home healthcare, inpatient hospital care, nursing home, and rehabilitation facility care, outpatient care, physician care, durable medical equipment, and hospice care.

If no savings were generated in a region, no incentive payments were made in that region. Results for 2008 produced an aggregate Medicare savings of $15.5 million for three of the four regions. The Midwest region did not achieve any savings.

Sunday, May 16, 2010

CMS Issues Notice on CMI

CMS is seeking 8(a) and small businesses with the capabilities and expertise to design, plan, organize, and develop the Center for Medicare and Medicaid Innovation (CMI) within CMS. The Patient Protection and Affordable Care Act of 2010 provides for the establishment of the Center by January 1 2011.

CMI is being established to test innovative payment and service delivery models that will help reduce Medicare and Medicaid program expenditures while preserving quality of care. The plan is for CMI to be the research and development arm for CMS.

CMI will identify problem areas in healthcare delivery and then identify and test new models to improve program performance. Once the problem areas or new models are identified, CMI will search and/or elicit knowledge on how to gain a more thorough understanding of the new model and then provide the background information needed to develop new program initiatives. CMI will also be pursuing basic research objectives and designing new research demonstrations, in consultation with relevant federal agencies, clinical, and analytical experts.

Another role for CMI is to design implement and evaluate Medicare and Medicaid demonstrations and pilot programs that will be put in place to test the feasibility, cost effectiveness, and quality outcomes of new healthcare delivery models.

CMI will oversee the spending of funds through a large number of contractual and provider arrangements and will provide fiscal oversight to make certain that the tasks and projects are completed as contracted.

Another role for CMI is to promote research and demonstration transparency by disseminating findings from literature reviews, basic research, and program evaluations. This information will be used to inform law makers and interested parties on healthcare delivery issues, new innovative concepts, demonstrations, and pilot programs.

This published notice is not a solicitation for proposals, proposal abstract, or quotation, but only issued by CMS to obtain information on the availability and capability of qualified sources. The notice published on May 14th requires all responses to be in by June 1, 2010.

For more information on solicitation (HHS-CMS-DRCG-SS-10-002), go to or contact Joseph M. Feibel, Contract Specialist at or call (410) 786-8261.

eHealth Can Help Survivors

The Feinberg School of Medicine at Northwestern University with NIH funding is developing Clinical Trial (NCT01114802) to study how multiple telecommunications technologies can be used to improve cancer survivors’ access to mental healthcare. Nearly 65 percent of individuals diagnosed with cancer will survive for at least 5 years, which means we have almost 10.5 million cancer survivors in the U.S.

However, the transition time for cancer patients from active treatment to survivorship has been identified as a time of high risk for depression and anxiety. Cancer survivors experience higher rates of anxiety and depression than those without a cancer history. Research has identified fear of recurrence, perceived loss of support, and social pressure to resume a normal life among other phenomena as sources for this emotional distress.

Only 20 percent of all patients referred for psychotherapy enter treatment and of those who initiate treatment, nearly half drop out before completion. This suggests that there are significant barriers to receiving care.

The internet promises to provide inexpensive access to treatment 24/7 but so far the potential for internet delivered services has not been realized. Studies examining treatments that simply provide access to an internet site commonly result in a very high dropout after the first site visit and very offer little or no improvement in targeting symptoms.

In general, e-mail support improves adherence and telephone support can improve adherence even more. Another type of support that has only begun to be investigated is the use of social networks to help maintain adherence.

The study called “Project Onward” is currently recruiting participants for the estimated enrollment of 72 and is expected to be completed by June 2011. For more information, go to or email Jennifer Duffecy, PhD, at or David Mohr, PhD, at

Moving to the Cloud

The Recovery Accountability and Transparency Board created by ARRA announced that is moving to the cloud. Cloud Computing is a new model for delivering computing resources such as networks, servers, storage, or software applications. Simply, Cloud Computing is a way for users to access computing power from a pool of shared resources. is the first government-wide system to move to the cloud. The move is part of the Administration’s overall effort to cut waste and fix or end government programs that don’t work. By migrating to the public cloud, the Recovery board will have the ability to keep the site up as millions of Americans help report potential fraud, waste, and abuse. The Board expects to save about $750,000 during its current budget cycle and develop significantly more savings in the long term.

In April, HHS leveraged cloud computing to support the implementation of EHR systems. To support the effort, HHS is working with The use of cloud computing will support HHS’s Regional Extension Centers to help doctors and rural hospitals in the selection and implementation of EHRs.

Wisconsin Governor Signs Bill

Wisconsin Governor Jim Doyle recently signed electronic medical record legislation. Assembly Bill 779, the “WIRED for Health Act” will strengthen the ability of Wisconsin healthcare providers to securely share electronic patient data in order to avoid duplicative tests, improve health outcomes, and decrease costs.

Funding from ARRA will be used to plan and develop the infrastructure for exchanging electronic medical records, as well as incentive payments for healthcare providers to start using electronic medical records.

The State of Wisconsin is receiving $9.4 million for the planning and development of a statewide network. The legislation signed by the Governor paves the way for hospitals to receive between $500 million to $800 million in incentive payments to help them establish and use electronic medical record systems. The “WIRED for Health Act” creates a framework for a state-level, private-public structure to govern and coordinate the implementation of the statewide network.

The Governor said that the exchange will help support the creation of new high-tech jobs in the state. As he explained, Wisconsin is home to some of the top medical record technology companies in the country, from Epic Systems to GE Healthcare to Marshfield Clinic. These companies provide software to hospitals and clinics across the nation.

Wednesday, May 12, 2010

Mobile Health Issues Discussed

A Capitol Hill roundtable discussion on “Policy, Technology, and Research Developments in Mobile Health” held on May 5th as part of the Congressional Seminar series was hosted by Qualcomm and the American Telemedicine Association.

Neal Neuberger, Executive Director of the Institute for e-Health Policy managing the Congressional briefing series, said, “Over 140 briefings and demonstrations have been held on Capitol Hill since 1993 with Co-Chairs in both the Senate and House involved in the briefing seminars. Right now the momentum to use technology is rapidly moving ahead in so many new directions, and as a result, so many new thoughts, ideas, and challenges are open for discussion.”

The moderator Dale Alverson, M.D. Medical Director, Center for Telehealth, University of New Mexico Health Sciences and President of the American Telemedicine Association, assembled experts from industry, government, private groups, and George Washington university to discuss the challenges and accomplishments in the field of health technology and particularly to discuss the current status of mobile health use.

Senator Tom Udall (D-NM), stopped by the discussion to relate how New Mexico a state with tremendous rural areas along with medically underserved areas is working to get adequate care to these specific regions.

Both Dr. Alverson and the Senator mentioned the importance of passing the “Rural Technology Telemedicine Enhancing Community Health Act of 2009”. Specifically, the legislation would establish telehealth pilot programs to expand access to stroke telehealth services under Medicare, improve access to store and forward telehealth services in the IHS and federally qualified health centers, and reimburse IHS facilities as originating sites.

Senator Ron Wyden (D-OR), also speaking to the group, emphasized the need to use telehealth technologies to help providers and patients have more options for care. By using e-care, it is possible for everyone in the U.S. to have a doctor, but to achieve this goal, the reimbursement iceberg has to move forward so that there will be more doctors and more value from the healthcare dollar.

He wants to see a rational strategy where everyone from the agencies involved in the issues could have productive discussions and work together. All of the agencies and other interested parties would then be able to come to the table and develop ways to help deliver more effective healthcare for the 21st century.

As Dr. Mohit Kaushal, FCC Healthcare Director, stated, “Mobile health is a new frontier to enable patients to receive care anywhere/ anytime, but it will require all concerned to proactively manage their healthcare in order to achieve better quality and to improve access.

“Mobile Health using cell phones with appropriate apps can really reach the population”, said Kent Dicks, President and CEO, MedApps Mobile Health Monitoring. “We need to align off-the-shelf devices to create a system that patients can use to enable people to stay in the home.” This is possible today with the MedApps Solution since the technology is completely mobile, not required to be tethered to a point of care location, and can be integrated with off-the-shelf medical monitors.

Robert Jarrin, Esq. Director, Government Affairs, Qualcomm, reported the good news that the healthcare industry is showing rapid growth among the largest fortune 500 companies. This is an important time for the expansion of health technologies and especially mobile health technologies, but we have to put the right policies in place to help enable technology adoption.

A specific area of interest to Alice Borelli, Government Relations Director, Intel Corporation & Continua Health Alliance is the aging market and the need for new mobile technologies to help deliver care. She not only wants to see new ways that mobile health can be used to deliver healthcare but also to deliver efficient healthcare globally. She is enthusiastic about the physician and nurse team concept used with technologies that will allow the aging population to remain independent at home.

Other panelists with innovative ideas included Lolita D. Forbes, Esq Counsel, Verizon Wireless, Audie Atienza, PhD, Scientific Advisor for Technology Partnerships at NIH, Ellen Blackler, Executive Director, Public Policy, AT&T, Neal Sikka, M.D., Director, Innovative Practice Section, Medical Director, George Washington University Lifesavers Program, Jane Sarasohn-Kahn, THINK-Health, and Victoria Obenshain, Vice President, Wireless Strategic Pansonic.

These panelists voiced their thoughts on actions needed to deliver effective healthcare:

• Bring the exam room to the patient via telehealth technologies and through such programs as the CVS Minute Clinics program
• Focus on community health especially in rural and underserved areas
• Keep looking for ways on how to break down the barriers to adopting EMRs
• Keep advancing the development of smart phones and incorporate them with any new innovations on the horizon
• Focus on an emerging regulatory landscape but at the same time, don’t discourage innovation
• Keep working to achieve interoperability
• Don’t reinvent systems but make sure that the systems that are available are user friendly and really work
• Develop more emergency medical centers in other countries so that people needing medical help will have access to doctors in the U.S.
• Follow through and keep working on reinventing the payment system in the U.S.
• Follow up with a national discussion on mobile health

For more information on future meetings, go to

NIH Issues RFI

Poor adherence to prescription medications and treatments has been labeled a worldwide problem. For example, up to 20 percent of patients fail to fill new prescriptions and approximately 50 percent of people with chronic health conditions discontinue their medications within 6 months. Adherence to behavioral and bio-behavioral treatments remains poor.

Access to medical care is vital but it can lead to better health outcomes only if it is accompanied by patient adherence to recommendations by healthcare professionals. Despite the need for improving adherence at both the individual and population levels, research on interventions related to adherence remains underdeveloped.

NIH released the Request for Information (RFI) to specifically identify the priorities needed for adherence research. Ideas are welcome for both short-term and long-term activities on the topic. Members of the scientific community, scientific organization, healthcare professionals, patient advocates and the public are invited to respond to the RFI. NIH seeks to determine the critical gaps in the science of adherence and then come up with the potential solution that can meet the challenge.

RFI responses are due May 25, 2010 via email to Wendy Nilsen, PhD at or call (301) 496-0979. The RFI identifier is NOT-OD-10-078.

To download the RFI, go to

Bill to Help Veterans

Veterans and their families have repeatedly expressed frustration with the cumbersome process they have to go through in order to transfer their military records and benefit information from military to civilian life. Congresswoman Niki Tsongas on May 6th introduced the “Improving Electronic Transition Services Act” (iVETS Act) in the House.

The Department of Veterans Affairs provides services and benefits to almost eight million veterans. The Act would encourage DOD and the Department of Veterans Affairs to create an internet-based portal so that veterans will be able to access their records and benefit information electronically.

The bill would model the web-based portal for veterans after the Defense Knowledge Online systems which all active duty military members use to access their Official Military Personnel File. The problem is that military personnel lose access to the system once they become veterans. With this bill, the service member retiring, being separated or discharged from the military will be able to transfer the Knowledge Online portal account of the service member to the veteran’s portal.

Efforts have been made to try to improve veterans’ access to their military records. The legislation would enable DOD and the VA to assess the feasibility of providing electronic access to information such as healthcare, service information, and benefits records through a platform that is already familiar to new veterans.

The legislation goes beyond current efforts by not only providing electronic access to these records, but also creates forums so that the veterans can talk to other veterans and care provides, a “white paper” directory for veterans to help find each other, a single source communication channel so that the VA will be able to inform veterans about new programs or benefits and includes a single sign-on system for email so it is easier for the VA and veterans to communicate.

The bill (H.R. 5225) was referred to the House Committee on Armed Services and to the Committee on Veterans Affairs.

Harvard & Portugal's Effort

The Harvard Medical School’s “Portugal Program” awards grants to help deliver and assess the impact that the availability of health information has on the people of Portugal. The Harvard Medical School is working with the Portuguese Ministry of Science and Technology to produce educational material for the general public concerning health, medicine, and biomedical sciences, as well as produce information for students and professionals in the field.

For example, one of the grants will help Portugal deal with chronic diseases of the airway. There is a need to provide health information to patients, the general public, physicians, and health students on this topic in order to share decision-making and self management for these chronic diseases.

Actions have been taken to further address the problem. Internationally, The World Health Organization recognizing the impact that chronic respiratory diseases have on populations, created the “Global Alliance against Chronic Respiratory Diseases”. Also, Portugal very concerned about this issue, has instituted a “National Program for Asthma Control” and also a program for the “Prevention and Control of Chronic Obstructive Pulmonary Diseases”.

Grant funding supports the Portugal research team that is working on chronic respiratory diseases. The researchers have backgrounds in allergy and asthma, pulmonary medicine, psychiatry, and primary care medicine, and expertise in patient education, behavioral change, ehealth, production of online health contents, patient-centered care, and training of health professionals.

This specific project led by Joao Almeida Lopes Fonseca, will develop the content and tools needed to develop a web platform that will cover several aspects of the chronic disease. The objective is to create different versions of the web platform for physicians, students, patients, the public, and for audiences with limited literacy.

The research team is working to develop the tools needed to promote shared medical decisions and to support disease assessments and monitoring. Standard web 2.0 technologies will be applied to enable users to be both consumers and producers of health information.

Grants will also be awarded to help in other areas of concern in Portugal. Research will be undertaken to develop effective ways to deliver health information on hereditary breast and colorectal cancer, address childhood obesity, evaluate the state of public knowledge on health and health information in Portugal, and study information that is available on how the population perceives quality and accessibility to health information sources in the country.

Events Driving Health IT

As a result of ARRA and the passage of healthcare reform legislation that will help deal with emerging reimbursement models and shifting consumer health trends, events are driving radical changes in the nation’s healthcare system and bringing about the convergence of telehealth, electronic health records, and health information exchanges.

This topic is the focus of the white paper “The Crossroads of Telehealth, Electronic Health Records & Health Information Exchange: Planning for Rural Communities” just published by the Northwest Regional Telehealth Resource Center (NRTRC). NRTC is one of five TRCs in the nation and leverages the collective expertise of 33 telehealth networks across Alaska, Hawaii, Idaho, Montana, Oregon, Utah, Washington, Wyoming, and United States affiliated Pacific Islands to share resources to assist in developing new telehealth programs.

“Accelerating adoption and utilization of telehealth technologies, telemedicine in particular will be critical to a successful stakeholder response to the disruptive changes now underway in healthcare”, said NRTC Executive Director, Christina B Thielst. “By leveraging telehealth networks and their existing infrastructures, Regional Extension Centers, HIEs, and other data-sharing initiatives will be better positioned to fulfill their commitments to the healthcare delivery system of the future—a system in which even the most rural and remote populations have timely access to care and their health records.”

The white paper explores emerging trends and recent disruptors impacting the healthcare delivery system and examines the opportunities they present for the advancement of telecommunications-based health solutions and the broadband infrastructure available through telehealth networks. The paper takes an in-depth look at the various uses of telehealth and the most common delivery models of telemedicine, as well as the role of the telehealth network and Telehealth Resource Centers (TRC) in the communities.

Finally, the white paper highlights the evolution of the REACH Montana Telehealth Network using teleradiology at just three remote sites now provides services to a consortium of healthcare providers at 18 sites linked by high-bandwidth telecommunications in the north central region of Montana. REACH, considers the HIE to be a primary function, and is currently working to leverage its existing T1 infrastructure to create “railroad tracks” to carry medical data and information within the region and beyond.

“This white paper is an excellent analysis of the intersection of telehealth and health IT and the opportunities and challenges electronic technology will bring to rural America”, said Terry J. Hill, Executive Director for the Rural Health Resource Center, the Duluth, Minnesota-based national knowledge center for rural hospitals.”

For more information, contact Christina Thielst by email at or call (805) 845-2450, or go to to download the white paper.

IHIE Receives $16 Million

The Indiana Health Information Exchange received $16 million of the $220 million awarded by HHS on May 4th through the Beacon Community Program to help communities at the cutting edge of electronic health record adoption attain a new level of healthcare quality and efficiency. The IHIE was one of 15 groups from over 130 applications throughout the country to receive an award.

The funding will enable the expansion of the country’s largest HIE to new community providers. This will help improve cholesterol and blood sugar control for diabetic patients and reduce preventable re-admissions by using telemonitoring for high risk chronic disease patients after they are discharged from the hospital. The plan is to help treat chronic diseases across 41 counties comprising 45 percent of the Indiana population base.

According to J. Marc Overhage, M.D. PhD, and President and CEO of the IHIE, said “We already are working with over 14,000 physicians and over 70 healthcare organizations, including 60 hospitals, and stakeholders to accelerate and demonstrate the feasibility and value of HIEs.”

The Indiana Beacon Community’s 36 month program will be conducted with three main activities:

• Currently, the exchange securely captures a rich set of clinical data, but patient information from physician practices has been difficult to capture. This information includes vital signs and point-of-care testing such as cholesterol levels that are “siloed” in physician offices. This funding agreement will enable this data to be included.

• IHIE will be able to broaden its Quality Health First Program by adding new disease and wellness measures and functionality while broadening provider participation to address efficiency, quality, and public health

• IHIE will work with providers and Indian’s federally funded HIT Regional Extension Centers and focus on rural physicians. Help will be provided to devise and implement electronic health record adoption and meaningful use in at least 60 percent of the primary care providers in the Indiana Beacon Community area

The goal in the state is to reduce preventable hospital admission and emergency department visits related to ambulatory care by 3 percent, reduce the number of ambulatory care re-admissions by 10 percent, reduce the number of redundant radiologic studies by 10 percent, increase the number of patients screened for colorectal and cervical cancer by 5 percent, increase the data for adult immunizations by 5 percent, improve the number of patients who are diabetic and have the condition under control by 10 percent, and improve the number of diabetic patients that have their cholesterol under control by 10 percent.

IHIE plans to work with other community partners, like Purdue’s Indiana Healthcare Information Technology Extension Center $12 million in ARRA funds to help healthcare providers adopt and use health IT.

In addition, the leaders of the IHIE think that the existing $10.3 million grant made to the state of Indiana from ARRA’s State Health Information Exchange Cooperative Agreement Program can be leveraged in new ways to improve health outcomes in the state and reduce costs across the continuum of healthcare.

Sunday, May 9, 2010

Telehealth Grants Available

HRSA’s Office of Rural Health Policy and the Office for the Advancement of Telehealth (OAT) announced that funding for the Telehealth Network Grant Program (TNGP) and the Telehealth Resource Center Grant Program (TRCGP) are now available. The TNGP will provide $2,000,000 to be available annually to fund up to eight grantees for fiscal years 2010-2012.

The primary objective of the TNGP is to demonstrate how telehealth programs and networks can improve access to quality healthcare services in underserved rural and urban communities. Applicants can apply for the TNGP in one of two areas. The grants for the Telehealth Networks involves the use of electronic information and telecommunications technologies to support and promote long distance clinical healthcare, patient and professional health related education, public health, and health administration.

In addition, the Telehomecare Network grants will be awarded to evaluate the cost and effectiveness of remote vital sign monitoring of individual patients to deliver healthcare services to the home by a healthcare provider using telecommunications technologies.

For fiscal year 2010, funding will be available for telehealth projects that comprise mixed networks to provide services to both urban underserved areas, as well as rural areas. These projects may include some urban as well as rural Telehealth Network Partner spoke sites that receive telehealth services.

The TNGP seeks to fund nonprofit organizations with a demonstrable successful track record in implementing telehealth, and with knowledge on how to expand services to new communities and/or populations. OAT is looking to fund projects that will effectively integrate administrative and clinical information systems with the proposed telehealth system and integrate the system into each provider’s normal healthcare practice. The funds are to be used to fund network expansion and/or increase services provided by existing successful telehealth networks.

The deadline for TNGP (HRSA-10-213) applications is June 14, 2010. The program contact for TNGP is Carlos Mena with OAT and he can be reached at (301) 443-3198 or by email at

The Telehealth Resource Center Grant Program (TRCGP) announcement also released on May 5th has funding for $975,000 to include three awards. The purpose of TRCGP is to establish and develop Telehealth Resource Centers (TRC). These centers are to provide technical assistance to healthcare organization, healthcare networks, and healthcare providers to help implement cost effective telehealth programs to serve rural and medically underserved areas and populations.

This cycle of grant funding will support up to nine centers to serve as focal points to advance the effective use of telehealth technologies in their respective communities and regions for clinical care. The funds will support six regional TRCs, two Telehomecare TRCs, and one National Telehealth Resource Center.

The deadline for TRCGP applications is June 15th, 2010. The program contact for TRCGP is Monica M. Cowan, with OAT, and she can be reached at (301) 443-0076 or by email at

For more details on both announcements, go to

Reinventing Primary Care

Primary Care is in crisis mode and as a result bold changes are needed to help the U.S. deliver and pay for primary care, according to the authors published in the May issue of “Health Affairs”. The thematic May issue discusses the primary care crisis, innovative models needed for reform, expanding the role of other health professions, and information on promising healthcare provider practices.

“The horribly broken primary care system that we now have is plagued by underinvestment and misaligned incentives,” according to Health Affairs editor-in-chief Susan Dentzer. She continued to say “primary care is stuck in a bygone era but health reform offers the opportunity to reinvent primary care and rapidly move it into the 21st century.”

To bring these ideas together on reinventing primary care, a briefing was held on May 4th at the National Press Club hosted by Health Affairs, to discuss the variety of thoughts and ideas presented by a number of key experts.

Kathleen Sebelius, Secretary HHS, said “This is a historical moment in the transformation of the healthcare system as we are remaking and rebuilding the American healthcare system. Stronger steps are needed to support the need for primary care.

The Secretary discussed the strategic moves needed to address the problem. These include providing for incentives and coming up with new initiatives to increase and attract the workforce to the primary care field, find ways to expand the community health center program, develop the framework needed to address reimbursement issues, examine ways for collaborative care to work such as in medical homes, invest in health IT, and upgrade prevention and wellness programs.

To discuss how medical homes can play a part in supporting primary care, Paul Grundy, Director of Healthcare Technology and Strategic Initiatives, IBM Global Wellbeing Services and Health Benefits at IBM, pointed out that the patient centered medical home can really drive change.

Grundy has visited a few communities with ongoing medical homes and sees the profound impact that it can have on the community. For example, since using the medical home concept in Shelby County area in Iowa, there has been a 47 percent reduction in hospitalizations, 32 percent reduction in emergency room use, 43 percent reduction in cost overall, and a 20 percent reduction in costs for CMS. Also, in Calhoun County Area in Michigan there has been a 49.7 percent reduction in hospitalizations, reductions in costs, and the patients and the physicians have expressed improved satisfaction with the program.

He continued to say “In order for the medical home model to take effect, financial incentives have to change, quality and safety need to be the hallmark of the medical home, and resources have to be made available with support to drive the transformation of care.”

In addition, “Coordination is key and has to be integrated across all elements of the complex healthcare community. Coordination is enabled by registries, establishing new communication paths between patients, personal physicians, and the staff, plus information technology and health information exchanges must be in place.”

Troy Brennan, Executive Vice President and Chief Medical Officer of CVS Caremark Corporation said, “Another new concept that helps to drive primary care is the Minute Clinic Model which enables people to have on-demand access to basic primary care and at their convenience. Minute Clinics provides services and increased access, but at the same time, helps patients re-engage with traditional care and can be an asset to further support the medical home.

A paper appeared in the May issue of Health Affairs authored by Daniel Fields, a law student at Harvard, Elizabeth Leshen a biological engineering student at MIT, and Kavita Patel, a former Director of Policy for the Office of Public Engagement at the White House that discusses driving quality and cost savings through the adoption of medical homes.

The paper discusses seven medical home model pilots and summarizes the outcomes. The pilots included in the study included the Colorado Medical Homes for Children, Community Care of North Carolina, Geisinger Health System, Group Health Cooperative in the Pacific Northwest, Intermountain Health Care, North Dakota, and Vermont’s Blueprint for Health. The pilots showed significant improvements, hospitalization reductions, emergency department visits reduced, and per-patient savings.

According to Dr. Patel, speaking at the briefing, “There is much work to do. It is important to determine if all the features in the model home model are essential and which features can vary. It is important to master the complexity of scalable implementation, be able to aggregate program data to learn from mistakes and successes, consider systematic reforms, and determine exactly what is needed to develop the primary care pipeline.”

For more information, go to

Disability Center Established

The HHS Office on Disability awarded over $6 million under ARRA to establish a Center of Excellence in Research on Disability Services, Care Coordination, and Integration. The contract was awarded to Mathematica Policy Research Inc. for a two year period and will help build the infrastructure necessary to support and conduct research on the effectiveness and comparative effectiveness of systems caring for people with disabilities.

“The data collected will enable the Office on Disability and CMS to examine the effectiveness of different services being provided, and in turn, will improve care for people with disabilities,” said HHS Secretary Kathleen Sebelius.

The Center will identify data sources, evaluate the usability of data, conduct research, and disseminate scientifically and clinically relevant information to help patients, providers, policy makers, consumers, caregivers, and family members make decisions on healthcare.

The key component of this effort is to collaborate with CMS and their Chronic Conditions Warehouse (CCW). “By linking existing Medicaid data sources and other datasets relevant to disability to the CCW, the Center will be able to increase the use of CCW information to do research on people with disabilities and/or chronic conditions,” said Rosaly Correa-de-Araujo, M.D. PhD, Deputy Director of the Office on Disability and the technical and scientific lead for the initiative.

In addition, Medicaid data with information on state plans and waiver services to be supplied by specific states will be assessed and used to identify and propose ways to achieve greater consistency on how services are used and defined.

Tools to Correct Brain Activity

Many neurological and psychiatric disorders are associated with abnormal activity in specific brain circuits. So far, approaches to correct abnormalities in brain circuits have relied on the use of electrical or magnetic stimulation which only relieves the symptoms partially or for a short period of time.

However, researchers in one of NIH Common Fund’s New Innovator program, has engineered a powerful new class of tools to shut down nerve activity for short periods of time using different colors of light. The development of these new technologies would allow the precise control of neural circuits which could lead to new treatments for disorders associated with abnormal brain activity, including chronic pain, epilepsy, brain injury, and Parkinson’s disease.

These techniques are based on genes recovered from bacteria and fungi that encode light activated proteins normally used for energy production in these organisms. These nerve cells expressing proteins are exposed to the appropriate wavelength of light and then are prevented from transmitting electrical signals. When used in combination with genetic techniques to target these proteins to specific brain regions or cell subsets, these tools can lead to a much deeper understanding of the brain’s role in health and disease.

The NIH Common Fund Program supports seven research programs plus research across NIH institutes and centers in order to accomplish work that no single institute or center could do alone. The research programs will distribute $17.8 million for Fiscal year 2010 and additional funds in future years.

For more information, go to

Study on Bar-Code eMAR

Using bar-code technology with an electronic medication administration record (eMAR) substantially reduces transcription and medication administration errors as well as potential drug-related adverse events. A new study funded by AHRQ was published in the May 6th issue of the “New England Journal of Medicine.”

Bar-code eMAR is a combination of technologies that ensures that the correct medication is administered in the correct dose at the correct time to the correct patient. When nurses use this combination of technologies, medication orders then appear electronically in a patient’s chart after the pharmacist approves.

Alerts are sent to nurses electronically if a patient’s medication is overdue. Before administering the medication, nurses are required to scan the bar codes on the patient’s wristband and then scan the medication. If the two don’t match the approved medication order, or it is not time for the patient’s next dose, a warning is issued.

Researchers on the project at Brigham and Women’s Hospital in Boston compared 6,723 medication administrations on hospital units before bar-code eMAR was introduced. The hospital then did 7,318 medication administrations after the bar-code eMAR was introduced.

The researchers were able to document a 41 percent reduction in non-timing administration errors and a 51 percent reduction in potential drug-related adverse events associated with this type of error. Errors in the timing of medication administration fell by 27 percent. No transcription errors or potential drug-related adverse events related to this type of error occurred.

The findings have important implications because bar-code eMAR technology is being considered as a 2013 criterion for “meaningful use” of health information technology under ARRA.

Wednesday, May 5, 2010

New Competition Announced

A new $12 million innovation competition called “i6 Challenge” was just announced by the Department of Commerce’s Office of Innovation and Entrepreneurship and their Economic Development Administration (EDA) in partnership with NIH and the National Science Foundation (NSF). EDA will award up to $1 million to six individual teams in the U.S.

Teams will need to come up with innovative ideas that will drive technology commercialization and entrepreneurship. NIH and NSF will award up to $6 million in additional funding to NIH or NSF Small Business Innovation Research grantees associated with the winning teams.

“The i6 Challenge will help new biomedical technologies succeed and foster their entry into the marketplace,” said NIH Director Francis S. Collin, M.D., Ph.D. “NIH supports small business through both the Small Business Innovation Research and Small Business Technology Transfer programs.

“The i6 Challenge is exactly the type of interagency collaboration that can help advance President Obama’s innovation agenda by supporting and rewarding innovative approaches that will turn ideas into new products and businesses to help America compete in the global economy,” said Aneesh Chopra, U.S. Chief Technology Officer and Associate Director for Technology in the White House Office of Science and Technology Policy.

Entrepreneurs, investors, universities, foundations, and nonprofits are encouraged to participate in the i6Challenge. The deadline for applications is July 15, 2010. Letters of intent to participate are encouraged and should be sent to no later than June 15th. Go to to learn more about the competition and for information on the conference call to take place at 2 pm EDT on May 17th. For other details, go to the May 4th issue of the Federal Register.

For further contacts, email Calvin Jackso at NIH at, Joshua Chamot at NSF at, or email John Atwood at EDA at

Tracking Radiation Doses

In a report published by the National Council on Radiation Protection and Measurement, the U.S population’s total exposure to ionizing radiation has nearly doubled over the past two decades. These figures are expected to continue to grow. This rise is largely attributable to increased exposure from CT systems, nuclear medicine, and interventional fluoroscopy.

In 2010, FDA’s Center for Devices and Radiological Health published a white paper “Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging” with information on the steps needed to promote the safe use of medical imaging devices, support informed clinical decision making, and increase patient awareness concerning this issue so that imaging procedures are not ordered without sufficient justification.

There are a number of issues that need to be addressed to support informed clinical decision making, since many ordering physicians do not always have access to patients’ medical imaging or radiation dose history.

Problems that arise due to insufficient information:

• Physicians may unnecessarily order imaging procedures that have already been conducted
• Standardized dose structured reporting, while technically available in new CT systems and Fluoroscopes used in interventional procedures, is still in its infancy
• Dose reports are not always contained in either the image files or in the patient’s paper or electronic medical records
• Ordering physicians may lack or be unaware of recommended criteria to guide their decisions about whether or not a particular imaging procedure is medically efficacious

Go to to download the report.

DOD Working with Academia

The Surgeon’s Office within the U.S. Joint Forces Command recently sponsored a working group meeting to bring military healthcare providers together with representatives from DOD’s partner academic institutions to discuss cutting-edge medical techniques. The working group in their study of restorative medicine is examining what DOD can learn from their partners to further develop medical technology to care for wounded warriors, according to Navy Rear Admiral (Dr.) Michael H. Mittelman, Command Surgeon for the Joint Forces Command.

The academic institutions are members of a consortium working with the Armed Forces Institute of Regenerative Medicine, a partnership set up in 2008 between the Defense Department and academic institutions to fund advanced research to rebuild human muscle and tissue.

Impetus for the working group came when Marine Corps General James N. Mattis, Commander of Joint Forces Command, visited the University of Pittsburgh’s McGowan Institute, one of the Armed Forces Institute of Regenerative Medicine partners. Admiral Mittelman said, “While Mattis was there, researchers demonstrated some important emerging care techniques.”

“There appears to be a lack of awareness in the DOD medical treatment facilities about new medical initiatives,” according to Admiral Mittelman. “We are attempting to establish relationships so that the services can educate the academic institutions on the ground rules and the academic institutions can then educate us on what they can provide to our wounded warriors and their families.”

The working group meeting enabled DOD representatives to meet with researchers from Rutgers University, University of Pittsburgh’s McGowan Institute, Wake Forest University, Mayo Clinic, Case Western Reserve University’s Cleveland Clinic, John Hopkins University, and Dartmouth College.

Commercialization Clinic Launched

The University of California Davis Health System received a two year $600,000 National Science Foundation “Partnerships for Innovation” grant to develop a Medical Technology Commercialization Clinic. The project will train students on how to translate innovative technologies developed in university laboratories into useful marketable products to advance patients health.

The grant will fund a multidisciplinary collaborative partnership of scientists, educators, and business leaders to stimulate economic development. The goal is to build a robust infrastructure to develop innovative medical technology as well as build up a diverse workforce.

The Clinic will use live and virtual forums to give graduate and postdoctoral students in biomedical sciences, engineering, and business, hands-on-training to convert high impact research into new treatments and products. This model will help to overcome the existing challenges to university technology transfer, which often focuses on discovering new knowledge and therapeutic applications rather than on business strategies. The students will gain entrepreneurship training and strategies to use to commercialize research projects.

A product now in development is a new endoscope that combines microscopic imaging and ultraviolet auto fluorescence for non-invasive real-time detection of cells progressing toward cancer in the esophagus.

The partnership will work with the UC Davis Center for Biophotonics Science and Technology plus other departments, centers and programs at UC Davis, and with Sacramento State University, a regional resource for medical technology entrepreneurs interested in researching, developing and testing new concepts and medical device prototypes.

Other partners include Fisk University, Los Rios Community College District, Pride Industries, T2 Venture Capital, Wavepoint Ventures, and the cities of Sacramento and West Sacramento.

HHS Awards Task to NORC

The National Opinion Research Center (NORC) at the University of Chicago, a social science research organization was awarded a contract for $561,632 on April 26, 2010. NORC will collect, analyze, and then submit the data to HHS so that the agency will be able to draft a Report to Congress. The report is mandated by HITECH and must be submitted by June 2010.

The legislation requires the Secretary of HHS to submit a report on the findings and conclusions to determine if payments are available to healthcare providers who are not receiving incentives or only minimal incentives under HITECH. After the information is received from NORC, the Office of the Assistant Secretary for Planning and Evaluation will draft a report to be reviewed at HHS and then the report will be submitted to Congress.

The report will include:

• The adoption rates for certified EHR technology by providers
• The clinical utility of the technology by healthcare providers
• Whether healthcare providers really benefit from the use of the technology
• Information on healthcare providers that might otherwise receive an incentive payment or other funding under HITECH, Medicare, Medicaid, or from other sources
• The potential costs and benefits for making payment incentives and any other funding available to healthcare providers

For more information, email Clint D. Druk at

Sunday, May 2, 2010

States Taking Steps

Colorado Governor Bill Ritter issued an Executive Order that creates the position of Director of Health Reform Implementation and a new Interagency Health Reform Implementation Board. Lorez Meinhold was named Director of National Reform Implementation and Joan Henneberry, Executive Director of the Colorado Department of Health Care Policy and Financing, will Chair the Board.

Henneberry’s responsibility will be to coordinate activities between agencies needed to implement healthcare reform in Colorado. The board will have a number of other tasks that will include making information transparent by developing an updated web site with up-to-date information. Another task will be to pursue federal and state grants to help the state implement all aspects of health reform.

The Board has the authority to establish advisory groups, task forces, or other structures from within its membership or outside the membership as needed. These advisory groups may include representatives of non-governmental entities including doctors, nurses, economists, actuaries, healthcare professionals, patient advocates, public health, consumer advocates and representatives from health plans, insurers, and businesses

In addition, the Governor signed into law HB 1138 to help healthcare professionals in the state. The Bill will improve the existing public and private loan repayment programs for healthcare professionals practicing in rural and underserved communities to help the primary care workforce grow. The governor also signed Senate Bill 58 to improve the state’s existing nurse loan forgiveness program to extend current eligibility requirements.

The State of Illinois is in the process of developing a state roadmap to detail and analyze anticipated federal healthcare reform legislation and the subsequent federal regulation governing implementation. The Illinois Chamber’s Healthcare Council secured $20,000 secured through the Chamber’s Foundation to fund the roadmap that will highlight state specific options and challenges in dealing with health reform and provide a complete education resource for employers, consumers insurers, and providers.

The state of Illinois also passed HB 6441 establishing state authority to operate the Illinois Health Information Exchange. Illinois received $19 million in federal funds to develop the statewide health information exchange.

With part of the funding, the Governor created a new State Office of Health Information Technology. The Office will promote health IT, increase adoption, assure privacy and security of electronic health information, and direct the state’s planning for a statewide exchange.

The Governor of Ohio Ted Strickland announced that seven regional sites across the state will receive a total of $26.8 million in ARRA funding to help implement the state’s health information technology initiative.

The regional partner sites include the Akron Regional Hospital Association, Case Western Reserve University, Central Ohio Health Information Exchange, Greater Dayton Area Health Information Network, Hospital Council of Northwest Ohio, Northeast Ohio HealthForce, and Ohio University.

The funding resources being used are a portion of Ohio’s total $43 million in stimulus funding awarded to the Ohio Health Information Partnership (OHIP), the nonprofit entity designated by Strickland to lead the implementation of HIT in Ohio. OHIP and the seven regional partners will help more than 6,000 primary care providers install EHR systems and connect to a statewide health information exchange.

In addition, Cincinnati-based Healthbridge, an established health information exchange in the Greater Cincinnati area, received a federal grant to support eleven counties in the Cincinnati region. OHIP is working closely with Healthbridge, to support Ohio physicians and help them transition to EHRs.

The Governor of Maine John E. Baldacci has put into action the process needed in the state to implement the healthcare reform law. The Governor’s Office of Health Policy and Finance, state health officials, the Advisory Council on Health Systems Development, and other offices along with a steering committee are beginning to discuss how to meet all of the requirements under the federal law.

The Governor’s Office and its Health Reform Implementation Steering Committee will be working with the Joint Select Committee on Implementation created by the Maine legislature, stakeholders, and local, federal, and tribal governments.

In Kentucky, Governor Steve Beshear announced that the Kentucky Health Information Exchange has been launched with six pilot hospitals and one clinic participating in the exchange. The cabinet will also work to bring other hospitals and providers on board in the months and years ahead. The project was funded by CMS through its $4.9 million Medicaid Transformation Grant program in 2007.