Sunday, January 30, 2011

DLT Awards $34.7 Million in Grants

The USDA’s Distance Learning and Telemedicine program awarded 108 projects in 39 states and one territory $34.7 million to fund educational projects and expand access to healthcare services in rural areas. Of the grants awarded, 63 will provide distance learning and 45 will be directed towards telemedicine.

At a briefing, Agriculture Secretary Tom Vilsack gave several examples of the projects to receive funding:

• Holzer Clinic will receive $400,83 to provide medical and healthcare training between the hospital hub and 19 outlying hospitals and clinics in 5 rural Southeastern Ohio counties

• Graham Children’s Health Services of Toe River will receive $264,000 to fund a school-based telehealth program called “My Healthe-School project so that school-aged children in two counties in Western North Carolina will receive primary health care, mental health care, and nutritional counseling

• Norton Sound Health Corporation will receive $483,705 to provide basic videoconferencing to use to deliver telemedicine services to help isolated communities in Northwest Alaska

• Schuyler County Hospital District will use funding of $170,000 to fund a portion of a digital mammography system for the Culbertson Memorial Hospital. services to help nearby hospitals in Schuyler, Cass, and Fulton counties

• Finger Lakes Migrant Health Care project will receive $488,265 in funding to expand a farm network and Telehealth network to connect eight migrant clinics and eight community child wellness centers in several areas of rural New York. The funding will also be used to connect hospitals and clinics in Syracuse, Geneva, and Cortland plus other communities to enable distant learning

• Avera Health System will receive a total of $1,107,173 in funding to increase access to telemedicine in rural parts of Iowa and the Dakotas. Telemedicine and telehealth consultations will be provided along with teleradiology, eICU, e-pharmacy, and e-emergency care

Go to for a complete listing of the awards. For information on the Distance Learning and Telemedicine program go to or contact Sam Morgan at or call (202) 205-3733.

Spotlight on Rural Health

Conference attendees came to Washington D.C from all over rural America to hear ideas and thoughts on how to handle critical rural health issues facing our nation. The National Rural Health Association (NRHA) and Policy Partners “2011 Rural Health Policy Institute” held January 24-25, 2011 presented many opportunities for attendees to hear from the federal agency officials, from members of Congress, to network with colleagues and leaders in the field, and make trips to Capitol Hill to meet with members and their staffs. The attendees at the annual NRHA luncheon were able to enjoy listening to a satirical group the “Capitol Steps” poke fun at the Washington political scene.

The Conference brought up some critical rural issues such as dealing with the workforce shortage crisis and how to eliminate the long-standing payment inequities for rural providers. Some of the other critical issues include the unfair treatment of Critical Access Hospitals, the need for rural clinics to participate in the 340B discount drug program, Medicare payment caps to rural health clinics needs to increase, rural access to anesthesia services needs to improve, and fair payment rates for rural pharmacies is vital.

NRHA has released their Health IT priority recommendations at the Conference. NHRA wants to see a centralized federal entity established to identify gaps in current federal program eligibility, determine potential funding streams from across agencies, build awareness of the HIT issues among agencies, collaborate to build an integrated network, and encourage compatibility among state requirements with state level programs.

Marcia Brand PhD, Deputy Administrator, HRSA presented an overview of HRSA’s activities in supporting rural health and how the agency has taken the lead on more than 50 provisions pertaining to rural communities contained in the Affordable Care Act.

The largest and most highly visible program is the expansion of the Community Health Center System and the National Health Service Corps. Also, Dr. Brand, reports that HRSA is working very hard on rural workforce and infrastructure expansion, making evidence-based information available, expanding rural telehealth and health IT, improving rural public health activities, initiating a quality improvement pilot program, and addressing the nation’s oral health needs.

Another speaker Dr. David Blumenthal, National Coordinator for Health IT is proud of the recent HIT achievements. Two weeks after the “Meaningful Use” incentive program was official, over 13,000 providers registered. “Meaningful Use” stage 2 discussions now underway involve health information exchanges, clinical decision support, and consumer and patient access.

He explained how on a recent visit to Holland a country of 16 million, he noted that 100 percent of the general practitioners are transmitting electronically through many local exchanges. As Dr Blumenthal discussed, it has been found that it is important to start information exchanges locally, develop trust in relationships, and then expand nationally. As Dr. Blumenthal explained, developing Health Information Exchanges is a team sport. The first step for the team is to work in communities, and then at that point, the government can help connect the system overall.

Dr. Blumenthal pointed out that the 15 Beacon Communities that received funding to use for HIT pilot projects will demonstrate the feasibility of putting widespread networks in place in diverse areas as Oklahoma, Mississippi, Maine, North Carolina, and Utah. In general, the Beacon community is a magnet for collaboration and innovation and will enable the health IT community to come together.

Dr. Blumenthal and Mary Wakefield, Administrator HRSA are co-leading a HHS Rural HIT Taskforce to address specific health IT challenges and zero in on what needs to be accomplished. In addition, the Office of the National Coordinator is working not only with HRSA but also with the FCC, VA, USDA, and the Department of Commerce on a number of issues of importance to the rural community.

For more information on the NRHA Conference, go to

Alaska's Healthcare Issues

The Alaska Health Care Commission released a preliminary draft report “Transforming Health Care in Alaska” describing 2010 findings and plans for 2011. The Commission was created to address the growing concerns over the state of Alaska’s healthcare system.

For example, the delivery of care is fragmented with costs rising and continuing to climb, they seem to be out of control. Many Alaskans lack healthcare coverage, or have coverage but can’t find a doctor who will accept them as a patient and levels and variations in the quality of care are not well understood. These facts leave consumers unhappy, providers are frustrated, and the system as currently designed is not sustainable.

The Commission prioritized the essential issues to study in 2011. In order to better understand the current cost of healthcare in Alaska in terms of total spending in the state for healthcare services, the Commission contracted with the Institute for Social and Economic Research (ISER) at the University of Alaska, Anchorage to analyze the situation.

The final report expected to be available in April 2011 will include:

• A review of historical spending trends, health insurance and health provider costs, and the distribution of public and private payers
• A ten year spending forecast
• An analysis of cost drivers, to include information on demographic trends, technology, the nature and extent of insurance coverage, and tax treatment of benefits
• An analysis of health spending in Alaska as compared to the rest of the U.S. including health spending trends as a percentage of GDP compared to other sectors

The Commission is going to contract with a healthcare actuarial consulting firm with expertise in the analysis of system-wide healthcare pricing and reimbursement. The consulting firm will conduct a study to compare healthcare provider third party and private-pay charges and reimbursement in Alaska to charges and reimbursement for the same services in Washington and Oregon. The consulting firm will also benchmark those charges against public coverage such as Medicare, Medicaid, Workers Compensation, TRICARE, and the Veterans Administration.

The Commission intends to award this contract soon and hopes to take delivery of the final report by July 2011.

In addition, the Alaska Health Care Commission is also interested in learning how health conditions variables included in the cost equation is driving the use and spending for healthcare services. The Commission has asked the Department of Health & Social Services to do another study to provide information on the health status of the Alaskan population including health trends, and health disparities, and then perform a comparison with national averages.

The Commission anticipates that the information will include data on chronic and infectious diseases, injuries, health risk behaviors, mental illnesses and disabling conditions. This report is scheduled to be available by May 2011.

Reverse Texting Helps Teens

Reverse texting, a new and innovative approach to improving medication adherence among teens and young adults has been developed by the company “iReminder”. Texting is the key driver of medication adherence among teens and young adults because it is their primary method of communication. Physicians are encouraging teens to participate in a sponsored reverse texting program to help teens better manage their asthma, control diabetes, and adhere to their vaccinations schedules.

For example, in a pharmaceutical sponsored program, patients who want to receive vaccination reminders via text messages are asked to text Compliance for Life® (CFL). Once enrolled, reminders are automatically scheduled according to the vaccination protocol and text reminders are delivered at the appropriate times.

This works well for 11-12 year olds who need tetanus, diphtheria and acellular pertussis (Tdap), Meningococcal (MCV4), and HPV vaccines. Reverse testing is also effective for older teens that need Hepatitis aB, polio, measles mumps, and rubella (MMR), and Varicella (chickenpox) vaccines. It is also used to remind teens that need pneumococcal polysaccharide (PPV) and Hepatitis A vaccines.

“This innovative use of testing empowers teens and young adults to take ownership of their disease,” says Army J. Yoffie, CEO of iReminder. “When they do so, they are more likely to stick to their regimen and they also know that CFL automatically alerts their medical provider, if they are not texting and might be at risk. Fitting medication adherence into patients’ lives is a key feature of our technology.”

At their newly re-launched site, more information is available.

Addressing High-Risk Pregnancies

Four BadgerCare Plus contracted health plans are working together on a medical home pilot program beginning 2011 and continuing to 2013, to improve care for high-risk pregnant women in Southeast Wisconsin. This initiative is now set to connect pregnant women with a medical home, according the Wisconsin Hospital Association (WHA) newsletter “The Valued Voice”.

The four BadgerCare Plus-contracted health plans in Southeast Wisconsin are Abri Health Plan, Children’s Community Health Plan, Community Connect Health Plan, and United Healthcare. Each plan emphasizes an obstetric care provider will be the primary point of contact for the women and will be responsible for coordinating all needed care among multi-disciplinary teams.

These plans were selected through a Request for Proposals to serve BadgerCare Plus members enrolled in the Standard and Benchmark plans in Milwaukee County and the five surrounding counties. The sites serve predominately low-income, minority populations and provide comprehensive prenatal and postpartum care for high risk women.

The healthcare organizations involved in the project have demonstrated success with their prenatal and postpartum programs. Many have established some of the capabilities required for a medical home and have demonstrated an interest and readiness towards becoming a fully-developed medical home, according to the plan submitted by Community Connect Health Plan.

The health plans will use the medical home model and a whole range of incentives designed to help ensure that women remain enrolled in the medical home throughout their pregnancy and throughout the postpartum period. The plan will ensure that women keep their appointments and will provide for follow-up for missed appointments and include home visits, personal phone calls, and the use of collateral contacts.

The medical home sites will use an Electronic Health Records (EHR) system or registry to manage medical home member data, organize clinical information including the presence of chronic conditions, track test results and make referrals if needed. The EHR system for each practice will vary based upon their investment in technology. There are a number of different vendors in the market all offering multiple variations from prescribing modules to patient portals.

In looking at EHRs, the higher certification from NCQA generally means that a practice will have an advanced EHR capable of providing the full spectrum of information on each patient. If a practice has not yet invested in an EHR system, it can still achieve a Level I from NCQA. For this practice to achieve a Level III, it would be difficult until they invest in a top tier EHR system.

Throughout the medical home initiative, the HMOs will monitor and report on a number of performance measures, including three Healthcare Effectiveness Data and Information Set (HEDIS) measures, early prenatal care, frequency of prenatal care and postpartum care, as well as patient satisfaction. Performance information will be shared regularly with practices, providers, and patients.

For more information, email, Jason Helgerson, Medicaid Director and Administrator, at or call (608) 267-9466.

Wednesday, January 26, 2011

Conference Ushers in New Era

The eHealth Initiative’s two day Annual Conference “Turning Policy Into Action” held in Washington D.C., wrapped up on January 20th with keynote speeches by Dr. David Blumenthal, the National Coordinator for Health IT, and Cokie Roberts, ABC Congressional Correspondent and Senior News Analyst for National Public Radio.

Registration for Meaningful Use incentives opened on January 3rd and as Dr. Blumenthal told the attendees, “The era of meaningful use is not the end of the journey—just the beginning. There is still an enormous amount of work and education to do.”

He continued to say, “ I think the Meaningful Use era and Meaningful Use concept provides a device for reaching consensus on the optimal use of information for healthcare improvement, both in quality and efficiency, but at the same time, it provides a process for us to hold ourselves accountable.” On January 14th, Dr. Blumenthal’s office released a new survey that showed that 81 percent of hospitals and 41 percent of practices plan to apply for Meaningful Use incentive payments.

Cokie Roberts followed Dr. Blumenthal and speaking as a journalist, a family caregiver, and a cancer survivor, assured attendees that despite the news coverage of Republican opposition to health reform, the current repeal effort in Congress would not succeed. She noted that among Democrats and Republicans now debating the issues, the only thing they can agree on is to support health IT.

Several interesting panels tackled coordinated care. According to Robert Fortini, MD, Chief Clinical Officer, Bon Secours Medical Group, his group has growth plans to include 500 doctors which will necessitate the maintenance of a coordinated system.

He reports that 400 people every hour turn 65, so the need to see more patients and improve patient compliance is essential and can only be accomplished by standardizing care as much as possible. This means that practices will have to analyze and assess their practices thoroughly to be able to perform a clinical redesign of the practice.

Dr. Fortini suggests that one of the first steps is to form a healthcare support team. For example, the physicians in the practice would handle new acute complaints and preventive medicine interventions with medical assistants handling point-of-care testing.

Practices would have case managers embedded in the care of the patients needing coordinated care. They would handle medication refills, monitor patients with chronic diseases, and provide patients with test results. Patients with acute mental health problems, or chronic disease compliance barriers would be helped by other team members perhaps specializing in behavioral health, medical nutrition therapy, and diabetes education.

Dr. Bruce Hamory, M.D, Executive Vice President, Chief Research Officer, Geisinger Health System, noted that new ideas and innovations are a must and we must develop new care management models. For example, we can put more effort into using kiosks to assist patients, and we can also encourage patients and caregivers to enter and check more of their own clinical information as it appears in the system.

Charles Kennedy, M.D., Vice President for Health Information Technology at WellPoint addressed the fact that since most electronic clinical data uses the HL-7 application level standard, a single WellPoint patient may have thousands of HL-7 messages over the course of one disease exacerbation. Each HL-7 message may have coded data, free text, and/or custom codes. Converting this extremely heterogeneous data stream into structured, coded data suitable for interoperability, analytics, and other purposes remains an unresolved challenge.

The Conference concluded with Jennifer Covich Bordenick, CEO, eHealth Initiative, saying “Legislation has passed, the first regulations have been issued, and now we turn to the same issue that we have been grappling with for the last decade—the adoption and use of health IT to improve the quality, safety, and efficiency of healthcare in the U.S. I am reassured after spending two days talking to leading experts and implementers in this country, that if money, expertise, and commitment are adequate inputs, we will certainly succeed in creating a nationwide system of HIT and information exchange.”

For more information on the Conference, go to

Pediatric Medical Home Results

In an effort to do a better job of coordinating the care of children with cancer, heart disease, spina bifida, and other musculoskeletal abnormalities, craniofacial abnormalities, and severe gastrointestinal disorders, Mattel Children’s Hospital established the Pediatric Medical Home Program at UCLA. This program has resulted in fewer emergency department and fewer hospital visits with more outpatient urgent care being used. This is the first study to look at the benefits of the medical home concept in a specialized children’s hospital.

The children enrolled in the program receive virtually all of their medical care at UCLA including primary care and specialist visits. The program focuses on children with complex medical needs because these children have multiple diagnoses, go to sub-specialists, take many medications and use a variety of medical equipment. As a result, their care can be difficult to coordinate. At present, the program serves 110 patients and their families but the goal is to enroll 400 to 500 clinic patients who could benefit from this type of program within the next few years.

Initial funding sources for the program came from the American Academy of Pediatrics’ CATCH grant of $6,000 to help plan the program, a $50,000 a year “Healthy Tomorrows” grant from HRSA covered operating costs during the pilot study, along with an additional $100,000 a year in funding from the Skirball Foundation to enable the program to expand.

Today, the program’s budget comes from the UCLA Department of Pediatrics, but also from a large group of local foundations, and from Medi-Cal. It is thought that changes included in the present health reform legislation combined with potential changes in state-level reimbursement may provide for increased reimbursement for program services.

To begin developing the program, Thomas S. Klitzner, M.D. PhD, Professor of Pediatrics at the hospital worked with a small group of individuals on securing grants and then created a larger committee to develop the program. After securing funding from HRSA, the initial pilot study was undertaken enrolling 43 patients in 2003-2004. At this point, residents were trained and a part time pediatrician was hired.

The UCLA pediatric residents are directly involved with making the program work. All of the patients are assigned a primary pediatric resident for their primary care. As the pediatric residents see more chronically ill patients, and participate in their care coordination, they become comfortable and experienced in taking care of pediatric patients with complicated medical problems.

The question at this point is how to sustain the program and how to establish relationships with would-be-funders. Until payment systems adequately reimburse for services provided by medical home programs is available, outside funding is essential to support program operations. UCLA program now has relationships with roughly 30 foundations to help keep the program operational for the next several years.

Currently, the founders of the program are approaching the public and private insurers along with community-based organizations to educate them on the benefits of the program including the potential to reduce emergency department visits.

The concept to serve other populations is under consideration. The program was originally implemented for a medically complex, socioeconomically disadvantaged patient population. However, the program could possibly be applied to other challenging populations such as treating working age adults and seniors with multiple chronic conditions and especially those individuals facing socioeconomic or ethnic/racial barriers when trying to access care.

Reaching Out to Veterans

The Department of Veterans Affairs (VA) created the “Office of Patient Centered Care and Cultural Transformation” to develop personal, patient-centered models of care for veterans. According to the office’s Director, Dr. Tracy Williams Gaudet, the office is in place to discover and demonstrate new models of care, analyze the results of that care, and then create strategies to allow for their translation and implementation across the VA.

The VA is also developing new ways to reach extremely rural communities and in involved in a partnership between the VA and the Indian Health Services to develop new models of health IT. The partnership will use telehealth services such as telepsychiatry and telepharmacy, mobile communication technologies, and enhanced telecommunications.

To address the needs of rural veterans living in VISN 20 that obtain their healthcare through the VA Roseburg Health Care System (VARHS) located in Roseburg Oregon, a recent draft study was done to find ways to reach out and improve services across VARHS.

One of the strategies recommended was to expand services in this primarily rural area by using more telemedicine services such as home-based monitoring, patient self-testing, remote imaging, and real time consultations.

According to the study, integrating information and communication technologies would enable patients to get care closer to their homes and employees would increase their knowledge and retain marketable telemedicine skills. The use of these services could serve as a model for care delivery in rural settings across the VA’s healthcare system.

In another effort, the VA is currently reaching out to younger veterans through the use of social media including Facebook, Twitter, YouTube, Flickr, and blogs. Currently, the 18-34 year age group still accounts for more than half of the users on the site but older veterans are beginning see the benefits of using social media. In addition, The VA is also going to launch an online communications hub to feature a central VA blog, topical blogs, and a section for guest pieces submitted by VA staff and the public.

The VA is also reaching out to help veterans that are having problems with not only benefit claims but also a number of other veteran issues. A new system called “Executive Contact Management System (ExecVA), cross-cuts throughout the VA. The system can handle calls from veterans from anywhere and has the capability to track the issue until it is resolved.

For example, if a veteran calls in complaining about the treatment he has received at a VA medical center, The veteran’s information and specific complaints are entered into ExecVA and assigned to the VHA where the problem will be addressed. Some issues may require more action by more than one VA employee to resolve a problem especially if the problem is complex.

“ExecVA cross cuts through all business lines throughout the VA,” said Debi Bevins, Director of Client Relations in the Office of the Secretary. “The system will track the problem or issue until it is resolved.” When a call comes in, the agency enters the information into the system and works to resolve the problem by tracking the issue, assigning tasks, and providing periodic reminders until all tasks related to the issue are complete.

Funding Tech Globally

The White House Office of Science and Technology Policy and USAID have formed a public private coalition in Bangladesh to support the implementation of “Mobiles for Health” (M4H), a country-led health information service. M4H provides both audio and text health messages to pregnant women and new mothers and is scheduled to be launched on a national scale in mid 2011.

USAID is providing technical assistance, technology development, and corporate sector engagement while M4H financing will be sustained through corporate sponsorships, co-branding opportunities, product advertising, user fees, and partner in-kind contributions.

Other global projects include two mobile device projects under development by Abt Associates to strengthen healthcare under USAID’s HS 20/20 project. Abt has introduced mobile devices to improve supportive supervision of health workers in Ethiopia and Nigeria. Currently, TB and HIV/AIDS clinic supervisors are using PDAs to monitor activities.

In another mHealth application under the USAID HS 20/20 project, Abt is assessing costs and quality of health services across six networks in Haiti based upon analysis of patient data. Using netbooks, the costing team is able to access, organize, and analyze substantial amounts of data directly from national EMRs stored in local servers. Netbooks require little or no training compared to PDAs to achieve a rapid start to collecting data.

The Bill and Melinda Gates Foundation, the Foundation for Innovative New Diagnostics, a public-private partnership with Cepheid Inc., the University Of Medicine and Dentistry of New Jersey, along with funding from NIH, have developed a fully integrated and automated instrument to detect the presence of TB and resistance to rifampicin in less than two hours. Rollout of the new instrument Xpert MTB/RIF Rapid Diagnostic Test for TB and Rifampicin resistance along with the release of a roadmap by WHO, has made the global community hopeful especially in rural areas.

The President’s Emergency Plan for AIDS Relief (PEPFAR), USAID, and CDC are going to work together to support the rapid scale-up and appropriate use of this new technology. Dr. Thomas Frieden, CDC Director said, “Having a reliable test that can detect TB and MDR-TB in less than two hours is a great tool. This is especially important in caring for HIV-infected persons who are at greatest risk for the rapid progression of TB.”

To improve the health of Kenyans in the western region of the country, USAID has awarded a comprehensive health service delivery project to the “Program for Appropriate Technology in Health” (PATH). The project referred to as APHIAplus “is going to work to strengthen the region’s healthcare system by rehabilitating health facilities, provide training to staff, and support supply and communication networks.

PATH and partners will implement the APHIAplus project in Western and Nyanza Provinces from January 1, 2011 to December 31, 2015 and work closely with the Government of Kenya. The amount for the five year award is $143 million and is one of several region-specific health projects that USAID/Kenya plans to award in the near future.

Malawi’s National Malaria Control Program (NMCP) uses quarterly supervision visits to monitor how facilities are diagnosing and treating malaria as well as collecting data and keeping tabs on the availability of malaria medicine. However, some health facilities lack internet connections for quickly gathering and consolidating the data.

In 2010, with funding from USAID President’s Malaria Initiative, the Strengthening Pharmaceutical Systems Program and the NMCP DataDyne’s free survey software tool (EpiSurveyor) was piloted on mobile phones with data collected via mobile phone networks throughout the country.

Grants for Pediatric Devices

FDA’s Pediatric Device Consortia grant funding supported by the Office of Orphan Products Development, has made approximately $2.5 million available to fund two to four new awards. The grants non-profit consortia will be awarded up to $1,500,000 in total cost (direct costs plus indirect costs) per year.

The development of pediatric medical devices currently lags 5 to 10 years behind the development of devices for adults. Children differ from adults in terms of size, growth, development, and body chemistry adding to the challenges of pediatric device development. The need to develop medical devices for children is important as well as adapting existing adult devices to use for children.

The grants are available to any domestic, public, or private, nonprofit entity including state and local units of government. Go to the January 19th Federal Register for more information with the full RFP available at The application is due on May 2, 2011.

For further information, call Linda Ulrich or Debra Lewis at the Office of Orphan Products at (301) 796-8660 or (301) 827-7175.

Sunday, January 23, 2011

Systems Available for Licensing

The Army is looking for industry partners to license and commercialize the advanced point-of-care Battlefield Medical Information System-Tactical (BMIST). The system developed by the Army’s Telemedicine & Advanced Technology Research Center (TATRC) was initially developed for use by Special Forces medics and other first responders.

BMIST operates on commercially available computer and communication hardware such as Pocket PCs with Wi-Fi wireless connectivity and has been deployed within the U.S. government within the U.S. Special Operations Command and the White House Medical Unit.

BMIST provides a point-of-care handheld device that enables healthcare providers, to record, store, retrieve, and transmit the elements of clinical encounters in an operational setting. The system also provides comprehensive point-of-care reference materials and diagnostic and treatment aids. Plus the system directly interfaces with handheld PC based medical instruments like a pulse oximeter for integrated patient diagnosis, monitoring, and record keeping. Further development could enable BMIST to incorporate advanced healthcare management applications including automated prescription drug management and automated patient billing.

BMIST is protected by a patent application. The Army will convey as part of a patent license agreement, commercial rights to the invention, as well as the source code. Collaborative R&D is a possibility.

For more information, email Sean Pattern at or Kurt Rued at

In another opportunity, the Army seeks to commercialize through patent licensing a web-based system to be used to electronically store and disseminate dental records and images between generalists and specialists to diagnose or determine a treatment plan.

TATRC developed the web-based communication technology to collect and disseminate data relating to a patient or a patient’s condition. The system includes a storage capability that enables the data to be accessed or amended at any time.

The system can create and transfer dental records including images, diagnosis and treatment records, and communications between referring providers and specialists. A series of prompts and drop-down menus ensure that the appropriate data is input by referring and consulting dentists. An image manipulation routine allows the consulting dentist to zoom in and out, invert, rotate, flip, and change the contrast and the brightness of images.

The patent “Teledentistry Consult Management System and Method” has been filed by the Army with the software code available for commercial licensing. For further information, email Kurt Rued at or Dan Swanson at

Telemedicine Bills Introduced

New York VP Pro Tempore David J. Valesky introduced SB 662 on January 5, 2011 to promote the development and accessibility of telehealth and telemedicine services especially in underserved geographic areas in the state. The legislation would also establish a New York State telehealth and telemedicine development and research grant fund.

AB 422 introduced January 5, 2011 by New York State Assembly Woman Aileen M. Gunther, would enable demonstration rates or payments to pay for telehealth services provided by certified home health agencies, long term home healthcare programs, and AIDS home care services. AB 422 would help to ensure the availability of technology-based patient monitoring communication and health management.

On January 5, 2011 (AB 548) was introduced by New York State Assemblyman Jeffry Dinowitz to provide a tax credit for the purchase of technology to be able to remotely monitor persons with Alzheimer’s disease and/or dementia.

A bill (H 37) was introduced by Representative Suzi Wizowaty in 2011 in the Vermont legislature and would require all health plans including Medicaid to cover telemedicine services. A healthcare practitioner licensed in the state would be able to prescribe, dispense, or administer drugs or medical supplies, and provide treatment recommendations to a patient after examining the patient either in person or by the use of instrumentation and diagnostic equipment. Images and medical records would be able to be transmitted electronically and prescriptions could be issued via electronic means.

State Representative Naomi D. Jakobason introduced (HB 010) on January 12th in the Illinois General Assembly to enable the Department of Healthcare and Family Services to reimburse for telemedicine services when used by physicians, advanced practice nurses, FQHCs, or psychiatrists. The Department would establish the criteria for the services to be reimbursed and could also include appropriate facilities and equipment.

Space Medicine Accelerating

One of NASA’s key initiatives is to adapt ultrasound to space flights and use ultrasound on the International Space Station (ISS) with remote guidance. The role for NASA’s Advanced Diagnostic Ultrasound in Microgravity (ADUM) research team, based at NASA’s Johnson Space Center, is to test how ultrasound is used in large medical centers and under laboratory conditions.

In studying the use of ultrasound for remote possibilities, the team links a remote expert with an on-site operator to conduct ultrasound examinations. The process is started when the ultrasound machine video output is transmitted to the remote expert via a satellite or internet connection with the on-site operator able to obtain the ultrasound images via voice commands.

The ADUM team has experience using ultrasound to help in remote environments such as on Mt. Everest and at the Arctic Circle. The team designed a self-contained system that includes a portable ultrasound device, solar power, satellite phone connectivity, and a laptop computer containing educational programs.

Using the technology enabled an untrained mountaineer to perform a complete lung ultrasound scan on a fellow climber on Mt. Everest using cue cards and remote guidance. When the non-expert did the ultrasound, he was able to send high quality ultrasound images to a remote expert to diagnose fluid in the lungs. A similar remote ultrasound system was used in the Canadian Arctic Circle enabling non-expert operators to perform targeted scans of almost every organ system.

The ADUM investigators are also studying how to use ultrasound to answer primary clinical diagnostic questions in unconventional settings where ultrasound is the only source of imaging, and where on-site expertise is limited.

In another project, by using NASA’s software developed at the Goddard Space Flight Center to enhance Earth science imagery, Bartron Medical Imaging was able to develop the new MED-SEG system to aid in the interpretation of mammograms, ultrasounds, and other medical imagery. The MED-SEG System can enable medical centers to send images via a secure internet connection to a Bartron data center for processing by the company’s imaging application. The data is then sent back to the medical center for use by medical personnel during diagnosis.

While crew health and performance depends on optimal brain function, many aspects of the spaceflight environment can adversely affect the brain and nervous system. Concerns include radiation, environmental toxins, elevated carbon dioxide levels, temperature extremes, nutritional effects, sleep deprivation, and chronic stress.

Physiological brain monitoring is not part of routine medical care for astronauts, due to an absence of practical neuromonitoring methods. The standard clinical brain imaging methods all fail to meet the basic flight requirements of low mass, low power, low volume, low crew time and low cost.

To address the ability to make in-flight neuromedical assessments, researchers at Harvard and Massachusetts General Hospital are in the process of developing lightweight, low power, mobile Near-Infrared Neuroimaging (NIN) systems that rely on near infrared light penetrating through several centimeters of tissue.

The technology underlying NIN can potentially support a range of field applications. The portable NINscan device is able to discriminate blood volume and oxygenation changes in the brain from those changes in the periphery, allowing examination of the effects of microgravity on blood circulation and tissue oxygenation. This is necessary to know to be able to diagnose and treat sleep deprivation, chronic stress, and depression.

On earth, numerous applications are possible since systems like NINscan could be used in outpatient settings to help identify neural markers of disease and to determine disease severity or treatment efficacy. Also, when caring for post-surgical brain-injured or sleep disordered patients, patients could wear devices such as NINscan to help with epilepsy or use if they are at risk for chronic subdural hematoma.

Another project nearing readiness for testing on the ISS is a device developed at the National Space Biomedical Research Institute. The device is a small noninvasive spectroscopic sensor that can continuously measure and report muscle metabolic parameters important in assessing the metabolic rate and the fitness and health of astronauts.

On earth, the spectroscopic sensor could be of value to emergency and critical care physicians in diagnosing and treating critically ill patients, plus the sensor holds promise for use in air, on ground ambulances, and on the battlefield. The device can also diagnose anemia and chronic heart problems. The muscle metabolic measurements may one day help rehabilitate patients with muscle injury or atrophy and be able to provide cost effective healthcare to adults and children in remote areas.

Two monitoring devices, Crew Physiological Observation Device (CPOD) and Biomedical Wireless and Ambulatory Telemetry for Crew Health (BioWATCH) are being developed to monitor the vital signs of astronauts aboard the ISS. Both devices would be worn on the body and would be able to wirelessly record or transmit information in real-time to a physician on Earth.

CPOD is being developed at Ames Research Center in partnership with Stanford University to track heart rates, blood pressure, body temperature, breathing rates, and blood oxygen content. With SBIR funding from The Glenn Research Center, ZIN Technologies has partnered with the Cleveland Clinic to develop BioWATCH to monitor heart rate, blood pressure, glucose, temperature, joint angels, body weight, planter pressure, electrocardiogram data, bold oxygenation, and other data.

ZIN Technology is also developing a commercial version of BioWATCH called vMetrics™, which has a platform technology that integrates with existing healthcare IT infrastructures supporting current patient electronic medical records standards. The device will transmit data in real-time via cell phone, wireless internet, or Bluetooth and has the capability to monitor patients receiving home care.

In addition, NIH along with other federal agencies, academic institutions, and industry are working together on the ISS to research projects of common interest. Specifically, NIH’s initial research on ISS will investigate specific disease processes in cells by using the microgravity environment to find novel mechanisms that scientists can use as targets for drug development.

A portion of the above information was abstracted from NASA’s magazine “Technology Innovation” in an issue devoted to health and medicine in both space and on Earth. To download the publication, and contacts, go to

TH/TM Issues in the State

In 2010, the state of Maryland conducted a statewide inventory of current projects to better understand the present state of telehealth/telemedicine (THTM) projects. This information was needed before the state could move forward with a consortium to deliver services, develop a compatible infrastructure, address key issues, use technology more widely, and potentially be able to apply for increased funding.

In 2010, the Upper Shore Regional Council obtained a grant to fund the survey through the Maryland Agriculture Education and Rural Development Assistance Fund and sub-contracted with the Maryland Rural Health Association to administer the survey.

The THTM Survey targeted 95 facilities including hospitals, FQHC’s, departments within the University of Maryland Medical System, JHU Health System, and MedStar Health, as well as local health departments, state correctional institutions, and projects within the Maryland Department of Health and Mental Hygiene. The survey respondents included 30 facilities representing 53 different THTM clinical sites. However, 12 of the 95 facilities reported having no involvement in THTM.

The response rate was lower than anticipated but the survey found that THTM projects were more plentiful but it was also found that the THTM programs were far more fragmented than expected. The survey also found that the four barriers to telehealth implementation included reimbursement and other funding issues, lack of coordination and leadership, lack of broadband in areas, and legal barriers still exist that relate to licensing and credentialing providers especially across state lines.

On December 8, 2010, the Rural Maryland Council hosted a roundtable in partnership with the Maryland Rural Health Association and Upper Shore Regional Council to review the results of the THTM survey and discuss recommended potential next steps to try to eliminate the barriers.

Potential steps and ideas included:

• Monitoring the impact of any proposed legislation related to THTM reimbursement during the 2011 legislative session
• Monitoring CMS response to the proposed THTM reimbursement regulations for telemental services and if approved monitor the cost to implement
• Advocating for broader implementation of THTM reimbursement outside of the public health setting
• Not pitting rural and urban providers against each other in the reimbursement arena
• Educating doctors about THTM to reduce a sense of competition for reimbursement dollars

The state also realizes that THTM does not having the appropriate state leadership and coordination to deal with the issues. To remedy this situation, the state plans to create a statewide telehealth network, establish a statewide coordinating boy, coordinate activities with the Health Care Reform Coordinating Council’s Telemedicine Task Force, and advocate for better telehealth training and education.

The state also needs to address the poor access to high speed broadband services available in rural areas. The goal is to support the expansion of the state’s high speed internet highway, consider incentivizing last mile providers to provide service to private practices and to the homes of physicians living in areas with no high speed broadband, encourage local ISPs in rural and underserved areas to improve service, and monitor the environmental assessment process.

The state realizes that it is necessary to deal licensing and credentialing that is especially important to providers across state lines. The recommended thought is to continue to communicate with the University of Maryland Law School as the School continues to study the issue, work with stakeholders and practitioners on recommendations, educate and inform legislators on the issues, provide medical services to underserved areas in surrounding states via THTM, and develop mutual credentialing and licensing procedures as part of that strategy.

A draft of the Final Report of the “December 2010 Maryland THTM Roundtable” was prepared January 2011. To view the report, go to


The Delaware Health Information Network (DHIN) became the first operational statewide health information exchange in 2007. Today, more than 345 Delaware practices are live on DHIN with more than one third of all DHIN practices receiving their clinical results or reports through the exchange. Additionally, 75 percent of the state’s acute care hospitals participate in DHIN and all participating hospital emergency departments and laboratories send their data through DHIN to the Division of Public Health for public health monitoring.

On January 3rd, DHIN issued RFP 01-2011 “Comprehensive Health Information Exchange Evaluation: ROI and Benefits Assessment”. The goal is to evaluate both the quantitative and qualitative value achieved through the health information exchange in order to provide benefit statements to stakeholders on an ongoing and future basis.

DHIN stakeholders include employers, health plans, hospitals and hospital systems, national reference laboratories, patients, physician practices and community health centers, and the state of Delaware.

DHIN’s goal is to reduce the time and financial costs needed to exchange health information among providers and payers by reducing the complexity of the current distribution methods and drastically increase the use electronic communications.

DHIN will use a financial model to recover costs incurred by participants relative to the benefits provided and show a plausible return on investment for the charges incurred. DHIN will use the information to craft a financial model for planning future services and to plan and obtain sustainability.

In the future, some of the interstate HIEs will need to connect to DHIN to help bordering hospitals and physicians. DHIN is primarily doing cross over business with Maryland, Pennsylvania, and New Jersey. Discussions are ongoing with these states on developing collaborations.

The proposal is due on February 14, 2011 with the contract to be awarded in March. For questions, email Sarah Matthews at or call (302) 678-0220. To view the RFP, go to

Cal eConnect Issues RFA

Cal eConnect has issued a Request for Applications (RFA) to implement Health Information Exchange (HIE) standards and protocols developed by the Federal “Direct Project”. The funding is made possible by the California Healthcare Foundation.

To meet the need to find a simpler way for providers to securely transmit patient information, the HHS Office of the National Coordinator (ONC) developed the “Direct Project” The project’s plan is to find a standards-based way for providers to send patient health information directly to known trusted recipients over the internet at a relatively low cost.

The development phase is complete and now ONC is initiating pilot projects to determine the overall viability of these simpler technologies and test specific priority information exchange scenarios. The exchange of information will also test specific scenarios of laboratory data exchange, care summary exchange, and public health reporting. The results will help develop Cal eConnect’s Core Services and help the ongoing development of standards and protocols by the Office of the National Coordinator.

The applications are due on February 18, 2011. Total funding for this program is $300,000 with a maximum award amount per grant of $100,000 with the project to be funded for six months.

Non-profits (501c3 and 501c4) organizations including HIE organizations, provider organizations, health plans, local government agencies or municipalities, and other community-based organizations are eligible to apply.

Go to for more details. For questions email Rebecca Kriz, RN, Program Specialist, or call (510) 978-4844.

Monday, January 17, 2011

2011 Health Technology Reports Available

Two updated and revised reports for 2011 have just been released by Bloch Consulting Group describing Federal government activities in telemedicine, telehealth, eHealth, health technology and related areas. “Activities in Telemedicine Telehealth and Health Technology” (2011 edition) includes information on 24 cabinet level and independent federal agencies. The other updated report for 2011 “Selling to HHS” helps individuals and companies navigate within all of the relevant programs at HHS.

“Today, we’re seeing new programs funded by the stimulus play a pivotal role in health information technology development plus we’re seeing how the healthcare reform legislation is going to impact health technology,” according to Editor Carolyn Bloch. “In fact, with the additional funding plus agency appropriations, many agency programs that were previously underfunded are now up and running.”

The 250 page edition of the “Activities in Telemedicine Telehealth and Health Technology (2011) report describes how agencies are organized along with many ongoing activities relevant to the field. The report points out numerous grant and contract programs that can give individuals and industry new ideas for further business development.

The newly updated version of the 45 page report “Selling to HHS” specifically helps individuals and companies market their technology products and services, secure grants, and locate good possibilities for funding. This report is included free with all orders for the 2011 Federal Activities report.

The reports are available as digital downloads in PDF format. More information is available at the Bloch Consulting Group web site at

FCC Chairman Speaks at CES

The 2011 International Consumer Electronics Show (CES) held in Las Vegas, displayed breakthrough devices that will bring a tidal wave of new mobile innovations and machine-to-machine wireless technologies according to FCC Chairman Julius Genachowski speaking at CES. He said “Since the consumer electronics industry is going wireless, the future success of the industry depends on whether the U.S. government acts quickly to unleash more spectrum to handle wireless traffic—the oxygen that sustains mobile devices.

According to the Chairman, without action, demand for spectrum will soon outstrip supply and this is why unleashing spectrum is at the top of the FCC’s 2011 agenda. As he reports, “The amount of spectrum available for mobile broadband represents about a threefold increase over where we were a few years ago. This sounds good, until you see the forecasts of a huge increase in mobile broadband traffic over the next 5 years.

Genachowski discussed how the FCC is addressing the need for more spectrum to be made available for broadband and to remove unnecessary restrictions on the use of spectrum. This means that the recovery of 25 megahertz previously used for wireless communications services and 90 megahertz of mobile satellite spectrum for use for terrestrial broadband will now be available. As a result, 500 megahertz of spectrum will be made available for broadband which is almost double of what is currently available.

As reported, the Department of Commerce’s NTIA is setting up a “Spectrum Management Advisory Committee to discuss the broad range of issues regarding spectrum policy. Commerce and other government agencies will continue to encourage dynamic spectrum sharing and secondary markets for spectrum as well as the development and deployment of smart antenna technology and devices. These devices have the ability to access unlicensed spectrum like Wi-Fi to off-load traffic from cellular networks, free up “white spaces” spectrum in the television bands, and remove barriers to the build-out of wireless infrastructure.

The Chairman commented on how voluntary incentive auctions would help free up spectrum for mobile broadband. The FCC is already paving the way for incentive auctions, going towards lifting technical restrictions so prime bands of spectrum can be freed for flexible broadband use. Just recently, a joint letter sent from associations in the industry representing more than 2,000 companies with over $1 trillion in revenue, was sent to Congressional leaders to swiftly pass legislation allowing the FCC to conduct voluntary incentive auctions.

In other FCC news, the agency has just announced the availability of their new “Open Internet Challenge” to encourage the development of innovative and functional applications. This program will enable users to have information on whether their fixed or mobile broadband internet services are consistent with the open internet. Software tools are needed to detect whether a broadband provider is interfering with DNS responses, application packet headers, or content. Details on the “Open Internet Challenge has been posted on

HRSA Releases FOA

On January 12th, HRSA’s Office of Rural Health Policy released the “Delta Health Initiative Cooperative Agreement” a Funding Opportunities Announcement (FOA). The funds will go to help an alliance of providers address longstanding unmet rural health needs in the Delta Region in Mississippi. The residents greatly need access to healthcare, health education, research, job training, and capital improvements.

The goal for the Delta Health Initiative is to help improve the health of the people as the Delta region is notable for its poor disease profile, high rate of heart attacks and strokes, as well as other life-threatening conditions. According to the Dreyfus Health Foundation, Delta poverty levels are significantly higher than national averages and access to basic healthcare is also a major problem in the region with nearly one in five Mississippians lacking health insurance.

Previously, HRSA’s Office of Rural Health Policy funded a 5 year Cooperative Agreement for $24.75 million in 2006, and $23 million in FY 2008. The grantees are working with 10 partners on projects aimed at improving chronic disease management, health education, and wellness promotion. The grantees are also working to improve access to healthcare services, develop HIT in the region, develop workforce training, initiate care coordination, and construct health facilities. The consortium proposed 24 projects, and devised communication and coordination systems among themselves.

To be eligible for the FOA, an organization must be a non-Federal, not-for-profit alliance, and consist of no fewer than four academic institutions committed to addressing the healthcare needs of the Delta region. The Alliance must include both the State Medical Association and the State Hospital Association, an academic health center, a minimum of two regional universities, a school of nursing, and have a relationship with a strong economic development entity. The alliance must have at least three years experience working with the FQHCs and local health departments.

The application deadline is March 15, 2011 with the projected award date to be July 01, 2011.
The cooperative agreement will provide funding for fiscal years 2011-2015 with approximately $34,000,000 expected to be available annually to fund one awardee. Funding is dependent on the availability of appropriated funds for the Delta Health Initiative.

For more information go, to or email Bridget Ware at or call (301) 443-3822.

Vermont's Blueprint for Health

Craig Jones, M.D., Executive Director for the Vermont Blueprint for Health program speaking at the December Health Affairs Innovation Conference reported that approximately 50 percent of Vermont’s population is overweight and roughly 20 percent are obese which eventually contributes greatly to developing chronic diseases.

To address the health needs in the state, the Blueprint program provides information, tools, and support to help manage an individual’s health and well being plus the program assists primary care clinicians to provide coordinated and patient-centered care. Basically, Blueprint provides a foundation for medical homes that includes community health teams supporting coordinated care linking to a broad range of services.

The program operates with local multidisciplinary teams set up to provide care coordination for individual patients. The teams consist of nurse coordinators, medical social workers, behavioral specialists, dieticians, public health prevention specialists, and other health professionals.

The Vermont Blueprint program initially selected six communities to participate and the program started by targeting diabetes care. This was accomplished by training providers, providing for payment incentives, using health IT, providing community outreach, and evidence-based care. Today, communities all over the state are joining the program.

Developing a workable payment system is a major issue in Vermont and the state also needs to address the state’s financial issues. The Blueprint program part of the answer expects to save $100 million over expected normal growth by 2013. The program has tested and supports multi-insurer payment reform to help medical homes and community health teams. Medicaid and private payers participate and providers are reimbursed based on their NCQA-PCMH score.

In addition, their health information infrastructure includes a web-based clinical tracking system called (DocSite), to provide electronic prescribing, EMRs, and a health information exchange network. The data is transmitted between EMRs, hospital data sources, and DocSite. Also available is an evaluation infrastructure that routinely collects data to support services and guide quality improvements.

During the pilot program for Blueprint, Medicare was paid by the state out of general fund dollars. This could not continue, so as a result, Vermont was selected to take part in the Medicare demonstration project along with other states.

Legislation had been introduced in the state to expand Blueprint and the legislation has a requirement for the Department of Vermont Health Access to expand Blueprint to at least two primary care practices in each hospital service area by July 2011 and to all primary care practices who wish to participate by October 1, 2013. The ability to expand further was dependent on receiving the CMS demonstration project grant.

The Commonwealth Fund and the National Academy for State Health Policy recently published a new report “Leading the Way: State Innovations in Primary and Chronic Care Delivery.” The report studies efforts underway in six states including Vermont. The report examines the roles that the states are playing to reorganize the delivery of primary and chronic care in more efficient and effective ways.

For more information on the Health Affairs Innovation Conference, go to, and to view the new Commonwealth Fund and NASHP report, go to

HP to Create Texas MHIE

On January 12th, HP announced a 52 month services agreement with the Texas Health and Human Services Commission to create a statewide Medicaid Health Information Exchange. The contract valued at $30 million includes an electronic health history system for all Medicaid clients. It will also replace current paper-based Medicaid identification cards with plastic magnetic stripe cards for automated eligibility verification.

Under the agreement, HP will provide web-based tools to streamline provider interaction and increase access to health information. Additionally, the updated system will aid the Commission in its efforts to improve prescription services which will provide Medicaid recipients with improved access to their health information. The system is going to be powered by InterComponentWare’s eHealth Framework.

Specific enhancements include:

• Permanent ID cards—Monthly distributed individual paper Medicaid ID cards will be replaced with permanent plastic cards for more than 3 million Medicaid recipients
• Provider web portal—The system will enable 70,000 Medicaid providers to have access to Medicaid recipients health histories via a secure electronic health information exchange network
• E-prescribing—Providers will have access to a web-based e-prescribing tool allowing doctors to send electronic prescriptions directly to the patients pharmacies
• Recipient care web portal—A website will be developed for recipients to securely access their personal health information and check program eligibility

“States need to improve health outcomes and enable better access to healthcare records,” said Susan Arthur, Vice President, U.S Healthcare, HP Enterprise Services. “With more than four decades of industry-leading experience, HP will provide the cost-effective healthcare solutions Texans need.”

For information on HP, go to

Helping Vets with Vision Issues

According to the December 2010 “VA Research Currents”, the Veterans Administration is exploring new technologies to help people with vision loss. Today, the blind are able to use “talking” handheld GPS devices sometimes with a guide dog to help them navigate.

However, there are limitations in using GPS devices. For example, directions for pedestrians can be off by 50 or even 100 feet, clouds or tall buildings can block signals, indoors GPS devices may not work at all, and even under ideal conditions, a consumer GPS device is usually accurate to only about 10 feet. To overcome these problems, a VA-funded group of researchers are designing a computer vision system to bridge these limitations.

“We envision combining out system with technologies such as GPS,” explained Cha-Min Tang MD, PhD, at the Baltimore VA Medical Center and the University of Maryland. He is being helped by David Ross Med, MSEE a VA rehabilitation engineer at the VA’s Atlanta Vision Loss Center.

To study the problems, a person with vision loss will wear stereo headphones with a small webcam and microphone attached to their clothing. The devices are wired to a small laptop carried in a backpack and the researchers are looking to the future when smartphones may be able to handle the computing. When the user wants to find a specific location, the computer compares the webcam’s view with still images of the area around the target that has been preloaded into the computer. Beeps and other audio signals in stereo indicate how to proceed along with computer-generated speech to provide additional feedback.

For indoor navigation, still images will be needed for every 15 to 20 feet along each path the user might follow. The idea is that a sighted volunteer would snap the images ahead of time and upload them into the user’s computer. Eventually, large public sites could eventually offer downloadable libraries containing images of high traffic areas.

For outdoors, a different approach is needed. One idea is to rely on the GPS to let the user know roughly where he is and then call up a small set of relevant images for that location. At that point, computer vision would take over and give more detailed guidance.

Another option is to add an Inertial Navigation Unit (INU) about the size of a flash drive. INUs are used to aid navigation on airplanes and submarines. The idea is to use a Google map and the GPS to let you know more or less where you are and then the INU and the camera will tell you how you are moving and pinpoint the location.

Researchers at the Atlanta VA are evaluating an alternative approach. Their system relies on a smartphone to stream video frames to a central server. The server analyzes the images and sends back navigation data. The plus is that users don’t have to carry their own computer. The minus is that connection speeds can affect how fast the system works.

The different approaches each have advantages but the researchers think that the ultimate solution is to build a combined system using complementary technologies that will be reliable under a wide range of conditions.

Wednesday, January 12, 2011

DOD's Dispensing Units

The Department of Defense is studying new medication methods to use to deliver individual doses of medication at regularly scheduled times and in the correct dosage. The Navy has partnered with DOD’s Telemedicine and Advanced Technology Research Center (TATRC) to study the potential benefits of a “Telepharmacy Robotic Medication Dispensing Unit” (TRMDU) for returning service members suffering from traumatic brain injuries or suffering from psychological stress.

The study will evaluate the impact of point-of-care medication delivery systems on medication adherence, drug related problems, the effect on hospital admissions and emergency department visits, impact of TRMDU’s on patient pain, on the psychological well-being and health-related quality of life, and lastly, the study will evaluate the costs for using TRMDUs.

The TRMDU, a FDA approved medical device is to be located in a warrior transition unit. The device with two-way communication software enables a healthcare professional to remotely manage prescriptions stored and released by the patient operated delivery unit. The delivery unit is about the size of a bread box and plugs into a standard power outlet. It stores prescription medications, emits an audible alert to the patient when the prescribed medications are scheduled to be taken, and then releases the medications onto a delivery tray.

Medications are delivered at appropriate times when the system is activated by the patient. Healthcare professionals would be able to use a web-based application to remotely schedule or adjust a patient’s prescribed medications and they are notified each time a patient accesses the system.

The TRMDU is a patient-friendly device linked wirelessly to software that can be used in a number of environments. Each TRMDU holds a one month supply of up to ten prescriptions and multiple TRMDUs may be connected to increase the number of managed prescriptions.

Autism Treated via Telehealth

CDC now estimates the prevalence of Autism Spectrum Disorders (ASD) to be 1 in 110, up from 1 in 150 just 3 years ago. While the causes of ASD are unknown, effective treatment is available and there are now more resources through public funds and private insurance to meet the need than ever before. It is clear that access to physicians and other diagnosticians is critical to helping families deal with ASD and by using telehealth technologies it can be an effective strategy.

That is why support from a “Real Choice Systems Transformation” five year grant funded by CMS, made it possible for the state of Missouri to help children with ASD. The funding for the grant “The Use of Telehealth for Service Provision to Children with ASD” helped the state use a number of strategies to improve access to community-based services with telehealth as one of the key strategies.

At this point, a small pilot study with 5 patients was conducted by Dr John Mantovani, M.D. Medical Director, St. John’s Mercy Children’s Hospital. The pilot focused on children between 2 and 4 years of age that had been referred for possible ASD issues by primary care physicians for diagnosis. According to the project completion document, telehealth technologies were used to evaluate the children and it was found that using telehealth for diagnosis depends on:

• Appropriate qualified professionals including state licensed physicians, psychologists, or other health or mental health professionals. They should have advanced training and clinical experience in the diagnosis and treatment of ASD and other neurodevelopmental disorders
• Reliable, secure, and confidential video access along with adequate support from the information technology staff available on both ends of the connection
• Availability of completed pre-evaluation information in the form of parental questionnaires and information on prior testing plus observational information from relevant care takers and professionals
• A range of age appropriate toys and other items to facilitate the evaluation
• Parents who can understand the examiner and can work with their child under the direction of the examiner

The pilot concluded that if two examiners instead of just one examiner observes and interacts with the child and family either simultaneously or in tandem, similar reliable results will occur. This approach is currently being used by Dr. Matt Reese and colleagues at the Kansas University Center for Child Health and Development where a physician and psychologist work side-by-side during telemedicine evaluations.

It was found that diagnostic reliability appears to be directly related to the severity of the symptoms when using telehealth to evaluate the child. It was felt that although a considerable number of young children can be diagnosed via telehealth there will still be children with more severe problems that can’t be adequately diagnosed by just using distance technology.

One of the issues that arose during the telemedicine examinations was not being able to have the child visible at all times. Sometimes a child may run around the room and be too far from the video screen or completely out of view. The thinking is that perhaps some type of barrier or small wall could be used to form a corral to contain the child.

It was also felt that the ability to interact with the child via the equipment could be improved by lowering the video-screen in the room to either eye-level with the mother’s seated position or the child’s eye level to enable the child to get as close to the screen as possible to enhance interaction with the examiner.

The report also points out that some of the barriers to using telehealth concerns the availability of networks and/or the ability to create new networks. Although many hospitals and medical centers have the capacity for telehealth connections, most often telehealth in these locations is used for distance learning, lectures, and conferences rather than for clinical activities. The MTN system operates many sites in the state, but these sites are limited to the University of Missouri Health System providers.

In the state, reimbursement is a key issue and needs to be dealt with locally and regionally since third party payers vary significantly with regard to coverage for professional services. So far, the Missouri HealthNet Program has been reimbursing telehealth services provided by physicians, nurse practitioners, and psychologists since 2008. An additional modifier code (GT) was added to the usual CPT code for the provider with reimbursement the same as for an office consultation.

Missouri continues to be active in the autism field. A bill signed into law in 2008, established a Governor-appointed Commission for Autism Spectrum Disorders plus an Office for Autism within the Division of Developmental Disabilities. Today, a home and community-based Medicaid waiver for children with ASD was approved by CMS and currently serves 150 children.

In addition, legislation to become effective this year requires private insurance to cover applied behavioral analysis for children through age 18 and establishes standards for professionals providing services to autistic children.

The report stresses that there is a need for a more comprehensive ASD project to continue to evaluate the use of telehealth to diagnose and manage children with ASD, but for another project to take place more grant funding is needed. The report looks for possible future financial grant support from HRSA especially in their rural health program, the Missouri Foundation for Health, Autism Speaks, and the Thompson Foundation.

To view the complete report, go to For more information, contact the Missouri Department of Mental Health at or call (573) 751-4122.

Telemedicine Faces Challenges

The New York State Health Foundation (NYSHealth) mostly supports grants to expand health insurance coverage, improve the management and prevention of diabetes, and encourage the integration of substance use and mental health services. NYSHealth is interested in opportunities that fit their mission but are also interested in opportunities that are perhaps outside of their priority areas.

Bassett Healthcare and affiliates is a system of physicians, providers, hospitals, and community health centers in 8 counties in New York, covering 5,000 square miles. The Mary Imogene Bassett Hospital, the foundation for the Bassett network is a 180 bed acute care inpatient teaching facility located in Cooperstown N.Y.

In their 2007 response to the NYSHealth grant program, Bassett Healthcare received funding for the grant “Expanding Access to Specialty Care in Rural Hospitals through Telemedicine” for $977,586 that ran from 2007to 2009. The goal for the grant funding was to use telemedicine to deliver healthcare in central upstate New York and provide telemedicine availability across Bassett healthcare’s system of care.

The project’s history began with a central hospital and four affiliated hospitals with 250 salaried physicians, 23, regional clinic sites, and 13 school-based pediatric clinics. This hospital system appeared to be the ideal place to implement a telemedicine system aimed at expanding access to care. Bassett initially foresaw a hub and spoke arrangement with its main hospital in Cooperstown being able to provide specialty teleconsulting services for patients at their affiliates.

Originally, in partnership with the New York State Department of Health, Bassett in 2000 put a Telestroke initiative modeled after the REACH program in Georgia in place to help treat patients in rural areas. The original plan was to use the grant funding to build upon their Telestroke initiative but at the same time explore treatment for other acute emergencies using telemedicine.

Portable video conferencing carts supplied by Polycom were placed at several locations in Bassett’s Cooperstown facility and at each of the affiliates to make it possible for consulting physicians in the emergency room, inpatient areas, and the outpatient clinic to treat patients. Subsequently Tandberg equipment was added to enhance equipment compatibility so that Bassett would be able to expand beyond treating strokes for remote patients.

Eventually, the telemedicine technology proved to be workable only for stroke patients but the physicians could see that the intended additional uses for remote technology for acute emergency care included in the plan were not going to work using telemedicine.

Challenges resulted in setting up the project. First of all, the technology from the start of the project was not always up to current standards. The project eventually explored and purchased alternative and more suitable telemedicine systems.

Secondly, because the initial plan was to use telemedicine to manage remote patients presenting with acute emergencies and strokes, using the REACH system, it might have worked in NY State as it does in Georgia, but the REACH technology only works for strokes and Bassett’s plans were more far reaching.

Thirdly, Bassett had invested in expensive technology but the technology would not work with cardiac patients or others presenting with acute emergencies. Groups of specialists were sending patients with acute emergencies immediately to the hospital rather than interact with the hub hospital remotely.

Also, additional state regulations introduced another challenge. New York State does not allow a hospital to transfer its credentialing approval to any of its affiliates so each physician delivering teleservices has to submit to a separate credentialing process as required at each of the affiliate sites.

The credentialing process not only includes a review of educational degrees and completed training, but also requires a separate assessment of the individual’s performance at that site which must be approved by the hospital board and renewed on a regular basis. These requirements severely constrain the possibilities for remote consultations on severe acute conditions. So if there is no neurologist available to assess a stroke patient and no cardiologist available to assess a heart patient, treating these patients at the smaller hospitals can be a potential violation of the state’s regulations.

To, meet the challenges and to look for new directions, focus groups were held, discussions with individuals and at conferences took place, and individual interviews with doctors and nurses were held to look for other ways that telemedicine could best address their needs. The need to manage home care patients with chronic conditions was discussed and a plan of action was initiated. Presently, 17 Phillips home monitoring units were placed with Bassett’s affiliated home care service “AHCare” to help patients with heart failure, chronic obstructive pulmonary disease, diabetes, and hypo/hypertension.

Bassett is also exploring other uses for telemedicine as for skin and wound care services, to provide remote sleep apnea for evaluations and other pulmonary services, to provide diabetes support, provide plastic surgery and dermatology teleconsultations, link to a dialysis center, use telemedicine for psychiatry, for post-operative interactions, and to treat pediatric asthma. Plans are to serve other migrant health clinics elsewhere in upstate New York.

NYSHealth still has an active grant program and has just issued their RFP in December 2010 for their “2011 Special Projects Fund” grant program. Funding requests range from $50,000 to $1,000,000 with grants typically in the $250,000 range. Organizations can apply for these grants at any time through May 5, 2011. Organizations nonprofit (501) (c) (3) and for profit organizations with a significant presence in New York state will be accepted.

For more information, go to NYSHealth web site at and click on Funding Opportunities. Projects that involve the purchase, installation, or upgrade of HIT systems including EMRs will not be accepted. To view the Bassett Healthcare Summary go to

MMIS Project Advancing

The Arkansas Department of Human Services as administrator for the state Medicaid program through their Division of Medical Services (DMS) is in the process of issuing an RFP to provide for the Arkansas MMIS Replacement Project. The RFP was due to be released January 3, 2011 but has been delayed until the end of January.

The goal for this procurement is to provide DMS with the information management tools and business partners to assist in managing the Medicaid program. The procurement will have a total of 23 or 24 RFPs all of which will have common boiler plate. The system RFPs will include an RFP for the Systems Integrator and RFPs for system components. Prospective bidders may bid on one or more RFPs.

After the RFP is released, the plan is to have the RFP out for four months and then the state will conduct demonstrations and evaluate vendor products. Vendors will need to have a working product to demonstrate by next May.

Gene Gessow, the new Arkansas Medicaid Director, explained how the future success for dealing with ballooning costs really depends upon Medicaid and Medicare and private insurance aligning their processes. It is also necessary to address quality, costs, information and data sets so that everyone is headed in the same direction so that single provider communities have a clear signal from the payer community.

The MMIS Replacement will be designed to interoperate and exchange both administrative and clinical data through the Arkansas Health Information Exchange. Whenever practical, HIE and MMIS will adopt a common infrastructure and technical governance, however, as of yet, there has been no decision about a Medicaid HIE but it is a possibility.

The release of the RFP is anticipated by the end of January, RFP responses by May, product demonstrations by June, and the award to come in October.

For information, email Drenda Harkins at When the RFP is released, it will be posted on

IT Industry a Bright Spot

North Dakota’s IT industry remains a growing and vibrant part of the state’s economy and is well positioned to expand its current IT businesses and attract new companies. As the industry continues to evolve, cooperation among the state’s industry, government, and educators, positions the state to take advantage of state and national trends and remain a strong competitor in the global economy.

Despite having one of the lowest population densities, the state continues to offer broadband services to the most rural communities in the state resulting in 95 percent of the state’s population having access to broadband services.

The state government recognizing the importance for a robust IT infrastructure to compete in today’s global economy, created the state’s Information Technology Department (ITD) along with several programs and incentives available to state IT businesses to grow or expand their businesses.

The ITD is working with the State’s Office of Management and Budget State Procurement Office and the State Enterprise Architecture program to issue a Request for Proposals (RFP) to re-bid State Contract 095-IT Professional Services Contract Pool. Under this state contract, state term contracts are awarded to multiple vendors in specific IT contract pool categories

By pre-qualifying vendors based on the state’s requirements and establishing master term contract, both state agencies and vendors benefit from lower procurement costs associated with work orders under this contract.

The state plans to release the RFP on February 14, 2011 where it may be downloaded from the State Procurement Office web site at For more details, email Patrick Foster or call (701) 328-1992.

The state is also pursuing other means and incentives to help state IT businesses expand and grow. For example, the North Dakota Department of Commerce through their Centers of Excellence program is encouraging researchers and students at colleges and universities to find ways to commercialize their new ideas into products, skills, and services to attract new businesses to the state. Seventeen new or expanded businesses currently operate in the state as a result of the Centers of Excellence program and three of these businesses are IT-related.

Another program “Innovate ND” looks for entrepreneurs who want to turn ideas into new ventures. The program brings together entrepreneurs, investors, and educators and works with participants from both new and existing companies to attract business to the state.

A third program “Technology-Based Entrepreneurship Grant Program” provides up to $1 million in grants to entrepreneur centers to help mentors, enable shared services, provide relationships with educational institutions, assist with marketing and financial management, and the program holds training sessions on how to comply with regulations.

Each year, the state publishes an industry guide. The “2011 State of the IT Industry Guide” is available online and was distributed to the Legislative Assembly in December. The document is available at

Sunday, January 9, 2011

Rural HIT Report Published

HRSA’s Office of Rural Health Policy (ORHP) provided onetime funding for $25 million to help 16 rural grantees implement health IT pilot networks in an 18 month time frame. The funding for the program was through the Medicare Rural Hospital Flexibility (FLEX) Critical Access Hospital (CAH) HIT grants.

In December 2010, HRSA published the report “Evaluation of the Flexibility Critical Access Hospital HIT Network Implementation Program”. The report evaluates how the grantees established HIT programs and helped future providers and networks adopt HIT. The report describes how grantees designed, created, and implemented functioning CAH HIT pilot networks and also describes the experiences of partner organizations.

The grant program enabled grantees to establish HIT systems, but also allowed them to use the funds in a flexible way. Some of the grantee hospital programs already had systems in place but others had very little or nothing in place. As a result, the program started with the grantees at different levels of maturity.

Grantees worked on a range of HIT projects, to include developing systems for practice management, disease registries, care management, clinical messaging, personal health records, electronic health records, and health information exchanges.

In evaluating the HIT approach, two day site visits were conducted with four grantees at the University of North Dakota Center for Rural Health, Oklahoma State University Center for Health Sciences, South Carolina Office of Rural Health, and the Board of Regents of the University of Wisconsin System, to explore how the Flex CAH HIT grants were administered, how they were implemented, and the initial outcomes.

In general, the grantees experienced several challenges involving the timeframe allowed, governance issues, unclear evaluation expectations, and issues on how to sustain the activities of the grant. Grantees also raised technical support issues since although they knew that technical assistance resources existed, it was difficult to find information on the resources and how to access them.

Grantees want to see a longer grant funding period for future HIT planning and implementation grants. They also want to see governance structures standardized, see ongoing evaluations, support broader sustainability planning, see the vendor selection expanded, have assistance with procurement and implementation, have adequate staff education and training provided, have a mechanism for cross-grantee collaboration and networking established, and see a better ways to handle the larger issues inherent in large system implementations.

The grantees learned several lessons such as the need and importance for good project management for such a large and complex project, the need to focus on the process of change, the need for good financial planning along with fiscal management, time management, plus good communication and coordination among partners is needed.

Go to to view the report.

HHS Tracking Innovations

HHS released the solicitation notice “Initiative to Support Innovation Scanning” on December 30th at seeking ways to track impending innovations and technology trends as they relate to health IT. The goal is to exchange information between the Office of the National Coordinator for HIT, key subject-matter experts, and HIT innovators and developers.

Today, the HIT industry is developing a range of innovative technological approaches. Some will not succeed while others will succeed modestly, while other innovative changes will have great impact. Futurists see the technology of 2015 being very different from the technology that is available today.

To have the most current information on innovations establishing an exchange will enable ONC and other HHS agencies to have continual updates on the most promising HIT innovations that will support meaningful use and the adoption of HIT. The exchange will enable the systematic identification of HIT innovations in critical care delivery areas where problems are not currently being addressed as well as identify early emerging, breakthrough advances that can shape policy and technology initiatives.

For more information on solicitation (11-233-S0L-00047), email Thomas P. Lawson at or call (301) 443-7081.

On January 3rd, AHRQ released a synopsis on the publically available “Health Care Innovations Exchange II” published in originally published in December. The synopsis seeks proposals on how to operate, maintain, and improve the present “AHRQ Health Care Innovations Exchange” (HCIE) resource which can be found at

HCIE is an internet-based repository for healthcare service delivery innovations and related information and showcases tools with publically available information. HCIE is needed to help make strategic decisions and also to promote further innovations in the healthcare system.

The five tasks listed in the synopsis are to develop content, recommend changes, design, develop, test, and operate the Innovations Exchange infrastructure and web site, propose learning and networking opportunities, and manage the project.

The full Solicitation will be released shortly. Individuals interested in responding to the solicitation need to monitor the release of the solicitation information through or

For more information on the synopsis (AHRQ-11-10006), email Erin Mills at or phone (301) 427-1169.

RFP for Epilepsy Projects

The new Therapy Grants Program is a partnership between two leading epilepsy nonprofit organizations, the Epilepsy Therapy Project and the Epilepsy Foundation. Both organizations are funding projects and request proposals from scientific and clinical investigators working on innovative projects. Grant funding will range from $50,000 to $500,000.

The goal is to advance new therapies, medicine, and therapeutic devices that demonstrate a clear path to commercialization to help children with epilepsy. All grant proposals must demonstrate a clear path from the lab to the patient.

The reviewers will take into consideration whether the program can lead to a new therapy that is approvable by FDA or can meet other criteria for reimbursement. Preference will be given to proposals that already have a commercial partner assisting with development and to proposals that have committed or have matched funding from a sponsoring institution, commercial partner, or other third party source. Proposals originating from outside the U.S. are welcome.

The Letter of Intent (LOI) is due on March 2, 2011 and if the LOI is accepted, the full application is due on April 13, 2011. For more information, email or go to

Broadband Helping Telemedicine

More than $4 billion in Recovery Act funding was allocated to Commerce’s National Telecommunications and Information Administration (NTIA) Broadband Technology Opportunities Program (BTOP). The funding helped deploy broadband infrastructure, expand public computer centers, promoted the sustainable adoption of broadband services. Today, BTOP projects are in the process of directly connecting or improving connection speeds for nearly 3, 000 hospitals and other healthcare facilities.

The Recovery Act funded grants to 56 grantees one from each state, a U.S. territory, and D.C. NTIA has just prepared a document that gives an overview for the grant awards. The publication “The Broadband Technology Opportunities Program: Expanding Broadband Access and Adoption in Communities Across America” specifically has information on programs developed that will or have helped deliver telemedicine to communities.

For example the ION Upstate New York Rural Broadband Initiative will expand a broadband middle mile network in Upstate New York and parts of Pennsylvania and Vermont. The project plans to extend its relationship with the New York State Office for Mental Health and the Bassett Hospital and Healthcare system to enable the state and Bassett to upgrade their telemedicine practices and better serve rural residents.

The Pennsylvania Research and Education Network or PennREN, intends to connect community institutions in South and Central Pennsylvania, PennREN plans to become the main artery for the exchange of healthcare information across the state, linking the Hospital and Healthcare Services Association of Pennsylvania, the University of Pittsburgh Medical Center, Penn State Hershey Medical Center, the Pennsylvania eHealth Initiative and the Mountain Health Care Alliance.

The Iowa Health System (IHS) is upgrading its 3,200 mile broadband network connecting or improving connection speeds for over 200 healthcare entities across the state including hospitals, primary care physicians, medical facilities, community health centers, clinics, and other providers, many in rural areas.

The state’s broadband capabilities will improve healthcare delivery, telemedicine, 3-D imaging, diagnosis, monitoring, transferring EHRs, research and distance education. In addition, Central Iowa Hospital Corporation’s Rural Telehealth Initiative links healthcare providers, EMS units, city governments, and schools to provide telehealth, improve health related distance learning, enhance EMS capability and disaster readiness, and provide telehealth services to correctional facilities.

The Nevada Hospital Association is building and will operate a telehealth network to connect 37 rural medical providers and the University of Nevada Medical Center, plus the Indian Health Board of Nevada which represents 13 tribal medical facilities across the state. Construction for the network will entail building 224 new miles of fiber, use an additional 453 miles of existing fiber and 580 microwave miles. The network will enable videoconferencing, telemedicine applications, and us of EMRs.

Go to to view the report.

PCAST Report on NIT

The President’s Council of Advisors on Science and Technology (PCAST), a group of presidentially appointed experts from academia, non-governmental organizations, and industry just released the report “Designing a Digital Future: Federally Funded Research and Development in Networking and Information Technology”.

The report includes several sections on Networking and Information Technology (NIT). The report makes recommendations on how NIT and the Nation’s Networking and Information Technology Research and Development Program (NITRD, a collaboration of more than a dozen Research and Development agencies working together, can help improve healthcare and the quality of life.

According to the report, the U.S. is spending considerably less on NIT research and would benefit both from a larger investment. The report makes it clear that although NIT has thoroughly infiltrated the business and some administrative aspects of healthcare, NIT has not come close to fulfilling its potential. The current push for meaningful use of EHRs, the increasing use of NIT as a surgical tool, the revelation of the structure of the human genome and the biomedical insight flowing from the information, and the increasingly broad and pervasive access to health information online are all promising starting points for future advances.

The business side of clinical care already makes wide use of NIT. The U.S is moving towards a future in which all health information sources, all professional and non-professional care, and most non-pharmacological interventions will be NIT-based.

Research in the field is needed on methods to use for the semantic analysis of natural language, for the extraction of semantic information from raw data, and for translating among different terminologies and categorizations used for the same kinds of information.

Making use of potentially huge quantities of health information of all kinds requires novel techniques to abstract higher-level concepts and explanations from lower-level data to determine relevance in context and to resolve conflicting information.

According to the report, the federal government has recognized the importance of NIT for health and has embarked on an aggressive program to institutionalize EHRs. The Strategic Health IT Advanced Research Projects (SHARP) program currently funded by ONC is excellent but it addresses relatively short-term problems.

Other agencies however, have initiated promising longer-term programs such as NSF’s Smart Health and Wellbeing Program, NLM’s health data standards and telemedicine projects, NIST’s Healthcare Infrastructure Integration projects, but still larger investments in these efforts are needed.

The report’s recommends that NSF, HHS with participation from ONC, CMS, AHRQ, and NIST, the Veterans Health Administration, DOD, and other interested agencies should invest in a national long-term, multi-agency research initiative on NIT for health that goes well beyond the current national program to adopt EHRs.

PCAST recommends that these agencies should build on national activities that promote the adoption and meaningful use of EHRs that are usable by all appropriate organizations, complement the shorter-term ONC programs, and augment the research investments that the various agencies are currently able to make.

The agencies should give increased attention to using NIT for wellness and for addressing chronic conditions, continue to investigate novel uses for NIT, such as NIT-assisted surgery to deliver care for acute conditions. They should also continue to pursue advances in sensing and monitoring to understand the basic biological and psychological mechanisms that underlie disease. The agencies also need to continue to address NIT research opportunities that support work by HHS and NSF on transformational innovation in healthcare delivery. Lastly, the funding levels and project durations must be sufficient to foster substantive collaborations between NIT researchers and clinical experts.

Go to to view the report.