Sunday, July 31, 2011

CMS Plans for Innovation

Delivering healthcare today is difficult because many people lack insurance, services are uncoordinated, and payment models need to be changed, noted Richard Gilfillan, MD, Acting Director for the CMS Center for Medicare and Medicaid Innovation (CMMI). He was a presenter at the first Annual ATA Policy Summit held July 27, 2011 in Washington D.C.

CMMI was funded with $10 billion to provide better healthcare, better health, and lower costs. The Center has a funding advantage since the HHS Secretary can expand successful models without going back to Congress for more funding.

As Dr. Gilfillan explained, the agency is soliciting ideas for new models and plans to test, evaluate, and select the most successful models. Once the new models of care are selected, CMMI will solicit partners to test the model by issuing a competitive “Innovation Partnership Opportunity” (IPO). The IPOs may include competitive processes such as Requests for Applications, Requests for Proposals, or other ways to solicit clinicians or others to partner with the Innovation Center. IPOs will be posted on the CMMI website.

The Administration’s new nationwide patient safety initiative “Partnership for Patients” (PFP) created by ACA, now has over 2,000 hospitals pledging their support for the program. With the collective effort of private and public stakeholders, the program aims to reduce preventable harm in hospitals by 40 percent over the next three years.

According to Gilfillan, right now, the PFP initiative has the potential to save up to $35 billion in healthcare costs, including up to $10 billion for Medicare. Over the next ten years, the initiative could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.

So far, two PFP funding opportunities have been created:

• Community-Based Care Transitions Program provides up to $500 million in funding for community-based organizations in partnership with hospitals to help patients safely transition between settings of care. Applications are accepted on a rolling basis. Go for more information

• CMS posted a request June 17th with added information on June 20th for bids to find state, regional, national, or hospital system organizations to manage improvement projects. The solicitation (APP111513) is soliciting a Hospital Engagement Contractor to support the program. CMS intends to award multiple contracts by September 30, 2011. For more information, go to or

HHS recently announced several new models to help states. One demonstration program is going to test two new financial models to help states better coordinate care, another demonstration program will help states improve the quality of care for people in nursing homes by enabling these individuals to receive the care they need without necessarily going to a hospital, and a new initiative to make a technical resource center available to states to help them improve care for high-need high-cost beneficiaries.

In addition, CMS is helping states better coordinate care for individuals enrolled in both Medicare and Medicaid. Also, a new model would enable a state, CMS, and health plans to enter into three-way contracts where the managed care plan would receive a prospective blended payment to provide comprehensive and coordinated care.

CMMI through their new “Community and Population Health Models” initiative is going to test care and payment models to improve public health especially in the case of smoking and obesity issues. The Center will work with other organizations to test new care and payment models that will impact the underlying drivers of health for Medicare, Medicaid, and CHIP.

For more information on the initiatives, go to

RFP for Informatics Vendor

The Massachusetts Technology Collaborative through the Massachusetts e-Health Institute is working with the Massachusetts Department of Public Health, Harvard Medical School’s Department of Population Medicine, and the Massachusetts League of Community Health Centers to develop the MDPHnet System.

MDPHnet will be a scalable, transportable, open source, distributed-data, and distributed-analysis system that will allow public health agencies to use patient and encounter-level data residing in practice-based EHRs without requiring the transfer of protected health information.

MDPHnet encompasses two distinct and innovative parts of a distributed public health data network:

• PopMedNet is capable of creating secure distributed networks among two or more partners

• The EHR supporting the Public Health System ESP enables data to be extracted automatically from the EHR into a format suitable for surveillance activities

The purpose for the “RFP for Informatics Vendors” (RFP No.2012-MeHI-01 is to find vendors with experience in creating the technical infrastructure to enable authorized public health users to perform distributed analysis of EHR data housed in ESP repositories.

The RFP was released July 27, 2011, a bidder teleconference to be held August 3, 2011, and RFPs are due August 11, 2011 The project through January 2014, is being funded through an Office of the National Coordinator Challenge Grant for Population Health.

The procurement team leader is Dawn Heisey-Grove. For more information contact the Massachusetts Health Institute at To view the RFP, go to

Broadband Plan Submitted to FCC

Six of the nation’s leading broadband providers have submitted a proposal called “America’s Broadband Connectivity Plan” to the FCC to speed broadband deployment to more than 4 million Americans living in rural areas. They also announced an agreement with three organizations that represent small carriers on a framework for complementary reform.

The two complementary plans share key goals to modernize the federal Universal Service Fund (USF) so that it is focused on building and sustaining broadband networks without increasing the size of the fund and the plan is to reform the ICC system that governs how communications companies bill one another for handling traffic.

The six broadband providers AT&T, CenturyLink, FairPoint, Frontier, Verizon, and Windstream collectively serve the vast majority of the U.S. telecommunications customers including those residing in high cost rural areas.

Joining in support of the reform are the National Telecommunications Cooperative Association, Organization for the Promotion and Advancement of Small Telecommunications Companies, and Western Telecommunications Alliance.

Key features of the plan are to:

• Define broadband as a minimum of 4 mbps downstream and 768 kbps upstream to support education, healthcare, and other applications

• Connect virtually all Americans to broadband access within 5 years and do so without growing the $4.5 billion high-cost USF

• Target support to broadband deployment in areas where there is no business case for companies to provide service

• Promote efficiency by targeting support more precisely to identified high-cost areas and support only one provider in each area

Also consistent with the parameters outlined in the “National Broadband Plan, the companies proposal would modernize intercarrier compensation to provide certainty, stability, and a healthy foundation for growth to meet the needs of consumers.

Detecting Alzheimer's Sooner

Scientists at Oak Ridge National Laboratory (ORNL), University of Kentucky, and the University of Tennessee are researching a method that could help primary care doctors detect Alzheimer’s in patients during the early stages of the disease.

An early diagnosis is considered critical because medications currently available are most effective if they are used in the very early stages of Alzheimer’s. Medications may be even more helpful if they are used when a patient has mild cognitive impairment, a condition that frequently progresses into Alzheimer’s dementia.

The research team conducted a pilot project to identify preclinical Alzheimer’s using EEG. Although neuroimaging methods like MRIs and PET scans are successful at recognizing early forms of Alzheimer’s, these scans are expense and prohibit everyday use. In contrast, EEG is a relatively simple test that measures electrical activity from the brain’s neurons from electrodes attached to the scalp.

Researchers at the University of Kentucky Medical Center collected EEG data from three groups that included patients with no dementia symptoms, patients diagnosed with mild cognitive impairment, and patients diagnosed with early Alzheimer’s.

Advanced data analysis performed by researchers at ORNL and the University of Tennessee revealed that the EEG test succeeded in terms of sensitivity and accuracy in identifying the conditions of the different groups.

The research team hopes to expand its initial study and increase the sample size of the groups to validate and improve the screening abilities of EEG analysis. The end goal is to develop a simple efficient device to provide real-time analysis in a general practice or in a community hospital setting.

Call for Submissions

The European Association of Healthcare IT Managers and the European Association of Hospital Managers is encouraging all IT managers, healthcare organizations, hospitals, and individuals worldwide to participate in the IT @ NETWORKING AWARDS 2012. This is the world’s only open competition of fully implemented operable healthcare IT and medical technology solutions. Hospitals, research institutes and companies from all over the world are invited to showcase their excellent solutions with the aim to win.

The Call for Submissions for the IT@NETWORKING AWARDS 2012 has just been announced. Have you recently implemented an innovative IT solution in your hospital or department? If yes, then reflect and build on your success. This is your opportunity to tell your story, and to show the global healthcare sector what your solution can do and why the technology deserves to win.

The IT @ NETWORKING AWARDS 2012 awards will take place on January 18-19 in Brussels, Belgium. On Day one, the MINDBYTE Session will take place by having each nominee for the award give a five minute presentation followed by a lively five minute Q&A. The audience will vote immediately after each presentation according to the voting criteria for each solution.

The WORKBENCH Session to take place on Day two will have eight top-rated nominees give a 25 minute in-depth presentation followed by a 15 minute Q&A discussion to provide the audience with a thorough understanding of the project.

IT @ 2012 is a real competition in which presenters are challenged by expert judges and participants. The competition is especially unique since each presentation is followed by a thorough questioning from the voters. CEOs, CIOs, CMIOs, hospital and IT managers will use the electronic voting system to support their preferred projects.

IT @ 2012 will identify some of the finest and most innovative departmental institutional local, regional, and national healthcare solutions. The top prize will be an Award Trophy plus a cash prize of 2,500 EUR around $3,615 in U.S. dollars. Additionally, the winning technology will be promoted in Europe’s leading healthcare management media which is valued at 47,500 EUR around $68,700 in U.S. dollars.

All entries must be implemented in at least one site and must be fully operable. Each submission must cover the importance of the technology, benefits, originality, difficulties, successes, and impact of the technology. Submissions need to be entered by September 16, 2011 so go to for more information.

Submissions without any commercial interest or any link to healthcare service providers are free. All other submissions are charged a one-time registration fee. For Federal Telemedicine News readers and subscribers, the rates are 160 Euros or around $225 in U.S dollars. When FTN readers are registering, choose group A. Then include the FTN blog website URL as your reference in the comments.

For more information, please visit or call +32/2/286-8501.

Tuesday, July 26, 2011

Improving MRIs

NIH’s Office of Technology Transfer reports the technology “Wirelessly Powered MRI Signal Amplification System and Method” (Reference No. 2281) is available for licensing and commercial development. The new technology is an MRI detection coil integrated with a parametric amplifier to provide local signal detection fully integrated with amplification. The amplification is wireless but enables efficient signal transmission.

There are several advantages:

• The invention can replace conventional MRI amplification typically done with transistors and eliminating the need for wires

• The technology can replace what is traditionally used as part of implanted or catheter coils for interventional procedures with MRI

• Since the detector/amplifier integrated system eliminates the need for transistors and is wireless, heat is reduced and sensitivity of detection is increased

• The system is compatible with interventional MRI devices

The system/device has several applications and can be used as part of a catheter MRI coil for MRI guided surgery, used as implantable NMR coil for localized spectroscopy with better sensitivity, used as a free floating MRI detector/amplifier, and swallowed for internal MRI detection.

Proof of principle has been demonstrated on a prototype device, testing is ongoing on a second generation device with smaller dimensions, and plans are to develop methods to decouple elements for use in MRI detector arrays.

The patent was filed March 29, 2011. For licensing information contact John Stansberry PhD, NIH Office to Technology Transfer at (301) 435-5236, email or go to

State Agency Releases RFP

The Alabama Medicaid Agency on July 22, 2011 released an RFP seeking technical expertise in planning for health homes for Medicaid enrollees with chronic conditions. The Agency has been interested in the health home concept for a number of years and is now going to expand efforts to pilot test three regional care networks with recent approval from CMS.

The networks are designed to function as a “medical neighborhood” and improve the delivery of healthcare services to Medicaid recipients especially those with complex medical conditions. The networks consist of regional non-profit organizations driven by a board of local healthcare providers.

This RFP seeks subject matter technical assistance in planning efforts and additional consulting service may be needed to identify required IT changes to MMIS. Other systems to accommodate reporting requirements for the new health home model and to assess provider technological capacity to meet the requirements of the health home model may also be needed.

Plans are to develop systems for capturing, analyzing, implementing, reporting, and other infrastructure building tasks and then to assess, report, and share results. The task is to see if efforts are succeeding not only in producing changes in primary care practices but also as it relates to containing costs and improving quality.

The RFP “ACA Section 2703 Planning for Health Homes for Individuals with Chronic Conditions” (2011-ACAPlanning-01) is due August 12, 2011 with contract notification to be August 22, 2011.

Go to for more information. The Project Director is Kathy Hall at

Legislation Introduced

Maryland Congressman Chris Van Hollen and Texas Congressman Michael C. Burgess, M.D., July 20th reintroduced the bipartisan “National Neurological Diseases Surveillance System Act” (H.R.2595). A similar bill (S 425) was introduced March 1, 2011 by Colorado Senator Mark Udall and has been referred to the Senate Committee on Health, Education, Labor, and Pension.

Congressman Van Hollen reports that while thousands in the U.S. are affected by Multiple Sclerosis, Parkinson’s, and other neurological diseases and disorders, very little accurate information is available to assist researchers, physicians, and caregivers.”

The funds to establish the surveillance system would total $5,000,000 for fiscal years 2012 through 2016.

The system at CDC would ultimately help future planning of healthcare needs, detect changes in health practices, promote advocacy, and support a wide range of research initiatives,” notes Dr. Burgess.

According to Dr. Burgess, “Surveillance activities similar to this system exist for other diseases, but not for neurological diseases. A coordinated approach to data collection would allow researchers, and physicians to be able to identify at-risk populations, diagnose diseases earlier, and find common factors to lead to cures.”

The system would include data on the prevalence of neurological diseases, demographics, include information relevant to the epidemiology of the diseases, provide the natural history of the diseases, provide approaches for managing and treating diseases, and lead to developing outcomes measures.

Epidemiologists with experience in disease surveillance or registries, representatives of national voluntary health associations, health information technology experts, clinicians, and research scientists with experience in conducting translational research will be consulted. Grants, contracts, or cooperative agreements will be awarded to public or private nonprofit entities to establish the surveillance system.

The information contained in the surveillance system will be made available to NIH, FDA, CMS, AHRQ, Department of Veterans Affairs, and the Department of Defense, and not more than four years after the enactment of the legislation, a report would be submitted to Congress.

Previously, the House passed similar legislation on September 2010 but the legislation was never brought to a vote in the Senate. This bill has been referred to the House Committee on Energy and Commerce.

Market for Pain Products & Devices

In 2010, combined U.S. sales of pain management products including pharmaceuticals and devices totaled $33.1 billion. Since pain is the single most common reason patients seek medical care, it is not surprising that this market is expected to increase at a compound annual rate of 3.7 percent reaching approximately $38.2 billion in the year 2014.

A new report “U.S. Markets for Pharmacologic & Device-Based Therapeutic Approaches to Pain Management” has just been published by Medtech insight and distributed by Life Sciences Intelligence.

This new 268 page report includes an analysis of products, technologies, current and forecast markets, competitors and opportunities in the U.S. pain management products market. Key topics include non-prescription and prescription data on analgesics/anesthetics, electrical stimulators, analgesia infusion pumps, pain management services, complementary and alternative medicine techniques for pain management, regulatory and legal issues, and much more.

The report’s key data includes current and forecast market sizes through 2014, market analysis, competitive analysis, trends and opportunities, patient populations, and much more key data available.

For more information, go to

Improving Border Healthcare

The Americas Branch in the Office of Global Affairs within HHS has announced funds are to be provided annually for $1,300,000 as part of cooperative agreements with the Arizona Department of Health Services, the California Department of Public Health, New Mexico Department of Health, and the Texas Department of Health. The plan is to strengthen public health services on the U.S. Mexico border.

The cooperative agreements are for a period of up to 5 years from 2011 to 2016. The primary goal of these cooperative agreements is to help the United States Mexico Border Health Commission (USMBHC) improve the health and quality of life for those living in the border region.

The focus areas under these cooperative agreements are tuberculosis, obesity, diabetes, infectious diseases, public health emergencies, strategic planning, providing access to care, research data collection and to form academic alliances.

The objectives are to:

• Focus on border health that transcends political changes
• Support investigations, research, or studies designed to identify evaluate and monitor on an ongoing basis health problems that affect the general population in the U.S.-Mexico border area
• Support bi-national public-private efforts to establish comprehensive and coordinated systems that use advanced technologies to the maximum extent possible to gather and monitor health-related data for the border areas
• To serve as a catalyst to prevent or resolve border health problems and educate the population concerning these problems

Sunday, July 24, 2011

Studying Payment Ideas

“It is evident that physicians remain unsure of what reform will bring which means that physicians face a time of uncertainty trying to understand the multiple approaches suggested by commercial, state, and federal payers” according to Tim Ferris M.D. Medical Director for the Massachusetts General Physicians Organization. He was speaking at a jointly sponsored briefing by the Commonwealth Fund and by the Alliance for Health Reform held on July 18th on Capitol Hill.

Understanding how the new payment system will work is confusing but there are some clear directional indicators. For one, the focus will change from units to episodes of care and to examining population health outcomes. Secondly, physicians will move forward with what they think will improve outcomes and/or reduce costs, and but at the same time, they want incentives that will reward innovation.

Ferris gave an example of how innovative ideas can be studied by describing how in 2006, CMS selected Massachusetts General Hospital (MGH) to participate in a three year demonstration. The goal was to test strategies to use to coordinate Medicare services for high-cost, fee-for-services beneficiaries. The payment model used is similar to proposed shared savings for ACOs in that monthly payments are based on the number of enrolled patients.

MGH originally enrolled 2,500 highest cost Medicare patients who account for $68 million in annual Medicare spending excluding pharmacy spending. On average, these patients take 12.6 medications, have 3.4 hospitalizations a year, and cost about $24,000 annually.

To help the primary care physicians manage these patients, MGH integrated 12 care managers into their primary care practices. The care managers developed personal relationships with enrolled patients and worked closely with physicians to help identify gaps in patient care, coordinate provider services, and facilitate communication especially during transitions. A health IT system is supporting the entire program which includes EHRs, patient tracking, and home monitoring.

CMS commissioned an independent evaluator, RTI to assess the performance of the demonstration. RTI found MGH’s program to be highly successful in the fact that savings of 12.1 percent were realized in gross savings, 7.1 percent in annual net savings, hospitalization rate among enrolled patients was reduced by 20 percent, and emergency department visits were lower by 25 percent. The end results show that for every dollar spent, $2.65 was saved.

In 2009, CMS renewed the MGH demonstration for another three years and expanded it to Brigham and Women’s Hospital and to the North Shore Medical Center. So far, the total enrollment is 4,582 patients but in the next three years, the program is estimated to grow to about 8,361 total patients across all three sites.

Colorado's HIT Actions

According to the State of Colorado’s June 30, 2011 “HIT News Bulletin” CORHIO announced that Centura Health, the largest health system in the state has signed an agreement to participate in CORHIO’s Health Information Exchange (HIE). With the addition of Centura CORHIO now has 25 hospitals, five mental health centers, and more than 250 office-based physicians participating in the HIE.

In addition, Alpine Urology is scheduled to “go live” on CORHIO’s network in August. With four physician offices in the state, Alpine is the first physician practice in Colorado to connect their EHR to CORHIO’s HIE.

Also, later in 2011, the CORHIO network is scheduled to be upgraded to include patient medication lists, information on allergies and immunizations, as well as laboratory and imaging orders. Right now, the HIE network provides access to lab tests and pathology results, x-rays, MRIs and other imaging reports, and physician transcription reports.

Legislation to create an all-payer database went into effect in 2010 and at that time, an advisory committee was created to guide the development and use of the database for the “Center for Improving Value in Health Care” (CIVHC). In order to establish the means to submit medical and pharmacy claims plus eligibility and provider data to the All-Payer Claims Database, the Executive Director of the state’s Department of Health Care Policy and Financing (HCPF) will be promulgating rules.

Later this month, CORHIO will assist HCPF as the Medicaid EHR Incentive Program is implemented. Under the terms of the agreement with HCPF, CORHIO will be responsible for program coordination and will provide education and communications.

The CO-REC has signed up more than 2,000 providers for no cost services and the program is expected to reach capacity by the end of July. Seven providers have already received their Medicare Attestation checks. Twenty four of the 28 Critical Access Hospitals are actively pursuing meaningful use by working with CO-REC.

Some other key updates:

• Colorado submitted the State Medicaid Health Information Technology Plan (SMHP) to CMS however, an updated SMHP will be submitted by August 2011

• The Pharmacy Automatic Prior Authorization System will reduce the decision time needed to approve all pharmacy and physical/dental services requiring prior authorization. The contractor has been selected and the system will be implemented in the fall

• The Accountable Care Collaborative will provide detailed analytical reporting and support to reduce costs and improve outcomes. The Statewide Data Analytics Contractor (Treo) is expected to start reporting this summer

• The pilot for the Colorado Immunization Information System has been completed with new system changes scheduled to go live by the end of the summer

• The Rehabilitation Information System for Employment Implementation is being implemented with a deployment date of September 2012

Recruiting for Study

UTHSC San Antonio’s Improvement Science Research Network (ISRN) is seeking to partner with hospitals and academic partners in a one-year multi-site landmark research network study. The study “Small Troubles, Adaptive Responses” (STAR2): Frontline Nurse Engagement in Quality Improvement”. The plan is to engage frontline providers in quality improvement and employ evidence-based practices across institutions. The ISRN is the only NIH supported improvement research network to accelerate inter-professional improvement in all systems across multiple hospital sites.

This specific Network study will determine the types and frequency of first-order operational failures that nurses self-detect during their work shifts and will evaluate whether the self-detected failures correlate with failures that are observed by others.

Nurses on participating units will use specially-designed pocket cards to record in real-time small operational failures that they encounter. Data will then be analyzed to determine a rate of small failures per patient per day.

There are specific requirements for eligibility:

• The hospital must have 100 or more inpatient beds and house at least three eligible clinical units

• Clinical units providing acute care need to have a minimum of 20 nurses per unit, have an average length of patient stay of 2 to 4 days, and in operation for at least one year

• Frontline participants must hold a license as a Registered Nurse, provide direct patient care or mid-level management in clinical units, have a minimum of one year of acute nursing care experience, and have a minimum tenure on the study clinical unit of 6 months as a frontline or mid-level management nurse

• The study site has to have at least one ISRN associate and a project coordinator/investigator

The study has certain exclusions. Units that primarily provide behavioral health, rehabilitation, physical therapy, ambulatory care or other outpatient services, and primary care are excluded. Also units providing services to patients with high acuity levels such as intensive care units, units that provide same-day surgery or procedural services, and hospitals located outside the U.S. healthcare system are also excluded.

ISRN is soliciting Letters of Intent (LOI) by August 15th from study sites interested in participating in one of the quality improvement studies. The LOIs will need to address the research projects, how the organization will meet all the eligibility criteria, briefly highlight the resources available to take part in one of the network studies, and interest in the ISRN.

Based on the LOIs received, a limited number of applicants will be invited by September 15th to submit a full proposal and at that time, more detailed instructions will be provided.

For more information, go to or contact Dr. Frank Puga at


NIH has made their “Niche Assessment Program” available for SBIR Phase 1 awardees funded in FY 2011 and 2012. All active NIH SBIR Phase 1 awardees as well as small businesses selected to receive a Phase 1 award in the first three month of the upcoming fiscal year are eligible to participate.

This program helps to “jump start” a company’s commercialization efforts by providing the market insight and data to strategically position products in the marketplace. The program assists companies with commercialization plans for Phase II applications, and helps businesses locate potential partners.

Foresight Science and Technology has been selected to do the unbiased assessment of SBIR appropriate market niches for products and services and will develop an in-depth report for each SBIR awardee.

The Niche Assessment Program is appropriate for all types of technologies such as devices, drugs, biologics, and therapeutics as well as for companies developing software, educational, and multi-media behavioral science products.

One hundred slots are available and will be filled on a first come, first served basis. The average time to complete a “Technology Niche” analysis is 2 to 3 months and will be completed between September 2011 and early March 2012.

For more information, email Ryan Hill at Foresight at Go to to see the NIH announcement.

In another initiative, the National Science Foundation (NSF) through their SBIR “MatchMaker” Program will help businesses by introducing companies to pre-selected, high technology emerging businesses such as Venture Capital Groups, Angel Investors, and Strategic Corporate Partners. The goal is to help Phase II grantees.

The SBIR companies involved in the “MatchMaker” Program must have secured nearly $1 million to develop and advance their early-stage cutting edge research. In order to take part in the program, only Phase II grantees that have successfully advanced to highly competitive selection rounds of assessment involving two rigorous technical peer reviews as well as one comprehensive commercial review, will be considered.

For more information on the program, go to

Register for Partners Symposium

Partners Healthcare 2011 Connected Health Symposium promises to be a premier opportunity for healthcare executives and key thought leaders to have in-depth discussions and debates on the tough healthcare issues that countries all over the world face in the 21st century. Save the date for the Symposium to be held at the Boston Park Plaza Hotel on October 20-21, 2011.

The theme for the Symposium “Driving Quality Up and Costs Down: New Technologies for an Era of Accountability” will provide vital information to over 1,100 health technology leaders, community-based practitioners, health plan executives, large employers, government policy makers, and investors. Exchange ideas with tech entrepreneurs, business execs, academic researchers, and patients.

Joe Kvedar, MD, Director for Partner’s Center for Connected Health is looking forward to hearing new ideas from all of the health innovators and attendees at the Symposium and taking part in the discussions and debates on delivering quality care outside traditional medical settings.

The two day event will be filled with top keynote speakers such as Brent James M.D., Chief Quality Officer, Intermountain HealthCare and the subject of the New York Times Sunday Magazine article “If Health Care is Going to Change, Dr. Brent James Ideas will Lead the Way”

Also presenting is Kate Pickett, PhD, Professor of Epidemiology, University of York in the UK and the author of “The Spirit Level: Why Greater Equality Makes Societies Stronger” named a Top Ten book of the Decade by the New Statesman

Other keynoters include Atul Gwande, M.D. Surgeon, Brigham and Women’s Hospital in Boston, New Yorker Magazine staff writer on healthcare, and Director for the World Health Organization’s Global Challenge for Safer Surgical Care.

Attendees will also listen to Janet Dillione GM for Healthcare, Nuance on how she developed healthcare uses for “Watson” IBM’s Artificial Intelligence System. “Watson “was the star computer system that beat two human champions on Jeopardy.

Using technologies to measure emotion will be addressed by Rosalind Picard, ScD, Director, Affective Computing Research Group, MIT Media Lab; a developer of software that recognizes and interprets facial expressions.

Also at MIT, Alex (Sandy) Pentland, PhD, Toshiba Professor of Media Arts and Sciences at MIT, Director, MIT Human Dynamics Lab, and Co-Founder of CogitolHealth” will talk about other pertinent ongoing research at the university.

Using virtual characters designed to sustain long term social and emotional relationships with people will be addressed by Timothy Bickmore, PhD, Associate Professor College of Computer and Information Science, Northeastern University and an expert on Relational Agents

To address the benefits of social media, William Shrank MD Principal Investigator, CVS Caremark Harvard Partnership for Improving Medication Adherence, has examined how Facebook can help diabetic patients.

Clifford Nash, PhD, Thomas M Storke Professor at Stanford University is the author of three books “The Media Equation”, “Wired for Speech”, and “The Man Who Lied to His Laptop” plus many publications on the psychology and design of interactive technologies.

From the business side, Robert S. Galvin, Chief Executive Officer, Equity Healthcare, and Executive Director, Corporate Private Equity, The Blackstone Group, is an expert on the management of healthcare for firms owned by private equity companies.

Attendees will want to hear from Eileen Bartholomew, Senior Director for Life Sciences Prize Development for the X PRIZE Foundation on her experiences in building innovative programs.

Also on the agenda are many breakout sessions with vital information on accountable care organizations, innovative ways to provide wireless for poor communities, ongoing developments in gaming psychology, entrepreneurship, enhancing decision making skills, dealing effectively with the marketplace, meeting future goals, and working effectively using today’s expanding social media.

The Symposium will be filled with drill down interviews, cut-to the chase debates, and many other great opportunities and events to help attendees have easy conversations with experts in the field. Don’t miss out on meeting all of the exhibitors and viewing their products and be the first to see rapid fire demonstrations of products and services to help you or your organization stand out and surge ahead to reach new heights in the healthcare field.

Be sure to make plans to stay for the “Boston Summit on Leadership: A Call for Action” to be held October 22, 2011 at the Boston Park Plaza Hotel. Distinguished faculty from different professions will discuss leadership principles in different domains.

Go to for more information on sponsorships, exhibiting, and registering for this major Symposium along with registering for the Leadership Summit. The early bird rate will expire on July 31st. Federal Telemedicine News readers will receive a discount of $100 off the full price ($1095 to register for the Symposium. The code to use is “Telemed News”.

For further details, email Joe Ternullo Organizing Chair at or email Margaret Spinale at

Wednesday, July 20, 2011

Rural Broadband Challenges

There are enormous challenges in providing the IT infrastructure needed to accomplish the broadband build-out for rural, minority, and underserved communities. New ideas and thoughts on the topic were presented by Members of Congress and leading experts at the July 13th Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” lunch briefing.

Neal Neuberger, Executive Director for the Institute e-Health Policy, and coordinator for the event, also serves on the Management Committee for the “National Health IT Collaborative for the Underserved”. He truly sees the need to provide an interconnected public and private health system where all consumers have access to high quality, affordable care, and to health IT but this requires the U.S. to provide broadband to all segments of this population.

According to one of the Honorary Steering Committee’s Co-Chairs, Representative Phil Gingrey, MD (R-GA), the issue “Net Neutrality” concerns him as he wants consumers to enjoy an internet free of federal regulations. Gingrey feels that “Net Neutrality would introduce unnecessary regulations that would result in increasing the demand for broadband while reducing the supply. The role of government is and should remain limited and not take over the internet because in the end innovation would be stifled.

Another Honorary Steering Committee Co-Chair Representative Tim Murphy (R-PA), a clinical psychologist, emphasized that each year billions of dollars and hundreds of thousands of lives are lost through medical errors, waste, and inefficiencies. This is the result of duplicative tests and redundant procedures resulting in preventable complications and readmissions. To meet these challenges and find solutions, it is important for government and Congress to work together to develop the interoperable technology needed to keep our country on the cutting edge of healthcare.

Leading the discussion on the value of Internet2, David Lambert President and CEO, Internet2 Networking Consortium, explained how the advanced networking consortium operates. The consortium is led by the research and education community with 220 university and college members working to develop and deliver new networking capabilities.

One of the Internet2 projects supports the U.S Unified Community Anchor Network (U.S. UCAN). The goal is to upgrade to 100 gigabit nodes with 8.8 terabit capacity using NTIA’s Broadband Technology Opportunities Program (BTOP) funding.

This project will help develop network services, regional networks, plus help Community Anchor Institutions (CAI) such as libraries, healthcare organizations, public safety organizations, schools, and colleges, gain access to very high bandwidth network services. U.S. UCAN will help to extend and advance the Internet2 Sponsored Educational Group Participant (SEGP) program enabling regional networks to connect to the CAIs.

In the healthcare arena, the U.S. UCAN program will provide broadband connectivity to meet the needs of rural and underserved areas where physicians, hospitals, and patients use electronic health records, HIEs, video conferencing, and teleradiology. Upgrading broadband in these areas will enable rural care providers to connect to remote specialists, provide advanced networking for demanding CAI apps, and support disaster recovery with redundant pathways.

Lambert sees future challenges and technology issues that need to be addressed. For example, sharing network infrastructure across CAI sectors are needed to support economic development in rural and underserved areas. BTOP, FCC’s Rural Health Care Pilot Program (RHCPP), and statewide HIE networks, will make it possible to work with interoperable health information exchanges, mobilize health data to support quality initiatives, and integrate healthcare data into the biomedical research arena.

From the industry point of view, Jeff Brueggeman Vice President, Public Policy for AT&T, sees the broadband of the future as robust, providing more and more services with reduced costs, and able to supply services to meet the needs of rural seniors and hospitals.

However, according to Brueggeman, the U.S. needs to find more spectrum to build networks since next generation networks and cloud technology will need more capabilities. The U.S. also needs to further promote broadband investment in the country, develop flexibility to better manage networks, and find experienced people to install hardware

From Verizon Communications point of view, Link Hoewing, Vice President for Internet and Technology Issues, described the perfect storm that providers are facing combining growing costs with declining revenues. The demand for healthcare reform is running high with the growing number of patients unable to pay their medical bills due to the economic downturn.

To meet the ever increasing innovative technology needs, Verizon has their Wireless 4G LTE with real-time responsiveness ready. The system is in place in 74 metropolitan areas across the country, 60 airports, and Verizon expects nationwide coverage by 2013 with new innovative devices and applications currently being developed

Hoewing gave several examples of Verizon projects that will help healthcare providers improve their effectiveness. For instance, at the College of New Rochelle Telenursing program, students are training in a simulated home healthcare environment, using data, video, and voice communications. Also, at the Community Hospital of Long Beach Foundation, clinicians have instant communications to all pertinent information through wireless communications systems which have been dubbed “Workstations on Wheels”

Verizon is interested in partnering with key providers, customers, and research groups on new mobile devices and software, and also looking to partner with key application developers to produce the next generation of applications that will work on today’s and tomorrow’s devices and platforms.

Healthland with 30 years experience is the only EHR provider focused exclusively on the rural hospital market, according to Odell Tuttle, Chief Technology Officer at Healthland Inc. An example of how effectively the company serves the rural market, Healthland just announced that Norton County Hospital in Kansas is using their EHR system while operating a 25 bed critical access facility and a rural health clinic which is helping greatly to serve not only Norton County but other surrounding communities in Kansas and Nebraska.

As Tuttle relates, today’s small rural hospitals are faced with several problems. One of the major issues is that since healthcare costs are out of control, it has become very difficult to provide efficient and sufficient care to an increasing aging and sicker rural population faced with many chronic conditions. He pointed out that there are additional pressures affecting healthcare such as additional regulations hindering the expansion of IT, fixed costs are going up, fewer people are entering the health workforce, and dealing with the many ongoing changes that occur in technology

As a result of these issues, it has been found that physicians and hospitals in rural areas are less likely to purchase technology and equipment resulting in very low EMR penetration in rural communities.

The bright spot on the horizon is cloud computing where complex systems will be located in remote data centers so this will help doctors simplify the purchase of technology. However, cloud computing requires up-to-date broadband expansion across the entire country especially in rural areas.

Presenting the ideas as an advocator and coordinator for the “Schools, Health & Libraries Broadband Coalition” (SHLB), John Windhausen, President of Telepoly Consulting provides SHLB legal and regulatory advice on a number of broadband issues. SHLB operates as a broad-based Internet2 coalition to ensure that anchor institutions such as schools, libraries, healthcare providers, public safety, public media, and other anchor institutions have access to affordable high-capacity broadband.

Windhausen discussed how anchor institutions are able to provide essential services such as distance education, remote telemedicine, job training, e-government services, and basic research to the most diverse and often vulnerable community members.

Recently, SHLB made advocacy efforts by asking the FCC to fund broadband to anchor institutions in rural high-cost regions through the Rural Universal Service Fund/Connect America Fund. SHLB is also engaged in discussions with the Obama Administration on next-generation broadband platform and applications.

Part two of the Steering Committee’s program to take place on July 28, 2011 will focus on “Rapidly Advancing Mobile & Wireless Applications Toward Improved Chronic Disease Management”. Presentations and mini-demonstrations will be held in collaboration with the American Telemedicine Association, Continua Health Alliance, and HIMSS.

For more information, email or

Innovation Key to Progress

“The only way that the power of innovation can be unleashed is by liberating data and using IT to provide the rocket fuel for innovation”, according to Todd Park, Chief Technology Officer, at HHS. “In order to achieve our goals, we need to develop timely clinical data decision support, integrate tools, use technologies to extend the physician’s reach to patients, engage consumers, support data mining, data networks, and analytics to produce better healthcare and outcomes.”

As the keynote speaker at the eHealth Initiative’s “2011 National Forum on Health Information Exchange” held July 14th, Park said the most effective innovations will come from new ideas to help solve real-life problems.

He described how the Direct Project enables a simple, secure, faster way for providers to send health information directly to recipients. As he explained, the basic purpose for the Direct Project is to find easy solutions for specific technological problems. So when doctors made it known they were looking for ways to push data from where it is located to where it is needed, organizations came together to participate in an open forum to solve the problem and find the solution.

As a result, a Direct Project pilot is underway at the Hennepin County Medical Center (HCMC) a premier Level 1 Adult and Pediatric Trauma Center in Minnesota. This pilot is first-in-the-nation Direct Project providing clinical exchange.

Ability, a company headquartered in Minneapolis is the Health Information Services Provider (HISP) that connects HCMC to the Minnesota Department of Health. Ability will expand this pilot project to additional providers and other states, including the Oklahoma State Department of Health which is already committed to participating in the program.

The Hudson Valley Initiative has issued three new issue briefs all dealing with various aspects of the Direct Project. The issue briefs include:

• In the issue brief “Beyond Babel: MedAllies Direct Brings a Provider-Driven Collaborative Solution to the Challenges of Interoperability”, John Blair III, MD MedAllies CEO and TIPA President offers an overview of the project
• Holly Miller MD, Chief Medical Officer at MedAllies focuses on the clinical implications of MedAllies Direct with the brief “Essential Information Available Immediately in the Right Dose: MedAllies Direct Delivers on the Promise of Quality Patient Care”
• In “Not So Elusive: MedAllies Direct “Advances Interoperability Allowing Clinicians to Share Data Across Systems, Across Providers, Across the Country”, MedAllies CIO Leroy “Lee” Jones addresses health IT issues including implications for providers, vendors, and HIEs

Park mentioned the success of another data connecting solution recently launched by NLM. MedlinePlus Connect enables health organizations and HIT providers to link patient portals and EHRs to for up-to-date health information for patients and families. This information is directly related to helping medical professionals make the correct diagnosis and provide correct medications and laboratory tests.

MedlinePlus Connect accepts information requests based on coding systems already used by EHRs and supports health IT standards used by certified EHR systems as part of the Medicare and Medicaid EHR Incentive Program. A XML web service will be released in the near future to further expand MedlinePlus Connect’s flexibility.

Park announced that the HHS site is helping to liberate even more data and operates as a one-stop resource for innovators who are very busy turning data into new applications and services.

The website at provides free access to health-related data supplied by a wide range of federal agencies and is available to users for free. The website also links users to a new “Health Apps Expo”, hosted and managed by the private sector innovation experts at Health 2.0. The Apps Expo proves information to consumers, providers, employers, communities, policymakers, and others to help make informed decisions.

By using the website’s blogs and forums, users are able to open threads of conversation about the data and also link to current app development competitions on and where users can enter contests with the goal to develop even better health apps.

For more information on the eHealth Initiative Forum, go to

Installing Smart Suite Technology

The Walter Reed National Military Medical Center in Bethesda Maryland and the Fort Belvoir Community Hospital in Northern Virginia are going to open shortly. The Army spent $2.5 billion on construction and outfitting the two new hospitals.

The new Cerner™ smart suite technology being installed will bring the latest capabilities to the new integrated delivery system in the National Capital Region (NCR) helping NCR handle one-quarter of the entire inpatient military health services in the region.

Each room comes equipped with a 37 inch flat screen television doubling as a computer monitor. The smart suite technology will provide smart beds, bed-side entertainment, two-way communication devices, high resolution audiovisual technology, and wireless capability. The technology will enable patients to control temperature and lighting at the bedside, while providers will be able to monitor the patient’s bed status, patient position, and will be able to alert care providers when the patient needs assistance.

One of the unique Smart suite features is “myCare Team” which introduces providers to the patient digitally. It enables patients to know when a doctor enters the room and displays the doctor’s information and information on the patient’s medical team. Another feature is “RoomLink”, an electronic signage device placed outside a patient’s room that displays patient information including allergies and even allows the patients to update their status.

The smart suites will be integrated with Military Health System Clinical Systems (Essentris and CHCS) to give critical care clinicians a single intuitive dashboard that displays electronic medical record and device data without having to log into different systems and view multiple pages.

In preparation for the smart suites, Cerner did a workflow analysis and held kick-off sessions with clinical staff from Dewitt Army Community Hospital, Walter Reed Army Medical Center, and the National Naval Medical Center to look at the new technology and observe on-site operations.

Surveying Health Issues

On July 11, 2011, Representative Madeline Z. Bordallo from Guam along with other co-sponsors reintroduced the “Pacific Islander Health Data Act” (H.R. 2486) that would develop and implement a national strategy to identify and evaluate the health status and healthcare needs in remote areas in the Pacific region.

The legislation directs HHS acting through the Director of the National Center for Health Statistics and other HHS agencies, to develop and implement a sustainable national strategy to obtain health data on remote Pacific areas to include Native Hawaiians and other Pacific Islanders living in the continental U.S, Hawaii, American Samoa, Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Republic of the Marshall Islands, and the Republic of Palau.

This bill would provide critical information provided through a health survey to assess healthcare in the Pacific region. This would help healthcare providers and organizations working with Pacific Islanders develop better strategies to serve these communities.

The legislation has been referred to the House Committee on Energy and Commerce. Companion legislation (S.71) was introduced by Senator Daniel Inouye from Hawaii earlier this year and (S.71) has been referred to the Senate Committee on Indian Affairs.

DOD Soliciting White Papers

On July 18th, the Air Force Research Laboratory, 711th Human Performance Wing on behalf of the Air Force Medical Support Agency (AFMSA) Modernization Directorate issued a funding announcement soliciting white papers on specific medical research areas. The Air Force anticipates awarding 10 to 20 awards with the estimated program cost to be $49,500,000 over five years. Small businesses are encouraged to propose on all or any part of the solicitation.

The Air Force has identified a need for medical modernization in the following areas:

• Force Health Protection—the focus in on preventing injuries and illnesses and the detection of emerging threats. Key area include bio-surveillance, occupational toxicology and protective countermeasures

• Enroute care—the focus is on the continuum of care during transport of patients from point of injury to point of definitive care

• Operational Medicine—focus is on clinical medicine enhancements, personalized diagnosis and treatment, TBI, psychological health, PTSD, regenerative medicine, clinical patient safety, autism, and definitive care

• Expeditionary Medicine—includes enhancing methods and techniques for remote monitoring and triage systems

• Human Performance—includes fatigue management, sensory protection and sustainment, vision enhancement, medical team performance, and medical modeling and simulation

This is a five year two-step solicitation. The first step is to submit the white paper due on August 31, 2011. Requests for Proposals will be sent in response to the submission of the white paper.

For more information, go to view the cooperative agreement grant notice BAA-11-03-HPW “Air Force Medical Support Agency Modernization Directorate Research/Development and Innovations” announcement. Contracting questions may be emailed to Kimberly Rhoads at, and for technical questions email

Sunday, July 17, 2011

Nat'l HIE Survey Released

Key findings on the progress of the current 255 Health Information Exchanges were announced at the National Forum on Health Information Exchanges convened by the eHealth Initiative July 14th in Washington D.C. The eHealth Initiative’s survey “2011 Report on Health Information Exchange: The Changing Landscape” demonstrates a net growth of 9 percent in the number of initiatives in 2011. This shows that an unprecedented amount of patient health information is being exchanged between physician offices, laboratories, and hospitals across the nation.

The National Survey shows that there are still a number of challenges for HIEs to meet head on. Issues dealing with business models and value, privacy controls, concerns with systems integration, and participation in the uncertain future of accountable care organizations are some of the issues.

“Some exchanges have solved their technical issues and are offering more advanced services such as analytics, quality reporting, wellness programs, and education to providers and hospitals. As a result, they are in a much stronger position than those that have not expanded services,” said Jennifer Covich Bordenick, eHi’s Chief Executive Officer. “The HIE initiatives that cannot adapt quickly may not last long in a transformed healthcare system.”

According to the survey, maintaining sustainability is a critical issue. HIEs depend on federal funding and this plays a part in trying to reach a sustainable business model. The majority of HIE initiatives totaling 115 reported that they were not dependent on federal funding in the last fiscal year but 65 respondents did indicate that they were dependent on federal funding. The survey did identify 24 sustainable initiatives in 2011 that were not dependent on federal funding in the last fiscal year.

The survey points out that HIE initiatives can obtain sustainability if they are able to provide services that customers really want and offer these services faster, cheaper, and more reliably than their competitors. The “meaningful use” program helps to provide information on what services will be in demand over the next five years. eHi recommends that HIEs move quickly to help providers with “meaningful use,” Medicare Shared Savings Program rules, and privacy recommendations.

Some HIE initiatives may be positioned to act as an intermediary between disparate systems and support ACOs. Forty eight initiatives indicated that they will participate with ACOs and 38 indicated that they would not participate but the majority of HIE initiatives, 110 are simply unsure of whether they will or will not participate.

A majority of initiatives totaling 113 have plans to incorporate the federal Nationwide Health Information Networks (NWHIN) Direct Project into their services offerings. In 2010, the Direct Project initiative was launched by the Office of the National Coordinator. The goal of the Direct Project is to use of the internet as an easy-to-use secure method to replace mail and fax transmissions between providers and other providers, laboratories, public health departments, and patients. The Direct Project is currently in a pilot phase, but HIE initiatives are planning to incorporate Direct Project into their service offerings.

In her opening at eHI’s National Forum, CEO Covich Bordenick reported “eHI will be publishing new documents this August. One report will focus on markets, vendors, and will include a list of vendors, a special report will be published on the 24 organizations able to maintain sustainability, and a report on all of the workforce problems dealing not only with employment issues but all the workforce gaps that exist in the healthcare system.

The “2011 Report on Health Information Exchange: the Changing Landscape” presents an overview of the exchange landscape, changing business models, patient services, enhancing patient privacy, recommendations for moving forward and much more. The full report and aggregate data sets are available for purchase at the eHI website

DOD Soliciting Applications

The Assistant Secretary of Defense for Health Affairs, Defense Health Program released a solicitation on July 8th seeking applications for the Psychological Health and Traumatic Brain Injury (PH/TBI) Research Program. For the first time in FY11, the PH/TBI Research Program “Post-Traumatic Stress Disorder In-Home Clinical Trial Award” mechanism is being offered with $5 million available for two awards.

Massive research efforts in PTSD have been launched in recent years to deal with the public health burden of PTSD on individuals, families, communities, and society at large. Many of the treatments use face-to-face in-office treatment modalities with only a handful of alternative treatment delivery modalities such as Tele-Behavioral health utilized.

This funding opportunity is specifically oriented toward evaluating the advantages of an in-home experience from the provider’s perspective which may allow for better insight into a patient’s total life circumstances.

The target population for the study is OIF/OEF veterans who have returned from deployment diagnosed with PTSD. The funding objective is to support randomized controlled trial comparative effectiveness research comparing behavioral healthcare delivered via three distinct treatment modalities:

• Face-to-Face In-Office
• Face-to-Face In-Home
• Tele-Behavioral Health by the provider to the in-home patient

Proposed projects need to include treatment outcome as the metric of primary importance. However, other comparisons and factors of importance include patient compliance, treatment satisfaction, optimizing patient match to treatment modality, ease of treatment delivery, provider/patient safety issues, costs, program management issues, and a “best practice guide to implementation.”

Applications may include a two-tiered approach that would include a limited-scope demonstration trial that transitions into a randomized, controlled, multi-arm research study. A statistical analysis plan is required to include sample size projections to meet the objectives of the study.

The Funding Opportunity Application (W81XWH-11-PHTBI-PTSD-IHT-CTA) is due October 10, 2011 and is available on For inquiries, email the CDMRP Help desk at

CMS & Home Health Demos

CMS recently announced that it will share nearly $15 million in additional savings with more than 100 Home Health Agencies (HHA) participating in the two year “Medicare Home Health Pay for Performance” (HHP4P) demonstration. The HHP4P demonstration conducted between January 2008 and December 2009 was undertaken to determine the impact of financial incentives on improving the quality of care for home health patients and how the savings would impact on overall Medicare costs.

A total of 123 HHAs out of 270 participating in the demonstration intervention group will receive incentive payments from savings based on their performance during the second year of the demonstration. In year one, 166 intervention group agencies in three regions received payments totaling more than $15 million. For year 2, the demonstration calculated aggregate savings of $14.95 million for two of the four demonstration regions. The Midwest and the Northeast regions did not achieve any savings and were not eligible to receive incentives. The demonstration is still being evaluated with additional results expected later in 2011.

To address chronic conditions, CMS will conduct their “Independence at Home Demonstration” slated to begin January 1, 2012 as mandated by the Affordable Care Act. Over three years, the demonstration will test a payment incentive and service delivery model using physician and nurse practitioner directed home-based primary care teams to improve health outcomes.

The demonstration is designed to allow Medicare beneficiaries with multiple chronic conditions to live independently in their homes and avoid unnecessary and costly hospitalizations, emergency room visits, and nursing home admissions.

The demonstration is to take place in high-cost areas, use health professionals that have experience in furnishing healthcare services to applicable beneficiaries in the home, use EMRs, health information technology, and provide individualized plans of care.

Helping Diabetics

MAS Epsilon located in Charlottesville Virginia, just announced the availability of the first FDA-accepted Type 1 Diabetes Metabolic Simulator (T1DMS) to be used as a substitute for animal trials in the pre-clinical testing of control strategies for Type 1 Diabetes. T1DMS is designed to simulate early-phase clinical studies with an in-silico population and provide a safe, interactive modeling and learning environment for the training and education of investigators, healthcare providers, patients, and families.

In-silico testing can produce credible pre-clinical results from testing interventions and management strategies at a fraction of the time and cost of current pre-clinical animal testing methods. The cost and time savings of metabolic simulation modeling is estimated in the millions of dollars and saving years of development when compared to current pre-clinical animal testing methods.

As Kurt Wassenaar, MAS Epsilon CEO, stated, “We believe that in-silico modeling can be a significant factor in accelerated development of new products for diabetes care, as well as central to the development of the artificial pancreas.”

Currently, over 50 academic and 10 industrial sites are using the test version of the simulator worldwide toward development of an artificial pancreas. Additionally, over 100 pharmaceutical and diabetes device companies are active in developing novel and more effective medications for diabetes and related conditions.

In early 2012, there are plans to have a web-based study on the testing and training services involved in the R&D of control algorithms, pumps, sensors, and novel insulin formulations for the Artificial Pancreas Project sponsored by the Juvenile Diabetes Research Foundation.

In order to better understand how to improve diabetic care, the University of Virginia Health System received a $300,000 grant to study the “Call to Health” model which uses text messages, stress reduction, and other techniques to help African-American women manage Type 2 diabetes.

The University was one of five organizations to receive two-year grants from the Bristol-Myers Squibb Foundation as part of the foundation’s $100 million effort to improve the health of Americans with Type 2 diabetes especially among African-American women who more frequently suffer from diabetes.

The “Call to Health” model focuses on empowering patients to control and manage their diabetes. Patients will design their own text messages which may include reminders to take their medication or to exercise. Healthcare providers from UVA will send weekly text messages designed to spark discussion on how to better manage diabetes

Patients will choose a “buddy” who may or may not have diabetes to help develop goals to improve their health by supporting them with phone calls and going with them to group medical visits

Researchers will also examine whether women more effectively manage their diabetes when they participate in all three main elements of the model such as text messages, group medical appointments, and the buddy program as compared with just receiving text messages.

During the two year study, UVA researchers will partner with the Charlottesville-Albermarle Community Obesity Task Force to compare the “Call to Health” model with the standard diabetes treatment provided at the university’s Medical Associates Clinic.

Developing All-Payer Database

According to the New York eHealth Collaborative’s newsletter “NYeC News”, the State Department of Health (DOH) is developing an All-Payer Database (APD) to serve as a repository for claims data drawn from all major public and private payers and if possible combine this data with clinical and public health data sources.

ADPs can support state level healthcare reform efforts by providing powerful tools to evaluate critical issues such as regional variations in utilization, quality, and costs. In addition, APDs are used to examine the impact of reimbursement methodologies, study public health interventions, and examine how healthcare resources are utilized in terms of quality, outcomes, and/or costs.

Nine states have created APDs such as Kansas, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, Tennessee, Vermont, and Utah. Three additional states are in the process of implementation and fourteen states have either taken initial steps toward creating an APD or have established a voluntary system.

New York passed the legislation building on the existing Statewide Planning and Research Cooperative system (SPARCS) to create an APD. The SPARCS collects clinical and demographic data on hospital discharges, emergency department visits, and certain ambulatory surgery and clinic visits.

The new APD system may be developed within SPARCS or as a separate entity, but either way it will include claims data related to inpatient, outpatient, emergency department, laboratory, pharmacy, and other healthcare services.

Currently the project is in the initial planning phase. In June, the New York State Health Foundation in collaboration with Commissioner Nirav Shah and the New York State Department of Health hosted a working discussion with various healthcare stakeholders regarding the establishment of the database.

At the meeting, the Office for Health IT Transformation presented an inventory of the existing data resources in New York that need to use payer data. The databases currently in operation include SPARCS, FAIR Health, New York Quality Alliance, and a state funded project in the Adirondacks.

At this point, the DOH after hearing the input is planning to reach out to a larger group of stakeholders to create a roadmap for implementation, locate potential funding sources and define requirements, as well as present a framework for an overall architecture model. In addition, a cross-cutting group within DOH will work on the regulations described in the legislation to address the collection and use of the data as well as provisions to protect patient privacy.

Register for Summit & Forum

Key policy barriers preventing further expansion of telemedicine will be discussed at the first annual ATA Policy Summit on July 27th jointly sponsored by ATA and the Continua Health Alliance. This information packed Summit focusing on federal telehealth policy will be held at the Westin Washington D.C. City Center.

This unique Summit will identify and discuss the swift changes underway in healthcare delivery and how this can affect and provide many opportunities in the field of telemedicine. Top speakers in the field will participate and share their thoughts on how the challenges and opportunities of health reform will enable telemedicine to play a much bigger role in the near future.

Some of the most knowledgeable speakers in the field such as Richard Gilfillan MD, Acting Director for the CMS Center for Medicare and Medicaid Innovation, Bakul Patel, Director for the Center for Devices and Radiological Health at FDA, and Adam Darkins, MD, Chief Consultant for VHA will share their thoughts on the many issues that need to be addressed and how to achieve the solutions that work. Other speakers will be announced shortly.

Make plans to attend the ATA Fall Forum 2011 where revolutionary ideas in telemedicine will be presented. Book your flight and head to the Egan Convention Center in Anchorage Alaska on September 19-21 to hear how telemedicine will change in the next 3 to 5 years. Go to hear out-of-the-box, futuristic, and visionary ideas on all of the uses for telemedicine in the coming years. This Forum is one meeting that will keep you on top of what is new and exciting in the field and at the same time, address the challenges ahead.

So if you are an administrator, provider, an investor, or a vendor, come to this creative setting in the big land and not only attend information packed-filled sessions but also have a lot of fun.

Abstracts are being accepted and be sure to register for the Fall Forum 2011 before August 15th to save on early-bird rates.

To register for the Summit or the Fall Forum or for both events, go to

Wednesday, July 13, 2011

Single Payer System Discussed

Last May, Vermont Governor Peter Shumlin signed the single payer healthcare law that will be financed through payroll taxes. This means that the Vermont single payer health system will operate as one publicly financed insurance fund to provide basic benefits to all citizens and pay providers under uniform mechanisms and rates. The legislation’s goal is to lower cost growth over time and overhaul the state’s payment system.

William Hsiao, PhD, K.T. Li Professor of Economics, Harvard School of Public Health, speaking at the National Press Club at a briefing presented by “Health Affairs”, discussed the hurdles, legal, fiscal, and institutional constraints on Vermont’s single payer system. His presentation was based on the paper authored by Hsiao and his colleagues now appearing in the “Health Affairs” July thematic issue “New Directions in Systems Innovations”.

According to the paper titled, “What Other States Can Learn from Vermont’s Bold Experiment: Embracing a Single-Payer Health Care Financing System”, Vermont’s recent passage of single payer legislation will greatly impact savings. The study came up with realistic predictions that will concur after ten years. Figures show that the single-payer system will reduce health spending by 25.3 percent compared to current spending, cut employer and household healthcare spending by $200 million, create 3,800 jobs, and boost the state’s overall economic output by $100 million.

Variations in Medicare claims and outcomes suggest that up to 30 percent of all health spending is attributable to waste and duplication of services. To help reduce the waste, the single-payer system will create a comprehensive claims database to further detect fraud and abuse. The study indicates that a single-payer system with a claims database could save 5 percent in health spending in the first two years of operation.

The goal is to overhaul Vermont’s payment system and transition away from its largely fee-for-service payment system. The study points out that payments going through an ACO and not going through individual physicians would create incentives, and in the end would improve outcomes and reduce inappropriate care.

The study also recommends that Vermont move to a “no fault” system of medical malpractice, both to maximize savings and to strengthen physician support for the proposal. The final single-payer law requires a plan for reforming medical malpractice that must consider a no-fault system but left ample room for more modest reform.

Vermont’s experience with the single payer system provides lessons for other states. As Hsiao pointed out, other states need to have a credible, viable, and practical reform plan ready when a political space in their state opens for reform.

In reality, states will need to take into account and overcome political, economic, legal, and institutional hurdles, employ credible, impartial, and technically competent groups to design the plan, and very importantly rely on evidence to derive recommendations.

However, if states find that they can’t adopt a full single-payer plan than they can develop parts of the plan in other ways. One suggestion is that states might establish single-pipe payments with uniform payment methods and rates as well as uniform claims processing. Also, a single-pipe system could promote establishing ACOs as a way to reduce the escalation of healthcare costs.

According to the conclusions contained in the study, the system can generate large savings, bend the cost curve while achieving universal coverage with generous benefits, and at the same time lower the cost of health care to families, businesses, and the state.

For more information, go to or email Dr. Hsiao at “Health Affairs” is published by Project HOPE and appears in print each month and on Facebook and Twitter. Web First papers are published periodically along with health policy briefs published twice monthly. Daily perspectives are posted on Health Affairs Blog.

House Passes Patent Reform Bill

In the last 60 years, tremendous technological advancements, from computers the size of closets to wireless technology that fits in the palm of your hand have taken place. Meanwhile the patent system that protects today’s technology has gone largely unchanged.

According to the House Judiciary Committee Chairman Lamar Smith (R-TX), the June 23rd passage of the House bill ( H.R. 1249) brings the patent system into the 21st century, reducing frivolous litigation while creating a faster and more efficient process for the approval of patents. No longer will American inventors be forced to protect the technologies of today with the tools of the past.”

The average wait time for patent approval in the U.S, is three years. The Patient and Trademark Office (PTO) with a backlog of 1.2 million patents pending approval have more than 700,000 patents that have not even reached an examiner’s desk. It takes an average of three years to get a patent approved in the U.S.

The bill H.R. 1249 ends fee diversion and preserves congressional oversight by creating a fund for fees collected by the PTO. Under current law, the PTO is forced to give the money it raises through fees for services back to the Treasury and must later request the funds from Congress during appropriations. However, rather than giving the funds back to PTO to help address the backlog of patient applications, the fees are often diverted to other federal programs. Since 1992, nearly $1 billion has been diverted from the PTO.

With the legislation, the money in the fund will be reserved and used by the PTO and only the PTO. This maintains congressional oversight while making sure that fees collected by the PTO can no longer be diverted. This means that good patents will be approved more quickly and therefore this provision will not increase federal spending or contribute to the federal deficit.

It has been reported that anywhere from $400,000 to $500,000 is needed to pursue an interference proceeding claiming the right to a patent based on an earlier invention. As the “New York Times” has pointed out, most small inventors don’t have that kind of money—big corporations do.

The legislation would establish a pilot program to allow the PTO to reexamine a limited group of questionable “business-method” patents. If someone is being sued by a “business-method” patent holder, that individual can partition the PTO to review the patent in question. As a result, bad patents that never should have been issued will be eliminated and good patents that pass this tough scrutiny will have even stronger legal integrity.

The House proposal switches the basic standard of patent approval from a first-to-invent to first-inventor-to-file. The first-inventor-to-file system creates certainty about patent ownership, and therefore reduces costly litigations. Also the “first-inventor-to-file” system makes it easier for U.S. inventors to patent innovation internationally because they will not have to prepare applications for two different systems.

The U.S is no longer winning in the race to publish patents. China is expected to surpass the U.S. for the first time this year as the world’s leading patent publisher surpassing not only the U.S. but also Japan in the total and basic number of patents. H.R. 1249 will harmonize the U.S. patent system with major trading partners and enable U.S inventors at universities and industry to compete more effectively in the global marketplace.

H.R. 1249 has broad support from industry leaders, independent inventors, and academic institutions such as 3M, Apple, Dell, eBay, Facebook, General Electric, Google, IBM, Johnson & Johnson, PhRMA, Proctor & Gamble. Eli Lilly, associations representing over 250 universities, a group representing more than 100 independent inventors, and the Small Business & Entrepreneurship Council representing more than 100,000 members.

In April 2011, the Senate passed its version of patent reform legislation with overwhelming bipartisan support by a vote of 95-5. The House bill passed on to the Senate for final approval has industry broad support and the President has said that he will sign the legislation into law if it passes the House.

Reducing Hospital Readmissions

Amy E. Boutwell, MD, President, Collaborative Healthcare Strategies, a presenter at the “Health Affairs” briefing on July 7th at the National Press Club, discussed the available data on the “State Action on Avoidable Rehospitalizations” (STARR) initiative included in the July issue of the Health Affairs Journal.

STARR is a project of the Institute for Healthcare Improvement, supported by a grant from the Commonwealth Fund. The resources from the grant support partnerships among hospitals and their community-based partners and today, four states, Massachusetts, Michigan, Washington and Ohio are mobilizing state-level leadership to improve care transitions.

The key findings report that after two years into its four year cycle, the initiative has 148 hospitals working in partnership with more than 500 cross-continuum team partners. The teams review events associated with rehospitalizations, identify their causes, develop strategies to improve patient education, provide timely follow-ups with patients after hospital discharge, and create universal transfer or discharge forms. Boutwell and her co-authors did find that more than 90 percent of participating hospitals with teams do routinely review rehospitalizations with their community-based colleagues.

Hospitals participating in Ohio’s STARR initiative contribute to the state funding model with the promise of reimbursement if they adhere to the initiatives core methodology. This approach has proved successful in encouraging participation.

One of the common challenges facing STARR is data collection since none of the four states have access to state-wide data on rehospitalizations. Other challenges include engaging hospital executive teams so that current and future financial analyses can be done on the impact of readmissions on their operations. However, three of the original states have used local solutions to best access available state-wide rehospitalization data reports.

The coauthors recommend that efforts to reduce rehospitalizations must go beyond the walls of a hospital if they expect to reduce rates sustainably without the explicit partnership of community- based providers. Secondly, state leaders should consider forming a state-level, multi-stakeholder entity that can ignite action, generate momentum, and leverage networks to increase interest in and visibility of a common aim. Finally, incentives and updated payment policies are needed to support the investment needed to deliver coordinated care across settings.

For more information, go to or email Amy Boutwell at

Maryland's HIT Activities

Maryland’s Statewide Health Information Exchange Policy Board recently met to brief members on the status of the state health information exchange and recent legislative activities related to telemedicine. So far, nine hospitals are currently connected to the state designated HIE operated by “Chesapeake Information System for our Patients” referred to as CRISP.

CRISP was formed as a not-for-profit collaborative in 2009 by Erickson Living, Johns Hopkins Medicine, MedStar Health, and the University of Maryland. CRISP received a federal grant for $8.4 million to become Maryland’s Regional Extension Center (REC) and the goal to obtain 1,000 providers to enroll in the REC was achieved in May.

So far, 46 acute care hospitals have signed a letter of intent to connect to the HIE. Clinical, radiology, lab, and demographic data are now available through the HIE with about 200 physicians in eleven sites consuming data and using the query functionality. CRISP continues to work with practices serving underserved populations to encourage HIE connectivity.

In another practical move to help physicians adopt EHRs, the Maryland Health Care Commission developed a state designation program for Management Service Organizations (MSO). These organizations offer EHRs hosted remotely in a centralized secure data center. This helps providers reduce costs for equipment and helps them deal with the maintenance needed to use the technology, and eases the privacy and security responsibilities that accompany storing of electronic data. At present 22 MSOs have received state designation candidacy status and three have become state-designated.

Legislatively two state House and three Senate bills were introduced during Maryland’s 2011 legislative session. HB 14, SB 744 and SB 208 would have required reimbursement for telemedicine services and HB 16 and SB 406 would have required the formation of a task force to study the use of telemedicine in medically underserved populations and rural areas. The bills did not pass this session but may be included in the Governor’s agenda for session 2012.

To further legislative activities, the Telemedicine Task Force established by the Maryland Institute for Emergency Medical Services Systems (MIEMSS) and the Maryland Health Care Commission through the Health Care Quality and Cost Council (HCQCC) will begin work on issues this summer.

Currently, four workgroups are in place to discuss legislative issues involving clinical providers, and hold further discussions on sustainability, financial models, and regulations. The workgroups plan to make specific recommendations on expanding telemedicine in the state and then send the report to the HCQHCC in January 2012. It is thought that the General Assembly will likely include the recommendations when drafting bills during the 2012 legislative session.

Caring for Safety Net Patients

The California Statewide “Specialty Care Safety Net Initiative” (SCSNI), a Center for Connected Health Policy (CCHP) sponsored telehealth demonstration project, connects 40 safety net clinics in medically underserved communities across California with medical specialists located at five University of California Schools of Medicine. SCSNI serves as a laboratory to find ways to establish permanent relationships between UC medical schools and California’s safety net providers.

The SCSNI currently uses existing telehealth networks and will eventually use the California Telehealth Network funded by the FCC, the California Emerging Technology Fund, and United-Health/PacificCare. The plan is to connect to more than 850 California healthcare organization and then to a statewide and nationwide broadband network


• Purchases medical specialty clinic time from the UC Schools of Medicine in dermatology, psychiatry, orthopedics, endocrinology, and neurology using telehealth technologies

• Reserves specialty telemedicine clinics for patients of SCSNI partners regardless of insurance status

• Provides education services to SCSNI clinic providers through UC physician-assisted patient consults and continuing medical education presentations

• Provides limited financial support for SCSNI clinic and UC Medical School partners

• Contracts with a telehealth technology consultant to provide support for each participating clinic.

One of the community clinics “Share Our Selves” (SOS) in Costa Mesa, California is testing e-consults in a program funded by “Access OC” a nonprofit program that addresses specialty care for the county’s uninsured population. E-consults can fill the bill for the type of referrals that don’t require real-time patient-to-doctor contact, such as neurology, dermatology, and cardiology. Currently 12 specialists participate in the program, assessing cases and returning their recommendations to the SOS doctors within 48 hours.

SOS Medical Director. Dr. Patrick Chen recently did a neurology e-consult for a 38 year old pregnant patient with a history of seizures. She was taking two anti-seizure medications, and Chen wanted to be sure they wouldn’t adversely affect the pregnancy. He documented her case, then sent it via e-consult to a neurologist and learned that both medications were safe to use during pregnancy.

Although teleconferencing systems are providing great results, but they still are expensive to use according to Hector Para who coordinated UCI’s participation in the SCSNI and helped develop the “Telepresence Interactive Operating System” (TELIOS) that is being used at the SOS clinic. TELIOS is completely software-based, free, and offers a very low barrier to entry but with a web browser and a webcam you can get some of the same features.

The University of California San Francisco is working with La Clinica a federally-qualified health center participating in the CCHP demonstration. Twenty six offices in Alameda Contra, Costa, and Solano counties are using store & forward technologies to make initial assessments on dermatology cases with the information going to UCSF.

UCSF dermatologists study the cases and then refer the cases back to La Clinca’s primary care providers with a diagnosis and treatment plans. They also treat complex cases in person via monthly specialty clinics at a La Clinica office in Oakland.

La Clinica can bill for the in-person dermatology consults that UCSF dermatologists provide at its clinics, however, La Clinica is not yet billing for the UCSF teledermatology triage consults. While Medi-Cal covers standard store & forward teledermatology consults, La Clinica is still working with Medi-Cal officials to clarify whether La Clinica can bill for these teledermatology triage consults.

“We didn’t think of this program as a moneymaker, we just want to break even,” says Nermeen Iskander, Projects Planner at La Clinica. “There are multiple benefits to patients and providers that go beyond cost. We are removing a burden on the safety net healthcare system overall, and we are creating a system where the patients who really need dermatology care can get that care.”

Iskander says the ability to bill for the UCSF telederamatology triage consults is key to getting close to the break-even point. She is hopeful that La Clinica and Medi-Cal can agree on terms for reimbursement.

Sunday, July 10, 2011

Health Solutions for Space & Earth

It took a number of years, but eventually scientists were able to develop ultrasound technology to remotely guide examinations for astronauts on the International Space Station (ISS) and in outer space. This technology can be used during long spaceflights but the technology also has applications for people living in rural and underserved locations and to conduct ultrasound training courses for the medical profession.

NASA thinks that eventually ultrasound will be able to evaluate and diagnose 250 medical conditions when crews in space need treatment. Some of these conditions may include traumas to the eye, shoulder, knee, tooth abscesses, broken or fractured bones, collapsed lungs, kidney stones, organ damage, hemorrhaging, and muscle and bone atrophy, plus many other medical problems.

The first ultrasound experiment referred to as “Advanced Diagnostic Ultrasound in Microgravity” (ADUM) was accomplished on the ISS. One of the first individuals to conduct an ultrasound exam in space was former NASA Astronaut and ISS Expedition 10 Commander, Dr. Leroy Chiao. His team demonstrated that even non-physicians can produce diagnostic quality ultrasound images using remote guidance.

When the National Space Biomedical Research Institute (NSBRI), NASA, Henry Ford Hospital in Detroit, and Wyle Integrated Science and Engineering, began their first ultrasound experiments, tele-ultrasound operations were used to help astronauts interact with researchers and flight controllers on the ground during the examinations. However, today’s current ultrasound imagery enables astronauts to conduct exams when quick communication with an expert is not available from Earth.

Dr. Scott A. Dulchavsky, the Roy D. McClure Chairman of Surgery and Surgeon-in-Chief at the Henry Ford Hospital, principal investigator and a member of the NSBRI Smart Medical Systems and Technology Team, reports that using ultrasound imagery techniques in space is vital since trained radiologists, the use of CAT scans plus MRIs are not available.

Dulchavsky and his colleagues have spun off the techniques for terrestrial use and published a reference guide for conducting exams. The American College of Surgeons have used the methods developed in space and have incorporated the techniques in their ultrasound training courses for surgeons in the U.S. plus medical schools are starting to incorporate this training for all of the medical students, not just surgeons.

Ultrasound imaging techniques have been used in specialized situations:

• Trainers for some professional sports teams received ultrasound training and remote guidance to help the Detroit Red Wings, Tigers, and Lions when medical assistance is needed

• The U.S. Olympic Committee used ultrasound to send point-of-care information on athletes and their injuries obtained from the U.S. Olympic Training Facilities in California, Colorado Springs, Lake Placid, Turino, Beijing, and Vancouver. For example, a non-physician athletic trainer was remotely guided to perform a point-of-care scan on a woman skier with an injured leg. The scan was able to confirm that she could continue to compete and she won a gold metal three days later

• In the high Arctic, ultrasound technology was used to determine the status of a pregnant Inuit mother. The information gained was used to determine whether her delivery could be done safely in her village

• A Swedish climber performed a comprehensive chest ultrasound examination at the Advanced Base Camp on Mt Everest. The Climber operator had never seen an ultrasound before but was remotely guided to perform the examination over the internet via a satellite phone. The exam was completed in ten minutes and showed that the climber had excessive lung fluid due to exposure to high altitudes

To keep up with the latest ultrasound technology, NASA’s final shuttle flight on July 8th took GE Healthcare’s Vivid™q Cardiovascular Ultrasound system to the ISS. Vivid q is a compact lightweight diagnostic ultrasound system designed for cardiovascular imaging and enables assessment of LV function and cardiac performance.

Very importantly, rural locations both in the U.S. and worldwide are gaining the most from diagnostic ultrasound capabilities and from telemedicine in general. Dulchavsky is collaborating with the World Interactive Network focused on Critical UltraSound to train individuals on using ultrasound techniques in underserved regions. Some of the countries where ultrasound techniques are being implemented are Mozambique, Lesotho, Madagascar, India, Brazil, and Nicaragua with programs being planned in Honduras, Congo, and Malaysia.

During the past four years, Dulchavsky and Neri, Director of the WINFOCUS Global Ultrasound Program, have given regular updates about ultrasound potentials at the United Nation’s Economic and Social Council, the Observatory for Cultural and Audiovisual Communication in the Mediterranean, and at the World InfoPoverty conferences held in Geneva and New York.

In another research effort to help cancer patients, NASA partnered with Quantum Devices Inc. of Barneveld Wisconsin to develop the WARP 75 device that uses High Emissivity Aluminiferous Luminescent Substrate (HEALS) a type of LED technology to provide intense light energy. HEALS technology provides the equivalent light energy of 12 suns from each of the 288 LED chips.

The WARP 75 device was used to provide light therapy treatment on cancer patients during a two year clinical trial funded by NASA’s “Innovative Partnerships Program” at the Marshall Space Flight Center in Huntsville Alabama. The Clinical Trial included 20 cancer patients from Children’s Hospital of Wisconsin and 60 cancer patients from the University of Alabama at both Birmingham Hospital, and Children’s Hospital of Alabama. It was found that the 670 nanometers of light technology when used in the Clinical Trial improved the painful side effects of chemotherapy and radiation in cancer patients undergoing bone marrow or stem cell transplants.