Wednesday, May 25, 2011

Helping Rural Surgeons

A study supported by Saint Alphonsus Regional Medical Center and Boise State University in Idaho addresses the need for remote presence general surgery to help build surgery capacity in rural communities. For example, in Idaho, there are at least six critical access hospitals (CAH) with one or totally without a general surgeon in their operating room.

This is a serious problem for the U.S. in general since 20 to 25 percent of the U.S. population resides in rural areas, while only 10 percent of general surgeons practice in these areas. Today, rural populations have only 4.67 surgeons per 100,000 residents plus the fact that rural surgical residency training programs account for only 5 percent of all offered residency programs. In future years, the number of general surgeons in rural areas is expected to decline.

The research team took part in the study “Remote Presence General Surgery Program: Building Surgery Capacity in Rural Communities” supported in part by TATRC, to study the feasibility of using telemedicine systems to help further educate surgeons.

In taking the first step, the team met with partnering hospitals to identify opportunities for possible collaborations. Next, the team worked on an operating room assessment to understand the necessary information on the cases performed at each CAH. The operating room assessment was then used as a tool to study how telemedicine could play an effective role. It was found that approximately $500,000 in annual surgical revenue could remain in the local hospitals, if telemedicine was used as a tool in some of the cases.

The team determined that rural surgeons could perform 70 percent of all inpatient operations at their own facilities if they had additional training available which could be done using telemedicine systems. It has been shown that rural hospitals with one well trained general surgeon can bill an average of $1.5 million in annual surgery revenues.

Through the use of “InTouch Health Remote Presence”, the partnering hospitals involved in the study were able to increase their education opportunities. With InTouch providing surgical telementoring and training, information can be provided on preoperative planning along with new procedure training using by two-way audio/video communications.

Telemedicine has been successfully used to educate and train surgeons and the staff but the technology can also be used to observe procedures in the operating room. Future development of surgical assessment tools based upon preliminary results will further help improve telemedicine education.

By studying how to use telemedicine technologies to help rural surgeons, the team learned some valuable lessons:

• Education is a non-threatening way to form relationships between providers and to promote consultations
• Initial telemedicine encounters need to be positive for continued utilization of the program
• Prior exposure to technology for educational purposes before clinical use is imperative for staff comfort
• Technology must be used on a consistent basis for users to be comfortable with its use in emergent situations
• The technology can’t interfere with surgical workflow
• Construction of assessment forms to identify site specific needs is vital
• Development of a flexible collaborative network is needed to create a balance

Research on Infant Brains

Psychologist Eugene Goldfield at the Center for Behavioral Science at Children’s Hospital in Boston, along with a team of engineers and scientists at the Wyss Institute at Harvard, are in the early stages of a research project to help infants with early brain injuries learn to move like other infants. This data was reported in the National Science Foundation’s FY 2011-2016 Strategic Plan.

Goldfield calls the smart clothing developed by the researchers a “second skin” where tiny sensors and programmable muscle-like actuators within the material are designed to detect the motions of the limbs and then small forces are added to expand the range of motion to increase the wearer’s ability to produce the motions.

Data obtained from studying the motions of babies will be programmed into the “second skin” with the aid of computer simulation so that actuators can provide the right kind of assistance. The expanded range of motion may provide new sensory information to promote restoration of brain function.

The research is being conducted with infants because the infant brain when injured has a remarkable capability for restoration of function, according to Goldfield. If the research proves to be successful, this technology could also be applied to others with mobility impairments, including children and adults with brain injuries, the aging population, and soldiers that are injured in combat.

In another research project at Children’s Hospital in Boston, a computational physicist and cognitive neuroscientist are studying the beginnings of a noninvasive test that will be able to evaluate an infant’s autism risk. The test if used would combine the standard electroencephalogram (EEG), to record electrical activity in the brain, along with machine-learning algorithms. In a pilot study, the system being studied has obtained 80 percent accuracy in distinguishing between 9 month old infants known to be at high risk for autism from controls of the same age.

The test will be a safe and practical way to identify infants at high risk for developing autism by capturing very early differences in brain organization and function. Parents would be able to begin behavioral interventions one to two years before autism can be diagnosed today through traditional behavioral testing.

William Bosl, PhD, a Neuroinformatics Researcher in the Children’s Hospital Informatics Program, and Charles A. Nelson PhD, Research Director of the Developmental Medicine Center at Children’s plus several colleagues have recorded resting EEG signals from 79 babies 6 to 24 months of age participating in the large study aimed at finding very early risk makers of autism.

Forty six of these infants had an older sibling with a confirmed diagnosis of ASD, while the other 33 infants had no family history of ASDs. Bosl hopes to follow the high risk group over time and compare EEG patterns in those who received an actual ASD diagnosis but who appear to be developing normally and then compare both groups to the controls. “With enough data, I would like to follow each child’s whole trajectory from 6 to 24 months since the trend over time may be more important than a value at any particular age.” said Bosl.

Helping Disabled Individuals

The FCC has established a “National Deaf-Blind Equipment Distribution Program” (NDBEDP) to enable low-income deaf-blind individuals to have access to modern communication services. The NDBEDP pilot program will help qualified individuals have access to the internet and advanced communications including interexchange services along with advanced telecommunications and information services. Individuals who are deaf-blind as defined in the Helen Keller National Center Act are eligible to apply for equipment.

The FCC is taking this action because a provision in the “Twenty-First Century Communications and Video Accessibility Act of 2010” allocated $10 million to be made available from the “Interstate Telecommunications Relay Service (TRS) Fund” for this distribution.

The FCC decided that the best approach would be to establish a two year pilot program with the option of extending the program for a third year if the program proves to be effective. The FCC will then have the option of extending the program permanently.

Under the NDBEDP pilot program, the FCC will certify and provide funding to one entity in each state to distribute equipment with no restrictions as to the brand. Also, the equipment may be off-the-shelf equipment. About $10 million in funding will be available for each year and the FCC will set aside up to $500,000 per year for national outreach efforts. Each state will initially receive a minimum initial funding of $50,000 with the balance of the available funds allocated in proportion to each state’s population.

The reasonable costs of state and local outreach efforts, individual assessments of a deaf-blind person’s communications equipment needs, equipment installation, and individualized training of consumers on how to use the equipment is also covered under NDBEDP.

The synopsis of the final rule for NDBEDP (Docket no. 10-210, FCC 11-56) was published May 9, 2011 in the Federal Register. For further information contact Karen Peltz Strauss at (201) 418-2388 in the Consumer and Governmental Affairs Bureau.

Care Becomes Top Priority

The May “Michigan Telehealth” newsletter reports that the Rural Health Center on Beaver Island provides both primary and urgent care to the 600 year round residents and to 4,000 summer residents and visitors. Situated on Lake Michigan 32 miles off the mainland, the island is accessible only by over a two hour ferry ride or by plane. During the winter months, air travel is the only option and that depends heavily on the weather.

The health center is staffed 24/7 by two mid-level practitioners who are supervised by two physicians on the mainland at the Charlevoix Area Hospital. Technology is used as an important link in order to provide for emergency triage of patients, telemedicine consultations, and diagnostic services. Three years ago, the Rural Health Center partnered with the Hospital and pursued new video conferencing and digital imaging equipment through the USDA Rural Utilities Services grant program.

“The recreational visitors are our riskiest patients,” reports Donna Kubic, RN, Managing Director. “They come here to bike, kayak, and hike, and with all of those activities sometimes accidents result.” The number of retirees makes it necessary to also link to the emergency department in Charlevoix. On an urgent bias, telemedicine is used two to three times per week during the winter months and four to five times per week during the busy summer months.

In addition, the video conferencing system has become a valuable tool for the island community. For example, a cancer support group connects with a similar group on the mainland, emergency personnel have been able to receive training and certification, and the fire department has had 21 volunteers complete year long first responder certification courses over the past two years. A paramedic certification course, and air transportation certification is planned for the near future.

For more information, contact Editor Sally Davis at

Building at Ft. Detrick

The Naval Medical Research & Development’s Newsletter reports that a new laboratory is being built to house the Navy Medical Research Center’s Biological Defense Research Directorate (BDRD) at Ft Detrick. When completed BDRD’s 36,660 square-foot biomedical research laboratory will be part of the National Interagency Biodefense Campus expected to be ready in the fall.

The Naval Medical Research Center (NMRC) scientists will join research teams from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, USDA, Department of Homeland Security, and CDC.

For nearly 15 years, BDRD has researched ways to protect military personnel in the event of a biological attack and is considered to be a leader in the field of detection. This includes research on hand-held assays, molecular diagnostics, and performing confirmatory analysis. More recently, the research team has developed a new DNA-based vaccine to protect against anthrax.

The second building under construction at FT Detrick will house the Joint Center for Excellence for Medical Research, Development, and Acquisition to include office space for 16 Navy Medicine personnel. The building will house the Chemical Biological Defense’s, Joint Project for Chemical Biological Medical Systems.

Sunday, May 22, 2011

HIT Strategy Discussed

According to Aneesh Chopra, U.S. Chief Technology Officer, Assistant to the President, and Associate Director for Technology within OSTP, the federal government needs to invest in innovation, healthcare workforce, and infrastructure including digital, while at the same time, emphasizing entrepreneurship.

As one of the speakers at the May 17th Brookings event “Health IT in an Era of Accountable Care: Update from the Beacon Communities” convened by the Engelberg Center for Health Care Reform in collaboration with the HHS Office of the National Coordinator for Health IT, he told the attendees, that providers with a need for specific tools and products are in a position to approach the best companies for any tools that they might need. Since billions of dollars are flowing into the healthcare marketplace, companies all over the country are ready and able to supply exactly what providers need at the best price possible.

He emphasized how health IT plays an important role in the Beacon Community Program. For example, the Southern Piedmont Beacon Community (SPBC) and their Care Plan is one of 14 regional healthcare partnerships in North Carolina established to improve the quality of care for Medicaid recipients while managing costs. This region has impressive EHR adoption with three nonprofit hospitals, VA hospitals, and close to 60 percent of the ambulatory care physicians in the area using EHRs.

The SPBC is using health IT and HIE to really make a difference in the region’s communities especially in treating asthma. Currently, SPBC is using text messaging inhalers with GPS tracking capabilities, coupled with smart phones, and web-based applications to help 2,000 asthma patients better manage their conditions.

SPBC is not only able to receive valuable information on patients with asthma, but able to analyze and see patterns from the information and data collected especially concerning environmental patterns. In addition, school nurses are monitoring students who have asthma and then sending the updates to the child’s primary care provider.

In addition, specialized software notifies care managers when patients are due to be discharged so that a smooth transition can be made from the hospital to the home or to another healthcare setting. Care managers and nurse practitioners, equipped with laptops have access to EHRs and other patient information when they make home visits to the patients. These visits are made within three days following the patient’s hospital discharge to see if they have the correct medications and instructions.

As the National Coordination for HIT, Farzad Mostashari, MD, pointed out the need for the U.S. to set goals, address HIT needs, and at the same time, develop a workable strategy to implement the technology. Many providers want to adopt technology to deliver patient centered care and fortunately there is help available through the Beacon Community program and Regional Extension Centers.

Joe McCannon, Senior Advisor to the Administrator at CMS announced three new initiatives made possible by the Affordable Care Act to help doctors, hospitals, and other healthcare providers become Accountable Care Organizations.

First, the Center for Medicare and Medicaid Innovation Center is supporting a new ACO model to be available to providers this summer. The “Pioneer ACO Model” will help organizations participate in shared savings with expectations that it will save Medicare up to $430 million over three years.

CMS just announced a “Request for Applications” (RFA) for organizations to participate in the “Pioneer ACO Model” beginning in 2011 and ending 2016. The Federal Register Announcement on the ACO model appeared May 20th with letters of intent due June 10, 2011 and applications due by July 19, 2011. To be eligible, organizations would ideally already be coordinating care for a significant portion of their patients and positioned to transform their care and financial models from fee-for-service to a value based model.

Secondly, the Innovation Center is offering “ACO Accelerated Development Learning Sessions” to provide executive leadership teams to teach essential ACO functions, ways to build the capacity needed to achieve better care, better health, and to lower costs using integrated care models. Four learning sessions will be held in 2011, with the first session scheduled for June 20-22, 2011 in Minneapolis Minnesota. The plenary session will be available to all interested organizations via a webcast.

The third Innovation Center initiative is seeking comments until June 17, 2011 on an “ACO Advance Payment” initiative that would provide additional up-front funding to providers to support the formation of new ACOs. The objective is to test whether and if pre-paying a portion of future shared saving could increase participation in the Medicare Shared Savings Program.

McCannon also mentioned the new measures in the “Partnership for Patients” campaign. One measure is to reduce preventable hospital-acquired conditions by 40 percent by the end of 2013 and the second measure is to reduce hospital readmissions by 20 percent by the end of 2013. As he explained, successful implementation could save as much as $35 billion to the healthcare system including up to $10 billion in Medicare savings.

Closing the Tech Gap

Ciena Corporation, a network specialist partnering with Telamon Corporation, a distributor, system integrator and reseller of telecommunication products, is bringing high-speed broadband access and 4G wireless services to the Navajo Nation. The need for the technology was initiated by the Navajo Tribal Utility Authority (NTUA) a non-profit, multi-utility company that provides services to the Navajo Nation spanning over 27,000 square miles in Arizona, New Mexico, and Utah.

The NTUA project is intended to enable area service providers to deliver affordable voice, video, data and cellular services to nearly 30,000 households, 1,000 businesses, and an additional 1,100 anchor institutions, including 49 Chapter Houses that serve as community centers.

Stimulus funding was made available through NTIA’s Broadband Technology Opportunities Program. This new next generation network will include 550 miles of new aerial giver-optic cable and 59 new or modified microwave towers. “The project will certainly close the wireless technological gap that currently exists here in the southwest. This improvement will open many doors that will bring progress to our region,” said Walter Haase, NTUA General Manager.

The Navajo Nation’s new converged optical Ethernet network will be connected by Ciena’s suite of packet-optical transport and Carrier Ethernet solutions. Ciena’s network management software will provide the “middle mile” service architecture.

Last mile wireless services will be offered at speeds between 1 and 3Mbps through the project’s wireless partner Commnet Wireless, LLC. The new network will enable public safety, health, social services, and emergency care facilities as well as local government and administration offices to deliver distance learning, telemedicine, security monitoring, SCADA services, and other advanced applications not possible with the current infrastructure.

“Together with Telamon, we’re building a high-speed packet optical network that will spur economic growth by improving internet access for the Navajo Nation,” said Theresa Caragol, Vice President, Global Alliances and Partners at Ciena. “As grant money from the Recovery and Reinvestment Act starts to flow through projects like the NTUA, this will have a positive and lasting impact on America’s communities for years to come.”

For more information, go to or

More Tests to Detect TBI

Today, the Department of Defense uses tools and tests to determine whether a service member has suffered a concussion or TBI. Mental evaluations are done if a concussion is suspected by a medic or a corpsman and then a tool called the “Military Acute Concussion Evaluation” (MACE) can be used.

The use of MACE detects concussions as early as possible and keeps service members off the battlefield where they could possible suffer another concussion before healing from the first. MACE can also confirm that a concussion didn’t occur.

Another test that DOD uses is the Glasgow Coma Scale (GCS). Even by using the GCS, mild TBI is still difficult to diagnose because many times the brain scans are negative. DOD realizes that GCS is not a very sensitive test for mild concussions, so DOD is looking at more objective tests other than studying the history and physical state of the patient. An objective test is needed that uses diagnostic markers, some of which include serum biomarkers by testing for proteins.

DOD is studying eye tracking machines that will enable devices to be placed on the eyes and pick up problems with attention and concentration which can be indicative of a concussion. In addition, DOD is also looking at machines that are capable of measuring the electrical patterns of brainwaves or quantitative EEGs to determine TBI.

Another possibility is to use vestibular plates that a patient stands on that will pick up idiosyncrasies in balance which can be indicative of changes that have happened deep in the brain stem that are consistent with concussions.

Kathy Helmick, Deputy Director for Traumatic Brain Injury at the “Defense Centers of Excellence for Psychological Health and TBI” reports that more tests are being studied but further evaluations are needed to see how well they work. Helmick reports that it probably won’t be just one test, but rather a combination of objective markers that will be able to help diagnoses mild TBI on the battlefield.

Coordinated Care Legislation

Legislation sponsored by Oregon’s Joint Special Committee on Health Care Transformation was introduced during the Oregon Legislative Assembly’s 2011 regular session. The legislation would establish the “Oregon Integrated and Coordinated Health Care Delivery System” to replace managed care systems for recipients of medical assistance.

The legislative goals are to create a system where:

• Consumers get the care and services needed with care coordinated locally using statewide resources when needed by a team of health professionals who understand their culture and speak their language

• Consumers, providers, community leaders and policymakers have the high quality information they need to make better decisions and keep the delivery systems accountable

• Quality and consistency of care is improved and costs are contained through new payment systems and standards that emphasize outcomes and value rather than volume

• Communities and health systems work together to find innovative solutions to reduce overall spending, increase access to care and improve health

• Electronic health information is made available when and where it is needed to improve health and healthcare through a secure confidential health information exchange

The legislation would require the Oregon Health Authority to seek federal approval to allow enrollment of individuals who are dually eligible for Medicare and Medicaid into coordinated care organizations.

NIST's Workshop on EHRs

The National Institute of Standards and Technology (NIST) will conduct a workshop on the usability of electronic health records on June 7, 2011 at NIST’s campus in Gaithersburg Maryland. The workshop “A Community Building Workshop: Measuring, Evaluating, and Improving the Usability of electronic Health Records” will bring industry, government, academia, and healthcare providers together to identify models and methods for collaborating to improve the usability of EHR systems.

The NIST health IT usability initiative provides guidance to the public and private sectors to develop health IT usability standards, and measures. NIST collaborates closely with industry, academia, and other government agencies to share test practices on electronic health record usability as well as gather technical feedback to use to develop EHR usability evaluation methods.

For more information go to,, or call 301-975-2776.

Wednesday, May 18, 2011

Veterans IT Program

Roger W. Baker, Assistant Secretary for Information and Technology and CIO for the Department of Veterans Affairs appeared before the House Committee on Veterans Affairs on May 11th, to discuss the Veterans Administration’s IT plans and actions.

According to Assistant Secretary Baker, the VA IT enterprise is a massive single, consolidated network with 152 hospitals, 791 CBOCs, and 57 benefits processing offices. With the $3.1 billion FY 2011 budget, the Office of Information and Technology (OI&T) manages a technology profile of over 314,000 desktop computers, 30,000 laptops, 18,000 blackberries and mobile devices, and 448,000 email accounts.

The VA has begun work on the Data Center Consolidation and on cloud computing. For example, the VA has a large-scale cloud program in the Post 9/11 GI Bill along with another program to address the development of the Veterans Benefits Management System in place to break the claims backlog.

Other initiatives include the Blue Button Program to allow veterans to download their personal health information from their My HealtheVet account, and the Pharmacy Reengineering program to replace existing pharmacy software modules.

In addition the VA has adapted a key component of the “Program Management Accountability System” (PMAS). Before the implementation of PMAS, approximately 283 development projects at VA met their milestone dates an estimated 30 percent of the time. Today the VA has 107 active development projects tracked in real-time through a project database and dashboard that meets the milestone dates approximately 75 percent of the time.

The Committee also heard that the VA has achieved full implementation of the medical device isolation architecture which is essential to mitigate security vulnerabilities in medical devices. The isolation architecture enables the VA to localize virus outbreaks in populations where it is very difficult to provide protection for medical devices. This is accomplished by using virtual local area networks and access control lists to enable the VA to identify threats and vulnerabilities plus quarantine them to prevent viruses from spreading across the VA network.

The VA’s Virtual Lifetime Electronic Record (VLER) enables service members, veterans, and caregivers to manage benefits and care from the day they enter military service and throughout their lives. VLER is now being used to support the exchange of healthcare information between DOD, VA, and private healthcare providers in San Diego, Hampton Roads, Richmond, Spokane, and in the Asheville North Carolina area.

By using VLER and further expanding the eBenefits portal, veterans are now able to access their information, including healthcare records, benefit applications, and other personal information through an interactive web portal. The eBenefits portal is rapidly growing with more than 278, registered users as of March 31, 2011.

According to the VA, the current VistA EHR system meets or exceeds the capabilities currently available from commercial EHR vendors. However, low investment in VistA over the last decade has eroded its standing from being the market leader to being merely competitive. While VA clinicians support and prefer VistA as a clinical tool, they also want to see the system updated and improved.

To keep costs, down, the VA has turned to Open Source as a way to produce production quality software. Market leading products such as UNIX, Linux, Netscape, Mozilla, Apache and many others have benefited from the Open Source approach.

So far, the VA has spent more than a year conducting a deliberative process to examine the implications of Open Source for VistA. The VA has studied numerous papers, emails, and comments on the subject and as a result, the VA has issued three RFIs. The current thought is that by using Open Source, innovation will improve and the budget will not increase. Just recently, the VA released an RFP to establish an Open Source “Custodial Agent” position that would run the Open Source community.

NIH Issues PAs & RFAs

Recently, NIH and TATRC issued two Program Announcements (PAs) and two companion Requests for Applications (RFAs). The agencies are seeking Virtual Reality (VR) technologies to visualize outcomes, teach, and motivate to help prevent and manage obesity and diabetes. The plan is to develop multidisciplinary projects utilizing VR and biomedical behavioral and pedagogical sciences.

The overall goal is to develop the potential of VR technologies as research tools for behavioral science-oriented studies in diabetes and obesity. In addition, the objective is to develop practical tools for clinical and public health-level prevention and management of obesity and diabetes.

VR applications are currently in development and are used for rehabilitation medicine, (stroke, Parkinson’s disease, pain control) and for behavioral medicine (phobias, post-traumatic stress disorder, drug addiction, autism). VR is also used to train surgeons and to provide treatment in remote sites.

However, except for small studies in clinical eating disorders ( anorexia, binge eating), there has been almost no development of the VR field in relation to common issues of food intake, food choices, and little to encourage physical activity among the broader population.

VR technology could be used to complement motivational interviewing, assess emotional states of readiness for behavioral changes, and to help patients deal with their emotional reactions to food choices. The visual presentations could assist patients in adjusting portion sizes, deal with unrealistic expectations concerning the rate of weight loss, and to manage sensory experiences that occur as a result of behavior changes.

Since TATRC has substantial in-house subject matter expertise and experience in applying IT, virtual reality, augmented reality, and gaming technologies for healthcare, TATRC is going to provide supplemental funding for research in this field.

The first NIH Program Announcements (PAs) issued May 10, 2011 include “Virtual Reality Technologies for Research and Education in Obesity and Diabetes” (R01) (PA-11-211 issued by NHLBI, OBSSR, TATRC and NICHD with multiple dates for submission. The URL is The second program announcement (PA-11-212) is available on and issued May 10th.

Two Requests for Applications (RFA) (RFA-HL-12-020) were issued on May 10, 2011 to encourage the small business research community to submit applications. For information, go to The second Request for Application (RFA) issued (R41/R42 HL-12-024) on May 10, 2011 can be viewed at

New African Initiative

The NIH Common Fund in collaboration with the Wellcome Trust, a global charity based in London, is planning a new initiative termed “Human Heredity and Health in Africa” (H3Africa) to study the genomic and environmental determinants of common diseases in Africa. NIH will fund $25 million and Wellcome Trust will contribute $12 million to fund the H3Africa Initiative

The vision of H3Africa is to create and support a continental network of laboratories equipped to apply leading-edge research to study the complex interplay between environmental and genetic factors which determine disease susceptibility and drug responses in African populations. The data generated will be used to address health inequity and ultimately lead to health benefits in Africa.

To accomplish this goal, the planners of the H3Africa Initiative are considering ways to enhance the necessary genomic expertise among African scientists and how to establish networks for African investigators.

A study, recommends the need to establish one or more biorepositories in Africa and also establish a bioinformatics network to train scientists in genomic research methodologies. A bioinformatics network would provide connectivity among the H3Africa awardees and provide information on how to utilize bioinformatics tools for research projects. This would be done by developing computational tools designed to address the African genomic research projects.

Because of transportation problems within Africa, more than one biorepository is needed and should be established at the regional level. The African biorepository would need to have facilities to receive human blood samples from African genomic research sites, and be able to make transformed cell lines and DNA from the blood and/or the cell lines. This has to be accomplished in a safe manner by securely using state-of-the-art technologies in order to distribute samples to requestors.

Before NIH can publish a funding announcement for the “H3Africa Bioinformatics Network”, NIH needs more information about existing African bioinformatics infrastructure and expertise. Two Notices of Intent to Publish a Funding Opportunity Announcement for the H3Africa Bioinformatics Network have been published by NIH. The two notices can be viewed at and at For further inquiries, email Jane Peterson PhD, at

NIST Studying EHRs

Clinical data in digital form represents a “digital library” with many of the same issues faced by digital libraries in other fields. Thought needs to be given to how health-related information stored in EHRs can be preserved, stored, and yet be totally accessible. So far, these issues have not been defined for EHRs.

This is an issue that needs to be addressed or valuable and irreplaceable information will disappear over time and affect patient care and valuable research. Also, replacing lost data can entail huge costs for patients, clinicians, administrators, and pharmacists.

Some of the issues facing the health IT industry concerning EHRs are:

• Retaining data and for how long
• Dealing with the obsolescence of hardware and software
• The interchange of information
• Costs involved
• Developing standards
• Addressing privacy issues along with data ownership
• Legal constraints

NIST is collaborating with the National Library of Medicine, the National Archives and Records Administration, the VA and others, such as Health Level Seven (HL7) to identify best practices and support standards development needed for the long term preservation and lifecycle management of EHRs.

Through these collaborations, NIST will work to develop an interoperable framework to support a wide variety of data types, data formats, and data delivery mechanisms, while providing a technology-independent infrastructure to acquire, store, search, retrieve, migrate, replicate, and distribute EHRs over time.

Another major issue concerns accessing EHRs by content which is a fundamental usage requirement for today’s electronic health record management systems. Today’s systems provide access based on structured fields—data elements in the record coded to allow effective access.

However, the majority of the content of a record is often in the care providers’ notes and other free-text fields that are not structured so as a result, standard text processing techniques do not work well for these fields. It is particularly difficult when the information does not contain well formed grammatical sentences, when highly specialized vocabulary is used with many non-word terms such as abbreviations and symbols, and when the notes are frequently too brief.

Health records will continue to have free-text fields since this is the way more users enter information. However, NIST is studying how to develop technology so that records can be based on the semantic content of free-text fields. The ability to find electronic health records by matching semantic content in free-text fields will help in the use of health records especially in applications such as medical trials and epidemiological studies.

NIST’s Information Technology Laboratory’s Text Retrieval Conference (TREC) project is working with the research community to develop test data sets, evaluation methods, and other infrastructure to foster the development of new text processing algorithms specially designed for EHRs.

STEP Act Introduced

Representative Glen “GT” Thompson on May 11th introduced the “Service Members Telemedicine & E-Health Portability Act” (STEP) (H.R. 1832). The Act would expand DOD’s state licensure exemption to allow credentialed healthcare professionals to work across state lines without the need to obtain new state licenses.

Currently, DOD has limited ability to allow its healthcare professionals to provide care when the patient is in a different state. By removing this state licensure burden, the legislation empowers qualified DOD professionals to use cutting-edge telemedicine and e-health applications to treat service members regardless of their physical location.

The problem is that DOD’s hands are tied when it comes to credentialed civilian employees and contractors who step in to fill shortages in desperately needed positions, especially in the area of behavioral health treatment. The STEP Act will expand the definition of healthcare professional under the previous exemption to include qualified DOD civilian employees and personal services contractors.

The Act requires a report within 90 days on DOD and Veteran Administration plans to develop and expand programs that will use new internet and communication technologies to provide improved access to telemedicine and electronic health programs.

Sunday, May 15, 2011

Facing Physician Shortages

In healthcare today, we face a changing landscape of national health policy along with increasing patient needs and physician shortages. Remote physician presence using telemedicine technologies leverages the availability of limited resources and ensures that care is available when and where it is needed. Currently, there are only 215 Board Certified neurointensivists in the U.S.

One innovative application provides neurointensivist support and neurologic coverage for hospital emergency departments especially among those designated as a Comprehensive Stroke Centers by the Joint Commission.

According to Dr. Herb Rogove, President and CEO of C2O Medical Group, a remote telemedicine physician program in southern California has demonstrated more rapid patient access to neurological care, better compliance with guidelines, and improvement in national quality standards. These results were presented during a panel on physician compliance and quality metrics at the ATA 2011 Annual Meeting held recently in Tampa.

A team of three remote vascular neurologists also board-certified in NeuroCritical care treated 129 patients over nine months. During this period, the response time for the off-site physicians was 21.8 minutes compared to greater than one hour for local neurologists to physically arrive at the facility.

The remote physicians attained a significant increase in compliance with Joint Commission metrics related to blood clot prevention, clot dissolving medications, cholesterol lowering medications, and stroke education. However, during the course of the following year, compliance by the local neurologist was significantly improved, due to the standard set by the telemedicine NeuroCritical care physicians, as well as the fact that outcome data was shared between both groups.

Physicians are open to new approaches and solutions to the challenges they face on a daily basis. For example, emergency department physicians are too often frustrated because they believe more stroke patients should receive the clot-busting drug t-PA. However, local neurologists are not always available for emergency consultations to identify appropriate candidates. Once the hospital started their telemedicine program, there was an increase in the utilization of t-PA, more complex diagnoses were being made, and more patients were being treated with neurological emergencies.

As Rogove explained, “In order for the implementation to be successful, you need buy-in at the highest executive level. In addition, identifying the opinion leaders and change agents plus involving them in planning is also very important.

For more information go to or email Christina Thielst at

Cal eConnect Posts RFP

Cal eConnect issued an RFP seeking qualified vendors to submit competitive and innovative proposals to design, develop, implement, operate, and maintain a “Provider Directory Service” with electronic Health Information Exchange (HIE) capabilities. Once developed, the directory will be the first of its kind in the nation. This will be a landmark achievement for California in its efforts to implement the widespread use of HIT.

The service will enable hospitals, providers, and other healthcare entities to find certified providers, obtain security and standards information, and make it possible to exchange health information electronically.

The purpose of the RFP is to procure the services of a vendor or vendor consortium that will work with Cal eConnect not only to launch, but to potentially sustain its core infrastructure. The contract resulting from the RFP will enable the electronic HIE to occur as outlined in the Office of the National Coordinator’s State Cooperative Agreement program for HIE.

Bill Beighe, Chief Information Officer, Physicians Medical Group of Santa Cruz as Chair of Cal eConnect’s Technology Advisory Group was heavily involved in the creation of the RFP along with his team.

The RFP (2011-011) was posted on May 9, 2011 on the Cal eConnect’s website. The deadline to respond is June 22, 2011 with a bidder’s conference scheduled for May 17, 2011 from 1:00pm to 3:00pm at Shriners Hospital in Sacramento.

Go to or go to the Cal eConnect web site at

mHealth to Help Diabetics

The McKesson Foundation’s “Mobilizing for Health” initiative awarded $1.3 million to six U.S institutions. The funding will be used is to improve the health of underserved populations with chronic diseases through the use of mobile phone technology. The grants up to $250,000 each will support studies on diabetes care and management.

George Washington University Medical Center researchers received two of the grants. One GW study will basically examine if information sent to individuals via their mobile phones using SMS text messaging will reduce emergency department visits for people with diabetes.

The researchers will evaluate the impact of a mobile phone-based text messaging system to see if the people receiving information through their cell phones helps to increase their knowledge about diabetes, improves their self-care behaviors, and if the information is then transmitted to researchers.

The other study will be a randomized, controlled trial of a cell phone based software application for patients with diabetes and hypertension. The software application will enable patients to monitor their blood glucose and blood pressure and share the information with case managers and primary care providers through existing electronic medical records. The plan is to improve information flow between patients, case managers, and healthcare providers. The study will also explore the potential for medication error reduction and perform a cost analysis of the intervention.

The McKesson Foundation decided to put diabetes management at the forefront of its “Mobilizing for Health” grant program when it was launched in 2010 and will continue to focus on diabetes management and research through March 2012.

GW’s School of Medicine and Health Sciences has spearheaded several other projects that include the D.C Chronic Care Initiative Cell Phone Project, GW/WellDoc Air Force Diabetes Project, plus other mobile health projects.

The other McKesson Foundation grantees include Johns Hopkins Bloomberg School of Health, Nova Southeastern University, Public Health Institute, and the University of Southern California.

For more information on the grant program, go to

Funds for Rehab Technology

NIH has provided about $30 million over a five year period to fund a network of centers to advance medical rehabilitation research and provide access to new technologies and resources. Rehabilitation research is done to promote recovery, adaptation, and functioning for patients with disabilities resulting from stroke, spinal cord injuries or brain injuries, developmental or regenerative disorders, or other persistent physical conditions.

The funding comes from the National Center for Medical Rehabilitation Research (NCMRR) located within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and also from the National Institute of Neurological Disorders and Stroke, and the National Institute of Biomedical Imaging and Bioengineering.

The centers are located at Stanford University, Children’s National Medical Center in Washington D.C., University of California, San Diego, University of Texas Medical Branch in Galveston, Boston University, Rehabilitation Institute of Chicago, and Dartmouth College and Simbex, Inc. in New Hampshire.

The “Medical Rehabilitation Research Network” within NCMRR connects the research community with courses and workshops, research facilities, mentorship, and provides for consultations with experts at the network centers. In addition, the network provides researchers with small grants to test new ideas.

The network provides expertise is such areas as:

• Computer simulations for understanding movement disorders and to evaluate how potential interventions might affect those movements
• Techniques for analyzing how genes and molecules influence the recovery process
• Technologies for studying muscle action and function
• Assistance in tracking how all treatments meet the needs of patients
• Analyzing population data to evaluate the broader impact of rehabilitative treatments and health services
• Studying how robots and sensors can be used to assist patients and help deliver therapeutic treatments
• Assessing new rehabilitation technologies and then be able to bring these new therapeutic devices to the market place

During the first year of funding, the network supported a variety of pilot projects. For example, pilots studied sensors to help amputees control prosthetic devices, how to develop devices for preventing falls in the elderly, and ways to monitor blood flow to and in the brain.

For more information, go to

mDevices Help Public Safety

New York City has unveiled the first public safety system where mobile devices will receive emergency alerts at critical moments. Mayor Michael Bloomberg, FCC Chairman, Julius Genachowski, and FEMA Administrator W. Craig Fugate along with top executives from AT&T, Sprint, T-Mobile, and Verizon gathered at the World Trade Center site to announce that the “Personal Localized Alerting Network (PLAN) is now on the fast track.

PLAN is a free service that enables customers with an enabled mobile device to receive geographically-targeted, test-like messages alerting them of imminent threats to safety in their area. When PLAN is operational, customers in an area affected by an emergency who have a PLAN-enabled mobile device will receive an alert of 90 characters or less.

Consumers will receive three types of alerts from PLAN to include alerts issued by the President, alerts involving imminent threats to safety of life, and Amber Alerts. Participating carriers may allow subscribers to block all but Presidential alerts.

PLAN will be available in New York City by the end of 2011 and Genachowski announced that by next April, PLAN will be deployed in cities across the country, represented by other carriers to include Leap, MetroPCS, and US Cellular.

Authorized government officials can send messages, where participating wireless providers will send the message via their cell towers to enabled mobile devices in a targeted geographic area. PLAN complements the existing Emergency Alert System, implemented by FCC and FEMA at the federal level through broadcasters and other media service providers.

Genachowski speaking at the launch of PLAN on May 10, 2011 said, “PLAN ensures that emergency alerts will not get stalled by user congestion which can happen with standard mobile voice and testing services. He continued to say, “To minimize networks from getting congested in the first place, more spectrum for mobile broadband needs to be unleashed and that is why the FCC is working with Congress to authorize voluntary incentive auctions.”

Wednesday, May 11, 2011

Wounded Warrior Research

Daniel J. Cleary Computer Scientist at GE Global Research located In Niskayuna. New York, explained how some of the technologies developed for jet engines are now helping returning soldiers deal with TBI and PTSD. He reported on research in this field at the “ATA 2011 16th Annual International Meeting and Exposition held May 1-3 in Tampa.

GE supported by a TATRC three year research study is evaluating returning soldiers for mental issues. The study is taking place at Ft. Gordon, Georgia to enable researchers from the Dwight D. Eisenhower AMC and the Center for Telehealth at the Medical College of Georgia to find new ways to determine and measure if wounded soldiers are actually affected with TBI or PTSD.

To research information for the study, the soldiers sleep as usual in their barracks but a cabinet is placed above their beds containing unobtrusive motion sensor technology and analytical software. Researchers fitted the cabinet with Doppler radar and environmental sensors to gather data when the soldiers are sleeping while a wrist watch measures activity during the day. This technology enables the soldiers to have their vital signs monitored plus have the radar output measure their heart and respiratory rates. The study is expected to be completed in 2011 and completely wrapped up in 2012.

Another TATRC project discussed at ATA 2011 is helping the wounded communicate with their case managers by heavily using a cell phone-based bi-directional messaging system. The “mCare system” enables the care team to enter a secure HIPAA compliant message to the soldier’s existing cell phone. The soldier is able to respond to the message, the care team views the response, and the next step is to report the information online.

The Army developed “mCare” by modifying commercial off-the-shelf technologies and created the HIPAA-compliant messaging system to work on wounded warriors and their existing mobile devices (cell phones) however, the system is distinct from text messaging or email.

The Army reports that “mCare” has been launched at 5 Community Based Warrior Transition Units (CBWTUs) across the country. Col. Ronald Poropatich, MD, Deputy Director, USAMRMC TATRC at Fort Detrick MD, pointed out that as of April 2011, 600 wounded warriors between 18 and 61 that including both enlisted personnel and officers volunteered to use “mCare”. Geographically, the user’s in 28 states and D.C. received case management services from over 600 miles that included sending over 78,500 secure messages.

In 2010, the “My Appointments” feature was created to enable wounded service members and case managers to submit appointment data that automatically generates reminders on the mobile interface. So far, over 3,000 unique appointments have been transmitted of which 1,200 were initiated by service members through their mobile interface.

In April 2011, the “mCare” Clinical Outcomes Study was initiated where a randomized clinical outcomes study will eventually enroll up to 400 participants both TBI and non-TBI patients. The study’s goals are to provide awareness, patient-provider contact rates, information on neurobehavioral symptom severity, soldier’s satisfaction with case management and system usability. The study is expected to conclude in 2012.

Expanding Info Sources

Researchers are now able to select a physical trait or phenotype and find the genomic variants associated with it by using a new web portal called the “Phenotype-Genotype Integrator” or referred to as (PheGenl). Genome-wide association studies have uncovered thousands of novel genetic variants associated with common diseases. However, data from the studies is often located in disparate databases that are hard to find, operate, or to be able to integrate the data for analysis.

PheGenl permits researchers to view a tabular display of genome-wide association study results for DNA sequence variations, genes, and gene expression differences for a given trait such as asthma or diabetes. For example, in a search for the trait “asthma” the data shows 88 genetic variant associations. The results are linked to their source databases where researchers can then dig deeper into the detailed data.

“This new web portal will help build the knowledge base that is crucial to accelerating research on genetic variations among basic scientists. It will also allow clinical researchers and epidemiologists who are unfamiliar with such data to explore genetic variations and the phenotype data that is related to the diseases they study” said, Lucia Hindorff, Ph.D., an epidemiologist in the National Human Genome Research Institute’s Office of Population Genomics. “PheGenl pulls genetic and genome-wide association studies data from multiple NIH databases and presents it compactly organized to the user.”

Today, PubMed has 20 million citations for biomedical literature available from Medline, life science journals, online books, links to full text content, and to PubMed Central plus publisher websites. In a recent development, PubMed Mobile Beta, a special lightweight web interface to make PubMed faster to load and easier to use on smartphones and other mobile devices, has gone live.

In addition, Mobile MedlinePlus available since 2010 builds on the NLM’s MedlinePlus Internet service and is available in English and Spanish at The mobile version includes a subset of content from the full web site with summaries for over 800 diseases, wellness topics, latest health news, an illustrated medical encyclopedia, and information on prescriptions and medications.

The National Library of Medicine has recently announced that their “Wireless Information System for Emergency Responders (WISER) 4.4 is available. WISER can now be downloaded to the WISER Windows, Pocket PC, and to SmartPhone platforms from the web site. The WISER for iPhone/iPod touch 1.1 is available from Apple’s App store.

To further increase app resources, NLM has launched a software development contest to find apps that will display more of NLM’s biomedical data. The contest is open to individuals over the age of 18 and any organizations in the U.S. Submissions can be for any kind of software application whether it is for the web, a personal computer, a mobile handheld device, console, or any platform broadly accessible on the internet.

Winners will be recognized at an awards ceremony at NLM on November 2, 2011 and links to the winner’s app will be publicized on the NLM web site. Entries must be submitted to the web site by August 31, 2011. For more information, email

Emergency Services Update

Each year, emergency medical service providers respond to more than 25 to 30 million transport calls requiring the most current information to be available to emergency care responders. For example, EMS providers use pre-hospital triage guidelines to determine whether a patient should be transported to a trauma center, but since the guideline’s accuracy and efficiency rely on the analysis of data sets from multiple sites, this information may not always be available or accurate.

The Clinical and Translational Research Institute, (CTSA) West Coast Consortium are working together with community partners to study how effectively emergency medicine is operating in the U.S. by looking at all of the data and expertise available on the subject.

The Center for Policy and Research in Emergency Medicine located at Oregon Health and Science University has launched a study on pre-hospital triage involving several CTSA sites. After some initial success, the research team plans to expand their efforts.

In an effort to further study emergency care, the Oregon Clinical and Translational Research Institute (OCTRI), the first inter-CTSA network dedicated to the translational science of emergency care was established. This CTSA network, referred to as the Western Emergency Services Translational Research Network (WESTRN) now includes seven CTSA sites at OHSU, University of Washington, UC Davis, UC San Francisco (with San Francisco General Hospital), Stanford University, University of Colorado (with Denver Health), and the University of Utah.

According to Eric Orwoll, Director of OCTRI, “Emergency medicine is an excellent example of the need for a translational approach with collaborations across disciplines and sites. We can’t address emergency medicine in isolation.”

The CTSA network has collected data on more than 325,000 patients at seven sites and has already been successful in securing additional funding and support from CDC plus additional university research financial support.

In a state action to reach the emergency crews in Nebraska, the state has partnered with the Nebraska Public Power District to build a new statewide wireless radio system to improve public safety. Equipment installations for this project were installed across 25 eastern Nebraska counties to complete the system.

By partnering and not building two separate networks, a shared network was developed that connects public safety personnel from several state agencies and utility crews to the state’s largest power provider.

In addition to providing a direct channel for communication among state personnel, the network will integrate with several regional networks already in existence for city and county officials. This move will enable the state to achieve full interoperability with local first responders and county emergency management personnel.

On the Federal level, the Incident Management Systems Integration Division within FEMA wants to see the development of free software to be used as a database management tool by Federal, State, local, and tribal officials to handle emergency situations.

Referred to as the “Incident Resource Inventory System”, this tool would allow emergency responders to enter typed and non-typed resources into a common database and search for resources to help in emergencies. Users would not only be able to inventory resources but they would also be able to share resource information with other agencies.

Grants to Help in Oregon

Northwest Health Foundation awarded $260,000 in grants for $10,000 each to provide general operating support to organizations engaged in healthcare reform activities. The Telehealth Alliance of Oregon (TAO) was named one of the recipients. TAO will use some of the funds to continue to advocate with healthcare providers, insurance companies, and associations such as Oregon Health Network, O-Hitech, HITOC, the Office of Rural Health, and the Community College Health Education Alliance for ways to help the healthcare system in the state reach specific goals.

They plan is to ask state officials to:

• Work on telemedicine reimbursement issues at the state and federal levels
• Support credentialing and privileging of telemedicine providers
• Provide information to organizations tasked with assisting providers with the implementation of HIT
• Share resources with other HIT organizations to help create shared strategies for efficient and effective access to healthcare services and information
• Promote telehealth strategies to deliver healthcare to contain costs and increase access to care especially in rural areas

TAO also plans to work with the Oregon Health Network to develop a resource directory of all the state and federal resources for health information technology that will include telehealth resources. The information will be available at no charge to healthcare providers, healthcare educators, state agencies, and policy makers.

Transition to e-Documentation

The NIH Clinical Center’s ICU is transitioning to an electronic documentation system containing patient medical records. The system is replacing a hard copy paper flow sheet that has been used in the ICU for decades, said Dr. David Henderson, Clinical Center Deputy Director for Clinical Care.

The new system will be accessible through the Clinical Research Information System (CRIS) and will mimic the format of the flow charts while streamlining the documentation in a single location. The new patient-care technology records will contain virtually every electronic observation made of a patient’s condition and vital signs.

Henderson reports that in addition to increasing efficiency and patient safety in the ICU, the system will also allow investigators access to important information that will benefit clinical research initiatives and enable researchers to easily access patient information that is collected in the ICU.

Ryan Kennedy, an information technology project manager for the Department of Clinical Research Informatics, coordinated and implemented this customized electronic documentation initiative. According to Kennedy, the system will make it easier for nurses to document patient information while displaying the information in an easier way for the physician group.

Bill Eliminates Co-Payments

On May 9, 2011, Senators Mark Begich (Alaska), Chuck Grassley (Iowa), and Jon Tester (Montana) reintroduced the “Veterans Telehealth Act of 2011” to waive co-payments for telehealth and telemedicine visits for veterans. The bill was originally introduced one year ago and in August 2011, the legislation passed the Senate Veterans Affairs Committee but did not receive consideration by the full Senate. Now the bill is to be directed back to the Veterans Affairs Committee.

The Veterans Health Administration Telemedicine program currently provides 42,000 veterans with in-home care. This includes an estimated 220 Alaska veterans who face a co-payment of up to $50 per telehealth appointment.

“For those living in rural Alaska, providing in-home care or care in a local clinic makes healthcare more affordable and relieves the stress of having to travel to a major city,” Begich said. “This legislation is a simple solution that saves money and actually improves the quality of services delivered by the government.”

For more information, call (907) 258-9304.

Sunday, May 8, 2011

CMS Finalizes New Rule

CMS finalizes a new rule for telemedicine services to ensure that patients in rural or remote areas continue to receive cutting edge medical care from local hospitals. The final rule changes the process that hospitals and CAHs use to credential and grant privileges to physicians and practitioners delivering care via telemedicine services.

The rule simplifies how hospitals and CAHs can partner with hospitals and non-hospital telemedicine entities such as teleradiology facilities to deliver care to their patients. The streamlined process will be particularly beneficial to patients of small hospitals and CAHs in rural or remote areas that may lack staff or resources to deliver specialized clinical expertise to their patient populations.

Before this rule, CMS practitioners could not provide care via telemedicine unless they were granted practice privileges both by their home hospital as well as by the remote hospital or CAH to which the telemedicine services were being delivered. The final rule aims to reduce the burden of the traditional credentialing and privileging process for Medicare-participating hospitals and CAHs.

A hospital or CAH furnishing telemedicine services to patients via an agreement with a distant hospital or telemedicine entity may now rely upon information furnished by the distant hospital when making credentialing and privileging decisions for the physicians and practitioners at the distant site that will furnish the services.


HRSA’s April 27, 2011 Funding Opportunities Announcement (FOA) solicits applications for the “Rural Health Information Technology Network Development” (RHITND) program. One of the challenges rural providers face is being able to secure the capital needed to make the initial investment for the necessary hardware and software to successfully implement HIT and EHR systems.

A “Rural Health Network” is composed of multiple independent rural healthcare providers and possibly other community organizations and is defined as a formal organizational arrangement among at least three healthcare providers that are separately owned entities.

Rural health providers benefit by forming Rural Health Networks as they have proven to be one of the best strategies for maintaining limited rural health resources when individuals in the community are faced with economic hardships and have decreased access to healthcare services. The HRSA funding will help networks expand their adoption of HIT and EHR and help providers in the network meet the meaningful use standards of EHR adoption.

Grant funds will support workforce analysis, EHR training, be used to purchase equipment, to identify and locate certified HIT equipment vendors, and to install broadband in rural areas.

This program will provide funding during FY 2011-2013. This is a one-time only funding opportunity and is based upon the availability of funds. About $12,000,000 is expected to be available annually to fund 40 awardees. The application deadline is May 27, 2011 with the start of the project expected to be September 1, 2011.

For more information, go to or

TATRC's Research Activities

According to the Army Medical Research and Materiel Command’s spring 2011 issue of “The Point”, new biosensors can be used with automated delivery pumps as part of a “Target-Controlled Infusion Anesthesia” (TCIA) system.

This system can deliver blood concentrations of drugs for general anesthesia or conscious sedation with studies of TCIA systems show improved anesthesia outcomes and reduced hospital costs. These systems are in use in operating theaters in Europe and other countries, but the FDA has not yet approved the system for U.S. military or civilian use.

Other sensors can measure the depth of sedation by blood pressure and other indirect measures. A research team in Tennessee has created and successfully tested electrochemical sensors that can continuously measure propofol levels in the blood at extremely low concentrations within the dose range of the drug.

The Army’s Telemedicine and Advanced Technology Research Center (TATRC) supports new studies to validate the new biosensors since the military has identified a need for new technologies for the real-time monitoring of casualties. According to TATRC Deputy Director Col. Ron Poropatich, “This project relates particularly to the need for a highly portable autonomous anesthesia system that can be used to maintain sedation during aerial transport.”

TATRC Trauma Portfolio Manager, Dr. Thomas Knuth reports that the team at TATRC was already developing electrochemical sensors for other uses, so the plan is to apply these biosensors to meet the military need for a closed-loop system to measure and regulate propofol. So far, this research looks very promising and the hope is that research in this field will also show how this knowledge can be applied to other anesthesia drugs.

TATRC will be involved in another new research project with $15 million in funding authorized by Congress to create an Alzheimer’s Research Grant Program within DOD. The research plan is to explore the causes, complications, and potential treatments associated with Alzheimer’s disease, particularly among those in the military. The funding will be used to create a peer-reviewed research grant program portfolio that will include TBI, PTSD, and other brain research areas.

SAMHSA Funding More HIT

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment within HHS, released a Request for Application (RFA) to use health IT to enable substance abuse treatment providers help individuals in underserved areas. Domestic public and private nonprofit entities are eligible for this funding.

The funding for health IT can be used to expand existing systems or be used for adjunct technologies such as consumer-oriented wireless technology, personal health record systems, or other electronic systems. The funding can be used to provide web-based services, smart phones, and behavioral health electronic applications (e-apps). These technological tools can also complement existing or new EHR systems.

FY 2011 Grant Request for Application (TI-11-002), titled “Grants to Expand Care Coordination through the Use of HIT in Targeted Areas of Need” was posted on May 2, 2011 and is due by June 13, 2011.

Funding for $5.6 million is available with up to 20 awards. The anticipated award amount will be up to $280,000 per year.

SAMHSA’s second Request for Application (SM-11-012) released on May 4 under the “Primary and Behavioral Health Care Integration” (PBHCI HIT) grant announcement. This grant funding is a one year supplemental award to expand the use of interoperable electronic health records to quickly identify both the behavioral health and primary care needs of patients. The goal is to deliver prevention services to link primary care and behavioral health needs but also to track outcomes.

The supplement support will enable the integration of primary care services with the care delivered in publicly funded community mental health and other community-based behavioral health settings. Through this initiative, the agency will work to increase the use of interoperable, certified EHR systems.

Eligibility for this supplemental funding is limited to current PBHCI grantees. The anticipated funding will be up to $11.2 million with 56 anticipated awards with the award amount to be $200,000 for one year.

For more information on (T-11-002), go to or email Wilson Washington at For more details on (SM-11-012), go to or email Trina Dutta at

Search for Health Policy Associate

The Alliance for Health Reform is looking to fill the position of Health Policy Associate. This associate health policy position will be an integral member of the health policy staff and assist the Executive Vice President and Senior Health Policy Associate to develop and execute briefings, research the health policy arena, and help to cultivate and maintain relationships with key congressional staff and other health policy stakeholders.

The Policy Associate’s responsibilities include organizing the content of Alliance briefings, scheduling and maintaining communication with speakers, research and analyze possible topics, assist in preparing and drafting a variety of publications and materials for retreats, attend briefings and provide logistical support, including assisting with setup, registration, and breakdown.

This position also helps to coordinate policy research among Alliance staff members, track health policy topics under discussion among analysts and policy makers, especially congressional staff, and keep Alliance staff informed about health policy developments.

Qualifications require an established background and interest in health policy, economics, public policy political science or other social science fields is required. A master’s degree or a combination of work experience and a B.A in one of the disciplines mentioned above is preferred.

Knowledge in one or more of the following areas is required to include health reform, quality, healthcare costs, disparities, children’s health, Medicare and Medicaid, long-term care, public health, and private insurance.

Excellent written and speaking skills, an ability and willingness to perform a variety of organizational tasks and commitment to the goals of the Alliance are essential. Applicants must be able to organize work and prioritize, take the initiative, have the ability to handle multiple tasks, be able to meet deadlines, plus have strong computer skills.

To apply, submit a cover letter, resume, and salary requirements to Word or PDF files only and please no phone calls.

Alliance Helps Consumers

MedApps, Inc. a mHealth company and Phoenix Kiosk, Inc, a kiosk design and manufacturing company have formed a strategic alliance to expand their companies in the remote health monitoring market. The plan is to integrate cutting edge technologies to not only use in store retail medical clinics but also in corporate entities.

The two companies showcased their products at the 2011 American Telemedicine Association conference held May 1-3, 2011 in Tampa. “Phoenix Kiosk’s capabilities and expertise in developing forward-thinking product compliments our approach and ability to be agile in the market,” says Kent Dicks, MedApps Founder and CEO. “The alliance will provide a highly economical entry into leading retail and corporate medical clinics across the nation.”

Specifically, the system uses MedApps’ CloudCare™ platform, the HealthReader ™ and Health Smart Card in collaboration with Phoenix Kiosk’s Personal Health Station hardware and software interface. The technology enables an economical gateway to MedApps’ CloudCare System to provide for remote health monitoring and connectivity to the consumer’s personal electronic health records.

The MedApps Smart Card has the capability to store biometric measurements when collected either from the in-store kiosk or remotely from the patient’s home using the HealthReader. The system uses wireless or wired technology to transmit biometric data collected at home or from retail devices to a central server with the data then forwarded to an EHR and/or online consumer records service. This system is ideal for individuals who may not have access to or may not want to use a computer or smart phone to upload health data to an EHR.

This system can also serve as a check-in point for remote patient clinics in the retail setting or as part of an employer’s program and has the capability to integrate the smart card to the retailer’s loyalty rewards program, to electronic coupons, and to provide prescription reminders, etc.

For more information, go to and

Spotlight on Healthcare Unbound

Networks, platforms, and applications for technology-enabled participatory medicine will be featured at the “Eighth Annual Healthcare Unbound Conference & Exhibition” on July 11-12, 2011 at the Manchester Grand Hyatt San Diego. The Conference will be a great networking and educational event, attracting hundreds of high level executives and clinicians from all over the U.S. and abroad. The focus will be on remote monitoring, home telehealth, mHealth, eHealth, social media, and how to better promote wellness, manage diseases, and facilitate accountable care using the newest technologies.

Today innovative technologies are driving opportunities to serve health consumers in new ways and in new settings. In addition to dramatically changing traditional healthcare delivery, this Conference attracts a range of companies that previously have not been deeply involved in healthcare such as in consumer electronics, telecom, gaming, fitness, along with information technology companies. More and more ideas and companies are coming on board every day.

You really can’t miss this event if you are involved in this exciting ever changing technology field. The information obtained from all of the keynote speakers and presentations will help not only healthcare providers and health plans, but also retirement communities, consumer technology companies, pharmaceutical, medical device, and diagnostics companies, as well as contract research organizations. Also, home builders, financiers, security analysts, consultants, and government officials will also play an important role.

Leading thought experts in the field will present a number of keynote presentations:

• Vince Kuraitis, JD, MBA, Principal, Better Health Technologies
• Michael J. Barrett, Managing Partner, Critical Mass Consulting
• Joseph Ternullo, JD, MPH, Director, International Corporate Relations, Partners HealthCare & Associate Director, Center for Connected Health
• Zachary Sikes, Senior Vice President, Leading Age
• Bryce Williams, Director Wellvolution, Blue Shield of California
• Majid Sarrafzadeh, PhD, Professor, Computer Science UCLA & Co-Director, UCLA Wireless Health Institute
• David Inns, CEO, GreatCall, Inc. (Creator of Jitterbug)
• Yan Chow, MD, MBA, Director of Innovation and Advanced Technology, Kaiser Permanente
• Charles (Chuck) Parker, Executive Director, Continua Health Alliance

The presentations and panels zeroing in on today’s critical issues will provide many opportunities for productive discussions in such topics as:

• Connected health used to support efforts to establish meaningful use
• Reimbursement and regulatory developments
• Emerging business models
• Health consumer engagement and behavior change through the use of technology
• Technology-enabled participatory medicine
• Leveraging technologies to promote wellness and manage diseases
• Health plan and employer perspectives on healthcare unbound
• Healthcare technology applications for baby boomers and seniors
• Promoting personalized medicine and wireless applications
• The role of technologies in the patient centered medical home
• Using telehealth technologies and the accountable care concept in home care
• Opportunities and challenges in creating linkages between electronic health records and consumer-facing technologies such as remote monitoring and social media
• Financier perspectives
• International perspectives
• Technology enabled chronic care management
• Participation in Health Information Exchanges
• And many more topics are being added daily to the agenda

Exhibits will showcase the newest technologies and give attendees ample time to see not only what is available today but information on future technologies that are going to greatly impact the medical and healthcare fields as we move through the 21st century.

Go to for more details, to register, or to exhibit.