Wednesday, July 28, 2010

VISN 20 Update

According to the Veterans Administration's Northwest News, VISN 20 has a number of ongoing projects. VISN 20 is expanding telehealth, examining the patient centered medical home concept, expanding outreach clinics, expanding rural healthcare services, improving behavioral health efforts, and partnering with providers in local communities where it is not feasible to establish a VA staffed clinic.

VISN 20 includes the states of Alaska, Washington, Oregon, most of the state of Idaho, and one county in Montana and in California. The 135 counties cover 23 percent of the U.S. land mass while 17 percent are classified as health professional shortage areas and 67 percent of these counties had a 2001 per capita income below $25,000.

The VHA’s Office Telehealth Services has been awarded funding to enhance telemedicine programs in VISN 20. The funding provides for the purchase of additional teleretinal imaging equipment, expansion of the Care Coordination Home Telehealth program, plus expansion of other specialty services using telehealth technology.

Today rural veterans can receive quality dermatology care at a VA clinic near their home through a telemedicine link to dermatologists at VA Puget Sound. Providers and technicians from 23 sites in VISN 20 have been trained in the process and over 1,000 consults have been completed.

The VA is interested in the Patient Centered Medical Home concept. Last spring, close to 130 VISN employees attended a Summit on the topic. An important part of the Patient Centered Medical Home will be to expand the services available to veterans via MyHealtheVet. The veterans will eventually be able to see their lab work and use secured messaging to communicate with their healthcare team. As a next step, an 18 month collaborative will begin soon and each VISN 20 facility will send teams to learn more about the concept.

To expand home-based primary care, VISN 20 is setting up programs in Newport, Camp Rilea, Warm Springs, Grand Ronde, and Grants Pass Oregon and in Boise, Twin Falls, Caldwell and Mountain Home Idaho. These facilities are recruiting staff and will have programs up and running by the end of September 2010.

Plans are to expand outreach clinics particularly in clinics offering Primary Care and Mental Health services. New clinics have opened in Burns and Grants Pass Oregon and in Crescent City, California. Two more clinics will be opening in Newport, Oregon and Mountain Home Idaho.

Over the last several months, VISN 20 has been phasing in some new projects to improve access and quality of care for rural veterans with funding provided by the VHA Office of Rural Health. The VISN Central Office recently provided an additional $14 million of dedicated funding to improve rural health care delivery.

The VISN 20 Behavioral health Committee (BHC) continues to improve mental health care. The BHC is developing a framework for mental health service delivery across all eight VISN 20 primary access points.

Where it is not feasible to establish a VA staffed clinic, facilities are entering into agreements with providers in local communities to offer primary care services. Contracts are being sought in several locations. Solicitations for offers have been posted and these agreements will be finalized over the next three to four months. A contract has already been awarded to a provider in Libby Montana who will begin seeing VA patients soon.

Telehealth Helping Older Adults

The Center for Technology and Aging awarded their second round of grants for $500,000 to provide remote patient monitoring technology to help older adults remain independent. The Center expects to identify and share other strategies from successful diffusion programs throughout the U.S. as well as from overseas.

The funding of $100,000 along with matching funds of $655,330 will help AltaMed Health Services and Stamford Hospital implement an evidence-based model of RPM for older adults across different systems of care including a community clinic model of care and program of all-inclusive care for the elderly.

The plan is to deliver the technology intervention to 150 patients and to 75 patients in Stamford, Connecticut in their home setting. They will use the Honeywell HomMed Genesis DM Remote Patient Care Monitor and peripheral devices. The technology will measure blood pressure, pulse, weight, and oxygen saturation levels.

After each reading, the data will be automatically transmitted to an encrypted server via telephone link or broadband and monitored daily by a member of the participant’s healthcare team. Data falling outside the normally accepted ranges will trigger intervention by a registered nurse or other appropriate care provider.

The California Association of Health Services at Home Foundation is going to use the funding of $100,000 and $140,322 in matching funds to provide patients with the Intel Health Guide. The patients will be monitored that have chronic disease conditions.

Intel’s Health Guide combines an in-home patient device with an online interface allowing clinicians to monitor patients and remotely manage care. The Intel technology can connect to specific models or wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters, and weight scales. Patients using the Health Guide can monitor their health status, communicate with care teams, and learn about their medical conditions.

Centura Health at Home funding of $100,000 plus matching funds of $88,000 will help blend their 24/7 call center technologies with telehealth. This project will modify the call center’s approach so that it will use a clinical business model to support a more robust telehealth program. There will be 14 telehealth call center technicians who can actively and adequately assist with the monitoring and questions.

Also, those individuals at highest risk will receive video monitoring. In those cases, the home telehealth video/call center monitoring program features a nurse stationed in an office with a server and monitor that allows for real-time connection to a patient. A second tier of patients receive assistance via an electronic home monitor and when connectivity is established, daily physical peripherals will be downloaded for review by the RNs.

The New England Healthcare Institute will use the $100,000 in funding along with $662,000 in matching funds to promote the broader adoption of home telehealth technology by treating patients suffering from CHF and by driving policy change in Massachusetts and nationally.

Each patient will receive the electronic house call system (EHCS) equipped with digital scale, an automatic blood pressure cuff, and a pulse oximeter. The device will be used to transmit the patient’s daily weight, blood pressure, heart rate, and information on key cardiac symptoms to a secure telemonitoring web portal through the telephone line or broadband.

EHCS will be programmed to ask specific questions related to medication use on a daily basis and the patient’s input will then be sent to the web portal. Once the web portal receives the data, an automated computer algorithm will check the patient’s data with acceptable ranges. If problems indicate an impending hospitalization or need for physician-directed intervention, then alerts will be generated.

Sharp HealthCare Foundation received $100,000 in funding with $200,000 in matching funds to reduce readmissions by utilizing remote patient monitoring technologies on a wider patient population with multiple chronic conditions. The goal is to reduce 30 day unplanned readmission rates by 30 percent during the grant term among senior patients and improve the quality of life for patients managing multiple co-morbidities by keeping them well managed in the home utilizing remote technologies.

For more information, go to

AAMTI Looking for Solutions

The Army Advanced Medical Technology Initiative (AAMTI) is searching for medical solutions to help service members at home and abroad. Recently, AAMTI issued their FY 2011 Request for Submission System Policy and Procedures document. The plan incorporates a Request for Submission for pre-proposals for FY 2011 with pre- proposal submissions due August 29, 2010. The Request for Submission for pre-proposals can be found at

This program is open to Army Medical Department (AMEDD) personnel only. However, collaboration with industry, academia, and other military services is permitted, but the Principle Investigator must be part of the AMEDD personnel and the funding must go to an AMEDD facility or command.

The major objective of the AAMTI is to provide technologies to enhance full spectrum force health protection, improve the skills and efficiency of care providers, increase access to healthcare, improve the quality of healthcare, and reduce the costs and time needed to deliver healthcare. The program is essentially designed to foster and encourage new projects that reflect medical technology entrepreneurship.

The FY 2011 program seeks a broad range of medical informatics submissions to streamline and enhance the documentation of medical encounters, develop heterogeneous databases to be queried for research into evidence-based medicine, perform information analysis, and integrate speech recognition technology into the healthcare delivery environment.

Of particular interest are technologies to:

• Address medical issues associated with TBI/PTSD
• Develop technologies to improve education for both patients and providers
• Work on applications that use cell phones and other technologies to monitor patients
• Demonstrate technologies that will enable medical care to help in remote and underserved populations
• Develop technologies that reduce the administrative burden within AMEDD
• Develop telesurgical applications to include real-time surgical consultations from theatre and between AMEDD medical facilities

In another development, Zargis Medical Corporation has just received a contract from the Army to develop an investigational device. Zargis will be developing a prototype version of their Signal-X6™ telemedicine system that will incorporate automated heart sound detection and murmur classification functionality. The development of the investigational device is being funded by TATRC through the AAMTI program and the $120,000 contract will begin August 1st.

Developing Medical Devices

SRI International and Stanford University School of Medicine announced that the Multidisciplinary Initiative for Surgical Technology Research Advanced Laboratory (MISTRAL) along with the Institute for Pediatric Innovation received a $1 million grant from FDA to commercialize innovative medical devices for pediatric care.

The key objective for the FDA funded project will be to develop new medical devices specifically to use in the newborn intensive care unit (NICU) setting. Other focus areas for pediatric product development will include surgical tools and catheter-related products.

“Children are the orphans of the medical device industry,” said Sanjeev Dutta, M.D., Associate Professor of Surgery and Pediatrics at Stanford. “Market and regulatory concerns often prevent medical device companies from investing in pediatric specific device development leaving some practitioners to use adult devices on children.

To improve opportunities for the successful commercialization of pediatric devices, researchers will work with advisors that will evaluate technologies and provide feedback on business plans. A venture-philanthropic program, the Pediatric Device Fund will be established to develop products that do not have sufficient market pull but products that would bring significant clinical benefits if brought to the market.

While observing surgeries and intensive care procedures, fellows at the University of Michigan Medical Innovation Center noticed that the current design for peripheral intravenous systems or IVs caused a great deal of hassle and had a high complications rate.

Researchers Adrienne Harris, Elyse Kernmerer, Merrell Sami, and Steven White started Tangent Medical Technologies, Inc., a medical device development company to change the way IVs are used for hospitalized patients. Tangent recently finalized its licensing agreement with the university to give the university an equity stake in the company.

The research project enabled the fellows to develop and commercialize Novacath a safer and more effective design for delivery of intravenous fluid and medication through peripheral veins. The patent-pending Novacath is currently in the prototype stage of development. In the near future, Tangent hopes to submit Novacath for FDA clearance and obtain a contract with a manufacturer for production and the sale of the device.

The Biotechnology Commercialization Center at the University of Texas Health Science Center in Houston is working with several companies to develop health and medical devices. For example, Colibri Heart Valve, LLC, a medical device company started by two physicians at St. Luke’s Episcopal Hospital, is working on medical devices to implant into the heart and vascular system. Colibri’s initial device is a novel heart valve implanted by catheter.

Another company, CorInnova, Inc. is a medical device company currently engaged in the development and use of innovative technologies to help heart recovery through the restoration of necessary mechanical stimuli. This minimally invasive technology promises to restore motion necessary for heart rehabilitation.

Nano3D Biosciences (N3D) Inc. is working on 3D cell culturing solutions. The company has created a simple device to magnetically levitate cells to enable 3 dimensional tissue growth. N3D’s “Bio Assembler” is an in vitro device that mimics the in vivo environment and has many major advantages over existing cell culturing methods. The company anticipates that the technology will address core needs in life sciences, drug discovery, toxicology, and regenerative medicine.

Doctors at Walter Reed Army Medical Center are using an electrical stimulation device to treat some of their patients for depression. The device called a repetitive Transcranial Magnetic Stimulation (rTMS) system uses electromagnetic induction which is the rapid changing of magnetic fields to create small electric currents that essentially jump-start the brain.

Lt. Col. Geoffrey Grammer, M.D., Chief of Inpatient Psychiatry at Walter Reed is compiling a team of researchers to develop new uses for the system and he thinks that the treatment could be used to exercise the brain of TBI patients.

Verizon Offering New Service

One of the obstacles to sharing patient information electronically is that healthcare systems and providers use a wide range of incompatible IT platforms and software to create and store data in various formats. Verizon’s new service called the Verizon Health Information Exchange will soon be available via the “cloud” to help both large and small healthcare providers to address this challenge.

The Exchange will consolidate clinical patient data from providers and translate the data into a standardized format that can be securely accessed over the web. Participating exchange providers across communities, states and regions will be able to request patient data via a secure online portal, regardless of the IT system and specific protocols the providers use. This will enable providers to obtain a more complete view of a patient’s health history, no matter where the data is stored.

Having more information at their fingertips will help providers reduce medical errors and duplicative testing, control administrative costs, and enhance patient safety and treatment outcomes. Since the monthly charges are based on a provider’s patient-record volume, the service is economical.

Since the Exchange will be delivered via Verizon’s cloud computing platform, healthcare organizations will be able to use their current IT systems, processes, and workflows, without large additional capital expenditures.

Verizon will use the services of several technology and service providers such as MEDfx, MedVirginia, and Oracle to deliver the clinical dashboard, record locator service, cross enterprise patient index, and secure clinical messaging.

Sunday, July 25, 2010

The Role Incentives Can Play

Eugene Heslin, M.D., Lead Physician for the Bridge Street Medical Group in Saugerties, New York, appeared before the House Ways and Means Subcommittee on Health on July 20th to support health IT and the meaningful use regulations related to the incentive payments.

He said, “Primary care physicians see Medicare age patients two to three times more often than younger patients and the number of older complex patients is going to double. Because of this, we will have to develop efficient systems and use more intelligent tools.

He described his practice as a typical primary care practice serving a community of about 18,000 in a suburban-to-rural small town. He told the Committee how 6 months ago he was called at 3 a.m. because an 89 year old patient of his was at the emergency room experiencing shortness of breath plus the patient was disoriented.

The patient had given the paramedics a list of his medications and Dr. Heslin was able to access his medical record from his home computer to look up his medications. He realized right away that the medications being read to him over the phone didn’t match his patient’s medical record. On a hunch, he pulled up the patient’s wife’s record and discovered the patient had given them his wife’s medication list by mistake.

He explained how with grant funding and technical support from MedAllies, his office went live with EMRs in 2006, and installed the second system in 2008. The system provides electronic registries and has the capability to use e-prescribing for about 90 percent of the prescriptions.

According to the doctor, the hardest part of the transition from paper to electronic record was redesigning the workflow and this is still an ongoing process. Two of the nurses in the office are now enrolled in a training course and in addition, more structured care management is being used in the office.

In 2009, his practice adopted the medical home model along with ten other Hudson Valley physician practices and three community health centers. The practices worked with Taconic IPA to help the practices achieve NCQA medical home recognition.

Over the course of one year, all 11 practices including 237 primary care physicians working at 51 practices sites, all transformed to the patient-centered medical home model and now these practices provide care to nearly half a million residents in the Hudson Valley.

Dr. Heslin emphasized that there was an incentive attached to that medical home project, and this speaks directly to the value of the Medicare meaningful use incentive payments. The Pay for Performance part of the project paid bonuses to the practices and incentives were paid by six local health plans and a large employer IBM. He told the committee that the incentives were useful and engaged physician interest and offset some but not all the costs of health IT adoption and meaningful use.

He added that ultimately my patients are why meaningful use of health IT is important. Although financing and practice workflow redesign are challenges for small practices, he said, “The federal incentives can help me persuade my colleagues that there is critical mass and that it is doable at the community level.”

eHI Releases Survey on HIEs

The eHealth Initiative (eHI) released the survey “The State of Health Information Exchange in 2010: Connecting the Nation to Achieve Meaningful Use.” The survey was presented before several hundred state and industry leaders gathered at eHI’s National Forum on Health Information Exchange held July 22nd in Washington D.C.

For seven years, eHI has been tracking the progress of HIE initiatives. This year, eHI identified 234 active HIE initiatives across the country and out of those HIE initiatives, 199 organizations responded to eHI’s annual survey.

Keynote speaker Farzad Mostashari, M.D., Deputy National Coordinator of Programs and Policy, Office of the National Coordinator for HIT, told the attendees that he is happy with the meaningful use rulemaking process since the process enables the right steps to be taken in the public’s interest. He said, “The new regulation provides change but yet it is achievable. The goal is to build on what we have today, build on with what is available, and lastly, do what is in the patient’s interest.”

Several key findings emerged from the survey such as:

• There is continued growth in the number of HIE initiatives, and growth in HIEs that are operational. Today, there are 73 operational initiatives up from 57 in 2009

• Sustainability is an attainable goal for HIE organizations but there is a small but critical mass of sustainable organizations. Initiatives receive start-up funds from a variety of sources. State grants are still the main source of funding for initiatives that are not state designated entities. Federal grants are a close third to state funds but providers in general have assumed a more significant role with respect to funding

• States and State Designated Entities have varying perspectives of their purpose and forty entities surveyed see their role as planning for HIEs

• Despite recent funding, significant challenges exist to support provider attainment of meaningful use. The survey showed that despite expanding capabilities, the ability of HIEs to support providers as they become Stage 1 meaningful users will be challenged by the current number of operational exchanges and the current capacity of HIE initiatives

• New challenges are rapidly emerging related to federal policy and governance of the HIEs.

• More organizations are reporting cost savings through reductions in staff time and have reduced redundant testing through the use of the health information exchange

• Patient engagement has increased dramatically and health information exchange initiatives have increased their focus on patients

• Initiatives are creating methods to address the complexities of security and privacy. More organizations are creating systems that allow patients to control the level of access to their information

“There is definite progress, but it doesn’t mean that we can rest on our laurels,” noted Jennifer Covich Bordenick, CEO, eHealth Initiative. “More initiatives and providers need to document cost savings, and promote services that involve patients in their healthcare.”

To download the report and to see an interactive map of health information exchange activity, go to

Advancing IT Projects

The Veterans Administration has announced a new contracting strategy known as “Transformation Twenty-One Total Technology (T4) to focus on giving veteran-owned small businesses more contracting opportunities. T4 will be managed and administered by VA’s Technology Acquisition Center in Eatontown, N.J. The Center provides acquisition and program management expertise to the VA’s Office of Information and Technology.

Secretary Eric K. Shinseki reported that the VA will soon issue a RFP for a program of multiple awards for up to five years that will go to firms that perform as prime contractors or subcontractors to meet the full range of VA’s long term technology needs.

T4 will award up to 15 prime contracts at least four of which are reserved for service-disabled veteran owned small businesses and three for veteran-owned small businesses. Over the five years, VA anticipates the program may approach $12 billion to support IT programs. The Secretary estimates that the T4 strategy will enable veteran owned small businesses to receive $800 million to 41 billion in contracts.

Large firms awarded prime contracts will have very aggressive subcontracting goals for both small and veteran owned businesses. To ensure the subcontracting goals are met, the VA will have the right to reserve set-asides for those businesses at the task order level. The VA has started a mentoring program to encourage large contractors to help small businesses improve their operations and the large contractors are also going to rely more on veteran-owned subcontractors.

The VA’s draft IT Strategic Plan FY 2010-2014 is currently under development and will be published and posted online once the document is approved. The goals as stated in the plan will reflect the current IT priorities of the Department’s Assistant Secretary for Information Technology.

NY Funding More Grants

The New York State Department of Health and the Dormitory Authority of the State of New York have requested grant applications for the HEAL NY- Phase 17 grant program. The funding will be used to expand care coordination through the use of interoperable health IT while at the same time support the Patient Centered Medical Home (PCMH).

Specifically, HEAL 17 seeks applications to support technological building blocks, along with clinical capacity and policy solutions necessary to transition healthcare from a paper based system to an electronic interconnected healthcare system.

Awards are anticipated to total $120 million, although if additional funding becomes available, this amount may be increased. The awards will be administered over a two year grant period.

HEAL 17 is also funding the continued operation of the Statewide Health Information Network for New York (SHIN-NY) through a Department of Health contract with the New York eHealth Collaborative and HEAL 17 is also providing for ongoing evaluation work through the Health Information Technology and Evaluation Collaborative.

Go to to see the grant application. For more information contact Steven R. Smith at the NY State Department of Health, Applications are due August 9, 2010.

Future Plans for Innovation

Maryland’s Governor Martin O’Malley convened a roundtable forum of industry leaders and experts, including medical system presidents, hospital CEOs, state officials, and other stakeholders to discuss healthcare reform, innovation in the state, health IT, and development of the HIE.

The Governor has set a goal for Maryland to become a national leader in health IT by 2012 by developing a safe and secure statewide HIE and by promoting the adoption of EHRs among providers. By 2010, the Administration aims to have universal compliance by all healthcare providers in the state. He is encouraging the adoption of EHRs, plus developing incentives for providers, engaging public schools, and working with the state’s business community to take advantage of health IT opportunities.

Lt. Governor Anthony Brown is actively working with the Chesapeake Regional Information System for our Patients (CRISP) on plans to develop the HIE. CRISP is a not-for-profit collaboration among Johns Hopkins Medicine, MedStar Health, the University of Maryland Medical Systems, and Erickson Retirement Communities. The Maryland government will work through CRISP to implement the exchange and use $10 million already allocated to continue to the work

Some of the O’Malley-Brown Administration plans are to:

• Revitalize the Task Force to study EHR
• Develop an electronic health records product portfolio to help physicians with purchasing decision information and information on vendors offering discounts
• Use the Medicare and Medicaid Services five year demonstration project. Maryland is one of only four states selected to participate in CMS five year demonstration project to encourage small to medium sized primary care physician practices to use EHRs
• Develop the Maryland Health Care Commission’s regulations that mirror the federal incentive program under Medicare and Medicaid for state regulated private payers.
• Encourage Maryland’s public schools to adopt EHRs.
• Engage minority and women-owned businesses to adopt EHRs. In June, the Lt. Governor, CRISP, and the Governor’s Office of Minority Affairs sponsored a forum to work with Maryland’s minority business enterprises on health IT efforts and future business opportunities

The specific HIE design characteristics are to:

• Use a hybrid approach to keep the data at its source facilities or with providers and use the HIE as the conduit for sharing
• Allow consumers to have access and control over their health information
• Let individuals have the freedom to participate or not to participate in the HIE
• Have standards consistent with emerging national technology standards
• Have the HIE build on individual use cases with individual HIE services that have demonstrated need and show clinical value to consumers and care providers
• Have the HIE focus on the medically underserved populations

Battlefield Healthcare Summit Coming

IDGA’s Battlefield Healthcare Summit “Combatant Care from Pre-to-Post Deployment” will be held at the San Diego Marriott Mission Valley Hotel on September 20-22, 2010. The military healthcare community will have an opportunity to come together to take part in advanced and focused discussions on up-to-date clinical diagnoses and treatment techniques and gain valuable knowledge on lessons learned from the battlefield.

This year’s summit is primarily dedicated to pre-deployment physical and mental healthcare and post deployment continuum of care. Attendees will walk away with a better understanding of the Army’s new Soldier Fitness Program, wound care and infection control strategies, military telemedicine, amputee care, and advances in TBI and PTSD care, plus other new and emerging topics.

Some of the specific topics to be presented on September 21st and 22nd include:

• Current initiatives at the Madigan Army Medical Center
• TBI clinical understanding and management from a neuropsychiatrist’s perspective
• Blast injury outcomes
• MTBI continuum of care
• Developing integrated MTBI care in the Afghan Theater
• Treating combat stress
• Advancing the VRT focus to treat psychological issues

In addition, panel discussions led by leaders in the field will be held so that participants will be able to earn continuing education credits.

Some of the expert speakers presenting are:

• James Kelly MD, PhD, Director, the National Intrepid Center of Excellence
• Edward Bagriele, PhD, Special Assistant to the Navy Surgeon General for Ethics & Professional Integrity, BUMED
• Col. Jerry Penner, Commander, Madigan Army Medical Center
• Col. Kurt W. Grathwohl, M.D. Medical Director, Surgical/Trauma Intensive Care Unit, BAMMC, Critical Care Consultant to the Army Surgeon General
• Col. Gerald W. Talcott, USAF, Chair Department of Behavioral Medicine, San Antonio Military Medical Center
• LTC Donald L. Helman M.D., Chief, Critical Care, TAMC
• LCDR Paul Sargent M.D, Staff Psychiatrist Comprehensive Combat and Complex Casualty Care, Naval Medical Center San Diego
• Julie C. Chapman PsyD., Principal Investigator MIND Study, Neuroscientist War-Related Illness & Injury Study Center, Washington D.C. VA Medical Center
• Nancy Kim PHD, Clinical Psychologist Comprehensive Combat and Complex Casually Care Program, Naval Medical Center San Diego
• Josef I. Ruzek, PhD, Director, Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System

A new and unique theater event is going to take place. An all new TBI/PTSD focus day dedicated to post deployment psychological health issues will feature a live performance of the Defense Center of Excellence’s “Theater of War” designed to increase awareness among care providers and service members, plus provide information on valuable resources.

Since 2008, “Theater of War” has presented readings of Sophocles’ Ajax, and Philoctetes to military communities across the U.S. These ancient plays timelessly and universally depict the psychological and physical wounds inflicted upon warriors by war.

By presenting these plays to military audiences, the hope is to de-stigmatize psychological injuries and open a safe space for dialogue on the challenges faced by service members, veterans, and their caregivers and families. Each reading is followed by a panel discussion and a town hall style discussion with the audience.

For more information on IDGA’s Battlefield Healthcare Summit, or to register, go to or call 1-800-882-8684.

Wednesday, July 21, 2010

Updates on Key Issues

Updates on the just released regulation defining meaningful use was one of the key topics introduced by Neal Neuberger, Executive Director for the Institute for e-Health Policy at the July 14th Capitol Hill Congressional Seminar. First on the agenda, experts discussed the Medicare and Medicaid Incentive Programs final rule and how both physicians and hospitals can become eligible for both Medicare and Medicaid incentive payments.

Specifically, the incentive payments can range from $44,000 to $64,000 per physician over the next five years. Hospitals are eligible for both Medicare and Medicaid incentive payments and could receive more than $5 million per program.

Joel C. White, Executive Director of the HIT Now Coalition reported that there are a total of 25 objectives that must be met by eligible professionals and 23 objectives for hospitals in their use of EHRs. The final rule divides the requirements into a core group of requirements that must be met, plus an additional menu of procedures from which providers may choose

Meredith Taylor, HIMSS Director Congressional Affairs, discussed another final rule just issued by the Office of the National Coordinator for HIT. This rule identifies the standards and certification criteria needed for the certification of EHR technology so that the systems adopted are capable of performing the required functions.

As for the EHR adoption issue, Taylor reports that the quarterly health IT implementation census data just released by HIMSS Analytics shows that the use of health IT among providers has steadily increased over the past four years. The EMR Adoption Model tracks the adoption of EMR applications for all U.S. civilian hospitals and health systems. As of June 2010, 16.3 percent of U.S. hospitals have achieved “stage 4” or higher of the adoption model and another 50.2 percent of hospitals have achieved “Stage 3”.

Prominent speakers from TriZotto, Wellpoint, and Premier Health Alliance presented their ideas on how value-based insurance design and purchasing can effectively reduce healthcare dollars and be utilized in the healthcare field.

Jeff Rideout, M.D, Senior VP, and CMO at TriZetto, said, “The healthcare share of GDP made its biggest one year jump ever in 2009 and went from 16.2 to 17.3 percent but even with the higher costs, there is still substantial underutilization of high value healthcare services.”

He reports that up to 60 percent of chronically ill patients have a history of poor adherence to evidence-based treatments resulting in up to one quarter of all hospital and nursing home admissions. The cost from poor medication adherence is estimated to exceed $100 billion annually with several factors contributing to the costs such as increased ambulatory care copayments and high co pays.

Gail Knopf, Vice President for Enterprise Strategy at TriZetto described how Value-Based Insurance Design (VBID) can actually work to help people to get preventive and effective patient care. This is accomplished by providing incentives and rewards to the consumer for making the right choices and discouraging procedures proven to be ineffective or dangerous.

For example, QuadMed LLC found that the overall average healthcare cost per employee from 2000-2007 increased by 4.9 percent. To address the problem, QuadMed established a program where there are no co-pays for chronic care treatment for diabetes, asthma, and hypertension. The goal is to stress and incorporate fitness and better health management among employees.

Both TriZetto speakers discussed how Congress should address VBID. The Health Care Reform Law does include section 2713(c) on VBID. According to the law, the Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs. Both Rideout and Knopf want Congress to continue to promote legislation that supports VBID in both the public and private sectors.

Also Senators Kay Bailey Hutchison and Debbie Stabenow introduced the “Seniors’ Medication Copayment Reduction Act of 2009” (S1040) to direct the Secretary of HHS to establish a demonstration program to test VBID methodologies for Medicare beneficiaries with chronic conditions. In 2009, the bill was referred to the Senate Committee on Finance

Lisa M. Guertin, Senior Vice President for Marketing and Products at Wellpoint agrees that 33 percent to 69 percent of all medication related hospital admissions are due to poor medication adherence and costs the health system approximately $100 billion a year.

Wellpoint is using VBID to drive behaviors and eliminate cost barriers by integrating medical, pharmacy and disease management programs to target chronic conditions such as diabetes, asthma, coronary artery disease, COPD, and heart failure.

Wellpoint manages the program by engaging high and moderate risk members in the program. Health Outreach specialists proactively reach out to these members via telephonic education and support. The members then agree to engage in a disease management program. At that point, the member and any covered dependents begin to receive value tier benefits. Members must remain engaged in the program to continue to receive reduced cost shares.

Blair Childs, Senior Vice President Public Affairs for Premier Healthcare Alliance, Inc. emphasized that value not volume is the answer and can be achieved with value-based purchasing and the use of HIT.

Premier’s demonstration project with CMS, the “Hospital Quality Incentive Demonstration” proved that payment and transparency drives better results. This was demonstrated in five clinical areas, such as with patients that had heart attacks, heart bypass surgeries, heart failure, hip and knee surgeries, or were sick with pneumonia. The average improvement across all 5 clinical areas was 18.5 percent.

Childs mentioned the provision in the health reform provision that will establish Accountable Care Organizations (ACO) to begin no later than 2010 to help hospitals and physicians work together to manage total patient cost of care and outcomes, and at the same time, meet quality requirements. ACOs stand to save $4.9 billion over 10 years.

According to Childs, an ACO environment needs to use HIT to provide for a population-wide data warehouse, to provide population health analytic capabilities, provide medical cost analysis systems, provide for case management systems, do physician profiling, predictive modeling, develop an clinical intelligence system and decision support, enable patient portal and personal health records, and use technology to connect with health information exchanges.

For more information on the 2010-2011 programs and possibilities for sponsorship, contact Neal Neuberger at

NIH Expands National Network

Nine institutions have received $255 million over five years to help bridge laboratory discoveries to patient treatments. The funds were awarded as part of the Clinical and Translational Science Awards (CTSA) program led by the NIH’s National Center for Research Resources (NCRR).

The 2010 CTSAs have expanded into new areas such as New Mexico, Virginia, and the District of Columbia, growing the consortium to 55 member institutions. When the program is fully implemented in 2011, it will support 60 CTSAs.

The nine new institutions to receive funds are:

• Children’s National Medical Center, Washington D.C.—to form a collaboration with a national network of 1200 community health centers on pediatric health issues and urban health disparities
• Georgetown University with Howard University, Washington D.C.—to coordinate a multi-institutional biomedical informatics infrastructure
• Medical College of Wisconsin, Milwaukee—to do research to enhance public health activities
• University of California, Irvine—to create new research tools by looking at new technology including micro devices
• University of California, San Diego—to foster development of novel technology to facilitate research
• University of Massachusetts, Worcester—to develop new therapies and interventions devices based upon new university discoveries
• University of New Mexico Health Sciences Center, Albuquerque—to create an incubator to research IT and informatics
• University of Southern California, Los Angeles—to study cutting edge methodologies for data acquisition
• Virginia Commonwealth University, Richmond—to do innovative research on substance abuse, women’s health, and rehabilitation science

A sixth and final funding opportunity announcement for CTSAs is available and applications need to be submitted by October 14, 2010 with the awards expected July 2011.

For more information on funding, go to or for more information on the awards, go to

HHS Developing CER Inventory

The Office of the Assistant Secretary for Planning Evaluation (ASPE) within HHS is developing a national inventory of Comparative Effectiveness Research (CER) and CER related information. In 2009, ARRA provided $1.1 billion for CER research and development. ARRA allocated $400 million to the Office of the Secretary, $400 million to NIH, and $300 million to AHRQ.

ASPE now seeks input on the approaches needed to develop the CER inventory that eventually will be accessible to the public, to include patients, clinicians, and policymakers through a web-based system.

On July 19th, HHS issued a Request for Information (RFI) seeking public comments to help ASPE develop and structure the CER inventory. The agency specifically wants to receive suggestions for potential sources for information on ongoing and completed CER, ways to encourage participation in the inventory, approaches to categorizing information, and ways to ensure that the inventory is useful and sustainable.

Comments must be received by August 9, 2010 and all comments will be available publicly at For more information, email Pierre Yong, ASPE at or call (202) 690-8384. To see the full announcement in the July 19th Federal Register, go to

Cell Microscope Developed

UCLA engineer Aydogan Ozcan created the world’s smallest and lightest miniature microscope to use for telemedicine applications in resource limited settings. A paper was published online in the Journal “Lab on a Chip”. The microscope builds on imaging technology and is referred to as Lensless Ultra-wide field Cell monitoring Array platform based on Shadow imaging (LUCAS).

Instead of using a lens to magnify objects, LUCAS generates holographic images of microparticles or cells by employing a light-emitting diode to illuminate the objects and a digital sensor array to capture their images. This technology can be used to image blood samples or other fluids and has the potential to help monitor diseases such as malaria, HIV, and tuberculosis in third world countries. Weighing just 45 grams, the microscope is a self contained imaging device and the only external attachments needed are a USB connection to a smart-phone, PDA, or computer.

Tools like this lensless microscope could be digitally integrated as part of a telemedicine network that connects various mobile healthcare providers to a central lab or hospital. Transmission connections for these networks already exist in cellular networks even in the most remote corners of the globe.

The lensless microscope, in addition to being far more compact and lightweight than conventional microscopes also eliminates the need for trained technicians to analyze the images produced since images are analyzed by computer with results available instantly.

Field tests of the cell phone microscope will begin shortly in Africa using funds received from the Bill & Melinda Gates Foundation ($100,000 Grand Challenges Exploration Grant), the National Geographic Emerging Explorer ($10,000), and the National Science Foundation (a CAREER award for $400,000).

Kansas Expanding Broadband

Kansas Governor Mark Parkinson is eager to provide faster and more reliable internet services to rural Kansans, so he has established through an executive order, the Kansas Broadband Advisory Task Force. The 24 member advisory group will help implement the state’s “Connect Kansas” broadband initiative. The Secretaries of Agriculture and Commerce have also been asked to serve plus four members will be appointed by legislative leaders.

The Advisory Task Force will develop recommendations to support statewide availability and adoption of broadband services consistent with the 2010 National Broadband Plan. The task force will coordinate input from key stakeholders in the public and private sectors to ensure that Kansas has a competitive advantage through a robust and growing digital economy.

Connect Kansas funded primarily by ARRA has invested $7.2 billion to help states expand broadband access to underserved communities. So far, the Recovery Act has awarded $174 million in grants and loans to expand broadband expansion and adoption project.

Currently, Connect Kansas is mapping the state’s existing high speed internet availability and looking for ways to improve broadband infrastructure. The mapping tool called “Broadband Stat” is near completion and will be launched in a few weeks.

In another development, Kansas had several broadband projects recently selected for USDA Rural Development funding:

• H&B Communications will receive $1,965,455 (loan), $4,586,064 (grant), and $1,637,880 (private investment) to provide high speed broadband to underserved rural communities surrounding Claflin and Ellinwood Kansas plus provide services to other areas in the state
• J.B.N Telephone Company Inc. will receive $1,000,568 (loan) and $2,323,576 (grant) to construct fiber-to-the premises throughout six towns in their eastern exchange area
• South Central Wireless Inc. will receive $560,000 (loan) and $557,621 (grant), and $575,973 (private investment) to construct a fiber-to-the-premise infrastructure for Attica Kansas

Sunday, July 18, 2010

FCC Broadband Funding

On July 15th, the FCC introduced their new healthcare connectivity program to expand investment in broadband for medically underserved communities across the country. The program would provide patients in rural areas access to state-of-the-art diagnostic tools typically available only in the largest and most sophisticated medical centers. In fact, nearly 30 percent of the federally funded rural healthcare clinics can’t afford secure and reliable broadband services.

The FCC program is going to invest up to $400 million annually to enable doctors, nurses, hospitals, and clinics to use communications technology to deliver world-class healthcare to patients no matter where they live.

Specifically, the FCC plan would:

• Partner with public and nonprofit healthcare providers to invest millions in new regional and statewide broadband networks in parts of the country where it is unavailable or insufficient
• Make broadband connectivity more affordable by sharing half of the monthly recurring network costs with hospitals, clinics, and other healthcare providers
• Deliver connectivity where it is needed most today to include skilled nursing facilities and renal dialysis centers, along with off-site administrative offices and data centers that perform support functions critical to healthcare networks.

According to the American Telemedicine Association (ATA), the FCC’s previous Pilot Program disbursed less than 10 percent of the promised funds and very few projects have received final approval. Also, guidance provided to applicants has been arbitrary, conflicting, and changing. Although the ATA applauds the FCC for taking a step to resurrect the failed FCC pilot program, the new FCC changes to their previous program do not appear to address core issues.

ATA urges the FCC to:

• Streamline the process for project approval and refrain from additional last minute requirements in order to accelerate the full funding of all eligible projects
• Reduce the amount of red tape for approved applicants to receive their funding
• Maintain a clear focus on healthcare. Eliminate the proviso allowing participants to sell excess broadband capacity to non-providers
• Remove the cash only requirement for applicant matching funds. There is no legislative requirement for a cash match
• Quickly reevaluate the costs per site for each approved project to ensure the efficient use of federal funding

Jonathan D. Linkous, CEO of ATA, said, “The ATA pledges to do all we can to work with the Commission to ensure that this exciting new opportunity is fully implemented.”

Go to for the Notice of Proposed Rulemaking. There is a 30 day comment period.

PCAST to Issue HIT Report

The President’s Council of Advisors on Science and Technology (PCAST) held a meeting July 16, 2010 in Washington D.C. Both John P. Holdren Co-Chair and Assistant to the President and Director of the Office of Science Technology Policy (OSTP) and Eric Lander Co-Chair and President, Broad Institute of Harvard and MIT, chaired the meeting to discuss and advise the President and the Executive Office of the President on several current issues.

Health IT was one of the issues discussed as the Advisory Committee has been working for the past seven or eight months on a report to help advise the President. A working group was chaired by Christine Cassel M.D., President and CEO, for the American Board of Internal Medicine and Craig Mundie, Chief Research and Strategy Officer for Microsoft. The Health and Life Sciences Subcommittee under the direction of William Press Ph.D, Rayner Professor in Computer Science and Integrative Biology at the University of Texas at Austin brought their ideas forward on the subject to present to the PCAST meeting on July 16th.

As Dr. Cassel pointed out, they began the study on health IT by looking at examples where health IT has been used successfully. They concentrated on the Veterans Administration’s health technology undertakings, and also studied how Kaiser Permanente operates their program. The group also looked at smaller physician offices and their specific needs to deliver medical records electronically.

As Dr. Press noted, the working and subcommittee looked very closely at privacy and security issues. As he reported, the Markle Foundation 2006 survey found that 80 percent of people are very concerned about theft and fraud as it pertains to their medical records. He continued to say that privacy was engineered from the start through legislation such as HIPAA, but that the current thinking is that HIPAA needs to be changed and simplified to meet future needs.

The current thought is that the patient should be allowed to consent to their information being used for research. Also, the patient should be notified when researchers are using the data and be able to choose whether they want to continue to release their information throughout their lifetime.

Discussion centered on small practices and the enormous amount of paperwork they are required to handle which is many cases necessitates the office to hire more staff. Many small practices find it difficult to deal individually with operational issues when installing EMR systems.

Mundie envisions that the computer industry will have large scale cloud facilities to host and handle operational issues for practices. The smaller practices could then take advantage of cloud computing to host their services and have their services delivered via the internet.

The biggest change is that the data would be owned by the patient and exchanged, but the data itself would not be centralized in any one location. Patients would control their preferences as to who sees the data and these preferences would move along with the data.

PCAST members heard about new ideas and innovative concepts that are likely to take place in the future such as creating patient centered medical homes, accountable care organizations, and efforts to encourage more value-based purchasing.

The Co-Chair of PCAST called for a vote and PCAST approved the health IT report. The report will be revised where needed and formally released.

For more information on PCAST activities, go to

HRSA Issues Presolicitation

The Health Resources and Services Administration (HRSA) plans to issue an RFP to develop the “Patient-Centered Medical-Health Home” (PCMHH) initiative. This initiative will help the Health Center Program promote the medical home to help the millions of underserved people have access to comprehensive, culturally competent, and quality primary healthcare services. HRSA anticipates that the period of performance will not exceed a five year period.

The purpose for the RFP entitled “Patient-Centered Medical Health Home Initiative” is to support health center efforts to undergo rigorous and comprehensive survey processes and be able to demonstrate the highest standards of healthcare quality. The RFP document will be available at and the solicitation HRS36648 will be posted on or about July 23, 2010 with a projected closing date to be on or about August 23, 2010.

For more information, contact Dottie Watson, Contracting Officers, Division of Contracts Operation, by email at

Tech Improves ER Care

Researchers at Massachusetts General Hospital’s Emergency Medicine Network (EMNet) have launched FindER™, a free iPhone application to help users locate the closest emergency room, provide directions, along with additional information all with a touch of the screen.

FindER uses the iPhone’s GPS to quickly direct patients to emergency rooms anywhere in the U.S. FindER is also designed for quick phone calls to both the care center and if necessary used to contact 911 emergency services. Once the symptoms are determined, information is available on specific emergency rooms that can treat the symptoms and the wait times for ERs.

EliteCare 24 hour Emergency Center in Texas has partnered with Healthagen® to promote their emergency center through the iTriage® applications. If help in an emergency is needed, the consumer can download the iPhone or android application or go to using any capable smart phone or computer to evaluate symptoms. At that point, iTriage will pinpoint the locations and provide turn-by-turn directions to the closest type of facility needed anywhere in the country.

Helping patients receive live ER wait times via text messages in the middle of an emergency is a new way to reach consumers. To do this, ERTexting in Miami manages a new free 4ER411 system. This new service available in hospitals all over the U.S. enables patients to text their zip code to 4ER411 and then receive their local participating hospital ER wait times.

To help deliver the patient’s medical information directly to a first responder or emergency room physician, Emerging Healthcare Solutions Inc. has a smartphone application under development called “e-911”. The “e-911” App automatically delivers the user’s medical information to first responders or to doctors when 911 is dialed from an iPhone. The “e-911” will first be made available for Apple’s iPhone and after assuring product quality, the e-911 will then be offered through Google’s Android and Research in Motion’s BlackBerry.

Identifying Biological Threats

The Military Health System reports that a new portable device using nanotechnology can identify biological threats in minutes. Integrated Nano-Technologies (INT) has developed a field portable device called the Palladium that can easily and accurately identify targeted infectious diseases and other biological threats.

The Palladium employs nanotechnology to obtain DNA analysis results that until now were not possible without lengthy sample preparation and the use of expensive equipment. Samples generally have to be taken to a lab for this level of analysis. Early research for the project was funded through the Defense Threat Reduction Agency, and continued prototype and engineering refinements were funded by the Telemedicine and Advanced Technology Research Center (TATRC).

With the handheld Palladium device, the user puts blood, tissue, or another type of sample in a disposable test cartridge, locks the cartridge into the reader and presses the start button. The device releases the DNA from the cells or viruses in the sample by bombarding them with small glass beads that are vibrated ultrasonically. Paramagnetic nano particles attach to the released DNA, which is drawn via electromagnets to a computer chip with sensors on its surface.

Then the DNA molecule matches two capture probes in a sensor then binds to the probes and creates a bridge. A meal coating is deposited along the bridge between these electrodes, forming a wire that shorts the sensor for that particular virus, bacteria, or strains. The device reads which sensors are activated and then reports the results to the user in less than 10 minutes. This enables the time, location, and results to be reported wirelessly to a central site allowing disease outbreaks to be readily identified and monitored.

In future developments, INT has identified additional development opportunities several of which have patents pending. The company is developing high resolution imaging arrays using nano scale electronic components which joins DNA with semiconductors. When assembled, an array will produce imaging resolutions thousands of times greater than current technology.

The NanoSyringe ™ is a site specific drug delivery system that will allow for delivery of therapeutic agents directly to specific cells within the body such as to tumors. The syringe should drastically reduce adverse drug reactions as drugs will only interact with the targeted cells and not with surrounding healthy tissues and will be used to treat cancers, drug resistant infections, and for gene therapy.

Wednesday, July 14, 2010

Philippine HIT Accelerating

The National Telehealth Center (NThC) within the University of Philippines (UPM) in Manila has been using telemedicine services over the past five years. The NThC currently maintains a network of more than 100 doctors and 20 domain experts with coverage as far north as Batanes and as far south as Tawi-Tawi.

NThC’s “Community Health Information Tracking System” (CHITS), an open-source web-based EHR system is working with the public and private sector through their 3G “Wireless Access for Health” (WAH) project. The WAH project recently completed the pilot phase recording over 12,000 patient consultations.

WAH is a collaborative consisting of the agencies of the Philippines Department of Health, Qualcomm’s Wireless Reach initiative, RTI International, Smart Communications, Inc., Tarlac State University, UPM-NThC, and the U.S. Agency for International Development.

CHITS was developed by the university and specifically designed for government health centers. The system makes it possible for local healthcare providers to compile reports on public health and send this information to the Field Health Service Information System (FHSIS).

Data submitted to the FHSIS through CHITS is used for policy analysis and planning at all levels of the public health system and helps clinicians have better access to quality patient records. The system provides good access to public health information and consolidates reports on patient visits. CHITS can be used on portable devices such as handheld game consoles and with communication devices such as Apple’s iPhone, and iPad.

“CHITS consolidates data captured during patient visits into reports for healthcare workers in four health units in the Tarlac region of the Philippines,” stated Dr. Ricardo P. Ramos, Chief of the Tarlac Provincial Health Unit. The project has trained 40 midwives and nurses at the rural health units in Gerona, Moncada, Paniqui, and Victoria to use computers for the first time, reduced the time needed to search for records to just seconds, plus Tarlac State University is developing software to meet the needs of the system.

In June, CHITS was showcased at the Summer Seminar on Population presented by UPM- NThC at the Philippine Health Insurance Corporation and the Hawaii-based East West Center. The UPM-NThC team discussed NThC’s eHealth initiatives that include eLearning for health, eMedicine or telemedicine, and eRecords. Free/Open Source Software (FOSS) was also introduced at the showcase to participants from the U.S., China, Thailand, India, and the Philippines.

Study Shows Improved Outcomes

A study on AHRQ’s Health Care Innovations Exchange web site demonstrates how supporting primary care managers with IT systems helps to deliver care to seniors with multiple chronic illnesses plus reduces costs and improves outcomes. The primary care managers in the study worked with healthcare providers, specialists, and community agencies to coordinate patient care and used an electronic tracking and reminder system.

Before the study began, Intermountain Healthcare, a leader in care management used the Chronic Care Model to expand the role of care managers to address the needs of patients with multiple chronic conditions as well with mental health and social needs. Then the care manager model developed at Intermountain was refined and expanded by the Department of Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU).

At that point, the John A. Hartford Foundation provided startup funding for the pilot project and awarded OHSU a four year $2.5 million grant to expand the Care Management Plus model into 40 rural and urban clinics. AHRQ provided the funds for the web-based tracking program that was used in the pilot.

During the first year of the program, care management services were pilot tested in seven clinics. Services were provided to 1.7 percent of the 106,766 adult patients seen in age from 65 to 80 plus years. The pilot showed significant improvements in patient outcomes, including fewer complications, deaths, and hospitalizations for diabetes patients. The care manager’s oversight and patient tracking software also increased physician productivity and reduced medical costs, yielding net benefits of about $75,000 per case manager.

The patients in the pilot were referred to a care manager then an individualized care plan was formulated with the patient and his/her caregiver. Periodic visits were made with typically 4.3 encounters per patient made per year. Face-to-face visits amounted to one-third of the encounters, telephone calls were made about 40 percent of the time, and joint meetings with medical team members were made with the patient and with care givers.

Care managers were also able to tap into other resources and settings. As needed, the care manager was able to schedule home appointments with patients, discuss medical issues with physicians and specialists, contact outside agencies and companies to advocate for patients, or arrange for other services to bolster the patient’s care and well-being.

The IT systems were used to facilitate and improve teamwork and communication between primary care providers and specialists to target information needed for each specific patient. The IT tools used did not act as the EHR, but they did augment and work with the existing EHRs. The EHR contained the patient’s record, a longitudinal record, reminders, alerts, and performance reports. The EHR was used as a mechanism so that physicians and care managers were able to communicate with each other on issues relevant to the patient’s care.

The patient worksheet automatically generated by the information system was integrated with the clinic’s scheduling system before each visit. Since the worksheet has pertinent clinical data and alerts for up to five chronic illnesses in a single document, it could be reviewed quickly by providers at the point-of-care and be easily integrated into existing workflows.

Before starting the project, at least 6 physicians were needed to support a care manager and form teams. The IT systems had to be revamped but it is very important to not underestimate IT needs. Also, it has been found that the ability to communicate with the entire team is not often met by the clinic’s present system.

This program is used by PeaceHealth in Oregon and Washington, Healthcare Partners in California, Kaiser Permanente in Oregon, the VA in Oregon and Washington, EXCELth in New Orleans, and several other health systems have adopted this program.

For more information, go to or email David Dorr, MD at Oregon Health & Science University at or call (503) 494-2567.

Tracking Prescription Deliveries

The Veterans Health Administration together with the VA’s Office of Information and Technology sponsored an Information Technology Innovation Program selecting 26 innovations prototypes out of 6500 submissions from employees. One of the submissions suggested a need to track mail prescriptions on-line.

Currently, the VA sends the majority of outpatient prescription medications to their patients through the postal system. In order for VA patients to track the delivery of their mailed medications, they must call their local VA Medical Center. This has resulted in an increase in phone calls to pharmacy staff and interferes with efficiency and satisfaction.

The VA is working to improve their web-based portal “My HealtheVet” for patients to use when they want to access their personal health information, order refills of medications, and communicate with healthcare providers.

When this is accomplished, the functional prototype will display a link within the “My HealtheVet” portal to the VA’s Consolidated Mail Outpatient Pharmacies. The plan is to provide a web service that will pass information on to the “My HealtheVet” portal, and at that point, the patient’s tracking information will be given to the patient upon request.

Last month, the VHA issued a Request For Information (RFI) seeking possible contractors with ideas on how to deliver the RFI entitled “On-Line Tracking of Mail Prescription Delivery System Enhancement”. The VA issued the RFI to find out from contractors if commercial items were available or could items be modified to meet the VA requirements needed to enhance the mail prescription delivery system. The market information was received in June and when the VA completes their market research from the information received, they will make their decision based on the requirements. At that time, the VA may enter into a competitive solicitation that will be posted.

URMC Studying Heart Device

Cardiologists at the University of Rochester Medical Center (URMC) are enrolled in a clinical trial to study how technology can help congestive heart failure patients. The technology will help patients and their doctors to more closely monitor heart health status on a daily basis and could potentially impact the progression of heart failure.

Currently physician’s care decisions are guided primarily by patient-reported symptoms such as breathlessness, reduced exercise capacity, swelling of the ankles, fatigue and weakness. Using these red flags, a diagnosis can be made regarding worsening heart failure and may prompt a change in medication dosage. Often by the time symptoms become obvious, the patient needs to be hospitalized.

The Left Atrial Pressure Monitoring to Optimize Health Failure (LAPTOP-HF) therapy is sponsored by St. Jude Medical. The trial is a pivotal, randomized controlled, prospective, multi-center clinical investigation to evaluate the safety and effectiveness of the company’s implantable Left Atrial Pressure (LAP) heart failure management system. The system is being studied under an investigational device exemption from FDA.

The system includes:

• A small pacemaker-size, stand-alone, implantable LAP monitoring device, or a cardiac rhythm management device with an integrated LAP monitoring device
• A lead or thin wire from the device to the heart with an LAP sensor
• Patient Advisor Module ®, a portable wireless, hand-held device used by the patient to check LAP status and through the DynamicRx® feature. Then the patient is directed to take specific medicines or make lifestyle adjustments based on the LAP measurement

The trial is expected to enroll about 700 patients at up to 75 centers across the U.S. URMC was the first center to implant the technology last September as part of a feasibility trial and is also the first center to participate in this current phase of the study.

The study will consist of New York Heart Association Class III patients with a history of ischemic or non-ischemic cardiomyopathy for at least six months and at least one heart failure hospitalization within the past 12 months.

The volunteers are randomized to a treatment group to receive the implantable sensor along with the hand-held device that wirelessly collects data from the LAP sensor and provides information. Medication recommendations go from the physician directly to the patient or to a control group that receives standard heart failure therapy.

Cardiac electrophysiologist Spenser Z. Rosero, M.D., Associate Professor of Medicine at URMC and Director of the Hereditary Arrhythmia Clinic, and Leway Chen, M.D. Associate Professor of Medicine and Director of the Program in Heart Failure and Transplantation are leading the study.

Save the Date

IDGA’s Battlefield Healthcare Summit “Combatant Care from Pre-to-Post Deployment will be held September 20-22, 2010 at the San Diego Marriott Mission Valley Hotel. The military healthcare community will have an opportunity to come together to take part in advanced and focused discussions on up-to-date clinical diagnoses and treatment techniques and gain valuable knowledge on lessons learned from the battlefield.

This year’s summit is primarily dedicated to pre-deployment physical and mental healthcare and post deployment continuum of care. Attendees will walk away with a better understanding of the Army’s new Soldier Fitness Program, wound care and infection control strategies, military telemedicine, amputee care, and advances in TBI and PTSD care, plus other new and emerging topics.

Some of the specific topics to be presented on September 21st and 22nd include:

• Current initiatives at the Madigan Army Medical Center
• TBI clinical understanding and management from a neuropsychiatrist’s perspective
• Blast injury outcomes
• MTBI continuum of care
• Developing integrated MTBI care in the Afghan Theater
• Treating combat stress
• Advancing the VRT focus to treat psychological issues

In addition, panel discussions led by leaders in the field will be held so that participants will be able to earn continuing education credits.

Some of the expert speakers presenting are:

• James Kelly MD, PhD, Director, the National Intrepid Center of Excellence
• Edward Bagriele, PhD, Special Assistant to the Navy Surgeon General for Ethics & Professional Integrity, BUMED
• Col. Jerry Penner, Commander, Madigan Army Medical Center
• Col. Kurt W. Grathwohl, M.D. Medical Director, Surgical/Trauma Intensive Care Unit, BAMMC, Critical Care Consultant to the Army Surgeon General
• Col. Gerald W. Talcott, USAF, Chair Department of Behavioral Medicine, San Antonio Military Medical Center
• LTC Donald L. Helman M.D., Chief, Critical Care, TAMC
• LCDR Paul Sargent M.D, Staff Psychiatrist Comprehensive Combat and Complex Casualty Care, Naval Medical Center San Diego
• Julie C. Chapman PsyD., Principal Investigator MIND Study, Neuroscientist War-Related Illness & Injury Study Center, Washington D.C. VA Medical Center
• Nancy Kim PHD, Clinical Psychologist Comprehensive Combat and Complex Casually Care Program, Naval Medical Center San Diego
• Josef I. Ruzek, PhD, Director, Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System

A new and unique theater event is going to take place. An all new TBI/PTSD focus day dedicated to post deployment psychological health issues will feature a live performance of the Defense Center of Excellence’s “Theater of War” designed to increase awareness among care providers and service members, plus provide information on valuable resources.

Since 2008, “Theater of War” has presented readings of Sophocles’ Ajax, and Philoctetes to military communities across the U.S. These ancient plays timelessly and universally depict the psychological and physical wounds inflicted upon warriors by war.

By presenting these plays to military audiences, the hope is to de-stigmatize psychological injuries and open a safe space for dialogue on the challenges faced by service members, veterans, and their caregivers and families. Each reading is followed by a panel discussion and a town hall style discussion with the audience.

For more information on IDGA’s Battlefield Healthcare Summit, or to register, go to or call 1-800-882-8684.

Sunday, July 11, 2010

Telehealth Network Advancing

The FCC is going to fund up to 85 percent of the costs for 7 Oregon healthcare organizations at 12 sites to help build out or grow their respective broadband infrastructure to support telemedicine and telehealth applications. The seven healthcare organizations to receive funding include:

• St. Charles Health System, Bend, Redmond, and Prineville
• Siletz Tribal Health Clinics, Siletz
• Bay Area Hospital’s Women’s Imaging Center, Coos Bay
• Umpqua Community Health Centers, Drain, Glide, Myrtle Creek, Roseburg High School, and Roseburg Health Center
• Clackamas Community College’s Harmony Campus, Clackamas
• Outside in Medical Clinic, Portland

The Oregon Health Network (OHN) will fund the remaining 15 percent of the costs for the broadband construction and installation as part of the FCC Rural Health Care Pilot Program’s $20.2 million awarded to Oregon to build and improve their broadband telehealth network. Through the RHCPP, OHN plans to bring as many as 200 eligible hospitals, clinics, community colleges, and government facilities into a high speed broadband network.

As a geographically large state with a small population, coupled with the fact that the majority of the state’s population reside within a defined geographic region, the state has encountered difficulties providing high quality and cost effective broadband service both to healthcare providers and communities in general. The state’s size and disperse population in particularly remote regions has made construction of high speed internet and intranet connectivity not economically feasible in many cases.

A number of telehealth and telemedicine applications are already operating in the state. Some of the projects involve:

• Pediatric intensive care video consultation and monitoring (OSHU and Sacred Heart)
• Telegenetics counseling (OSHU, Medford, Bend, and Boise but currently suspended until payer reimbursement is activated)
• Psychiatric video consultations (OSHU with a prison and tribal clinic)
• Specialty telemedicine consults (Eastern Oregon and Idaho hospitals)
• Cardiology Stemi consults and data transfers (Southern Oregon Hospital, EMS ambulance and emergency departments)
• Trauma consults for triage patients
• Adult image interpretations and over reads (store and forward)

In July 2010, President Obama announced sixty six grants and loans for $795 million through the Department of Commerce and USDA to be matched by over $200 million in outside investments to bring broadband services to many communities. The state of Oregon was one of the grantees to receive funding for two specific broadband projects:

• Bend Cable Communications, LLC received $4.4 million with an additional $1.9 million match to construct more than 130 miles of new fiber in areas of central Oregon that lack adequate broadband connectivity
• County of Clackamas received $7.8 million with an additional $3.3 million match to bring high speed internet service to northwestern Oregon

Twenty one sites in Oregon are now live on OHN’s broadband telehealth network monitored 24/7. These sites include hospitals, community colleges, an FQHC, and a county data center. A number of additional sites have contracted with OHN that includes five integrated delivery networks, two hospitals, multiple FQHCs, and four additional community colleges.

Another OHN initiative is to work on a broadband mapping project led by the Oregon Public Utility Commission (PUC). The Oregon PUC is contacting the state’s community anchor institutions to develop a congressionally mandated national map also to be used as an Oregon-specific map. The state has contracted with BroadMap under a grant from Commerce’s National Telecommunications and Information Administration on this effort.

This broadband mapping initiative is going to provide data on infrastructure gaps and enable the state’s Health Information Technology Oversight Council (HITOC) to find ways to close the broadband gaps. According to the HITOC Draft Strategic HIE Plan made available for public comment in mid June, the HITOC over the next three to five years expects all communities in the state to have access to broadband internet to help support HIEs.

The Strategic HIE Plan outlines the priorities needed for the adoption of a statewide HIE. First, a high percentage of healthcare providers must be using electronic health records or using some form of electronic communication such as electronic prescribing. Secondly, there needs to be sufficient penetration of broadband internet connectivity to handle the transmission of healthcare information. Once these two pieces are in place, these systems need to be able to exchange data in a standardized format in a standardized way. In addition, a centralized organization with representation from stakeholders must define and set the standards by which data is shared.

Applying Technology to Privacy

On June 29th, ONC’s HIT Policy Committee’s Privacy & Security Tiger Team hosted a hearing to discuss how technology can be applied to complex and sensitive issues surrounding patient privacy. Several companies discussed how their technology helps consumers deal with privacy and consent issues.

Michael LaRocca representing InterSystems Corporation recognizes that operational tasks that involve collecting consent policies from patients is burdensome and potentially confusing plus when collecting consent information from patients, there is always a need to balance simplicity with functionality.

He explained how InterSystem’s “HealthShare” deals with their secure EHR systems on a regional or national level. To begin with, consumers accessing personal health information have to be verified by HealthShare’s Consent Service. All consent policy definitions are stored in HealthShare’s Consent Registry. When the user queries the HealthShare Consent Service, the Consent Registry returns a single merged version of the consent policies that covers the exchange of all health information.

Michael Stearns M.D. President and CEO of e-MDs, Inc. an EHR and practice management software provider and also serving as President of the Texas e-Health Alliance, a non-profit advocacy body to examine consumer consent policy issues at the state level.

He said, “Today, policies, workflow, and technology issues related to the protection of confidential information are areas of vigorous debate within the healthcare system. Our e-MD EHR system enables the patient to have some ability to decide what information is to be shared but yet additional patient-centric controls are needed”

He described how e-MD’s EHR implements the patient’s consent. To start with, information can be marked as confidential in several areas of the EHR including the Health Summary and Progress Notes sections. Confidential information can also be removed or blocked from view in documents that are exported from the system.

The EHR allows the provider to make components of the health summary confidential and viewable only by certain individuals based on their privileges. Protected information can be marked as private or preselected as confidential during the template development and editing process.

The patient does not have a direct role but can ask the provider to mark certain information as confidential where this information will be blocked out when viewed by someone who does not have the specified privilege.

Today, e-MDs has over 27,000 users in 49 states and U.S. territories and probably impacts over 1,000,000 patients served by their providers. This will increase because right now the private information is not available to external facilities or HIEs.

Robert Shelton CEO of Private Access, an early stage company, is developing a consumer-centric technology platform to enable individuals to create and manage privacy protections for their confidential health information and permit their confidential information to be efficiently located and shared when they consider it beneficial.

Patients set up secure accounts where they establish consents and make their privacy preferences known about some or all of their personal health information. These consents can be given to an individual, to an entity, or to groups of entities.

He told the Committee that his company has invested nearly $8 million in building the first generation of the PrivacyLayer® system. The company is now launching a series of commercial beta releases that began earlier this year with live patient data. On the basis of this work, the company is preparing for a series of later broader commercial releases.

Info on Healthcare Coverage

HHS has unveiled a new on-line tool to help consumers take control of their healthcare. The website helps to provide information and resources to help access quality affordable healthcare coverage. Called for by the Affordable Care Act, the website provides consumers with both public and private health coverage options tailored specifically to their needs. is the first central database with information on health coverage options that combines information on public programs from Medicare to the new Pre-Existing Conditions Insurance Plan with information available on more than 1,000 private insurance plans.

Consumers can receive information on options specific to their life situation and local community. In addition, the website can connect consumers to quality rankings for local healthcare providers as well as preventive services.

“ makes it easy for consumers and small businesses to compare health insurance plans in both the public and private sector and find other important healthcare information”, said HHS Secretary Kathleen Sebelius.

“This website was developed with significant consumer input and is remarkably easy to navigate despite the sheer volume of content that it offers consumers. The site has billions of healthcare choices through the insurance finder and more than 500 pages of new content”, said HHS Chief Technology Officer Todd Park.

As the healthcare market transforms, so will In October 2010, price estimates for health insurance plans will be available online. In the weeks and months ahead, new information on preventing disease and illness will be posted.

Support for Cloud Computing

GSA has a significant leadership role in supporting the adoption of cloud computing in the federal government, according to Dr. David McClure, Associate Administrator, Office of Citizen Services and Innovative Technologies, at GSA. He appeared July 1st before the House Committee on Oversight and Government Reform’s Subcommittee on Government Management, Organization, and Procurement to discuss cloud issues.

As he pointed out, GSA facilitates innovative cloud computing procurement options, ensures that effective cloud security and standards are in place, and identifies potential multi-agency or government-wide used of cloud computing solutions.

Currently, GSA in supporting OMB is working with agencies to develop plans to consolidate their data centers. It will be the role of the agencies to analyze viable cloud computing options to meet their business and technology modernization needs. By using the right deployment models, agencies will be able to buy improved services at a lower cost within acceptable risk levels and not have to maintain expensive, separate, independent, and often needlessly redundant brick and mortar data centers.

GSA’s leadership role in supporting the adoption of cloud computing in the federal government will be to streamline the procurement process. So far, the agency is working to provide easy access to cloud based solutions from commercial providers that meet federal requirements.

Dr. McClure explained that cloud services are usually offered and purchased as commodities and for the agencies this will be a new way to buy IT services. In the near future, GSA is going to select vendors that are capable of offering services and products to the other agencies. This will make it better for vendors as it will be easier for the federal agencies to enter into contracts.

To assist agencies in buying new commercially provided cloud services, GSA has established the website modeled on other GSA product and service acquisition “storefronts”. The purpose for the web site is to provide easy simple ways to find, research, and procure commercial cloud products and services. The site provides government buyers with information and buying tools to complete their procurements.

The website allows agencies to search for “Software as a Service” (SaaS) products that are categorized under 33 business purpose headings. This enables the agencies to get product descriptions, price quotes, and then link to more information on specific products. Usage patterns to date indicate that agencies use this information to either directly buy SaaS products, or use the information as a source of marketplace research to support cloud procurements, plus use the information with other vehicles such as the GSA Schedule or GSA Advantage.

The website also has information on no cost social media applications. When a user hits the SEND REQUEST button, they are linked to their agency’s social media coordinator to complete the request for use of the tool in compliance with their agency’s social media policy. will bring new players into the contracting field but many smaller companies lack the background in the federal marketplace to compete. This means that small businesses will need to get up to speed in order to deal with federal contracting. The larger firms already familiar with the agencies are now poised to meet the demands of the federal customers.

To support access to cloud-based “Infrastructure as a Service” (IaaS), the cloud program management office is working with the Federal Acquisition Service (FAS) at GSA. The FAS has primary responsibility for operating on-line acquisition services that are available for government-wide use.

In May 2009, the Program Management Office issued a Request for Information asking the marketplace how they would address cloud computing business models, pricing, service level agreements, operational support, data management, security, and standards. The responses received from the RFI, was incorporated into a Request for Quote for IaaS capabilities and pricing which closed at the end of June 2010.

The information is currently being evaluated but the resulting information may be used to develop a multiple award blanket purchase agreement that agencies can use to procure cloud- based web hosting, virtual machine, and storage services within a moderate security environments.

It is very important to address other issues such as security, standards, and specific cloud-based solutions with government or multi-agency use such as cloud-based e-mail services. The Federal Cloud Computing Program Management Office (PMO) created at GSA in 2009, has formed working groups to address various issues.

The groups are chaired by a government expert and NIST was selected to lead both the standards and security groups. Also, the Federal Risk and Authorization Management Program (FedRAMP) is being formed. This is a government-wide initiative that will be launched to provide joint authorizations and continuous security monitoring services for all federal agencies with an initial focus on cloud computing.

Software to Improve Privacy

A computer security invention patented a decade ago at the National Institute of Standards and Technology (NIST) is ready to help safeguard patient privacy in hospitals. The patented invention, an algorithm can be built into a larger piece of software designed to control access to information systems. John Barkley, the algorithm’s creator, says the idea could solve one of the most difficult issues in the country’s healthcare system.

In the past, access to information was available to anyone whose name was on a specific list of authorized users, but a large organization might have thousands of restricted files, each with its own access list, therefore making security management difficult. The creation of Role-Based Access Control (RBAC) helped and meant that e a person’s job function and not their name was the key to accessing a particular file. However, even RBAC would allow large numbers of people to have unlimited access to information.

In the healthcare field, it is crucial but difficult to guarantee patient privacy. For example, at a hospital, the patient admission procedure involves a number of steps, and in each step someone needs access to the patient’s medical records for a specific purpose like registering the patient or verifying their insurance information.

“However, once a patient has been admitted to the hospital, the admissions staff doesn’t necessarily need access to those specific records anymore. But in many hospitals, the admissions staff members nonetheless continue to have access to every record on file,” Barkley explains. “By using the algorithm we have patented, those staffers would only be able to access a patient’s record during the admission process. After the patient is admitted, the admissions staff would find the information unavailable, but the doctor treating the patient would still have access to the information.

In 2008, NIST released a SBIR solicitation to help find a company to develop the product from the patent. At that time, Virtual Global Inc. was searching for a way to protect electronic records for their clients. The company purchased the rights to the patent and then integrated the invention into its “HealthCapsule” cloud platform. Virtual Global is now using “HealthCapsule” to create a pilot security system for LIFE Pittsburgh, a long term-care facility.

Funds to Connect Networks

The Department of Commerce’s National Telecommunications and Information Administration (NTIA) announced awards of more than $62.5 million in federal stimulus funding through the Broadband Technology Opportunities Program (BTOP) with additional matching funds for $34.3 million from proposal partners and suppliers.

This grant funding is going to help interconnect more than 30 existing research and educational networks also known as Internet2 that spans 50 states to create a nation-wide high-capacity network. The U.S. Unified Community Anchor Network (U.S. UCAN) will enable advanced networking features to be available for more than 100,000 essential community anchor institutions.

U.S. UCAN will ensure that life-changing applications such as telemedicine and distance learning are available to all community anchor institutions including those in areas previously considered too remote or economically depressed to support advanced network services.

U.S. UCAN provides a jumpstart in implementing the FCC National Broadband Plan released in March 2010 which recommends the development of a unified network dedicated to community anchor institutions to build on the investment that the research and the education community have already made in national network infrastructure.

Doug Van Houweling, Internet2 President and CEO said, “This award provides an unprecedented opportunity to pioneer advanced research and education networking capabilities and to pass these capabilities to the public where they can introduce new possibilities into everyday life. We are honored to be part of this visionary effort, and look forward to rolling up our sleeves alongside both familiar and new partners to bring life-changing internet uses to learning, medicine, job creation, and public safety.”