Wednesday, April 27, 2011

Today's Knowledge Explosion

Former Speaker Newt Gingrich at the “Promoting Biomedical Innovation and Economic Value” event co-sponsored by the Engelberg Center for Health Care Reform at Brookings and the Leonard D. Schaeffer Center for Health Policy and Economics at USC said, “The human race is on the edge of the greatest explosion in scientific knowledge in history.” As he sees it, there will be four to seven times new knowledge discovered in the next quarter century as was discovered in the entire last century.

For example in the future, regenerative medicine will enable individuals to use their own cells to grow solutions totally compatible with their bodies. In kidney dialysis alone, the federal government spends $27 billion a year. Kidney dialysis will soon be a larger cost than the entire NIH—yet regenerative medicine stands at the edge of making kidney dialysis an obsolete therapy. In addition, regenerative medicine is creating the potential for revolutionary breakthroughs for spinal cord injuries, cancer patients, and heart disease.

Brain science stands on the edge of an even greater revolution in knowledge and capabilities than regenerative medicine. Because of breakthroughs in instrumentation and computation, brain science will be one of the most exciting and explosive areas for new knowledge in this lifetime.

To make it possible to address the critical health issues that will take place in this century, it is essential to have the FDA provide for the free flow of information and make it accessible to all scientists across bureaucratic lines. As Gingrich stated, “This country needs to develop a FDA that is able to function effectively from the laboratory all the way to the individual’s medicine cabinet.”

One of the issues that Gingrich feels needs to be addressed is to develop a new system so that information can easily be obtained from clinical trials. When we have electronic communications in place, it will be possible to monitor clinical trials on a daily basis/real-time to obtain data on side effects and any unexpected developments if they occur.

According to the FDA report on “Strategic Priorities 2011-2015”, the agency is now developing a clinical trials repository and collects clinical trial submissions from many sources. So far, valuable information has been obtained on safety, effectiveness and performance of drugs, biologics, and devices both before and after approval.

FDA finds it difficult to analyze all of the data since the information is submitted in various non-standardized structures in formats that are sometimes paper-based. FDA needs to be able to convert all of the data into an electronic uniform standard structure in a common language or format.

According to the FDA report, in the next five years, the agency plans to develop innovative strategies to help in the development of new biomedical products and emerging technologies. The agency plans on playing an important regulatory role in systems biology, wireless healthcare devices, nanotechnology, medical imaging, robotics, cell and tissue-based products, regenerative medicine, and combination products.

FDA’s goal is to build their CER clinical data and standards infrastructure, tools, skills, and capacity by forming large study data repositories containing information applicable to CER. In the future, comparative effectiveness pilots and other complex research projects will use FDA’s vast but untapped stores of patient safety and clinical efficacy data.

In many other ways, the electronic transmission of data is going to play an important role in the coming years. Looking to the future, FDA will need to make new investments in informatics hardware and software to effectively be able to review multiple studies and perform analytical studies.

To view the FDA report “Strategic Priorities 2011-2015, go to

RUS Announces Grants

USDA’s Rural Utilities Service (RUS) recently announced that the “Delta Health Care Services Grant Program” application window is open with $3,000,000 in grant funds available with the minimum award to be $50,000. Grants will be awarded to eligible entities in the Delta Region serving communities of no more than 50,000 inhabitants to help to address the long standing and unmet health needs of the region.

The Delta Regions refers to the 252 counties and parishes within the states of Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee served by the Delta Regional Authority.

The “Delta Health Care Services Grant Program” provides financial assistance to help meet health needs in the Delta Region by cooperating with healthcare professionals, institutions of higher education, research institutions, and other entities in the region. Grant funds may be used to develop healthcare services, health education programs, healthcare job training programs, and to develop and expand public health related facilities in the region. Applicants are strongly encouraged to emphasize distance learning and/or telemedicine projects.

Applications are due on June 3, 2011. For more information, go to the April 4, 2011 issue of the Federal Register, or go to the web site or call (202) 720-8427.

Funding Opportunity Issued

The Defense Medical Research and Development Program (DMRDP) released a funding opportunity on April 19, 2011 “Clinical Trial Award for Regenerative Medicine, Pain, and Sensory Systems” (CTA-RPS) to be funded in FY 12.

CTA-RPS will support early phase clinical trials with the potential to have a major impact on treating combat-related injuries in the areas of pain, restoration of sensory systems (balance, hearing, and vision), and regenerative medicine technologies.

Proposed projects need to demonstrate the safety and efficacy of novel therapies and diagnostics in human patients suffering from serious, debilitating injuries of the extremities, skin, and sensory systems of the craniomaxillofacial area due to trauma. Of interest are projects focused on testing and translating investigational interventions already proven in relevant animal models and then moving these interventions into advance clinical development.

The focus research areas are:

• Regenerative medicine—Research to promote tissue repair and reconstruction through the use of stem cells, progenitor cells, growth factors, biomaterials, and/or immunomodulation

• Pain—Research needs to include early phase clinical trials of novel pharmaceuticals or devices with the potential for significant impact on the alleviation of pain in wounded warriors. Novel analgesics are sought for the full spectrum of acute and chronic pain

• Vision—Research should include early phase clinical trials of novel pharmaceuticals and devices focused on restoration and rehabilitation of vision loss

The DMRDP expects to allot $15.3 million of the FY 12 appropriation to fund approximately five CTA-RPS applications. FY 11 DMRDP funds for up to $15 million may also be available to fund an additional five CTA-RPS applications. Funding for this program is contingent upon the availability of federal funds for the program and on the quality and number of applications received.

Applications for the funding can include investigators within the military services but also multidisciplinary collaborations among academia, industry, military services, Department of Veterans Affairs, and other federal government agency.

Go to to view the program announcement. For questions, email or call the Congressional Directed Medical Research Programs help desk at 1-301-682-5507. The application deadline for the DMRDP program announcement (W81XWH-12-DMRDP-CTA-RPS) is August 25, 2011.

State Issues RFP for HIE

The state of Connecticut’s Department of Information Technology, IT Contracts, & Purchasing Division has issued an RFP for the Health Information Technology Exchange (HITE-CT). The HIT-CT will connect physicians and other healthcare professionals in the state with the initial effort to support Meaningful Use Stage 1. However, the longer term goals are to support a broad spectrum of clinical and population health services.

Today, the state licenses and regulates 16,690 physicians, 32 acute care and children’s hospitals, 14 community health centers with over 50 satellite sites, 77 local health departments, 241 nursing homes, 251 outpatient clinics, 424 behavioral health facilities, and 29 urgent care centers. Beyond physicians, the Department of Health licenses over 60 different practitioner titles plus the state has hundreds of emergency medical services managed by municipal, public, and private entities.

There are currently five statewide collaborative initiatives within the state and six local HIE initiatives already under way which are expected to become part of the HITE-CT with varying timelines.

In order to support this project and future growth, HITE-CT plans to establish an XDS Document Sharing Infrastructure for the HIE within the state along with NHIN Direct support for those providers unable to connect to the exchange.

The RFP was issued April 14, 2011 with submissions due May 13, 2011. Short list vendors will be asked to present demonstrations of the products that they propose via web-based conferencing. These conferences will be completed by June 10, 2011.

Go to, to view the RFP.

RFP Issued for VAST

As reported in “Virginia Telehealth News Weekly” the Virginia Acute Stroke Telehealth (VAST) network received Rural Healthcare Pilot Project funding to build a telecommunications backbone for telemedicine and telehealth to primarily support stroke care and health information technology.

The vision for VAST is to design and implement a robust, secure, sustainable telehealth network that has sufficient scalable high capacity links communicating from the hubs to the cloud. The goal is to support healthcare applications of the end-to-end networks to allow for seamless and dynamic routing for data from the hub-managed partners to hub-managed partners.

Telehealth application will include the transfer of images, ability to share electronic health records, provide consultations, information on disaster readiness, clinical research, and provide for health education applications.

Participating network hubs will be the University of Virginia Health System (Charlottesville), Culpeper Regional Hospital (Culpeper), Eastern Shore Rural Health System (Nassawadox, and Middle Peninsula-Northern Neck Community Service Board (Saluda).

VAST in issuing the RFP is soliciting bids from vendors, suppliers, and service providers to provide connectivity. The network is seeking consolidate bids and partial bids.

VAST expects to receive competitive offers for network deployment from independent telephone companies, local exchange carriers, cable operators, hardware distributors, manufacturers, cabling and construction contractors, and others.

Questions on the VAST RFP need to be submitted in writing. Email Eugene Sullivan Assistant Project Coordinator, located at the University of Virginia, Office of Telemedicine at The RFP is posted on

Search for Program Officer

The Commonwealth Fund is searching for a Program Officer to direct their new “Program on Vulnerable Populations” in their New York City office. This new program will seek to ensure that low-income, uninsured, and minority populations receive care from high performing health systems.

The program has two components:

• A grantmaking program on “High-Performing Health Systems Serving Vulnerable Populations” was created April 2011
• The Commonwealth Fund/Harvard Minority Health Policy Fellowships established in 1996 based at Harvard Medical School, seeks to develop physician leaders who will address the health needs of vulnerable populations

Working closely with the Executive Vice President for Programs, the program officer will be responsible for all aspects of the program, including grantmaking, intramural research, and dissemination strategy to include:

• Monitoring and Tracking—Documenting and tracking healthcare utilization and quality of healthcare for vulnerable populations at the state level
• Delivery System Reform—Encouraging state and regional/local-level planning for systems of care that can meet the healthcare and related needs of vulnerable populations
• Current Models and Future Opportunities—Identifying promising practices and delivery system models, and developing and disseminating policy recommendations to support innovations and improvements in care systems so they can better serve vulnerable populations
• Government Policy Levers—Working with CMS, state Medicaid programs, HRSA, and other agencies and payers to identify incentives and supportive federal and state policies to achieve equity in access and quality, and address concerns related to vulnerable populations across a continuum of care

The qualified candidate will have doctoral level training, although outstanding candidates with a combination of relevant experience and education will be considered. Ten years’ related work experience with healthcare delivery systems, public health, and vulnerable populations experience is required.

This experience should ideally include working with government and organizations at the state and national level, and/or in healthcare delivery systems serving vulnerable populations. The candidate should also have a strong background in health insurance coverage, particularly Medicaid, and policy, including health services financing and delivery system issues, quality improvement and efficiency, managed care, and availability of and access to care. Health policy and research analytical skills required to include the ability to summarize and present information from different sources, including quantitative sources.

A complete job description is available at A CV/resume, cover letter, and salary history should be emailed to Diana Davenport, VP for Administration at

Wednesday, April 20, 2011

Proposals Sought for CCTP

The “Partnership for Patients” a new national partnership has been funded for $1 billion with $500 million of that funding available through the “Community-based Care Transitions Program” (CCTP) to provide services. The objective is to effectively manage transitions for Medicare beneficiaries from acute to community-based settings.

CMS is now accepting applications to participate in the CCTP to not only improve transitions from inpatient hospital settings to other care settings, but specifically to improve quality of care, to reduce readmissions for high risk beneficiaries, and to document measurable savings.

Community-based organizations and acute care hospitals partnering with community based organizations can now submit applications for the funding. Applications are being accepted on a rolling basis and will be made as funding permits.

Applicants for the funding must identify root causes for readmissions and define their strategies for identifying high risk patients. Applicants must also specify care transition interventions that include strategies for improving provider communications in care transitions.

In addition to the CCTP funding and in coordination with stakeholders from across the healthcare system, the CMS Innovation Center will fund up to $500 million to support new demonstrations related to reducing hospital-acquired conditions. These collaborative models will help hospitals adopt effective interventions to improve patient safety.

The CMS Innovation Center will help hospitals adapt effective evidence-based care improvements to target preventable patient injuries on a local level and help to develop innovative approaches and then share these strategies with public and private partners.

For more information email Juliana Tiongson at or call (410) 786-0342.

USTDA Supports ICT

The U.S. Trade and Development Agency (USTDA) supports the development of ICT systems to help in worldwide emerging economies. USTDA links U.S businesses to export opportunities by funding project planning activities, pilot projects, and reverse trade missions.

On March 14, 2011, USDTA released the Synopsis/solicitation (2010-11020A titled “Nigeria-Children’s Hospital Project” to provide technical assistance on the proposed Children’s Hospital project in Nigeria. The project is envisioned as an 80 bed hospital to feature a neonatal intensive care unit, biomedical research laboratory, teaching facilities, and a children’s health outreach program.

The technical advisor chosen for the project will assist in planning the hospital’s clinical services and facilities. The plan is to support infrastructure, provide medical equipment, information technology systems, and telemedicine equipment for remote diagnosis services. The grant award for $289,000 will be paid in U.S. dollars.

In another example, last month, USTDA provided grant funding of $645,944 to help India expand an Integrated Emergency Communications System (IECS). The grant was awarded to India’s Ministry of Home Affairs to plan a pilot project to develop the IECS in Hyderabad, Andhra Pradesh, sixth largest city in India.

India does not currently have a nationally standardized system that can manage emergency communications and services like “911” in the U.S. India has designated the exchange “108” as the national integrated emergency number. The support from the U.S. will help to establish a national model for implementing IECS throughout the country. The implementation of a national system holds the potential to open India’s market for $800 million in U.S. exports to include homeland security and emergency response and communication equipment and services.

In addition to the USTDA grant, “Optimal Solutions and Technologies, Inc., a U.S provider of management consulting, information technology, and engineering services will also contribute additional resources towards the completion of the feasibility study.

A few years ago, a $700,000 USTDA grant was awarded to the Special Telecommunications Service of Romania to improve Romania’s ability to manage emergencies so that users can share voice, data, and multimedia content instantly. With the funding, Telecordia Technologies of Piscataway, N.J conducted the study “Romania Next Generation Network Infrastructure for Emergency Management.”

When the President of China made a state visit to the U.S., last January, USDTA, HHS, and the U.S. Department of Commerce joined with China’s Ministries of Health and Commerce to support the establishment of a new public-private partnership in the healthcare sector.

The objective for the collaborative effort is to foster long term cooperation with China in the areas of research, training, regulation, and to increase accessibility to healthcare services in China. Through this program Chinese participants will have greater access to U.S. private sector expertise and be able to find out about innovative technologies that will be important to long-term healthcare delivery.

Over time, the partnership will provide for cooperation in areas such as rural healthcare, emergency response, personnel training, medical information technology, and management systems while also exploring ways to support traditional Chinese medicine.

The program will support a Healthcare Professional Personnel Exchange Program with potential funding from USTDA in terms of studies, consultancies, training, pilot projects and related project development.

For more information, go to

Program to Help AI/AN

The Indian Health Service (IHS) and Brigham and Women’s Hospital (BWH) a teaching affiliate of Harvard Medical School are working on an Outreach Program to help American Indian/Alaska Native (AI/AN) remote communities receive specialty services. This Outreach program is important since AI/AN communities especially in the Navajo Nation are vastly underserved and impoverished.

The Navajo Nation is the largest tribe in the U.S. with 225,000 members and is based in Arizona, Utah, and New Mexico. Patients have to travel extremely long distances to obtain medical services and often experience cultural differences with their providers. The situation is dire because there is a chronic lack of primary care physicians and specialists available to provide timely care.

There is a five year shorter lifespan for the AI/AN population which has the highest prevalence of Type 2 diabetes in the world with the rate of cardiovascular disease increasing at a rate significantly higher than the rest of the U.S population. In addition, the communities have among the highest rates for substance abuse and dependence in the nation and have higher rates than all other Americans for tuberculosis, accidents, homicides, and suicides.

Since the Outreach program began, 25 BWH physicians have worked in partnership with the IHS representing numerous specialties including rheumatology, cardiology, dermatology, neonatology, neurology, and others. In addition to providing direct patient care, the volunteer physicians provide skills training and educational lectures for the IHS staff at each facility.

The IHS sites currently partnering with BWH include the Northern Navajo Medical Center known as “Shiprock” and the Gallup Indian Medical Center. The Shiprock Service Unit is the largest service unit within the Navajo Nation caring for approximately 45,000 AI/AN mostly Navajo patients. There are 75 physicians working at the unit averaging 400 visits per day with limited availability of on-site specialty services.

The Gallup Indian Medical Center located in New Mexico on the border of the Navajo Reservation cares for 40,00 AI/AN patients and serves as a referral center for many of the smaller health centers within even more remote areas of the Navajo reservation.

The program also includes a longitudinal component that is delivered through telemedicine technology. BWH physicians communicate with IHS clinical colleagues via video conferencing technology. The physicians are now able to conduct medical rounds and listen to challenging clinical cases presented by IHS physicians using the technology.

According to an article appearing in the IHS Office of Information Technology April 2011 newsletter, the first video conference was held November 2010 between the Northern Navajo Medical Center and BWH physicians from the Division of Rheumatology. The one hour conference was a coordinated effort between IHS technology support staff in Aberdeen and Shiprock working with IT staff at BWH.

Test calls were conducted prior to the actual video conference to ensure compatibility among all systems with conference bridge support provided by both Aberdeen and Boston video engineers. A second rheumatology video conference between Shiprock and BWH was held in February 2011 with a third video conference to be held in the spring and there are plans to expand the program to Gallup.

NASA's Research Efforts

NASA’s inventors at the Johnson Space Center in Houston have developed a rotating device known as the bioreactor to enable the growth of tissue, cancer tumors, and virus cultures outside the body in space and on Earth. This device has many advantages over typical laboratory methods.

The bioreactor has been used for experiments aboard the space shuttle, the Russian Mir space station and on Earth. Researchers across the U.S. use this technology to study cancer, stem cells, diabetes, cartilage and nerve growth, and infectious diseases.

Lab-grown cell cultures tend to be small, flat and two dimensional but unlike normal tissues in the body. However, tissues grown in the bioreactor are larger and three-dimensional, with structural and chemical characteristics similar to normal tissue. The bioreactor has no internal moving parts, which minimizes forces that might damage the delicate cell cultures.

Researchers at NIH used this method to propagate HIV, in artificial lymph node tissue. This research resulted in being able to study the virus life cycle under controlled conditions outside of the human body.

The bioreactor is a spinoff technology that entered the commercial world when Synthecon based in Houston licensed the device in 1993 and manufactured it for commercial sale. Regenetech Inc. also based in Houston, licensed eleven patents from the Johnson Space Center in Houston in 2001 to produce three dimensional tissues in the bioreactor. Through a special NASA agreement, the bioreactor provides the technology to pursue rare disease treatments. In December 2010, Emerging Healthcare Solutions Inc. acquired a sublicense from Regenetech to use the bioreactor.

Just announced on April 15, 2011, the bioreactor was inducted into the Space Technology Hall of Fame. Three of the co-developers for commercial use of the bioreactor were also inducted and include Dr. David Wolf, NASA Astronaut, Physician, and Electrical Engineer, Tinh Trinh, Senior Mechanical Engineer, for Wyle Integrated Science and Engineering Group, and Ray Schwarz, Chief Engineer and Co-Founder of Synthecon Inc.

The Human Research Programs located at NASA’s Glenn Research Center has been very involved in developing sensors to monitor astronaut health, and is currently researching advanced fluid systems that will be used to perform medical laboratory tests with reusable devices.

The Glenn Research Center is looking for federal laboratory, academia, or industry partners to collaborate with them on their Human Research Program “Exploration Medical Capability Gaps.” The Center is particularly interested in noninvasive diagnostic imaging capabilities and techniques. For more information, email Laurie Stauber at or call (216) 433-2820.

The Glenn Research Center is collaborating with BioEnterprise, a business initiative designed to grow bioscience companies. The agreement between the Glenn Research Center and BioEnterprise will work collaboratively to further the development and commercialization of life science-related technologies in Northeast Ohio.

A commercial product called vMetrics systems was announced by ZIN Medical Inc., a company jointly owned by ZIN Medical and the Cleveland Clinic. The system provides real-time monitoring of patients through a compact wireless device and can be used in space, military, and commercial applications. The first commercial application is supporting the atrial fibrillation market.

The Ohio Technology Cluster Commercialization Program through the Glenn Alliance for Technology Exchange has launched an initiative to apply biocompatible nanoporous filters for biomedical purposes that can possibly revolutionize the standard of care for kidney disease. The filter design is based in part on work from a John Glenn Biomedical Engineering Consortium project.

In addition, there are several other projects from the Glenn’s Human Research Program that have the potential for commercialization and include:

• A method and system to remotely monitor in real-time via the web, an EKG and other vital statistics of patients without constraining their movement
• A method and apparatus for determining the physical characteristics of the lens and other ocular tissue
• A system that measures oxygen consumption and carbon dioxide production to quantify the level of exercise and state of fitness

Sunday, April 17, 2011

CER a Top NIH Priority

Comparative Effectiveness Research (CER) has moved into the spotlight at HHS since the American Recovery and Reinvestment Act of 2009 appropriated $1.1 billion for CER, with $400 million allocated to NIH, the remainder to AHRQ, and to the Office of the Secretary. The Director of NIH, Francis S Collins, M.D, PhD, recently said at “The Atlantic’s 2011 Health Care Forum” held in Washington D.C on April 7th. “NIH is committed to CER as a research priority to encourage new research and new ideas.”

Dr. Collins noted that CER can be an effective tool to generate evidence to demonstrate what works, help to make medical decisions, support decisions based on quality and value, and possibly help to lower healthcare costs. The key challenge is to get the results of CER studies out to providers, payers, and the public.

He further commented that CER will be guided by the emerging science of genomic and personalized medicine. The research will study what groups may or may not respond to an intervention. It is also important for CER studies to include participant genomic and environmental exposure data to help scientists understand why some individuals benefit from a specific treatment while others do not.

Several NIH Institutes support research involving Health Maintenance Organizations (HMO). In order to advance the science of healthcare decision-making, the HMO Research Network Collaboratory was formed and includes 16 integrated health systems. The primary goal is to accelerate large epidemiology studies, clinical trials, and healthcare services research so that the Collaboratory can focus on risk factors, rate diseases, CER, patient accrual, and reimbursement models.

The Collaboratory has issued a Request for Information (RFI) titled “Input on Strategies for Leveraging Existing Health Data Linked to New or Existing Bio-specimen Repositories for Large Scale Epidemiology Research” due June 1, 2011. The RFI is seeking comments from organizations and individuals that have repositories adaptable for research.

The Collaboratory also issued a Funding Opportunity Announcement (FOA) “NIH-HMO Collaborator Coordinating Center” looking to develop, expand, and evaluate the infrastructure needed to support the project’s long-term objectives. The deadline for the FOA is May 27, 2011.

NIH is working closely with the non-profit “Patient-Centered Outcomes Research Institute” (PCORI) established by ACA to organize and fund research, provide a peer-review process for primary research, and to disseminate research findings. Dr. Collins pointed out that NIH and AHRQ are embracing PCORI to build on the investment in CER to provide well validated evidence-based approaches.

There are several studies and program that have in the past or are currently using knowledge gained from CER that went out to communities to help the general population and providers receive up-to-the-minute research data. A good example is the NIH “Diabetes Prevention Program” (DPP) with total funding of $267,589,000 that studied 3,000 plus adults at risk for developing Type 2 diabetes.

The study followed participants for ten years and looked at not only the lifestyle changes needed by individuals at risk for Type 2 diabetes but also studied treating participants with the drug metformin. A decade later, both lifestyle changes and metformin were still found to lower the risk for Type 2 diabetes. The information obtained from DPP was then broadly disseminated into communities and to providers.

In another campaign program to prevent Type 2 diabetes, the National Diabetes Education Program(NDEP) through NIH, CDC, plus more than 200 public and private organizations developed the “Small Steps, Big Rewards” program.

The NDEP through this program created campaign messages and materials for people at risk for diabetes including African Americans, Hispanic and Latino Americans, Native Americans and Alaska Natives, Asian Americans and Pacific Islanders, woman with a history of gestational diabetes, and older adults. NDEP and their partners are promoting diabetes prevention and sending the information to healthcare professionals so that they will have the tools to help their patients take small steps to prevent or delay the disease.

For more information on the Atlantic’s 2011 Health Care Forum, go to

Reaching Out to Rural Vets

According to Mary Beth Skupien, M.D, Director of the Veterans Health Administration’s Office of Rural Health (ORH), rural veterans have difficulty obtaining access to quality healthcare. This is due to the fact that many veterans may have to travel long distances to healthcare facilities, they can lack health insurance, and in general, there is a lack of specialty care providers working in rural areas. Added to these facts, rural veterans suffer from unique health complications associated with exposure to combat such as PTSD, depression, and TBI.

ORH has invested over $95 million dollars in telehealth equipment and is continually building up telehealth capabilities particularly home-based telehealth. Reports show that by the end of September 2010, over 71,000 veterans were enrolled in the VA Care Coordination Home Telehealth program.

It has been announced that the VA just awarded new contracts to keep up with changing telehealth solutions. On April 11, Authentidate announced that it was one of six companies to be selected by the VA to be awarded a home telehealth contract. VA facilities will now be able to use the company’s Electronic House Call™ and its Interactive Voice Response (IVR) system to remotely monitor patients.

The Office of Rural Health Newsletter “The Rural Connection” reports in their April issue on several new telehealth programs to address health problems in rural areas. For instance, the VA Stars & Stripes Healthcare Network (Region 4) is using the E-Consult program. Once the patient gives approval, their primary care provider in a rural clinic and a specialty provider located in a VA hospital are able to communicate about their care by using secure email along with electronic records.

Researchers from the VA’s Center for Health Equity Research and Promotion based at the Pittsburgh VA Medical Center evaluated the E-Consult program based on satisfaction, quality, time, access, safety, expectations, confidence, and intent to continue to use E-Consult. Overall, veterans and primary care physicians are significantly satisfied with the program and there are plans in 2011 to expand.

Rural health challenges are not new to the VA Rocky Mountain Network (Region 19) which includes Montana, Utah, most of Wyoming, Colorado, and parts of Idaho and Nevada. Region 19 is now able to provide tertiary specialty care in critical care. This has really been a problem, since it is particularly difficult to treat veterans in this low population region due to the lack of available medical and surgical specialists in the region.

To help in this situation, critical care is delivered virtually by what is referred to as vICU which happens to be the first of its kind to be used in the VA system. Unlike other virtual ICU models, this program is unique because it is nurse driven. Modeled after a traditional Rapid Response Team (RRT) approach, a critical care certified nurse manages the vICU system 24/7 from a VA facility in Denver and provides consultations and support. The nurse also coordinates the point-to-point video communication between hospital physicians at the rural sites and specialty physicians in Denver.

Telehealth is valuable within the VA Salt Lake City Health Care System and they have embarked on an aggressive telehealth program to help the 10 to 38 percent of veterans that are 65 years old and older that live in isolated areas within the region.

Last February, the Salt Lake Health Care System opened a second primary care telehealth outreach clinic in Idaho. In the past, veterans in the area would have to travel one hour for primary care service and over three hours for specialty care services that are now provided though telehealth technology. Future primary care telehealth outreach clinics are due to open soon in Nevada and Idaho.

Unfortunately, cancer treatments are not available at all VA facilities so to address these limitations, the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston supported by the VA’s ORH, has implemented a Virtual Tumor Board (VTB) between different institutions located in the South Central VA Health Care Network.

The VTB project was designed to enable physicians at smaller distant clinics to present complex cancer cases during the MEDVAMC tumor board conference using telemedicine technology. High tech communication enables the physicians to review the cancer patient’s case and to discuss and develop a consensus for a treatment plan. The DeBakey Cancer Center is now working to implement this project on a wider scale with the goal to provide this service throughout Region 16 and across the country.

Go to to view the Rural Connection Newsletter.

Kentucky Issues RFP

Kentucky’s Beshear Administration wants to implement managed care within the state Medicaid Program to help balance the state’s budget. To accomplish that goal, the Administration initially issued a Request for Information (RFI) to gather ideas and suggestions on how managed care principals might be applied to the program. Several companies responded to the RFI.

On April 7, 2011, the Administration issued a Request for Proposals (RFP) regarding managed care within Medicaid so that the state can begin to hire vendors to set up and manage services for the state.

The Commonwealth through the RFP titled “CHFS Medicaid Managed Care Organizations” (758 1100000276) is going to contract with multiple managed care organizations in each of the Medicaid Managed Care Regions that deliver healthcare services to Kentucky Medicaid members at the most favorable, competitive prices. Companies can bid to manage Medicaid throughout the state but also to manage Medicaid within one of eight geographic regions of the state.

The goals of the RFP are to measurably improve healthcare outcomes in diabetes, coronary artery disease, colon cancer, cervical cancer, behavioral health, prenatal care, and oral health. In addition, the goal is to reduce unnecessary ER visits, improve care coordination especially for individuals with chronic illnesses, promote wellness and healthy lifestyles, and to lower the overall cost of healthcare. Vendors would also be responsible for customer service, financial management, claims management, and for maintaining sufficient information systems.

Companies that are interested must respond by May 25, 201. Questions must be received by April 20th, and the vendors’ conference will be held May 11th. The goal is to have one or more managed care companies operational by July 1, 2011. To view the RFP, go to or call (502) 564-4510.

State Developing MSOs

In Maryland, Management Service Organizations (MSOs) are going to help deal with the challenges that occur when providers adopt EHRs. The MSOs will help with cost containment issues and help providers maintain their systems.

State Designated MSOs will enable physicians to access a patient’s record wherever access to the internet exists. MSOs will enable EHRs to be hosted in a centralized secure data center away from the physician’s office and the MSOs will assume the responsibility for managing privacy and security. Also, technical support usually extends beyond the standard business hours and in some cases is available 24/7.

In addition, according to legislation passed in the Maryland General Assembly in 2009, the Maryland Health Care Commission is required to designate one or more MSOs by October 1, 2012. If physicians adopt EHRs through an MSO, they will then be able to exchange information through the statewide HIE.

MSOs can be collaborations among provider groups, hospitals, or other entities that work together to mitigate the costs associated with acquiring EHRs and other services.

In order to reduce costs, MSOs can secure more favorable pricing for their subscribers since the average cost of a client server EHR system is around $53,000 per physician over three years. However, the average cost of a MSO hosted EHR is around $28,800 per physician over three years plus MSOs will assume the vendor negotiating role.

The MHCC designated the multi-stakeholder group “Chesapeake Regional Information System for our Patients (CRISP) to build the statewide Health Information Exchange. CRISP was awarded $6.4 million through the Office of the National Coordinator for HIT to build the HIE. Health care providers using EHRs that seek payment from a state regulated payer must adopt EHRs that are certified and capable of connecting to the HIE by January 1, 2015. MSOs will help by offering connection to the statewide HIE and eventually to NHIN.

Practices may be able to seek additional monetary incentives if they adopt a certified EHR through a state designated MSO and then connect to the HIE For more information, go to or to

Fund Establishes New Position

The Commonwealth Fund Office located in Washington D.C., has created a new position, Federal State Health Policy Officer within their Federal Health Policy program. The program on Federal Health Policy is designed to strengthen the link between the work of the foundation, including the Commission on a High Performance Health System and the Federal policy process.

The program focuses on the identification, development, evaluation, and spread of policies that expand access to affordable, high-quality, and efficient care—particularly for vulnerable populations while reducing health spending growth. The program provides outreach to states and promotes a healthy dialogue between federal and state officials on reform implementation issues.

This new position reports directly to Rachel Nuzum, Assistant Vice President for Federal Health Policy. The primary goal of the Federal State Health Policy Officer is to inform federal health policy makers about state innovations, as well as the impact of Federal health policy reform on state activities. At the same time, the Federal Health Policy Officer will help to identify issues that are relevant and timely to state policymakers as they implement health reform activities.

The qualified candidate will have a master’s degree in a field related to health services research, or health policy, or health economics and five years related work experience with demonstrated health policy experience, plus experience working with government and organizations at the state and national level.

The candidate must have a strong background in health insurance coverage and policy, health services financing and delivery issues, quality improvement and efficiency, managed care, and availability and access to care. Health policy and research analytical skills require the ability to summarize and present information from different sources including quantitative sources.

A complete job description is available on To apply for the position of Federal State Health Policy Officer, include a CV or resume, cover letter, and salary history. Email this information to the VP, for Administration Diana Davenport at

Wednesday, April 13, 2011

HIT Essential for ACOs

A great deal of interest has been generated since CMS released the proposed rule for Accountable Care Organizations (ACO). As a result, many private sector healthcare organizations and CMS are exploring how HIT, electronic health records, registries, and other tools can be used to coordinate care to provide seamless high quality care for Medicare beneficiaries through ACOs.

On April 6th, leading experts came to a Capitol Hill briefing to discuss the role of health IT and ACOs. Neal Neuberger, Executive Director of the Institute for e-Health Policy, pointed out how ACOs and health IT will need to effectively interface and work together so that healthcare providers will be able to treat individual patients across care settings.

Senator Sheldon Whitehouse from Rhode Island stressed that a robust health IT structure is truly needed to coordinate care, reduce costs, and prevent fragmented care in our nation. The Senator said, “ACOs have generated a great deal of buzz with the release of the rules and most realize that health technology will be the framework for this new model of care.”

To make health IT even more effective, on March 10th, the Senator introduced the “Behavioral Health Information Technology Act of 2011” (S539) which has been referred to the Committee on Finance. The purpose for the bill is to make sure that health IT assistance is clearly provided to behavioral health, mental health, and substance abuse professionals.

Susan M. Christensen, Senior Public Policy Advisor at Baker Donelson as moderator thinks that the “Individual Health Record” will play an important role. The IHR would do so by integrating all clinical and financial data on a regional basis from original and unaffiliated sources to enable patients and physicians to use a common record.

Establishing an ACO means transformational change, according to Pamela Friedman, Vice President with the Strategy and Governance Practice of, Ingenix Consulting. She explained that it can be a lengthy, complex process that involves overcoming governance and legal hurdles, changing existing cultures, and implementing new processes and information systems.

Ingenix believes that a “sustainable health community” needs to be created. As Friedman explained the “sustainable health community” would require all participants of a community to function in harmony to achieve community health in terms of optimized care, quality, and result in lower costs. These communities must be connected, intelligent, and aligned with all of these elements to be operative and synchronized for a workable system to be produced.

Keth Figlioli, Senior Vice President of Informatics, Premier Healthcare Alliance described how the Alliance was put in place to reduce costs, improve quality, to mitigate risk, and shape policy and advocacy for members operates with over 2,000 hospitals and more than 70,000 non acute sites.

Figlioli further explained that health IT must be at the heart of the accountable care framework in order to build a patient centric system of care, to improve quality and reduce the cost for delivery system components, coordinate care across participating providers, use IT data and reimbursement to optimize results, and build payer partnerships.

An example of technology at work in a rural state was presented Lisa Harvey-McPherson, Vice President, for the Eastern Maine Healthcare System & Home Care Technology Association of America. She told the attendees that although the state is a large geographic area of 6,000 square miles, the Eastern Maine Health System (EMHS) is able to operate with a well organized network of local healthcare providers that offer high quality and cost effective services to their communities.

Harvey-McPherson discussed how important it is to provide homecare in the largely rural areas in the state. Just last year, the Eastern Maine Home Care (EMHC) staff drove more than 1.35 million miles to provide 67,997 visits to 3,581 patients in northern, eastern, and central Maine to provide nursing, therapies, social work, and hospice care.

Today, telehealth at EMHC involves patients uploading data daily to a telehealth nurse in Caribou Maine. A telehealth nurse calls the patient when they see clinical “red flags” on information sent online by the patient. At this point, the telehealth nurse determines what the next level of intervention should be.

This can mean making the decision to either make a home visit or to contact the physician. Since most clinical changes are handled by the telehealth nurse versus an additional home care visit, a savings of $120 is achieved every time telehealth is used instead of paying for a home visit.

As Harvey-McPherson explained the “Beacon Program” a nationally federally funded grant program was put in place to help communities build and strengthen their health IT infrastructure and exchange capabilities. The Bangor Beacon Community is just one of the 17 sites nationwide and now operating a three year project funded with $12.7 million. The funding from the Beacon Program will be used to build an EMR/IS system for EMHC and to provide additional telehealth units for all home care participants in the grant program.

The medical home using technology to coordinate care is gathering support. Martin Lipstick, M.D, Senior Vice President, Excellus Blue Cross Blue Shield Association discussed how the Rochester Medical Home Initiative is faring.

Rochester New York’s two largest health insurers, Excellus BlueCross BlueShield and MVP Health Care are coordinating and paying for the three year medical home initiative that now includes seven primary care practices and 21 doctors already using EMRs.

Each doctor receives funding to help cover their startup costs and to cover the cost of a care manager. The participating primary care physicians and practices are accredited through NCQA’s “Physicians Practice Connections-Patient Centered Medical Home” program.

The practices have found that their office care is improving, staff identifies with patients that have chronic diseases, and the staff is vigilant about contacting patients and scheduling them for appointments. As a result, physicians are spending more time with patients and seeing patients within five days of a hospital discharge to ensure that patients understand their treatment.

However, he commented on some of the challenges. Some of these problems are technological, economic, some political, organizational, and involve privacy and legal issues. Some additional challenges include practices using different EMR systems, doctors using idiosyncratic documentation, the lack of standard specifications.

The Institute for e-Health Policy holds the 2011 Congressional Luncheon Seminars behalf of the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics. This program has been ongoing for 19 years to inform the Members of Congress, Congressional staff, key Federal agency officials, industry professionals, and the general public on issues of immediate concern in the health technology field.

For more information, go to or email Neal Neuberger at or Arnol Simmons, Manager, Public Policy Initiatives at

Reducing Health Disparities

HHS on April 8th released two strategic plans aimed at reducing health disparities. According to the “HHS Action Plan to Reduce Racial and Ethnic Health Disparities” access to timely and needed primary healthcare services continues to be a major challenge for racial and ethnic communities. The second plan “National Stakeholder Strategy for Achieving Health Equity” provides goals and objectives to help racial and ethnic minorities and other underserved groups reach their full health potential.

According to the HHS Action Plan, HRSA will provide technical assistance and resources to health centers so that the centers will be able to adopt and meaningfully use health IT, track clinical control of blood pressure, provide clinical management of diabetes, and track reductions in racial and ethnic disparities in low birth weight child births.

The HHS Action plan specifically calls for HRSA to award 350 New Access Point grant awards to support new health center service delivery sites in medically underserved areas. Funds will be used to not only expand services at existing health center sites, but will also to support major construction and renovation projects at community health centers nationwide. Also, community-based health teams will establish agreements with primary care physicians and other healthcare professionals to improve care coordination through patient-centered health homes.

In addition, there will be help available to racial and ethnic minority communities so that they can adopt certified EHRs. These communities will collaborate with federal and private sector partnerships, the National Health Information Technology Collaborative, and other health organizations. The report “HHS Health Information Technology Plan to End Health Disparities” will be released in the near future and will stress HIT interagency collaborations.

An important goal for the action plan is to implement a multifaceted health disparities data collection strategy across HHS. The plan is to establish data standards and activities reports for race, ethnicity, gender, primary language, and disability status as authorized in ACA. Another goal is to develop and implement strategies to increase access to information, tools, and resources to be able to conduct collaborative health disparities research across federal departments.

Another goal is to improve language access in Medicaid and the plans are to pilot test software for a web-based enrollment system to enable Medicaid staff to interview non-English speaking or low literacy applicants, which in turn, will help those applicants apply for Medicaid and CHIP benefits.

The plan suggests the importance for agencies to streamline grant administration for health disparities funding and to improve the administration of grants. One way is to identify effective ways to implement processes that simplify grant administrative activities for communities, community-based organizations, tribes, and states.

The second report “National stakeholder Strategy for Achieving Health Equity” presents a common set of goals and objectives for public and private sector initiatives and discusses the need for partnerships to help racial and ethnic minorities and other underserved groups reach their full health potential.

Go to the HHS Office of Minority Health at to view both strategic plans.

Enhancing Consumer HIT Design

Current research shows that managing personal health information is complex and practices vary greatly. For example, commonly used information such as the doctor’s contact information and prescriptions may be stored in multiple locations within a home and sometimes outside of the home.

Very often, health information is not only stored in multiple locations but also in multiple devices such as calendars and file cabinets. In addition, information needs may change as people age, and very often records of medical incidents are lacking and leave gaps in an individual’s health record. All of these factors affect the design of consumer health IT systems that need to be flexible and accessible for different types of users and across different settings.

At the same time, personal health records may require complex tasks to be performed by sophisticated consumers but they may find the tasks challenging. These tasks can include tracking and integrating health-related information from various sources, coordinating care across different healthcare providers, obtaining test results, supplying information on office visits along with other personal health information.

The collection of information may be even more complicated for older adults, chronically ill patients, people with disabilities, and the underserved, low income, minority populations. Other barriers to managing effective personal health information can include anxiety to use technology, low level of health literacy, costs to purchase and maintain consumer health IT applications, and anxiety concerning the security of the data.

Until all of these factors are considered, developers of consumer health IT solutions and systems will likely fall short of promoting patient-centered care and culturally competent care. Therefore, it is important to understand the implications for health IT design and to identify what kinds of applications such as interactive/dynamic applications or stand-alone applications are better suited for different types of information.

In 2009, AHRQ’s Health IT Portfolio funded a contract that resulted in an action agenda to study how individuals manage their personal health records and their needs. The contract provided for a comprehensive background report regarding consumer personal health record management practices and the effective development that is needed for consumer IT.

What was made clear from the report was that more research is needed in this field. As a result, on April 8, 2011, AHRQ released a Funding Opportunity Announcement (FOA) to find a way to build a knowledge base on how consumers could better manage their personal health information.

The FOA focuses on the needs and preferences of the diverse user groups, personal health information management practices, and user capabilities and motivation. This research will contribute to a better understanding of user needs and greatly impact consumer health IT design.

Go to to view Program Announcement (PA-11-199). The total cost awarded through this FOA will not exceed $500,000 per year for a project period of up to five years and will be awarded to only public or non-profits.

Clinical Trial Using Telehealth

The “Peer-led and Telehealth Comparative Effectiveness Research (CER) Clinical Trial (NCT01307137) will study how Telehealth CER can help veterans prevent diabetes. The sponsor for the study is the South Florida Veterans Affairs Foundation for Research and Education.

The overall objective for this study is to implement evidence-based interventions to increase the adoption of findings from CER to prevent and manage diabetes in South Florida older veterans. The investigators will conduct a 12 month randomized controlled trial in older veterans with pre-diabetes.

The Clinical Trial has two specific interventions:

• Peer-led intervention—An expert patient in the peer-led intervention will provide effective support for patients and families to accelerate adoption of CER for diabetes prevention and management in the elderly

• Telehealth intervention—Participants in this group will receive mobile phones programmed to monitor specific clinical parameters and promote adoption of CER to prevent and manage diabetes in part based on the input from focus groups. The devices will display messages, tips, reminders and questions regarding healthy lifestyle and clinical parameters of diabetes

Primary outcomes include changes in self-efficacy, weight, and hemoglobin Alc. Secondary outcomes include changes in blood pressure, lipids, physical function, quality of life, and healthcare utilization. In addition, the potential racial/ethnic disparities affecting the adoption of CER to help patients prevent and manage diabetes will be evaluated.

The study is not yet open for participant recruitment but the estimated enrollment for the study is expected to be 85 veterans 60 years and older, diagnosed with diabetes or pre-diabetes, enrolled in the “Healthy Aging Regional Collaborative program, be able to operate a telemedicine device, respond to text queries, and use his/her glucose meter, a blood pressure monitor, and a scale for daily weights.

South Florida provides a unique setting to accelerate the adoption of CER evidence into practice and to address the obesity and diabetes challenges of the aging population. There are more than 800,000 multi-ethnic residents age 60 and over with many that have one or more chronic diseases living in the area. Additionally, a large number of older veterans that have or at high-risk for diabetes, currently receive care in the Miami VA Healthcare System.

For more information, go to

Sunday, April 10, 2011

Apps Help TBI & PTSD

New smartphone applications and upgrades designed to aid in the treatment of TBI and PTSD are coming this month and will provide new options for service members and their families. One of the new apps is called “Breathe2Relax a portable stress management tool that is headed first to iTunes, than to Android.

The new app can be used as a standalone tool or in tandem with clinical care. The app can be used by a healthcare worker to help individuals with proper deep-breathing exercises to reduce stress and use video based instruction to explain how the body reacts to stress.

The National Center for Telehealth and Technology known at (T2) located at the Joint Base Lewis-McChord in Tacoma Washington, last September released their “Mood Tracker” application for android-enabled smartphones. This application won first place in the mental health category of the Army’s 2010 “Apps4Army” software development challenge.

Since the “MoodTracker” app was launched, the software has been downloaded nearly 13,000 times and for nearly 34,000 sessions. “The beauty of the “MoodTracker” is that individuals can record in real time, their actual emotions and actually graph them”, reports Robert Ciulla, a Clinical Psychologist at T2. Now developers at T2 are working on an upgraded version of the “MoodTracker” software that will also be available for iPhone and iPad through the iTunes store and will come with a new user interface and improved navigation.

Development of new apps is just the beginning. The Army is working on a larger software suite to offer in the future. The plan is to create as many as two dozen applications, including more apps for individuals to use on the go. Also some apps are going to be designed to target healthcare providers and provide access to clinical practice guidelines for PTSD, depression, and other health issues.

Taking Actions on HIE

According to the State of North Carolina’s Information Technology Plan, the state’s health information infrastructure consists of various organizations operating at the local, regional, and state levels. Many of these organizations have their own health IT systems and networks.

Today’s, networks have differing priorities regarding the data they collect and transmit. However, plans are in place for the evolving statewide health information infrastructure to complement and integrate but not to supplant these networks.

The North Carolina Health Information Exchange (NCHIE) is making immediate plans to develop and operate a statewide HIE infrastructure. To begin the process, last January, a Request for Proposal (RFP) was released to find a contractor to assume the responsibility to implement HIE core services as described in North Carolina’s HIE Strategic and Operational Plans document. Responses were due last February.

On March 31, 2011, NCHIE announced the upcoming release of another Request for Proposal. At this point, vendors are being sought to work with NCHIE in designing, implementing, and operating the state’s statewide HIE platform. This RFP is to be released on Monday April 25, 2011 and will be posted on the North Carolina Office of Health Information Technology web site plus the information will go out to the vendors known by NCHIE.

The Letter of Intent required for consideration will be due April 29, 2011 with the proposal due on May 20, 2011. These dates are preliminary and subject to change. At this time, any inquiries on the RFP will have to wait until the RFP is publicly released and at that time, contact information will be provided.

In legislative news related to the HIE, State Senator Josh Stein introduced Senate Bill 375 in the General Assembly of North Carolina in March. This bill would help regulate the disclosure of protected health information through the secure electronic transmission of individually identifiable health information among healthcare providers, health plans, and healthcare clearinghouses that would be consistent with HIPAA.

Go to to view the State of North Carolina’s Information Technology Plan published February 2011.

Moving Tools to the Marketplace

NIH invests significantly in new technologies to study the brain and behavior—from basic to clinical perspectives. This investment has produced a large number of technologies including hardware, software, and wetware such as cell free assays, bioactive agents, imaging probes, etc. While these technologies are put to good use by their developers, little attention is devoted to making these tools robust and easy-to-use by the broad research community.

NIH’s National Institute of Neurological Disorders and Stroke (NINDS) in affiliation with their “Blueprint for Neuroscience Research” has released a Funding Opportunity Notice “Lab to Marketplace: Tools for Brain and Behavioral Research” seeking small business applications in connection with the SBIR program to further develop more user-friendly technologies to disseminate in the commercial sector. It is expected that this funding opportunity will require partnerships and close collaborations between the original developers of the technologies and small business concerns.

Up to $350,000 total costs per year will be awarded for Phase I SBIR awards. Also, applications for competing renewals of existing Phase II grants to do research and develop technologies could provide up to an additional three years of support for up to $800,000 per year.

The funding announcement (PA-11-134) was posted on February 25, 2011 and expires January 8, 2014. For more information, email Stephanie Fertig, research project manager at or call (301) 496-1779. Go to to view the funding announcement.

Responding to Disasters

Dealing with humanitarian crises from Libya to Japan reminds us that fast and accurate information is imperative to respond effectively to emergency efforts. As Kathy Calvin, CEO of the UN Foundation says, “Today increased access to collaborative technologies and networks presents an important innovation milestone and an opportunity to rethink how data concerning urgent humanitarian needs are gathered, processed, and shared.”

The UN Office for the Coordination of Humanitarian Affairs (OCHA), United Nations Foundation and Vodafone Foundation have released the new publication “2.0: The Future of Information Sharing in Humanitarian Emergencies”. The publication examines how technology can be used to further reshape the information landscape when aid groups and emergency responders are faced with sudden emergencies.

The report specifically examines how the humanitarian community and the emerging volunteer and technical communities worked together in the aftermath of the 2010 earthquake in Haiti. The report then recommends ways to improve coordination in future emergencies.

As Valerie Amos, UN under Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator said, “The challenge is to better coordinate efforts between the structured humanitarian emergency system and the relatively loosely organized volunteer and technical communities. She further explained “Without a direct relationship that includes both the humanitarian system and the volunteer and technical communities working together, runs the risk of mapping needs without being able to make certain that these needs can be met.” To view the report, go to www.unfoundation.or/disaster-report.

A new study addressing the use of telemedicine to respond to disasters such as earthquakes was just published by researchers at Weill Cornell Medical College and the University of California, at Davis. The study envisions using technology more effectively to provide for improvements in patient outcomes after major earthquakes.

The study suggests that a control tower style telemedicine hub is needed to manage electronic traffic between first responders and remote medical experts, reports the study’s Senior Author Dr. Nathaniel Hupert, Associate Professor of Public Health and Medicine at Weill Cornell Medical College and Co-Director of the Cornell Institute for Disease and Disaster Preparedness.

The team’s results published in the “Journal of Medical Systems” show using telemedicine to link remote specialists and emergency responders in the aftermath of a wide spread disaster would decrease both patient waiting times and hospitalization rates at nearby hospitals. At the same time, it would be more likely for patients with life threatening injuries to receive appropriate case as compared with standard emergency department based triage and treatment.

“These findings demonstrate the need to use interdisciplinary approaches to deal with the complex issues that incorporate medicine, public health, and logistics,” says study lead author Dr. Wei Xiong, Assistant Professor of Public Health at Weill Cornell Medical College. “We applied engineering methods to look at how to effectively manage this type of emergency medical care.”

“We know that when disasters strike, local hospitals, clinics, and medical personnel can be completely overwhelmed,” says co-author Dr. Aaron Bair, Associate Professor of Emergency Medicine and Interim Director of the UC Davis Center for Health and Technology. “We focused on testing how telemedicine can expedite response and getting help to where it is needed in a relatively short timeframe.”

Wednesday, April 6, 2011

CEO Calls for Changes

Dr. Herbert Pardes wants to see more attention given to the problems facing the current healthcare system before the nation’s academic medical centers are inadvertently damaged. As President and President and CEO of New York-Presbyterian Hospital in New York City affiliated with Columbia College of Physicians and Surgeons and Weill Cornell Medical College, he spoke at the National Press Club on March 31st.

Dr. Pardes pointed out that academic medical centers provide the best in clinical care, provide the bulk of medical innovation and life saving techniques, cover all diseases and medical conditions, provide all levels of care, and therefore are well positioned to help lead the transformation that will occur because of health reform.

He said that this country has many fine hospitals, rural, community and specialty hospitals, but academic medical centers have a special place. Academic centers take care of the largest number of the most vulnerable and neediest patients. Even though the academic centers constitute only 6 percent of all hospitals, they provide 41 percent of the charity care, 28 percent of Medicaid, 22 percent of Medicare, and at the same time, provide care to the undocumented which imposes an ongoing burden.

Since academic medical centers treat the sickest most complex cases and the most vulnerable patients, “value based purchasing” as enacted in health reform legislation could wind up rewarding hospitals in more affluent areas and punishing excellent hospitals in challenged communities where many academic medical centers are located. In addition, the rules for hospital readmissions could penalize academic medical centers since they treat the poorest patients with multiple conditions.

Academic medical centers are also vulnerable to cost-cutting efforts because they seem more expensive to run than other types of hospitals since these institutions have a higher cost base. There is the danger that in the desire to reduce costs across the board, academic medical centers could be disproportionately impacted because of their higher cost base.

Another serious major problem this country faces is going to be the shortage of physicians. By 2014, 32 million more Americans will have health insurance and will need access to care. In addition, the vast numbers of baby boomers are reaching retirement age and facing the increased medical needs of old age. Providing for this healthcare will not be possible if the Association of American Medical Colleges’ projection of a shortage of 130,000 physicians by 2025 takes place.

Academic medical centers are making great efforts to address and stimulate quality. For example, New York-Presbyterian residents have formed their own quality councils as a way to give doctors-in-training a direct role in developing and implementing quality standards. The medical center is also developing a healthcare model based on data mining to identify the highest-cost patients and using predictive modeling to find out which patients are likely to be readmitted to the hospital.

Dr. Pardes emphasized that new innovative approaches have to go forward to manage high-cost patients and gave several examples of programs currently taking place:

• Duke has developed a health management program called “Just for Us” to provide in home visits to seniors when they are part of an integrated team of care providers
• Massachusetts General has built an intervention program for seniors to reduce Medicare expenditures for their senior population by 12 percent
• Emory University Healthcare has developed an innovative system for patient and family care management across the spectrum of care
• UCLA has developed a Pediatric Medical Home for coordinating care and has found that emergency room visits have been reduced

For more information, email Jody Fisher at or call (212) 843-8296.

Addressing Behavioral Health

The Substance Abuse and Mental Health Services Administration (SAMHSA) within HHS has released the draft of their plan that identifies eight Strategic Initiatives to reduce the impact of substance abuse and mental illness in communities.

The plan “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014” reports that by 2020 behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.

The plan stresses the need for the mental health field to use information technology to share information. By using technology, information can be obtained from national surveys, surveillance activities, and on evidence-based practices. Also, the web, print, social media, and public appearances should be used to reach the general public, providers, and other stakeholders involved in the mental health field.

The plan points out that in the past, the specialty behavioral health system has often operated independently from the broader health system and this has resulted in differences in the type and scope of information technology used.

The goal for SAMHSA is to work collaboratively with the Office of the National Coordinator for HIT, to drive the adoption of HIT and EHRs, and to enable specialty behavioral health to be easily exchanged with primary care by 2014.

On the state level, Nebraska has faced slow growth in their technical infrastructure because of limited investment capital. According to Nebraska’s Operational eHealth Plan, the state’s behavioral healthcare services are operated on a shoestring, and many of the providers rely on fundraising efforts to be able to continue to deliver services.

In general, consumers in the state are actively participating in Nebraska’s largest active health information exchange the Nebraska Health Information Initiative (NeHII). Consumers are also extremely satisfied with the telehealth services provided through the Nebraska Statewide Telehealth Network.

The state is continuing to improve behavioral health resources, and as a result, the new state Health Information Exchange “Behavioral Health Information Network” (eBHIN) will be activated in Region V in the southeast part of the state. According to Wende Baker, the Network Director for eBHIN, the system will go live in June 2011

eBHIN will include software with enterprise architecture a software solution that operates on a single database supporting the requirements of multiple organizations, multiple practices, and multiple locations.

Federal funds made available through the State HIE Cooperative Agreement program will help fund eBHIN’s Central Data Repository (CDR) as proposed for the HIE system. The CDR with a centralized database will maintain wait lists, referrals, and provide easy access to centralized consumer data, and lab results.

The system will reduce redundant data entries, improve consumer safety through clinical data sharing, have capabilities to report data at any level, decrease the cost of deploying and maintaining software across regions, and accomplish all of the goals while complying with HIPAA. The CDR will operate in a web-enabled environment located at an existing state-of-the-art data center with the capability to assure system security 24/7.

Very importantly, CDR will provide the Virtual Behavioral Healthcare records that can be uploaded to NeHII and be available to medical providers across the state. This will be the vehicle by which medical records available from NeHII will be available to behavioral healthcare clinicians.

The initial pilot includes Blue Valley Behavioral Health, Community Mental Health Center of Lancaster County, and ByanLGH Medical Center Behavioral Health Services. The pilot will be based on the current Community Health Solutions database purchased from Nextgen.

It will be eBHIN’s responsibility to collaborate with stakeholders, the NITC eHealth Council, the State Health Information Technology Coordinator, NeHII, and the Office of the National Coordinator to comply with reporting requirements. For more information, email Wende Baker at

MN Developing Demo

The Minnesota Department of Human Services (DHS) on March 23, 2011 issued a Request for Information (RFI) on the future “Health Care Delivery Systems Demonstration Project”. The demonstration project is going to create a structure for provider organizations to voluntarily contract with DHS to care for Minnesota Health Care Program patients.

The demonstration will work with both fee-for-service and managed care patients under a payment model and will hold organizations accountable for the cost-of-care and quality of services. DHS seeks input on the definition of the payment model, performance measures, and other program rules.

DHS plans to implement demonstration projects in different parts of the state and across different models of care delivery in order to integrate healthcare with mental health providers, safety net providers, and social service agencies whenever possible. The project will include clear incentives for quality of care and targeted savings and will result in increased competition in the marketplace through direct contracting with providers.

DHS is in the process of holding webinars and other meetings to gain input on the RFI and to discuss the future Request for Proposal (RFP) that will be released in May 2011.

Go to, for more details, email Ross Owen at

Occupational Safety & EHRs

The National Institute for Occupational Safety and Health (NIOSH) has requested that the Institute of Medicine’s Board on Health Sciences Policy conduct a study to examine the rationale and feasibility for incorporating work history information into patient electronic health records.

NIOSH want to ensure that the meaningful use of occupational information is included in electronic health records by 2015 which will require the agency to demonstrate feasibility by 2013.

The IOM is planning to hold data-gathering meetings, including a public workshop, conduct analysis, and prepare a letter report with findings and recommendations on the following issues:

• What are the potential benefits for incorporating occupational information in EHRs for individuals and public health officials?
• Are there current systems that incorporate work history into the record that supports clinical decision making and public health reporting activities?
• What are the perceived technical barriers to incorporating work history information into the patient’s EHR?
• What are the barriers to using current systems of coding industry and occupations and what are the alternatives?
• How can the technical issues be addressed by EHR system vendors and researchers?
• What are the next steps to take to advance this effort and what efforts should NIOSH take as well as with non-governmental partners?

For more information email the Study Director, Cathy T. Liverman at

VA's Open Source EHR

The Department of Veterans Affairs on April 1, 2011 released a draft RFP to develop an Open Source community around the VistA electronic health record system. When an award is made to obtain a custodial agent, VA will deploy the Open Source VistA to all of its facilities and will participate in Open Source VistA with other public and private sector participants. A key step in the process has to be to select a custodial agent to perform all aspects of operating the Open Source community.

The VistA system is currently used in 153 major VA hospitals and more than 800 community-based outpatient clinics across the U.S. It forms the basis of the Resource and Patient Management System, the EHR system used by the Indian Health system as well as the basis of installations in more than 50 hospitals globally.

“VistA is an important asset for VA and the Nations,” said Secretary of Veterans Affairs, Eric K. Shinseki. “As we work to ensure that we provide veterans with the best in healthcare, modernization of VistA is absolutely critical. This move towards Open Source welcomes private sector partners to work with the VA and in turn, will ensure that VA clinicians have the best tools possible.”

According to Roger Baker, VA Assistant Secretary for Information and Technology, “We want to ensure that vendors of proprietary products can easily and confidently integrate their products with VistA to make them available for the VA to purchase and use in our facilities.”

VA expects to begin conversion to an Open Source version of VistA by this summer.

Sunday, April 3, 2011

Briefing on "GovCloud"

Dawn Leaf, NIST’s Senior Executive for Cloud Computing at a briefing on “GovCloud” held at the National Press Club on March 29th, stressed the need for the federal government to develop partnerships and collaborations with industry to more effectively advance possibilities for cloud computing.

Cloud services can be either public, private, hybid, or community based. According to Leaf, right now, the federal agencies are initially supporting the adoption of cloud computing using the private delivery model which will probably expand to a community model or hybrid as more and more people become experienced using cloud computing.

Cloud computing provides for convenient, on-demand network access using shared computing resources requiring minimal management effort. When services are monitored by the cloud provider, much of the control of the data is provided to the consumer.

The U.S. government leads in IT spending with almost $80 billion spent annually on more than 10,000 systems. As Leaf pointed out, $20 billion of the almost $80 billion spent on IT, goes for cloud computing which means that cloud computing is not adding additional spending to the money spent on IT.

Cloud computing is cost effective and relies on sharing computing resources. Cloud computing enables the user to access documents and applications worldwide and enables groups to work together on projects, saves money, handles changes and needs as it relates to the latest hardware and software, initiates projects rapidly, provides a more reliable system, easy to use, and has the capability to provide essential services 24/7.

Leaf continued to explain that NIST is providing the technical leadership needed to deal with interoperability, portability, and security standards as they relate to using cloud services. At the same time, NIST is working collaboratively with industry, standards organizations, academia, and federal, state, and local government agencies, along with the international community to develop a “U.S Government Cloud Computing Standards Roadmap”.

The “Roadmap” will provide data on interoperability, security, portability, standards, and guidance, research, pilots, studies, prototypes, and government policies to help agencies develop the cloud. The goal is to have the “Roadmap” draft completed by October 2011 or if not by the end of the year.

NIST has been presenting a series of workshops to enlighten stakeholders on cloud computing activities in the Federal government. On April 7- 8, 2011 another stakeholder workshop will be held at NIST headquarters and will include a keynote presentation by top officials at the Department of Commerce plus other key federal officials at other agencies. Sessions will highlight the updates needed to further develop the “Roadmap”, discuss business use cases, and deal with the vital security issues related to cloud computing.

For more information on the April workshop, go to or call Angela Ellis at (301) 975-3881.

Developing Glucose Sensors

Many people with diabetes have a difficult time managing their blood glucose levels. A new type of self-monitoring blood glucose sensor is now under development by Arizona State University (ASU) engineers along with clinicians at the Mayo Clinic in Arizona.

The ASU-Mayo research team began the project with funds from a seed grant from Mayo Clinic and assistance provided by ASU students involved in research at ASU’s Biodesign Institute, the Ira A. Fulton School of Engineering, and ASU’s undergraduate Research Initiative program.

The new sensor being developed enables people to draw tear fluid from their eyes to get a glucose-level test sample. Glucose in tear fluid may give an indication of glucose levels in the blood as accurately as a test using a blood sample, the researchers report.

Jeffrey T. LaBelle the designer of the device technology is leading the ASU-Mayo research team along with Mayo Clinic physicians Curtiss B Cook, an endocrinologist and Dharmendra Patel, Chair of Mayo’s Department of Surgical Ophthalmology. The team has come up with a device that can be dabbed in the corner of the eye and is capable of absorbing a small amount of tear fluid like a wick that can then be used to measure glucose.

The major challenges are to perform the test quickly and efficiently with reproducible results, without letting the test sample evaporate and without stimulating a stress response that causes people to rub their eyes intensely.

Because of the possible impact on healthcare, the technology is of interest to BioAccel, an Arizona nonprofit that helps to bring biomedical technologies to the marketplace. “A critical element to commercialization is the validation of the technology through proof-of-concept testing” reports Nikki Corday BioAccel Business and Development Manager. “Positive results will help ensure that the data is available to help the research team clear the technical hurdles to commercialization.”

With funding provided by BioAccel , the research team will conduct critical experiments to determine how well the new device correlates with the use of current technology that uses blood sampling said Ron King, BioAccel’s Chief Scientific and Business Office. King also explained that the results should help to secure downstream funding for further development work from such sources as NIH.

DARPA Seeks Technology

The Defense Advanced Research Project Agency (DARPA) through their Microsystems Technology Office is working to develop clinically viable technologies to enable wounded service members to control state-of-the-art prosthetic limbs. DARPA often selects their research efforts through the Board Agency Announcement (BAA) process.

In order to accomplish this goal, DARPA wants to see reliable in-vivo Central Nervous System (CNS) motor-signal recording and sensory-signal stimulating interfaces developed. For the purposes of this BAA, the CNS is defined to include the brain down to but not including the dorsal (sensory) and ventral (motor) roots.

Despite the challenges, recent technological advances now make it possible to develop high-channel-count CNS interfaces that can reliably provide the amount of motor-control information needed for amputees to accurately and quickly control many DOF prosthetic limbs needed to perform the activities of daily living both in military and civilian life.

The Funding Opportunity (DARPA-BAA-11-37) was posted March 30, 2011 with the proposal due on May 16, 2011. It is anticipated that $18 million with multiple awards will be awarded.

For more information, go to or go to

Children's Healthcare News

Researchers at HRSA’s Maternal and Child Health Bureau discovered that medical homes can ensure better healthcare for children. These findings were published in the April issue of “Pediatrics” where it was reported that only 57 percent of children in the U.S. have access to a medical home. Also children without a medical home are nearly four times more likely to have unmet needs for healthcare, three times more likely to have unmet needs for dental care, and were less likely to have had a preventive healthcare visit in the past.

It was found that medical home access is twice as prevalent among children in families where English is the primary language, children in fair or poor health were about half as likely as healthier children to have a medical home, and insured children were almost twice as likely to have medical homes as uninsured children.

Daniel Low, MD of Seattle Children’s Hospital led a research study to develop the iResus application to help in emergencies. Thirty one doctors at the Royal United Hospital in the UK took part in the study. The purpose of the study with results published in the April issue of “Anesthesia” was to see if the iResus application using user-friendly prompts produced better results in a simulated medical emergency than physicians relying purely on memory.

The doctors were divided into two groups. One group was armed with the iResus and the other without. They were put through a simulated cardiac arrest emergency with the doctors’ knowledge and skills evaluated using the CASTest scoring system.

Doctors who used the iResus application scored an average of 85 out of 100 which was significantly higher than the 72 achieved in the control group. It was found that one of the most significant ways that iResus helped was with out-of-hospital pediatric emergencies to determine what, when, and how much of a drug should be specifically administered to children.

The Upper Peninsula Telehealth Network of Michigan part of the Marquette General Hospital System is the state’s most extensive telehealth network and provides clinical telemedicine services to residents of Upper Peninsula and the Northern Great Lake region.

By having an extensive telehealth network, Marquette General made it possible for a father to see his newborn son from 6000 miles away where he is stationed at an Iraqi Air Force Base. Stephanie Craddock and her husband Andrew were miles apart when their son Ethan was born at the Marquette General’s Birthing Center. Video conferencing equipment was used to enable Andrew to see his newborn son.

To help children with special needs in the state, the Department of Community Health’s Children’s Special Health Care Services (CSHCS) provides telemedicine services to care for children that must have access to bleeding disorder specialty services according to the monthly newsletter “CAH Hospital” published by the Michigan Critical Access Hospital.

These services are available to residents in the northern Lower Peninsula with a team from Munson Healthcare in Traverse City and a physician on staff at the Barbara Ann Karmanos Cancer Institute in Detroit available to provide telemedicine consulting.

Also, the e-news online publication “Michigan Telehealth” promotes the use of telehealth to deliver healthcare to Michigan’s residents who qualify under CSHCS. The April 1, 2011 issue explains why telemedicine makes sense in situations where specialty care is greatly needed.

For example, Madelyn age 15 was diagnosed with epilepsy last April and her sister Gwyneth age 14 was diagnosed with diabetes six months later. The entire family was extremely upset with the diagnoses and was faced with the challenge of managing both of their daughters’ medical care.

Unfortunately, their community does not have pediatric sub-specialists nearby. There is however, a pediatric endocrinologist that comes to their area every three months and sees Gwyneth, but Madelyn has to travel eight hours one way to see her specialist. Madelyn is frustrated with her specialty physician being so far away because she doesn’t like to miss school and she is scared about changes in her treatment regime.

This is a situation that needs to change. According to e-news, Chief Medical Consultant for CSHCS, George Baker, MD, FAAP who recently retired, has been very active promoting the use of telemedicine. He has influenced the state’s policy on Medicaid reimbursement for telehealth, worked to obtain a federal grant for pediatric epilepsy and telemedicine, and generally gets the word out on how telemedicine can play a vital role to help children and teens particularly in Michigan.

For more information on “Michigan Telehealth” contact the Editor Sally Davis at

ATA 2011 Almost Here

The American Telemedicine Association’s 16th Annual International Meeting and Exposition on May 1-3, 2011 in Tampa, Florida will present many new ideas and thoughts at all of the sessions and exhibits. Attendees will walk away from the meeting with vast amounts of knowledge and expertise to help deal with today’s highly complex telemedicine/telehealth field.

Attendees will be able to see and hear how telemedicine, telehealth, and mhealth and all of the other 21st century technologies are achieving exciting results. A very special plenary session will feature conversations with a soldier, a nurse, and a child whose lives were saved because telemedicine technologies were used.

ATA meeting attendees will be able to hear highlights on important research studies related to remote monitoring. For example, remote monitoring is becoming necessary to reduce costs. It has been shown that hospitalization and the use of emergency rooms by COPD patients contributes considerably to the $800 billion anticipated to be spent on care over the next 20 years.

A session on this topic will discuss how a study is being conducted to identify which COPD patients are best suited to benefit from remote monitoring and could help greatly to reduce the cost for caring for COPD patients.

Other study results will be available regarding the use of remote monitoring on health outcomes and costs. A four year NIH sponsored study by the Yale University Medical Center is testing how effective telemonitoring is and also to see if a positive impact is being made specifically on outcomes in heart failure populations.

Several other presentations will reveal the results of a NHS study on home telehealth monitoring involving over 6,000 patients.. Other sessions will talk about studies concerning the effect of remote monitoring on hospital readmissions involving several hundred Congestive Heart Failure patients residing in Connecticut and Ontario Canada.

Preliminary data will also be available on data from two large ongoing randomized clinical trials reported by the VA San Diego Healthcare System and the University of California San Diego. The clinical trials so far offer evidence on the value of telemental health versus in-person therapy in treating PTSD.

It has been shown that continuous remote monitoring can make life and death differences for trauma patients on the way to the emergency room. A nineteen month study of several hundred trauma patients showed that the use of continuous monitoring of several key vital signs can have a significant effect on keeping patients alive while being transported to the emergency room.

Don’t miss attending the “how-to-sessions” that will provide practical tips for reimbursement, how to deliver care in other countries by using the right strategies and services, how to deal with the issues involved in moving data, such as standards, policies, interoperability, plus how to fully integrate telemedicine into individual private practices.

In addition to all of the information coming out of the meeting, ATA 2011 will have over 200,000 square feet exhibiting the latest telemedicine, telehealth, and mHealth technologies and services. See and handle thousands of cutting edge products and services available from a wide array of vendors. Nowhere else in the world will you be able to see so large a collection of remote medical technology products.

Go to to view the Virtual Exhibit Hall and to see the Expo’s mobile webpage. Online registration is available at

For more information on exhibiting, sponsorship, or advertising opportunities, contact, Sandy Hung at 202-223-4249 or by email at