Sunday, February 27, 2011

CMS Budget Request

CMS for FY 2012 is requesting $777 billion, a net decrease of $10.2 billion below the FY 2011 level. The funding request includes $661 million for general IT systems and other systems to manage and administer Medicare Advantage Part D benefit and the CMS data center and telecommunications infrastructure. The request includes $244 million to modernize and transform CMS enterprise-wide IT systems.

The Affordable Care Act provides funding to states and territories to establish their Exchanges. In 2010, HHS awarded $48.8 million to 48 states and the District of Columbia to begin planning for their exchanges. Additional planning and establishment grants will be awarded in FY 2011 with renewals available through January 1, 2015. After the initial implementation, the exchanges are to be self-funding.

To deliver innovations in providing care, Accountable Care Organizations (ACO) are scheduled to begin in early 2012 will enable providers to receive a portion of any savings in the Medicare program resulting from effectively coordinating high quality care. Also, expected in early 2012, the “Medicare Independence at Home” demonstration will use home-based primary care teams directed by physicians and nurse practitioners. In addition, ACO also created the Center for Medicare and Medicaid Innovation to be funded at $10 billion over ten years that will work with private sector partners to find promising models to test.

The budget request also includes savings proposals to offset the cost for two years so that physicians will not sustain cuts resulting from the Sustainable Growth Rate (SGR) formula. The Administration intends to work with Congress to provide longer-term relief for physicians.

mHealth Grants Available

The Center for Technology and Aging located in Oakland California has announced that “Mobile Health Diffusion Grants are available to help fund the adoption of mHealth technology to help older adults and also to reduce the burden of care on clinicians and caregivers. As many as six one year grants will be awarded for up to $100,000 each from the $500,000 grant program. Grantees are required to provide a match in new funding and/or in-kind support that is equivalent to at least 25 percent of the award amount.

For this initiative, mHealth is broadly defined as the delivery of health-related services to patients, clinicians, and caregivers through mobile technology platforms on cellular or wireless networks. Mobile technologies can include but are not limited to tablets, cell phones (hardware and software), smartphones, mobile-enabled diagnostic devices, or devices with mobile alert systems.

The grants applications need to address how mHealth technologies will impact older adults along with caregivers and providers. Also, the benefits that can result in treating and monitoring chronic conditions, improving socialization and communication possibilities, and the ability to provide enhanced monitoring. Other care-related issues that can be addressed include medication compliance, safety monitoring, and access to health information. The grants however, cannot be used for technology and equipment costs.

The eligible organizations that can apply can include non-profits with a 501c (3) designation, local, state, and federal government agencies, and universities and colleges. Grantee projects must have established a relationship with a health provider and vendor.

Letters of Intent are due April 5, 2011 but full proposals will only be accepted if invited by the Center. Full proposals are due May 13, 2011.

For further information, email Margaret Whelly, Research Program Administrator for the Center at or call (510) 285-5685. To review the Grant Application Guide, go to

AJRR Pilot Established

The American Joint Replacement Registry (AJRR) is an independent, not-for-profit to uniformly collect joint replacement and revision data to monitor device performance. The Registry was created to provide the data needed to support best practices related to safety, costs, and advances in technology.

Existing registries outside of the U.S. have resulted in up to a 10 percent reduction in revision rates. The American Association of Orthopedic Surgeons estimates that there are more than 800,000 hip and knee replacements performed in the U.S annually. This means that even a modest two percent decrease in the U.S. revision rate would yield a savings of $65.2 million in one year with potential projected savings of more than $1.3 billion in over 20 years.

New York University (NYU) one of 16 locations selected to participate in the new Joint Replacement Registry Pilot. The locations selected by AJRR’s “Hospital Surgeon Participation Workgroup” and range from academic centers to smaller community hospitals plus private orthopedic practices have produced a diversity of hospitals in terms of geographic locations, size, and practice types.

According to Joseph D. Zuckerman, Professor of Orthopedic Surgery and Chairman of the Department of Orthopedic Surgery at NYU Langone Medical Center, “Similar registries in other countries have proven to be successful and with the aging baby boomer population, it is necessary to engage and educate our patients to develop the best care for their joints in the future.”

Replacement joints have a relative lifespan before a device many become loose and potentially require additional surgery. This procedure is called revision arthroplasty where a previously implanted artificial joint is removed and replaced with a new one. AJRR can play an important role as early implant failure can be indicated, evidence can be made available that can positively influence physician behavior, decrease the burden of disease and costs associated with surgical morbidity and mortality, and reduce the volume of premature revision procedures.

AJRR will collect data from both younger joint replacement patients (40-60) as well as from Medicare patients. The data from younger patients will provide long term information about the progression of joint replacements and the impact of wear and tear over time from a more active population. The data will help patients make more informed choices in consultation with their surgeon, how to time their total joint replacement procedures, and provide information on the best course of rehabilitation.

The pilot will conclude once it generates three months of data from each institution but the long term goal is to capture data from 90 percent of U.S. hospitals where hip and knee arthroplasty procedures are performed for the next 5 years.

For more information contact Randolph R. Meinzer, Director of Information Technology at (847) 430-5033.


The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) on February 15th issued a Request for Applications to support the continued development of the “NIDDK Consortium Interconnectivity Network Coordinating Unit” (dkCOIN-CU).

The expansion of the dkCOIN-CU to be awarded through this announcement will help to create and expand a user friendly web interface to seamlessly integrate information, resources, and data held by a number of NIDDK related research groups.

Other goals for the program are to move towards cloud computing, implement tools to foster mining of information, provide links to relevant data sources from the broader research community, and to develop and hold workshops and other collaborative activities.

Eligible applicants can include higher education institutions, non-profits, for profits, state and county governments, plus other entities are invited to apply.

The application is due by April 15, 2011. NIDDK plans to award $600,000 in FY 2012 with one award. For more information, call (301) 435-0714, email, or go to

Maryland Helps Post Docs

A new hands-on course called “INNoVATE ™” located in Maryland is geared to help post-doctoral fellows and research scientists in the life sciences bring innovations to the marketplace by starting their own companies. Billions are spent on research in life sciences in the D.C. Metro area at NIH, universities, federal, state, and local research centers, laboratories and now there is the need for entrepreneurs to bring this newly developed technology to the marketplace.

There are 5,000 post-docs in the D.C. area with academia employing 7 to 10 percent of these post docs. Since there is a lack of opportunity, very often the talent leaves the area. The program INNoVATE ™ started with grant funding from the National Science Foundation and is backed by the University of Maryland Baltimore County, Johns Hopkins University’s Carey Business School, Montgomery County Department of Economic Development, and Rockville Economic Development to help the post-doc community develop innovative science-based companies.

The course is taught by seasoned life sciences business people who have all started and run their own companies. With the proper guidance, the hope is that many of the participants in the program will actually start their own companies. Post-docs with particular scientific expertise are matched with mentors from the business community and work with either a technology they bring in themselves or work with a technologies offered by local academic or government institutions such as NIH and NIST.

The 2010 INNoVATE ™ class had 16 post docs and 9 scientists plus business people enrolled. At the end of the program, three companies were formed with four or five more participants considering forming companies.

Once participants establish their companies through INNoVATE ™, they are encouraged to contact TEDCO, one of the business incubators in Montgomery County, or seek help from the Technical Council of Maryland, or from MDBio.

The program’s three year goals are to:

• Train 45 post docs to start companies using technologies from federal and academic laboratories
• Train 45 business people, scientists to start science-based companies
• Evaluate 60 candidate technologies from NIH and other federal laboratories
• Continuously modify the curriculum to fit the needs of science and technology entrepreneurs
• Develop a model for federal tech transfer
• Study, monitor, and evolve the program to complement traditional offerings at prestigious business schools

The 2011 class started in February. For more information on the program, email Dr. David Fink, Director of Entrepreneurial Service at the University of Maryland, in Baltimore at or go to the INNoVATE web site at

Tuesday, February 22, 2011

AHRQ's Budget Request

The FY 2012 budget request of $390 million for AHRQ is $12 million below the FY 2010 level. To meet their health IT research needs, AHRQ is requesting $28 million to support on-going projects. AHRQ’s health IT program works in collaboration with the Office of the National Coordinator for Health Information Technology to implement health IT research as authorized in HITECH Act.

The FY 2012 budget level for health IT will support 46 research and training grants funded at $14 million. In addition AHRQ will support $13 million in contracts related to synthesizing and disseminating evidence on the meaningful use of health IT and help to develop the tools and resources needed to implement best practices.

AHRQ’s support for patient safety activities includes $65 million in the budget for FY 2012 with $34 million for projects to reduce and prevent Healthcare-Associated Infections (HAI). Of this total, $10 million will be invested specifically in the implementation of evidence-based practices to prevent common HAIs such as central-line associated blood stream infections and catheter-associated urinary tract infections.

AHRQ’s current research projects to prevent HAIs are now operational in every, state, Puerto Rico, and the District of Columbia. These projects provide evidence-based practices, tools and training in hospital intensive care units. In FY 2012, AHRQ will continue to expand the program to more hospitals in each state and to more healthcare settings beyond the ICU.

Starting in 2010, 86 AHRQ tools to advance patient safety were made available to healthcare providers to include research summaries, training tools, surveys on patient safety culture, along with access to web-based patient safety networks. Plans are for AHRQ to continue to increase the number of resources to total 92 tools in FY 2011 and 98 tools in FY 2012.

An investment for $4 million in FY 2012 would help to continue projects such as “My Own Network” powered by AHRQ, also known as “MONAHRQ” that provides states and communities with software to publically report comparative quality improvement data.

In addition, the budget included $92 million for crosscutting research in a range of topics related to improving quality, effectiveness, and efficiency in healthcare. This funding would help AHRQ further support innovative health services research, coordinate data collection, perform measurement and analysis, and disseminate and translate research findings.

The budget includes $33 million for investigator initiated research projects and to continue the support of core data and measurement activities related to the Healthcare Cost and Utilization Project and the annual National Healthcare Quality and Disparities reports.

Alaska Initiates HIE Pilot

The Alaska eHealth Network started the New Year by initiating a Health Information Exchange (HIE) pilot to help Alaska’s volunteer hospitals and ambulatory clinics. According to AeHN’s publication “Exchange”, the first phase of the pilot now connects four hospitals and four clinics. Upon completion of the pilot phase in April 2011 AeHN will begin to implement HIE services statewide.

Initial pilot sites include Alaska Heart Institute, Alaska Native Medical Center, Bartlett Regional Hospital, Fairbanks Memorial Hospital, Providence Hospital, Tanana Valley Clinic in Fairbanks, and Valley Medical Center in Juneau. The selected HIE vendor Orion Health will expand the number of sites and provide for over 300 interfaces in 2011.

Initial HIE services provide the secure exchange of laboratory data, to do e-prescribing, provide demographics data, and to provide admission discharge and transfer data. Priority for data selection was determined based on the requirements for “meaningful use” set by CMS.

With one common interface to the HIE, providers are able to connect with many services across Alaska, thus, eliminating the need to develop and manage multiple electronic health record interfaces.

For more information, contact AeHN’s Director Bill Sorrells, at

CDC's Budget Request

CDC’s total FY 2012 budget request plus the funding needed for the Agency for Toxic Substances and Disease Registry is $11.3 billion. Of this amount, $753 million would be available from the $1 billion allotted to the Prevention and Public Health Fund or referred to as the “Prevention Fund”. This would help CDC build on prior investments in public health infrastructure, help community and state prevention efforts, and to set up programs to try to prevent smoking and obesity.

CDC is asking for $1.2 billion to address their “Chronic Disease Prevention and Health Promotion” program of which $460 million would be funded through the Prevention Fund. The budget redirects $705 million for a new competitive grant program to refocus activities from disease-specific programs into a program that is more comprehensive in its approach. Since many chronic disease conditions share common risk factors, the new program would be better able to coordinate interventions to reduce chronic diseases.

CDC would award grants to:

• Health departments to implement evidence-based strategies to address the leading causes of death and health disparities
• Academic health centers to develop, test, and evaluate effective interventions to reduce chronic conditions
• National organization to provide technical assistance, training, and support to health departments
• States will receive performance awards if they significantly improve health outcomes

To meet the needs of the agency, the budget eliminated duplicative community grant programs and the “Preventive Health and Health Services Block Grants” because CDC will address these activities through the new Prevention Fund and through Community Transformation Grants.

The “Community Transformation Grant” program was launched in FY 2010, and is a Recovery Act initiative put in place with $650 million. Of that amount, CDC awarded $373 million to 44 communities to reach over 50 million Americans to implement evidence-based prevention and wellness strategies.

The budget includes $494 million, which is $53 million above FY 2010 to improve public health surveillance and infrastructure. This increase includes a decrease for the genomics program and includes increases for the public health workforce, and for the healthcare surveillance and statistics programs.

As for the health surveillance and statistics program, CDC requests $197 million which is an increase of $38 million over FY 2010. The funding for the program would be used to obtain and use statistics to understand health problems, recognize emerging trends, identify risk factors, support electronic birth records in all 50 states, guide programs and policy, and monitor the impact of health reform.

CDC’s Environmental Health programs budget request includes $138 million with $9 million in the Prevention Fund to finance a portion of the Environmental Public Health Tracking Program.

The Budget request for preparedness and responding to terrorism is $1.45 billion for biodefense and emergency preparedness activities which is a decrease of $70 million below FY 2010. Within that total, $643 million is requested for Public Health and Emergency Preparedness Grants. These grants support local preparedness efforts and the grant program is coordinates their efforts with the Hospital Preparedness Grants administered by the HHS Assistant Secretary for Preparedness and Response.

Early Innovator Grants Awarded

HHS awarded seven cooperative agreements with funding of $241 million to help a group of “Early Innovator” states design and implement the information technology infrastructure needed to operate health insurance exchanges. Using the new funds, the selected states will develop Exchange IT models that can be adopted and tailored by other states.

The “Early Innovator” states to receive funding include:

• Kansas: Kansas Insurance Department ($31,537,465)
• Maryland: Maryland Department of Health and Mental Hygiene ($6,227,454)
• Multi-State Consortia: University of Massachusetts Medical School ($35,591,333)
• New York: New York Department of Health ($27,431,432)
• Oklahoma: Oklahoma Health Care Authority ($54,582,269)
• Oregon: Oregon Health Authority ($48,096,307)
• Wisconsin: Wisconsin Department of Health Services ($37,757,266)

All “Early Innovator” states will have to be committed to developing technology that is reusable and transferable. Using the grants, the states will provide models for how Exchange IT systems can be created. At the same time, states will continue to have the flexibility to develop an Exchange that best meets the needs of their unique health insurance market.

Go to for more information.

Medicaid Contract Awarded

HP announced winning a $281 million seven-year IT services contract with the Oklahoma Health Care Authority (OHCA) to extend their long-time service agreement with the state. HP will continue to act as the state’s fiscal agent, providing systems support and business process outsourcing services for the state’s SoonerCare Medicaid Management Information System (MMIS).

OHCA manages SoonerCare benefits for more than 750,000 Oklahoma residents through 29,000 providers while processing about 40 million claims per year. The state expects as many as 240,000 additional SoonerCare members after healthcare reform takes effect.

Through the new contract, HP will provide:

• SoonerCare Medicaid online enrollment, eligibility determination, and claims processing
• A call center and internet to provide desk support for members and providers
• A web-based member portal allowing Oklahomans to apply for and track benefits online
• An upgrade to the existing web-based provider portal
• Assistance to the state to add new International Classification of Diseases—10th Revision (ICD-10) medical coding features and information on federal HIPAA 5010 requirements

Under the previous contract, HP worked with the agency to develop processes for online member enrollment with instant eligibility determination, online provider enrollment, and streamlined prior authorization workflow. The new provider process reduced the approval time for new healthcare providers from several weeks to days. HP also developed the Newborn-1 website giving SoonerCare qualified mothers of newborns easier access to healthcare.

New York State Issues RFP

The New York State Office of Mental Health (OMH) issued a Request for Proposals (RFP) to find eligible applicants to provide behavioral healthcare coordination and/or related services to large urban populations. The funding of $3,200,000 is available to provide these services through the New York City “Care Monitoring Initiative” (CMI).

CMI monitors mental health services for consumers and was developed jointly by the Department of Health and Mental Hygiene (DOHMH) and the New York State OMH. CMI works directly with Medicaid claims and other secondary data to identify individuals with serious mental illnesses living in New York City who may be experiencing lapses in needed services.

When the Medicaid claims are reviewed, notification flags are used to:

• Identify individuals that have not received ambulatory mental health care or substance abuse services in the prior 120 days
• Identify individuals that have not had psychiatric medication prescriptions filled in the prior 60 days
• Identify individuals that have had two or more emergency room visits or psychiatric inpatient hospitalizations in the prior 120 days

The CMI staff reviews the monthly notification reports and establishes contact with the providers that last served the identified individuals. Then outreach and retention strategies are put in place to help individuals receive the services that they need. For example, “Return to Care” teams are being developed within the program and will work to locate and engage the identified consumers and their families on the importance and availability of support services.

RFP eligible applicants include public, private, non-profit, or for-profit entities. Preference will be given to applicants with the ability and/or history to provide services to individuals being served in a public mental health system.

The RFP was released January 28, 2011 with proposal submissions due April 1, 2011 with the anticipated contract start date to be July 1, 2011.

Go to for more information

VA's $100 Million Competition

The Department of Veterans Affairs (VA) opened the 2011 “Industry Innovation Competition” with up to $100 million in awards to identify, fund, and evaluate promising innovative technology proposals to improve the quality of healthcare for veterans.

The competition is part of the VA’s “Innovation Initiative” (VAi2), a department-wide program that solicits the most promising innovations from employees, the private sector, non-profits, academia, and entrepreneurs, to improve the quality of services delivered, enhance VA operations, and reduce or control the cost for delivering services.

The program is specifically looking for new ways to:

• Leverage telemedicine solutions to provide audiology services to veterans that live far from medical centers
• Create and implement enhancements or novel uses of VA’s “Blue Button” personal health record
• Design innovative prosthetic socket designs to improve the fit and comfort of prosthetics
• Fully automate sterilization of medical equipment
• Empower veterans with self-management technologies for vocational rehabilitation

This is the second Industry Competition launched by VAi2. Awards from the 2010 competition are announced on a rolling basis as contracts are finalized. For more information about VAi2, go to and go to for more federal opportunities for businesses under the VAi2 program.

Wednesday, February 16, 2011

NIH Budget Request

HHS Secretary Kathleen Sebelius, NIH’s Director Francis S. Collins MD, PhD, and the other HHS top officials held a media briefing to clarify some of the details in the HHS FY 2012 Budget Request. Overall, the budget for HHS totals $891.6 billion in outlays with $79.9 billion in discretionary budget authority proposed.

For NIH, the FY 2012 budget requests $32.0 billion which is an increase of $745 million or 2.4 percent over the FY 2010 level. In FY 2012, about 83 percent of the funds appropriated to NIH will go out to the extramural community to support the work accomplished by more than 325,000 scientists and research personnel affiliated with over 3,000 organizations, including universities, medical schools, hospitals, and other research facilities. About 11 percent of the budget supports an in-house or intramural program for basic and clinical research activities.

Dr. Collins made some comments on the new proposed groundbreaking “National Center for Advancing Translational Sciences” (NCATS) included in the NIH Budget Request. The drug development process is complicated, expensive, and sometimes can prove to be either ineffective or perhaps dangerous to use on humans. As Dr. Collins pointed out, “In order to move drug research and discoveries forward at a fast pace and through the pipeline faster, the “translational medicine” approach is needed.

This translational approach would have government and universities working more effectively together to develop fast timelines for drug deliveries. A good example of how to increase drug discoveries and delivery via collaborative efforts, occurred in the 1980’s when a partnership was formed between scientists and clinicians at the National Cancer Institute, Duke University, and a drug company to help develop AZT to treat the HIV virus. Because of this intense collaboration, AZT was able to help patients and reach the marketplace in just two years.

By establishing NCATS, a number of trans-NIH programs that inherently are cross-cutting will work together. For example, the Cures Acceleration Network (CAN) would be able to play a leading role to accelerate the development of “high need cures.

One component expected to be a part of NCATS includes the Clinical and Translational Science Awards (CTSA) program. The budget requests $485 million for CTSAs to fund a nationwide consortium of biomedical research institutions to accelerate therapeutics development, engage communities in clinical research efforts, and to train clinical and translational investigators.

In addition, NIH in FY 2012 plans to provide support for $50 million to go to the “Therapeutics for Rare and Neglected Diseases” (TRND) program. TRND was the first program to create a drug development pipeline within NIH and works to stimulate research collaborations with academic scientists working on rare illnesses as well as develop partnerships with patient advocacy organizations, disease-oriented foundations, and others interested in treatments for particular illnesses.

To accelerate discoveries to develop more effective therapies for diseases such as heart disease, cancer, and Alzheimer’s it is vital to research the complex causes of diseases. To do this, investigators will need to take advantage of a number of technologies such as DNA sequencing, microarray technology, nanotechnology, new imaging modalities, and computational biology. NIH plans to support further development and application of these advanced technologies.

NIH’s aim is to not only spur the development of new treatments, but also to support rigorous programs to assess the effectiveness of treatments within populations and for individuals. This will necessitate more research to be done in personalized medicine to help provide the evidence-base for decision making needed today in clinical practices.

In addition, NIH will contribute $20 million to the “National Robotics Initiative” to study how to best use robots for home care, provide personalized care for special needs populations, accomplish wellness/health promotion, robot-assisted recovery, rehabilitation, behavioral therapy, and provide for surgical and interventional robots.

NIH estimates that it will support 9,158 new and competing Research Project Grants (RPG) in FY 2012 with the total number of RPGs expected to be 36, 852. The average cost of a new and competing RPG in FY 2012 will be about $433,000.

HRSA Budget Request

The FY 2012 HRSA Budget request includes $9 billion, a net increase of $975 million above the FY 2010 program level. HRSA is the principal agency charged with improving access to healthcare in medically underserved areas and increasing the numbers in the healthcare workforce.

The budget request includes $1.3 billion including $315 million in mandatory funding to support a health workforce strategy that will improve the distribution of the primary care workforce, encourage inter-professional training, focus on elder care, and reduce disparities in the workforce.

There is the need to track and analyze health workforce-related data, so the budget request includes $20 million which is an increase of $17 million over FY 2010 to support the “National Center for Health Workforce Analysis”. This budget item would support the Center’s work to develop reliable methodologies to analyze the nations’ health workforce status and provide accurate data.

The budget request includes $163 million an increase of $16 million over FY 2010 to improve the diversity of the health workforce. This is key to reducing health disparities related to socioeconomic, geographic, and ethnicity factors.

HRSA has health centers budgeted for $3.3 billion to include $1.2 billion in mandatory funding provided through Affordable Care Act Community Health Center Fund. Through continued investments in new access points and medical capacity expansion, the Health Center program will support more than 1,100 grantees to provide comprehensive primary healthcare services to 24 million patients at over 8,000 delivery sites.

The FY 2012 budget request includes $124 million, a reduction of $61 million for targeted rural health programs. This includes $57 million, an increase of $1 million to implement collaborative models to improve healthcare access and quality for the 55 million Americans living in rural areas.

This total also includes $26 million to continue funding for all continuing Rural Hospital Flexibility Grants, $20 million for research, technical assistance, and policy development to improve rural health outcomes, $12 million to expand access to quality care through telecommunications, and $7 million for screening and caring for miners with occupational-related impairments.

HRSA is looking at developing new, innovative models for the delivery of healthcare services by providing team-based care to include medical homes and accountable care organizations. The budget includes some new cross-programmatic initiatives to support training and practice reforms to ensure that health professionals can work more effectively within inter-professional teams.

FY12 Budget Increase for ONC

The Budget request for the Office of the National Coordinator for Health Information Technology is $78 million, $17 million above FY 2010. The FY 2012 budget will enable HHS to continue to implement the HITECH Act. The Budget request also includes resources for ONC to serve as the Federal Health IT leader.

In addition to funds requested for ONC for health IT, the Budget request has funding for other HHS divisions that support health IT. Funds for $2.75 million have been requested by AHRQ to advance the use of health IT to enhance patient safety plus $1.3 million is requested by the Office of Civil Rights to strengthen and enforce EHR privacy rules.

The Budget request includes $6.5 million for ONC to work with Regional Extension Centers to help others reach Stage 2 of meaningful use, to support Communities of Practice for RECs, and to help large hospitals, healthcare systems, and EHR vendors achieve meaningful use.

To continue the work on standards, the budget request includes $23 million to develop health data standards that will enable the interoperability of EHRs, and to make the standards available for both the private sector and for federal use. This funding will support standards development, testing, and implementation, as well as expand the standards and interoperability framework to enable health data to be used for public health purposes, clinical research, and quality improvements.

The budget request includes $1 million to maintain the health information exchange network capabilities, to support the “Nationwide Health Information Network” (NwHIN), and to support the expansion of health information exchange capabilities. In 2011, ONC will establish an effective governance mechanism for the NwHIN with the goal to attain a self-sustaining business model

In order to deal with privacy and security issues, the budget included $5.9 million to support federal privacy and security protections for electronic health information and to address protections for personal health information. ONC will work with partners such as the Office for Civil Rights, CMS, States, and other stakeholders to protect patients and their health information.

HHS Launches HIW

HHS now has a new web portal to provide health and healthcare indicator data to support innovations in information technology. The Health Indicators Warehouse (HIW) contains a collection of health indicators along with new web 2.0 technologies that supports automated data services through Application Programming Interfaces (API). The health indicator data sets and the web tools provided by the warehouse are expected to support technology development leading to a wide array of application (apps) and data services.

HWI has a collection of health indicators obtained from a wide array of HHS data sources that support researchers, technology developers, and policymakers. Health indicators are measurable characteristics that describe the health of a population (life expectancy, mortality, disease incidence or prevalence), determinants of health (health behaviors, risk factors, physical environments, and socioeconomic environments) and health care access in terms of cost, quality, and use.

The purpose of the HIW is to:

• Promote a single user friendly source for national, state, and community health indicators
• Meet the needs of multiple population health initiatives
• Facilitate harmonization of indicators across initiatives
• Link indicators with evidence-based interventions
• Serve as the data hub for the HHS Community Health Data Initiative

HIW is maintained by CDC’s National Center for Health Statistics. Data support and funding is provided by CMS, HHS Office of Deputy Secretary, Office of Adolescent Health, Office of Disease Prevention and Health Promotion, Office of Minority Health, Office of the Assistant Secretary for Planning and Evaluation, and HRSA. New partners and new indicators will be added over time.

Todd Park, Chief Technology Officer at HHS, said, “We recognize that one of the keys to better health and healthcare is data-driven decision-making at all levels and the HWI will help to remove the barriers for technology development.”

For more information, go to

Grants for Medically Underserved

Alliance Healthcare Foundation (AHF), a local nonprofit and independent healthcare foundation in the San Diego region will provide “Mission Support Grants” to agencies in San Diego and Imperial Counties. The plan is to streamline the funding process and to fund up to $1,000,000 this year with individual grants up to 100,000. The first grants under this new program will be awarded March 2011.

The “Mission Support Grants Program is an invitational program. Qualifying agencies must be operationally stable with strong leadership and have demonstrated their commitment to increasing the capacity of the healthcare delivery system for the poor, working poor, and the homeless population of San Diego.

AHF has been a source of funding for the San Diego area for nearly two decades. Over this time, AHF has dedicated over $44 million and leveraged an additional $41 million towards the most pressing health issues in the region.

Their efforts are directed to:

• Helping the poor and the medically underserved
• Fill the gaps in the system that are not being addressed
• Lead through innovative grantmaking and advocacy

AHF is trying to increase access to healthcare with a focus on increasing the capacity and coordination of the healthcare delivery system through advocacy, information technology, workflow improvements and innovation in order to improve health outcomes. The Alliance is looking for innovative solutions to use technology to identify and adopt the best practice care models in and outside of San Diego.

For more information, go to

Bill to Establish Task Force

Maryland State Senator E. J. Pipkin on February 4, 2011 introduced Senate Bill 406 to establish a Task Force in the state. The Task Force would study the use of telemedicine in medically underserved populations to determine how to use telemedicine efficiently, reduce the cost of health care, and how to mitigate health disparities in underserved populations in the state. HRSA has designated the portions of the state that are medically underserved or containing medically underserved populations.

Specifically, the Task Force would:

• Study the impact of the changing physician supply and address the increased demand for physicians in medically underserved populations

• Complete a cost-benefit analysis on the use of telemedicine in medically underserved populations. This analysis would look at the implementation and continued use of telemedicine, the impact of telemedicine on non-health related issues, such as the impact on the environment, and the feasibility of using a unified credentialing system for physicians, physician assistants, and nurse practitioners

• Collaborate with roundtables established to study the issues

• Review and consider any studies, reports, or other work regarding telemedicine in underserved areas as discussed and reported by the roundtables plus study any other topics that the Task Forces needs to make recommendations

The Task Force members would include the Chairs of the Senate Education, Health, and Environmental Affairs Committee, and the House Health and Government Operations Committee, Secretary of Health and Mental Hygiene, and the Director of Program Development for the Maryland Critical Care Network.

In addition, two representatives from the medical communities that serve medically underserved populations in the state or are located in medically underserved areas as designated by HRSA, two consumer members, two representatives from the health insurance industry, and one representative from the established roundtables would serve on the Task Force.

Sunday, February 13, 2011

FCC Plans to Modernize USF

FCC Chairman Julius Genachowski speaking at the Information Technology and Innovation Foundation event in Washington D.C. on February 7th announced plans to modernize and streamline the Universal Service Fund (USF) plus bring the related Intercarrier Compensation (ICC) system into the 21st century.

The USF provides communities with affordable telecommunication services. The USF’s Rural Health Care program supports reduced rates to rural healthcare providers for telecommunications and internet services

The Chairman agrees that the USF has become wasteful and inefficient in some situations by paying over $20,000 a year—nearly $2,000 a month in support per line for some households while providing little or no support in other communities that lack broadband.

He explained that the ICC system consists of a complex system of payments that phone companies make to each other when they connect calls. It has long served as an implicit subsidy for rural carriers with intercarrier rates set well above costs resulting in long distance service subsidizing local networks. As a result, it can cost 10 times more to call a friend a few towns over than to call someone on the other side of the world.

The Chairman continued, “The ICC system is not only flawed, it is unstable. Overall, interccarrier revenues are in rapid and unpredictable decline, as more and more people drop landline phone service. Also, there is considerable uncertainty and ongoing litigation about how the ICC should work in a modern era with VoIP services. This means that some companies are in fear of losing millions of dollars if they upgrade traditional telephone equipment to IP equipment to enable more efficient IP interconnections.

Therefore, the FCC is now addressing some key reforms. First of all, rules are now being proposed for the ICC to stop waste when companies exploit loopholes in FCC rules and the ICC specifically needs to address the proper treatment of VoIP traffic.

The FCC also proposes to start a multi-year transition path, in partnership with the states, to phase down intercarrier payments and shift any necessary recovery to the USF. Doing so will provide much needed predictability for the industry and investors, while also reducing the inefficiencies and perverse incentives created by the current system.

As for dealing with the USF funding issues, the FCC would take existing funding used inefficiently and transition this funding to the Connect America Fund to provide ongoing support to rural consumers. This would provide a single smart and efficient fund to use for both high speed internet networks.

The Chairman explained how broadband could be funded for unserved areas out of savings from existing programs, while constraining the size of the USF. This would move the FCC towards a fairer distribution of the USF and would allow more carriers an opportunity to expand their services through public-private partnerships that would include wireline, fixed wireless, mobile, and satellite providers.

Chairman Genachowski announced that to build on the work of the National Broadband Plan, the USF and ICC reform agenda rests on addressing specific issues. Therefore a Notice of Proposed Rulemaking (NPRM) and Further Notice of Proposed Rulemaking issued on February 8th adopted by the FCC, outlines how programs should be transformed.

Four key principles to guide USF reform are included. The first proposal would be to eliminate waste and inefficiency that is apparent throughout the current program. This can be accomplished by transitioning funding for duplicative phone service being provided by multiple phone companies operating in the same area. Impose reasonable limits and guidelines for reimbursement to providers that have little incentive under our current subsidy system to operate efficiently. Review the continued need for funding mechanisms that have not been re-evaluated in many years.

Secondly, use savings to spur investment in high-speed internet in unserved areas by identifying unserved areas according to the forthcoming NTIA national broadband map. Plus, use market-based polices to support providers in areas where broadband funding will have the biggest impact. Create the Connect America Fund that would contain and consolidate the five separate USF programs supporting rural phone networks.

The next proposal would be to stimulate investment in broadband by reforming the ICC system. This can be done by eliminating wasteful billing disputes by closing loopholes and tightening rules. This would prevent “phantom traffic” where carriers disguise the source of calls to reduce or avoid payments to other carriers. It would also reduce “traffic pumping” where local phone companies enter into arrangements with chat lines or conference calling providers to inflate the volume of incoming calls.

The last proposal would increase accountability for recipients and for government to effectively measure program performance. This means that clear performance goals and metrics would need to be adopted for the Connect America Fund. It also would require increased disclosures about the operating performance and financial conditions for companies that receive universal service support.

The FCC plans to hold a series of public workshops on the key issues proposed in the NPRM. These workshops in addition to the submission of written comments will provide an opportunity for the public to provide input to help refine the proposals in the NPRM.

Millions for Prevention

HHS is investing $750 million to prevent diseases, detect them early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living. To accomplish these goals, some of the funds will be allotted for health IT projects to improve the public health infrastructure and for research and tracking.

Funding for $298 million will be used to help promote health and wellness in local communities with $222 million to be used to prevent heart attacks, strokes, cancer, and other conditions by reducing tobacco use, preventing obesity, and reducing health disparities. The program will launch a consolidated chronic disease prevention grant program.

An additional $182 million will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new healthcare law. The funds will also help increase availability and the use of immunizations. Of the total amount, funding for $70 million will assist communities with the coordination and integration of primary care services into publicly funded community mental health and other community-based behavioral health settings.

In general, $137 million will go overall to boost the public health infrastructure and provide workforce training to help states and local health departments. Funding for $40 million is allotted to improve the public health infrastructure and funding for $45 million will go to support the public health workforce investment in information technology and training.

For research and tracking purposes, $133 million is allotted to help collect data to monitor the impact of the Affordable Care Act. Of that amount $84 million will go for healthcare surveillance and planning with another $49 million to go for research with the goal to identify and disseminate evidence-based recommendations on important public health challenges.

For more details, go to

VAi2 Awards 4 Projects

The Veterans Administration has made four awards for the third VAi2 Industry Innovation Competition which is the first competition to involve the private sector. VAi2 was launched last June seeking innovators to submit proposals will new scalable solutions for the 21st century.

The first award went to mVisum, a privately held company located in Camden N.J. to deploy a pilot of their Cardiology Communication System at the Veterans Administration Medical Center in Washington D.C. With the system, cardiologists will be able to receive and review emergent patient data such as EKGs, laboratory reports, medical images including MRIs and Echocardiograms directly on their Blackberry smartphones.

The second award went to Agilex Technologies Inc. of Chantilly, Virginia to develop a pilot project also at the Washington D.C. VA Medical Center. The pilot will explore the possibility to extend elements of the VA’s EMR system to electronic devices. The pilot will enable patient search, demographics, laboratory data, allergies, medications, appointments, and problem lists to be displayed. Agilex will also integrate clinic schedules and secure messaging onto the device.

The third company, MedRed LLC, will use the funding to pilot their TBI Toolbox system at the McGuire VA Medical Center in Richmond Virginia. The project will allow the free exchange of data and rapidly evolving treatment guidelines at the VA Polytrauma Rehabilitation Centers and DOD medical facilities.

Last year, MedRed was awarded a $500,000 contract by the Center for Neurologic and Regenerative Medicine (CNRM) to expand the data collection system at the Walter Reed Army Medical Center WRAMC. The MedRed Chart system is currently in use at WRAMC is doing research in patho-physiology and TBI.

The last company to receive an award, Venture Gain, LLC of Naperville, Illinois will use the funds at the George E. Wahlen VA Medical Center in Salt Lake City, Utah to pilot a next generation system of wearable sensors in combination with software analytics to predict and prevent complications for patients diagnosed with heart failure.


The TRICARE Management Activity (TMA) issued a Request for Information (RFI) for qualified firms to provide web-based EMRs/EHRs to support the Military Health System. The EHRs/EMRs are to obtain data for each patient across providers, be able to operate in all care settings, and share information with other health partners.

The responses to this RFI are due on February 18, 2011 but the RFI was issued solely for information and planning purposes and does not constitute a solicitation at this time. However, a Request for Proposal is anticipated to be released in the near future which may result in a multiple year FFP or CPFF type contract.

Some of the information to include on the proposed web-based EHRs/EMRs may include:

• Scope of current utilization
• CCHIT certification status
• Extent of interoperability with NHIN, national reference laboratories and ePrescribing
• Medical device interfaces
• Clinical decision support, immunization, and personal health record features
• Scheduling, reporting, and practice management features
• Is the code open source and is the code design compliant with applicable national standards
• Performance in terms of speed, reliability, and usability
• Costs

Other information may be included as it concerns the value and applicability of using the system within the MHS, VA Health System, and/or in a joint collaboration between the VA and MHS.

For more information, go to The Point of Contact for this RFI is Wendy Sellers. She can be reached at

In other TRICARE news, the TMA, in their Acquisition Management and Support Directorate has established the Office of Small Business Programs (SBP). This office will sponsor small business fairs, procurement conferences, as well as participate in trade group seminars, conventions, and other forums to help small business contractors.

For more information on SBP, email Marisol Vargas-Busch at

Spotlight on Rural Health

The 2011 Virginia Telehealth Summit co-sponsored by the Virginia Telehealth Network will be held April 5, 2011 at the Wintergreen Resort in Central Virginia. A variety of topics important to the leaders and executives in the rural health field will be presented for a full day of non-stop rural health information.

Karen Rheuban, MD., President and Chairman of the Virginia Telehealth Network will give an overview of the issues confronting today’s rural health field. This will be followed by Karen Jackson, Deputy Secretary of Technology for the Commonwealth of Virginia who will present the results of the Virginia Healthcare Broadband, HIT, and Telehealth Survey.

Funding in the telehealth field is a very important issue and the attendees will have the fortune to hear top speakers with expertise in this area. The presenters will include Sherilyn Pruitt, Director, Office for the Advancement of Telehealth, Office of Rural Health Policy at HRSA, Eugene Sullivan, Program Manager, for the Office of Telemedicine, at the University of Virginia, and from Ellen Matthews Davis, Virginia State Director for Rural Development at USDA.

Telehealth projects can only proceed so far without sustainable programs. Presenters on this topic will be:

• Patrick M. Hamilton, Health Insurance Specialist/Rural Health Coordination for CMS in their Philadelphia Regional Office
• Gregg A. Pane, MD, MPA, Director of the Virginia Department of Medical Assistance Services
• David Selig, CEO, for the Community Care Network of Virginia, Inc.
• Karen Rheuban M.D., Professor of Pediatrics, Senior Associate Dean for External Affairs and Continuing Medical Education and Medical Director for the Office of Telemedicine, at the University of Virginia
• Keven L. Barger, CEBS, FAHM, CPC Network Management Director, Provider Engagement and Contracting Central Virginia, Anthem

Understanding and dealing with legal and regulatory issues will be discussed by Brian W. Murray, Attorney with Latham & Watkins, LLP, Washington D.C. Gary Capistrant, Senior Director, Public Policy, ATA, plus two speakers from the Center for Telehealth & E-Health Law (CTeL) to include Greg Billings, Executive Director and Senior Government Relations Director, Drinker, Biddle & Reath along with Rene Quashie, Regulatory Attorney for CTeL, and Government Relations Director/Regulatory Attorney for Drinker, Biddle & Reath.

Other topics to be discussed include a “View from the North” to be presented by Edward Brown M.D., CEO Ontario Telemedicine Network in Canada. Additional presentations will help the attendees have a better understanding of the topic “HIE, HIT and Meaningful Use” to be presented speakers Patrick M. Hamilton, and Michael Matthews, CEO, MedVirginia.

The day will conclude with a discussion on the Virginia Health Reform Initiative will be discussed by Geoffrey Brown, Senior VP and CIO for INOVA, Karen Rheuban, MD, and Stephen Bowman, Senior Staff Attorney/Methodologist for the Joint Commission on Health Care.

In addition, several concurrent sessions will be held on topics involving telemental health, mHealth, social media, and high risk OB.

Kathy H. Wibberly, Ph.D., Director, for the Division of Primary Care and Rural Health at the VDH Office of Minority Health and Health Equity will present the wrap up for the day.

If you wish to be an exhibitor or sponsor go to Go to for more details on the Summit.

Wednesday, February 9, 2011

NINR's Draft Strategic Plan

Rapid advances in technology and genomic science, as well as changes in demographics, healthcare policies, and practices have placed pressing demands on nursing to use fresh approaches and interventions to improve health outcomes. The nursing profession is learning to use emerging technologies to translate research findings into cost-effective clinical applications and disseminate the clinical applications directly to patients, caregivers, and healthcare providers.

The National Institute of Nursing Research (NINR) has just released their draft strategic five year plan emphasizing the need to invest in new technologies. Today, the nursing profession is developing innovative strategies and technology to deliver real-time personalized information to individual patients, families, and communities.

NINR’s goals for the next five years are to:

• Develop new technologies and informatics-based solutions that promote health, prevent disease, manage symptoms, and involve patients in their own healthcare
• Develop and create new technologies including the adaptation and application of comprehensive high-throughput technologies
• Encourage risk taking, innovation, re-invention, and creativity, including high risk/high return concepts
• Expand knowledge and the application of telehealth and telemedicine interventions to improve self management and access to healthcare
• Extend preventive interventions that improve health for underserved community groups and develop new technologies to link underserved populations with available resources
• Investigate factors influencing how technology is adopted and used to generate best practices
• Mobilize technology to form global partnerships with international schools of nursing to exchange information

NINR invites public comments on their draft Strategic Plan until March 19, 2011. To view the draft plan, go to Comments on the plan can be emailed to The final revision of the Strategic Plan is due to be released in October 2011.

NC HIE Scheduled for 2011

North Carolina is getting ready to exchange data through the North Carolina Health Information Exchange (NC HIE). Core services initially will provide a foundation for more complex capabilities at a later date that will enable the system to search, locate, and integrate information across multiple systems.

NC HIE does not intend to build duplicate or provide competing HIE services in the state. Instead the focus will be on providing core services such as registries of authenticated exchange partners.

The NC HIE issued an RFP on January 21, 2011 with the proposal due February 4th to find the services of a Consultant/Contractor either an individual or a firm to help NC HIE find vendors to implement the system.

The goals for the state HIE in 2011 in general are to:

• Support legislation to facilitate an “Opt Out Consent Model” and to harmonize various state laws related to medical records
• Identify and contract with an IT vendor
• Deploy core services representing the suite of registries, record locator services, and security functions
• Draft a set of policies and procedures to govern participation in the HIE
• Identify and contract with Qualified Organization Pilot sites to utilize the HIE
• Develop and secure financing
• Recruit more highly competent staff and further develop the non-profit organizational structure
• Initiate value-added service development and in the future roll out for more robust service offerings that will be of immediate value to participants
• Finalize the Board of Directors bylaws

After a consultant contractor is selected, plans will be made to develop the Request for Proposal for the HIE with the RFP to be released on March 22, 2011. However, vendors have only 18 business days to prepare proposals that are due April 18, 2011.

Plans for the spring are to develop a financing approach, address privacy and security policies, develop the criteria for qualified organizations, review proposals, and negotiate the awarded contract. Later in the summer time framework, work will begin to build the initial HIE services and connect to qualified organizations. Later in the year, plans are to develop and deploy additional services.

The state has been working very hard to refine cost projections and identify additional revenue sources. The initial feedback has suggested that the cost estimate for $24 million over 5 years was too high. As a result, NC HIE will use information received from other states and the RFP process to refine cost calculations.

A Pre-Payment Model has been proposed to help rise the $11 million to cover the estimated minimum $24 million development costs. By raising the money upfront, North Carolina would be able to deploy the full range of HIE services as soon as possible, encourage widespread participation, maximize meaningful use participation, lock in multi-year commitments from a critical mass of constituents, create lock-in of stakeholders, and reduce the administrative burden.

The Pre-Payment Model would include:

• Pre-payments from 6 to 10 of the largest hospital systems of approximately $3.85 million over four years to cover 35 percent of the needed funds
• Pre-payments from two or three of the largest commercial payers of approximately $3.85 million over four years to cover 35 percent of funds
• The North Carolina Medicaid would use would contribute $2.2 million over four years to cover 20 percent of the needed funds
• Providers would make pre-payments from large practices of 100 or more to provide approximately $1.1 million over four years to cover 10 percent of the needed funds

If the state used The Pay As You Go Model with flexibility in payment options, it would be more affordable for smaller stakeholders. However, there are risks involved in using this model. First of all there may be insufficient grant funds to implement advances in the HIE and there would also be lower adoption rates as participants would wait for more compelling functionality and value and this could result in lower revenues. Further financial details and approaches are being studied at this time.

For more information on the RFP, go to or email Anita Massey, at

SSA's Future Technology

The Social Security Administration (SSA) has established the “Future Systems Technology Advisory Panel” (FSTAP) to recommend and submit ideas to the SSA Commissioner on future systems technology and electronic services. The panel is looking down the road for the next five, ten, or twenty years and trying to determine how people will be able to interact with SSA based on available future technology.

One of the FSTAP’s sub-panels are specifically looking at how health IT can be used to help SSA handle the enormous future workload and have come to the conclusion that electronic self service will be the only possible solution to meet SSA’s needs in the coming years.

The goal is to develop an electronic customer self-service model to move transactions to the internet each year until 90 percent of the business with SSA takes place online. At the same time, the agency will have to provide channels to use for complex transactions that are not suited to online execution but also to help individuals that cannot or will not use technology. Perhaps the solution would be to set up government service centers to help deal with complex issues or to provide video kiosks that will also help move customers to an electronic self-service platform.

The most common tools that will be used to access the internet in the future will be the smart phone and mobile devices. So the thinking is that in designing online applications, SSA should support mobile devices and be prepared to convert internet applications to these platforms while simultaneously maintaining the current platforms for the PC. One of the most important goals would be to develop a new prototype and then at that point, produce systems to distribute benefits via cell phones.

Simply handling the disability claims backlog submitted to SSA is very challenging. It is a fact that when disability claims are denied and when the claims are appealed, a great deal of study and human judgment is required however human judgment is difficult to automate. In addition, very often, the claimant fails to identify all of their medical conditions and sometimes they do not recall or supply all of the medical information needed resulting in an initial denial.

In the not so distant future, all disability claims will require that electronic medical records be used to supply all of the information needed since ultimately the use of electronic records will make the initial determination go faster and reduce the number of appeals. Another way to handle disability claims faster would be to implement a video capability for disability claimants at field offices and for those individuals at home that have cameras on their PCs.

In the next one to ten years, futurists are predicting that SSA will use smart phones with biometric identification, use email and social networking to reach 300 million users, provide a national ID card, electronic records adoption rates will reach 70 percent by 2016, SSA services will be reorganized and centralized, and life vaults will enable every user to have all of their information on their lives including their medical records on record by the year 2020.

Genetic Info for Mountainous Region

Delivering genetic services to the eight states that make up what is called the “Mountain States Region” with a combined area of 1,081,813 square miles and a population of more than 44 million people is extremely difficult. This is going to become even more difficult since the states that make up the region Arizona, Colorado, Montana, Nevada, New Mexico, Texas, Utah, and Wyoming are expected to experience continuous population growth over the next two decades especially among minority populations.

More than 800,000 births occur annually and currently the birth rates in the region are higher than birth rates in the U.S., however, 3 to 5 percent of these births are complicated by a genetic condition and as a result, more than 18,000 infants and their families in the region require genetic services each year.

In addition, Arizona, Nevada, New Mexico, and Texas have larger concentrations of Hispanic/Latino populations that the U.S. average. The Mountain States Region is home to a higher percentage of Native Americans than the U.S. as a whole and in the four states along the U.S.-Mexico border, a language other than English is spoken at home in one quarter to one third of all households. Therefore, the region is challenged to deliver genetic services to unique populations many of whom are culturally and linguistically distinct from the majority population.

The Mountain States Genetics Regional Collaborative Center MSGRCC) located in the eight state region operates to ensure that individuals with genetic issues have access to the appropriate genetic expertise and information delivered in the context of a medical home. The goals for MSGRCC is to provide newborn screening, expand and fortify the infrastructure for genetic services, improve care coordination for people with heritable disorders, improve access to services, and serve as a catalyst in the development of emergency backup systems for newborn screening services.

However, the region has additional problems that interfere with providing genetic services that relate to fiscal challenges, increases in children enrolled in Medicaid, the increase in states doing newborn screening, a need to coordinate laboratory screening with short-term and long-term follow-up across states lines, the fees needed to pay for newborn screening lab work, plus follow-up administrative costs can vary greatly in the states.

The states do offer some individual programs that coordinate genetic services. The typical delivery model for genetic services is a single major urban genetics center often using only one or a few board certified genetics providers to serve both the urban and rural population. Often patients needing services are often located hundreds of miles from subspecialty providers. To meet the needs, primary care providers often provide a high level of specialty and even subspecialty services in collaboration with distant subspecialists.

There is a great need to use telemedicine to provide genetic services, but currently telemedicine genetic services are not well developed in the entire region. The National Genomics and Public Health Conference held at NIH in December 2010 focused on genetic testing and speakers discussed why more genomic medicine is not brought to more Americans especially in rural areas via telemedicine technologies.

Several barriers exist that are slowing down the use of telemedicine in the Mountain State Region and the rural areas in general. Sylvia Mann Au, State Genetics Coordinator for the Hawaii Department of Health reported that she has been working with the U.S. Regional Genetics Newborn Screening Collaboratives on a national effort to use new software for videoconferencing. She explained that very often the present software is too complicated to use but other programs now being developed will use simpler systems to link patients and be easily accessible to the specialists.

However, when telemedicine genetic services have been offered in the Mountain State Region, they are well received by both families and providers. Some of the states in the region have strong IT systems and use telemedicine to deliver healthcare but Montana is only state that specifically offers genetics counseling through their Eastern Montana Telemedicine Network.

A MSGRCC Telemedicine Workgroup is in place to help the MSGRCC obtain data on the availability and use of telemedicine systems to provide genetic services in the region and the plan in this region is to take into account the development of telemedicine along with the medical home.

At the MSGRCC meetings, the group discusses some possible solutions in order to deliver more genetic services to their region. One way may be to contact some large providers with closed systems and see if it is possible to partner with them in order to eliminate barriers to the use of telemedicine. Also, high tech may not always be the answer to reach the target population since in many cases, high tech and even most low tech systems do not exist in rural and frontier areas so the only technology available to use may be the telephone.

In addition, developing marketing brochures for the region may be the key to reaching more people to increase the use of technology to deliver genetic services. Development of brochures on telemedicine could be aimed at consumers with another brochure targeting providers in the region. The telemedicine workgroup is continuing marketing efforts to bring genetics clinicians and telemedicine providers together with the goal to get the clinicians excited about the use of telemedicine in the region.

Awards to Support RECs

HHS Secretary Sebelius has a strong personal interest in rural health and has made rural health a high priority. Last year, she convened a new HHS Rural Health IT Task Force to develop action recommendations to ensure that Federal resources are used effectively to help rural providers qualify for meaningful use incentive payments.

Dr. David Blumenthal in his “HealthITBuzz” blog recounts how in the past two weeks, he has had the opportunity to meet with rural healthcare leaders at the National Rural Health Association Policy Institute and the American Hospital Association’s Health Forum to discuss the barriers faced by rural providers in adopting and using EHRs. The barriers include a lack of financial capital, shortage of skilled personnel, and having access to affordable broadband connectivity sufficient to transmit relevant patient data in a reliable way.

According to the Blog, On February 8th HHS released an additional $12 million to add additional support to help 47 Regional Extension Centers (REC) assist Critical Access Hospitals (CAH) and other rural facilities. Last September, HHS increased support to the RECs that serve rural areas by about $20 million in additional funding that went to 46 of the 62 RECs to help critical access and rural hospitals convert from paper-based records to certified EHR systems.

In the February 8th award announcement, CIMRO of Nebraska in their Wide River Technology Extension Center was awarded $1,068,000 to continue to offer technical assistance, guidance, and information on best practices to support provider’s efforts to become meaningful users of EHRs. ONCHIT is also establishing an HIT Research Center to enable the Wide River TEC and other RECs to collaborate with one another to share best practices in EHR adoption, effective use, and supporting providers.

Go to for a complete list of the February 8th awardees.

Sunday, February 6, 2011

FDA Clears Mobile Radiology

FDA has just cleared a new mobile radiology application to allow physicians to view medical images on the iPhone and iPad. The application is the first to be cleared by the FDA for viewing images and making medical diagnoses based on computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine technology such as positron emission tomography (PET). It is not intended to replace full workstations and is indicated for use only when there is no access to a workstation.

Radiology images taken in the hospital or physician’s office are compressed for secure network transfer than sent to the appropriate portable wireless device via software called Mobile MIM. Mobile MIM, manufactured by Cleveland-based MIM Software Inc., allows the physician to measure distance on the image and image intensity values, display measurement lines, annotations, and regions of interest.

The FDA reviewed performance test results on various portable devices and measured luminance, image quality, and noise in accordance with international standards and guidelines. The FDA also reviewed results from demonstration studies with qualified radiologists under different lighting conditions. All participants agreed that the device was sufficient for diagnostic image interpretation under the recommended lighting conditions.

The display performance of mobile devices can experience significant variations in luminance levels even between mobile devices of the same model. The Mobile MIM application however, includes sufficient labeling and safety features to mitigate the risk of poor image display due to improper screen luminance or lighting conditions.

The device includes an interactive contrast test in which a small part of the screen is a slightly different shade than the rest of the screen. If the physician can identify and tap this portion of the screen, that the lighting conditions are not interfering with the physician’s ability to discern subtle differences in contrast.

Direct Project Pilots Launched

The Office of the National Coordinator for Health IT (ONC) announced that providers and public health agencies in Minnesota and Rhode Island are now able to exchange health information using specifications developed by the “Direct Project.”

The project was launched in 2010 as part of the NHIN to provide a simple secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet in support of Stage 1 Meaningful Use requirements.

Participants include EHR, and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal and state organizations, and regional health information technology consultants.

Direct Project supports the transfer of laboratory results, physician-to-physician transfers of summary patient records, transmission of data from physicians to hospitals for patient admissions, transmission of hospital discharge data back to physicians, and transmission of information to public health agencies.

Since mid January, Hennepin County Medical Center (HCMC), Minnesota’s premier Level 1 Adult and Pediatric Trauma Center has sent immunization records to the Minnesota Department of Health. VisionShare a company in Minnesota connects HCMC to the Minnesota Department of Health and plans to expand this project to other states including the Oklahoma Department of Health.

The Rhode Island Quality Institute (RIQI) has delivered a pilot project with two primary goals. The first action is improving patient care when patients are referred to specialists by providing direct provider-to-provider data. Secondly, RIQI is leveraging “Direct Project” messaging as a means to securely feed clinical information with the patient’s consent from practice-based EHRs to the statewide health information exchange. This action helps to improve quality by addressing the gaps in care and making sure the full record is available to all care providers,

Other “Direct Project” programs will be launched soon in Tennessee, New York, Connecticut, California, and Texas:

• Tennessee is working with the VA, local hospitals, and CareSpark to provide care to veterans and their families
• New York is working with Med Allies to implement the Direct Project with clinicians in hospitals, ambulatory care settings, and to help EHR vendors
• In Connecticut, Medical Professional Services is working to demonstrate the successful exchange of laboratory results back to the ordering physician and the system will be able to exchange referral information between providers and local hospitals, ambulatory care settings, and a FQHC
• Redwood MedNet are to provide health information exchange services in rural northern California. Participants in the Redwood MedNet Direct Project pilot include small practices, community clinics, small hospitals, as well as the state immunization office to operate.
• South Texas is collaborating with hospitals, ambulatory care settings, public health, and community health organizations to improve care to mothers with gestational diabetes and provide care to their newborns

For more information on the Direct Project, go to

Telehealth Assistance Expands

HRSA’s Office of Rural Health Policy is funding the Telehealth Resource Center Grant Program (TRCGP) to establish Telehealth Resource Centers (TRC). The TRCs provide assistance to healthcare organizations, networks, and providers to help implement cost-effective telehealth programs serving rural and medically underserved areas and populations. The funding will support three different types of resource centers to include a national resource center, two regional telehealth resource centers, and two telehome care resource centers.

The awards will provide funds for states that are currently not supported under the Telehealth Resource Center Program. These grants will provide support for up to three “Regional” telehealth resource centers in Kentucky, West Virginia, Virginia, Ohio, Indiana, Illinois, Michigan, Maine, New Hampshire, Vermont, New Jersey, New York, North Carolina, Pennsylvania, Connecticut, Massachusetts, Rhode Island, Delaware, Maryland, and Washington D.C. It is also expected that regional TRC applicants will propose to cover four or more states.

In addition, this funding will support one National Resource Center to provide legal and regulatory assistance to all of the Regional Resource Centers as well as help HRSA-funded grantees, rural, and underserved communities. Three hundred thousand is available to fund one National Telehealth Resource Center annually for a period of up to three years.

The program will provide funding for FY 2011-2013. Approximately $975,000 is expected to be available annually to fund three grantees under the Regional TRCGP and applicants many apply for up to $325,000 per year.

Eligible applicants can include non-profit organizations and institutions. Applications are due on March 17, 2011 with the projected award date to be September 1, 2011.

For more information on funding notice (HRSA-11-141), go to or email Monica Cowan, Office of Rural Health Policy, at

Monitoring Drugs for Safety

The drug-approval process is known for its rigorous standards on safety and effectiveness, but even with pre-market clinical trials involving thousands of people, it can’t possibly uncover everything about a drug’s performance that may occur when used by a larger and diverse population.

Presently the FDA’s adverse Event Reporting system relies primarily on voluntary, spontaneous reporting of suspected drug safety issues by health professionals, patients, and consumers. The Observational Medical Outcomes Partnership (OMOP), a public-private partnership was initiated to help improve the monitoring of drugs for safety and to help develop an approach that is systematic, proactive, and cost-effective.

OMOP draws on the expertise and resources of the pharmaceutical industry, academic institutions, non-profit organizations, the FDA, other federal agencies, and is funded and managed through the Foundation for the National Institutes of Health (FNIH).

The goal for OMOP is to use databases with patient medical records and health insurance claims in order to detect and evaluate drug safety issues over time. The partnership is conducting a two year initiative to find feasible and useful methods to use to analyze existing healthcare databases. By using the database information, researchers will be able to identify and evaluate safety and benefit issues of drugs already on the market.

J. Marc Overhage, M.D. PhD, Director of Medical Informatics and Research Scientists at the Regenstrief Institute and Professor of Medical Informatics at Indiana University School of Medicine, speaking as a OMOP Research Investigator, gave a review of the OMOP Experiment at the OMOP Symposium held January 11, 2011.

He explained how a traditional study would conduct an analysis to estimate the association of one drug—one outcome contained in one database—at one point in time. What is envisioned is a national active surveillance system that will be able to do ongoing monitoring of any medical product and any health outcome of interest across all of the databases in the network at any time.

According to Thomas Scarnecchia, Executive Director for FNIH, longer term research plans are to expand OMOP’s methods program to a broader array of medical products to include medical devices, and biologics. The plan is also to expand methods program beyond product safety along with available computational resources.

OMOP is seeking collaborators to work on their 2011 Research Plan. Opportunities are available through FNIH grants, contract project work, and partnerships. For example, on January 12, 2011, OMOP released a “Request for Application” seeking researchers to collaborate on “Methods Research” with OMOP. The procurement is open to any researcher or organization with awards anticipated to be $50,000 to $250,000.

The due date for the RFA is February 14, 2011 with the award date scheduled for February, 28, 2011. For more information on the RFA, email Emily Welebob at For general information on the OMOP program, email Thomas Scarnecchia at

DOD Releases STTR 11.A Solicitation

The Department of Defense is currently seeking STTR (N11.A) proposal submissions. The STTR program is funded at over $100 million dollars annually with six components, including the Army, Navy, Air Force Missile Defense Agency, DARPA, and Defense Research & Engineering. The response to the STTR (N11.A) solicitation is due March 30, 2011.

The STTR program is similar to the SBIR program but the STTR funds cooperative R&D projects that can place a small business and a research institution together to work on research more effectively in order to move ideas from research institutions to the marketplace.

To participate in the STTR program, a firm must be a U.S. for-profit small business of 500 or fewer employees, the research institution must be a U.S. college or university, the small business must perform a minimum of 40 percent of the work, and the small business must manage and control the STTR funding agreement.

The Navy issued the specific solicitation (N11A-T033) to find a way to have naval personnel use a wearable recording device to capture, synchronize, and download environmental, physiological, physical, and capable of looking at subjective measures that can contribute to physical and cognitive fatigue.

Currently, the Navy has increased their operational capability but the Navy is forced to do this with a reduced number of warfighters. Since there is less personnel, it is essential to accurately predict the Navy’s warfighter’s performance and then know how their performance ranks with others. This can be accomplished more effectively by using hardware and software, as opposed to just using just human capabilities with resulting limitations.

Presently, the Navy does use human performance models such as Total Crew Model and IMPRINT but even though today’s performance models are good, they still lack the fidelity to support tradeoff analyses. Also, most models are not validated and have little capability to account for the impact of environmental stressors such as fatigue, motion, vibration, and extreme temperatures.

A significant challenge in validating human performance models is the ability to collect environmental and performance data from warfighters and other naval personnel in an operational setting. Current methods are primarily paper-based and the process of coding self-reported responses is time consuming and increases the likelihood of errors in data entry.

Therefore, to overcome the data collection challenges associated with validating human performance and to ensure an accurate account for the effects of environmental stressors on performance, a novel, integrated, non-obtrusive data collection and analysis system is greatly needed.

The Navy anticipates that sensors will be used for data collection and it has been shown that recent advances in individualization algorithms are making possible a whole new generation of systems capable of tailoring mathematical and model-based assessments with capabilities to determine the fatigue level of differences among Naval personnel and operators of equipment.

The Navy realizes that academia and industry are increasingly developing portable and wearable data collection technologies. For example, services such as the iPod touch have the capability to obtain subjective responses. However, none of the devices or technologies developed so far are able to collect information non-obtrusively and then have the capability to incorporate this data with environmental, physiological, physical information and subjectively be able to measure fatigue existing in on the job.

Go to then go to (N11A-T033) to view the solicitation.

The responsibility for the Navy’s STTR program is with the Office of Naval Research. The Navy STTR Program Manager is Mr. Steve Sullivan and he can be emailed at

For general questions regarding (N11A-T033) with the title “Multi-Sensor Data Collection Suite for Unobtrusive Human Performance Measurement”, contact June Chan at

For technical questions about the topic before February 28th, contact Amy Bolton at or phone (703) 588-2547 or contact Igor Vodyanoy at or phone (703) 696-4109. After February 28th, go to the DOD web site at

Wednesday, February 2, 2011

HIT for Patient Care Supported

The Markle “Survey of Health in a Networked Life” is the first survey to compare the core values of physicians and patients. The survey shows that both doctors and patients overwhelmingly agree on health IT priorities to improve patient care and that health IT will increase the quality, safety, and cost efficiency of care, as well as provide core privacy protections.

“A surprising 74 percent of doctors say they want to be able to share patient information with other professionals electronically. As medical professionals shift from paper records to electronic systems, the public and physicians overwhelmingly agree that we need to measure the payoff from investments in information technology in terms of better health and more cost-efficient care,” according to Markle President Zoe Baird.

“Roughly 80 percent majorities of both the public and doctors agree that it is important to require participating hospitals and doctors to share information to better coordinate care, cut unnecessary costs, and reduce medical errors,”, said Carol Diamond, MD, Managing Director of the Markle Foundation, a New York based nonprofit foundation.

“By the same overwhelming margin, four in five doctors and patients expressed the importance of privacy protections for online medical records, an expectation we have repeatedly found expressed by the public in our previous surveys. They also agree on the importance of measuring progress,” said Diamond.

Majorities of 70 percent to 80 percent of both patients and doctors support letting people see if their records have been accessed, patients being notified if they are affected by information breaches, and giving people the mechanisms to correct information if needed.

Of the doctors surveyed, 94 percent said their patients sometimes forget or lose track of potentially important things they are told during doctor visits, and 34 percent of the doctors said they themselves at least sometimes forget or lose track of potentially important things that their patients tell them. Among the patient group, 30 percent perceived that their doctors forget or lose track of potentially important information at least sometimes.

Among the public, 10 percent reported having an electronic Personal Health Record (PHR) which is up from 3 percent who reported having a PHR in Markle’s 2008 survey. “Past surveys show that most adults believe personal health records should include copies of their own medical information to help them improve their health and communicate better with health professionals,” reports Josh Lernieux, Director of Personal Health Technology at Markle.

He said, “This survey indicates that there is an increase in PHR use and also that roughly two out of three doctors agree that patients should have the option of online access to their personal health information.

Knowledge Networks (KN) conducted the surveys August 10-26, 2010. The general population survey of 1,582 adults age 18 and older used KN’s KnowledgePanel®, a probability-based panel of 50,000 individuals designed to be representative of the U.S. populations. The survey of 779 physicians was conducted using KN’s Physicians Consulting Network (PCN), an invitation-only list of more than 45,000 practicing physicians.

Results of the survey are available at

Personalized Medicine & HIT

The question is how do we handle the enormous influx of genetic and medical data plus financial information and then incorporate this data into medical histories. In the future, personalized medicine will offer better targeted treatments, provide for health system cost savings, and help produce a better understanding of care options.

The 21st century healthcare model will use technology to incorporate information into large databases. By using this massive amount of information, medical professionals will have many ideas and choices as to what types of therapies will work for specific people.

A Brookings event held on January 28, 2011 brought forth discussion and ideas on the challenges involved in handling enormous amounts of data and properly utilizing IT to meet future health needs. Darrell West, PhD, Founding Director of the Center for Technology Innovation (CTI) at Brookings and Vice President and Director of Governance Studies, centered the discussion on the just released CTI paper “Enabling Personalized Medicine through HIT”.

Experts in the field such as David Brailer MD, PhD, Chairman, Health Evolution Partners and the first health information czar during the Bush Administration, Mark Boguski Associate Professor, Center for Biomedical Informatics, Harvard Medical School, Emad Rizk MD, President, McKesson Health Solutions, Donald W. Rucker, MD, Vice President and Chief Medical Officer, Siemens Medical Solutions, and Paul Billings MD, Chief Medical Officer, Life Technologies Corporation all offered their valuable ideas and thoughts on the subject.

Dr. Brailer started the discussion by saying that the public does not really recognize or understand the value and benefits of combining health IT and personalized medicine but enormous benefits would result. The health community could use genetic information to shape diagnoses, genetic testing could be used to enlighten patients on what their tests really mean, physicians would be provided with even more knowledge on the patient then they already have, and this in turn, would reduce or prevent unnecessary tests and provide for better treatments.

As Dr. Boguski pointed out, patients want to take an active role in their healthcare and be empowered patients. This means that in order for medicine to move forward, patients have to be co-managers of their healthcare.

Some of the challenges and issues discussed by the panel regarding the incorporation of personalized medicine into clinical practices would mean:

• Reshaping privacy and security needs since privacy is always a concern when combined with genetic information. A 2009 Institute of Medicine report concludes that the HIPAA Privacy Rule does not do the job and calls for a new approach to privacy

• Demonstrating the value of integrating personalized medicine into the payment systems. It is very important to emphasize the value of personalized medicine and this has to be demonstrated to CMS

• Interoperability will be even more important since a tremendous amount of data from many different sources will be incorporated into data bases. This means that as more and more information is available on diseases and treatments, even larger data sets will be needed so that interoperability will be an even more important factor than it is today

• Handling the documentation on tests from laboratories will greatly increase since 70 percent of clinical decisions are based on laboratory information. This means that in the future, pathologists will play a bigger and more important role which will necessitate that the profession be upgraded

• Enabling people to use social media to spread medical and health information to where it needs to go. Although today, many people use social media, it is still underutilized for medical data. Social media could be an invaluable asset to get information circulated worldwide on rare diseases

• Making certain that electronic health records play an important role in connecting genomic, other personalized information, plus drug information to genetics. EHRs with the right coding information could not only link treatment information with outcomes, but could also provide reimbursement based on the end result.

• Developing differentiated billing codes for various molecular or genetic conditions and tests so that researchers will be able to link genomic information to disease diagnoses and treatment

• Reducing the isolation of health research and genetic research information since this valuable information will need to be introduced into medical records and clinical practices

• Producing decision support tools especially for younger providers. HHS hopes to add decision models to the last stage of providing incentives to providers

Go to to view the CTI report “Enabling Personalized Medicine through Health Information Technology.

Review of VA's 2010 Performance

The VA's new initiatives along with their current ongoing programs has contributed to turning the VA into a 21st century organization that is people-centric, results driven, and forward looking. VA programs and activities have increased in rural healthcare, telehealth, upgrading the benefits system, providing for more transparency, and developing a new competition to find solutions to problems.

In the area of rural health, the VA continues their Rural Mobile Health Care Clinics pilot program. In addition, the VA supports studies and analyses on a wide range of healthcare issues relevant to rural and highly rural veterans. Specifically, studies on how to implement telehealth, how to address the unique needs of the Native American population, and how to treat the many older veterans in the VA system are ongoing.

In total, the VA telehealth program has expanded by 30 percent in providing home telehealth services. The program provides care to Veterans with chronic medical and mental health conditions, and today, the program enables 46,000 veteran patients to receive care and live independently in their own homes and local communities.

To help in the area of health IT and to increase efficiency in delivering healthcare, the Department of Defense and the VA are in the process of establishing a Virtual Lifetime Electronic Record (VLER) to provide seamless and efficient access to the information needed to provide services and benefits.

The goal is for DOD and the VA to exchange information between their different systems and their points of service in the private sector. To move the project faster from concept to implementation, the VLER initiative has been divided into two major lines of business such as health and benefits.

The implementation of this system will eventually allow for a standards-based information exchange between the health information systems of the two departments and the private sector. A series of pilots are underway to produce a scalable approach that will deliver the initial capabilities required by the end of calendar year 2012 with the implementation to be expanded to a mature state by the end of calendar year 2014.

The VA’s benefits information system is also undergoing an incremental implementation approach. Today, the current VA and DOD benefits information-sharing mechanisms are being evaluated and will be developed to provide basic administrative information in a seamless format between the departments by the end of calendar year 2012 and by 2014. At that time, access will be established to retrieve all of the necessary administrative information between the departments as well as relevant and accessible information in the private sector.

The VA was directed to develop a specific and actionable plan to be more transparent, participatory, and collaborative to meet the needs of the Administration. Some of the changes include the submission of 30 data sets to, the collaborative development and soft launch of the “Blue Button enabling veterans to download their personal health records, and the imminent delivery of the Fast Track system for automated claims process of presumptively service-connected disabilities.

A new program, the VA Innovation Initiative (VAi2) was launched in 2010 to identify, prioritize, fund, test, and deploy the most promising solutions to VA’s most important challenges. The program invites employees, private sector companies, entrepreneurs, and academic leaders to contribute their best ideas for innovations. Innovations are needed to increase the veterans’ access to services, improve the quality of services delivered, and/or enhance the performance of VA operations. In 2011, VAi2 will continue to provide oversight to more than 50 projects initiated in 2010 to ensure their implementation

The VA also recently established the Technology Acquisition Center (TAC) in Monmouth, New Jersey. The TAC is a strategic department asset providing acquisition support for the VA’s Office of Information Technology. During 2010, TAC awarded over $478 million in contracts and developing an effective procurement strategy to support VA’s major initiatives.